This somewhat depressing HealthAffairs article looks at the current tangled nature of the hospital-physician relationship.

The article concludes:

“Overall, despite the appearance of increasing hospital influence, the terms of trade between hospitals and physicians actually appear to be deteriorating for hospitals as baby boom physicians retire. Entrepreneurial baby boom physicians who did not wish to be employed by the hospital are being replaced by Millennial physicians heavily burdened by medical school debt, with a revealed preference for significantly shorter work weeks compared to their elders. Many younger physicians also appear disinclined to participate in the system development and medical policymaking required to participate in new payment models like the ACO and bundled payment.

“Hospitals have a vital interest in the renewal of the primary care physician base in their communities, a particularly vital one if the community is struggling economically. Yet all over the U.S. hospitals have become midwives to an expensive intergenerational transition in medicine, perhaps permanently raising their expense base. Due to competitive pressures, hospitals are supplying an increasing percentage of physician income at a time their top line revenues are growing in the low single digits, if at all. This rise in physician expense challenges hospital managers and clinical leaders to improve clinician productivity as well as the quality of their work product.”