Medical Staff Modeling.

The relationship between a hospital's medical staff and the hospital can take on several different configurations. What configuration, or configurations, will meet the needs of both the medical practitioners and the hospital can be influenced by several factors. When I've been faced with this question of the relationship model, my first question has always been simply, "Why..." That is why does an organization and a physician or a group of physicians want to be aligned and have a relationship.

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After all, this is a question to be put to all parties involved. Hospitals and physicians have differing reasons for affiliation, but those reasons can generally be considered, and should be, complementary. 

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The other consideration is regulatory. Various legal or regulatory constraints may exist depending on your country and your deciding jurisdiction. Many of those are not prohibitive, but merely serve to regulate organizational relationships between or among the partiers. Regardless, if the first question is , "Why," then the second is, "How?" 

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So let's briefly speak to the three most common types of physician hospital relationships.

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Employed

Independent

Contracted Entity

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EMPLOYED

When we think of employed physicians, we most commonly expect some type of employment directly with the hospital. Again, depending on your jurisdiction, employment may be that of a general employee of the institution or it may be managed with a separate contract. However, if the organization consists of several specific companies, as is common in many jurisdictions, physicians may potentially be employed by any one of those appropriate companies or business units for the purpose of providing medical services via the hospital. 

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If physicians are employed by a business unit other than the hospital itself, then the relationship may take on fewer of the attributes of employment and more of those of working with a Contracted Entity (see below). 

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INDEPENDENT

Physicians may also have what you might consider an indirect relationship with a hospital in the sense that they are independent, private practitioners, but they apply to be members of the hospital's medical staff and by such application and membership agree to abide by certain rules of performance and or participation with the hospital. 

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And, while independent physicians are free to come and go as they wish, to admit patients for perform surgery or other procedures at the hospital as their medical staff membership application may allow, hospitals often look for opportunities to attract these physicians' loyalty and increased use of the facility by providing certain benefits to physicians. These benefits may involve the acquisition of special equipment for the physicians' use, training of staff to support the physicians' work and or preference in scheduling of services, to name a few. 

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Regardless, this is the relationship that provides both hospital and physician with the least amount of influence or leverage or control over one another. 

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CONTRACTED ENTITY

Various contractual relationships may exist between hospitals and physicians. Such "entities" may be owned by physicians, by hospitals or by other entities, such as insurance companies, or investor organization. And, the relationship will very often be greatly influenced by the physician entity's ownership. 

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Regardless, the primary objective of such relationships is to have physician medical services provided based on an agreed set of performance standards, based on an agreed fee structure, and for an agreed period of time. And, the premise of such contracted relationships is that anything legal is negotiable. 

 

SUMMARY

So, to begin at the beginning, "Why" do you want a relationship? Whether physicians with a hospital or a hospital with physicians. The "why" will set the stage to determine the most effective, "How" to create a mutually satisfactory  model. 

 

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