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The impact of corporate structures on physician inclusion and participation
L R Burns1, R M Andersen, S M Shortell
1Department of Management and Policy, College of Business and Public Administration, University of Arizona, Tucson 85721.
Insights
Corporate healthcare arrangements surprisingly lead to less physician employment but more physician involvement in management. This challenges common beliefs about healthcare corporatization limiting physician roles.
Area of Science:
- Healthcare Management
- Organizational Behavior
- Medical Economics
Background:
- The increasing corporatization of healthcare systems has raised questions about its impact on the hospital-physician relationship.
- Previous hypotheses suggested that corporate structures might limit physician autonomy and involvement.
Purpose of the Study:
- To investigate the effects of for-profit ownership and multihospital system membership on physician inclusion and participation.
- To examine how corporate arrangements influence physician employment and engagement in healthcare governance.
Main Methods:
- Analysis of the relationship between corporate structures (for-profit, multihospital system) and physician inclusion (salaried, hospital-based).
- Assessment of physician participation in governance and management roles within corporate healthcare settings.
Main Results:
- Corporate arrangements were associated with lower physician inclusion (e.g., fewer salaried positions).
- Physician participation in governance and management was notably high in corporate settings.
- No evidence was found that corporatization restricts physician decision-making or movement.
Conclusions:
- Contrary to expectations, healthcare corporations appear to enhance physician participation to foster goodwill and legitimacy.
- Corporate healthcare structures may actively promote physician welfare and involvement rather than restrict it.
Abstract:
This study examines the impact of corporate arrangements on the hospital-physician relationship. Specifically, it investigates the effects of for-profit ownership and membership in a multihospital system on physician inclusion (salaried employment, hospital-based practice) and participation (involvement in governance and management). Contrary to common perceptions and several hypotheses drawn from the literature, corporate arrangements are associated with low physician inclusion and high participation. There is no indication that corporatization of healthcare restricts the physician's freedom of movement or decision-making role. It is instead argued that health care corporations do just the opposite in order to please physicians, promote physician welfare, and to gain legitimacy.