Physicians who joined hospital systems through practice acquisitions report friction over staffing decisions, work schedules and inadequate onboarding, even as both groups agree the deals improve patient care, according to a new study.
Researchers from Northeastern University interviewed 37 hospital system leaders and employed physicians across three nonprofit systems for a qualitative study published June 10 in JAMA Network Open. The interviews surfaced a consistent gap between how the two groups experienced life after an acquisition.
Hospital leaders said their biggest frustration was physician productivity. Leaders reported that employed physicians were less productive than independent physicians on the same medical staff, attributing the gap to weaker financial incentives under employment models. Performance incentive structures tied to relative value units and quality metrics existed at all three systems but remained a work in progress.
Physicians saw it differently. Most said their productivity remained high and that losing autonomy, particularly over hiring, staffing and scheduling, was their sharpest regret. Few surveyed physicians raised concerns about clinical autonomy; the frustrations were operational.
Onboarding was another pressure point. Most physicians said acquisitions came with minimal formal orientation, leaving them to figure out new EHR systems, protocols and personnel on their own. Researchers noted that some physicians described the transition using phrases like “dropped in” or “jumped in.”
Tension between newly employed physicians and their independent colleagues on the same medical staff also emerged early in the post-acquisition period, with some reporting trust and communication breakdowns driven partly by patient competition.
The authors said these tensions, particularly over productivity and autonomy, echo conflicts that contributed to a wave of practice closures and divestitures in the late 1990s during an earlier period of hospital-physician consolidation.
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