The Hospital-Physician Relationship: Past, Present, Future

Dear Colleagues:

Happy New Year.


Here is a gift of light reading.


Confucius said, “Study the past if you want to define the future.” Few of us consider history until we contemplate becoming part of it. That said, here is an article I doubt most of you saw as it was published 13 years ago. It specifically considers the question of physicians vs hospitals and presents an opportunity for a physician-hospital collaboration. At the time this may have seemed novel, but it was an important proposal given the context of erosion of physician autonomy and intrusion of governmental regulations. This proposed collaborative relationship was based on an ASC “partnership”. When I considered the genesis and evolution of the ASC through the lens of the institution inclusive of the past Orthopedic Leadership and Hospital leadership, I came to understand the difference between “saying” and “doing.”


When this article was published in Clinical Orthopedics and Related Research in 2007, the Ambulatory Surgical Center Growth surge was already underway across the nation. Not surprisingly large AMC’s like the MGH where I work, were late adopters. The catalyst for this project was the dissatisfaction of several orthopedic staff members with our ambulatory service situation at the main hospital. The context of hospital vs physician and the hope for hospital with physician is nicely outlined, if not somewhat verbosely considered in this article.


What we created at the time, promised a reward to all who participated; but even though the presented metrics were complex, in the end, we had neither transparency nor management that delivered on this promise. Despite this, this venture was incredibly successful in the value created due, in no small part, to the leaders and staff we, the orthopedic department leadership, selected to be on our team. It was the culture that we created which transcended the words and promise of the article I have enclosed. I did not realize this until, while at HBS, I had the opportunity to analyze our structure and culture relative to the main hospital and also financial performance of our ASC.

So, what is the point of this message? Now, 13 years after this article put forth a vision of physician-hospital collaboration, we have an evolving context in healthcare which offers both challenge and opportunity. Many of you who read this have an ownership position in an ASC or perhaps you work, as do I, in an ASC which is owned by the hospital. We have all endured the impact of a global pandemic that strained our financial health and adversely affected the health and wellbeing of our patients. All of us have an opportunity to adopt principles of Value-Based Care and, in the process, the opportunity to capture some of the value we create during this process. Perhaps those with whom we work in our administrations will recognize that “Strategy is a commodity, but Execution is an art.” (P. Drucker). The challenge for all of us is maintaining the culture which transcends the verbose promise of this article. It is evident to me that we, the doctors and staff, are the secrete sauce which makes our ASC’s wholly exceptional and allows us to deliver value.


I believe as we shift much of our care to an outpatient setting, we will create great value for all stakeholders. This includes the inevitable move of arthroplasty to the outpatient setting. Many of you already work in such an environment. For those who are considering this, remember that you need to make the argument that you are an important part of the value creation and as such are a partner in such ventures.

My best wishes to all of you.

JP Warner

Founder, The CSS



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