1. Most physicians will be employed. Most physicians will be employed — either by hospitals or large group practices, but mostly by hospitals. This trend will progress rapidly because both sides are actively pushing for it. Hospitals are looking to align as closely as possible with their medical staffs. Many small practices are having difficulties breaking even and young physicians are entering larger organizations right out residency.
2. Medical staffs will shrink. Medical staffs will get smaller and more aligned in non-rural areas. In places like metropolitan Chicago, physicians have privileges at several hospitals. Most of the 1,130 physicians on staff at Northwest Community also have privileges at 2-3 other hospitals. But with alignment, “physicians are going to have to declare allegiance to one or the other hospital,” Mr. Crowther asserts. With the rise of bundled payment arrangements, clinical protocols will become essential. Physicians at each hospital will be developing a unique set of protocols for their organization. It would be confusing for them to work under differing protocols at two or more hospitals.
As physicians concentrate activities on a particular hospital, each hospital would need fewer of them to cover the same number of patients. For example, if physicians at Northwest Community were to become 100 percent aligned with the hospital, the hospital would need only 250 of them. Ideally, half of those physicians should be in primary care and half in the specialties.
3. Peripheral service lines will be closed. “It doesn’t make financial sense for each hospital to offer all major service lines,” Mr. Crowther says. The overhead in each product line is enormous. “Today, hospitals feel the need to be all things to its community, but I don’t think that will continue, at least not in urban areas where there are a lot of hospitals,” he says.
4. Stand-alone hospitals will join systems. “In the future, hospitals need strength in numbers to cover service lines, better deploy capital and share services,” Mr. Crowther says. This means stand-alone hospitals will need to join or form systems. Northwest Community is a stand-alone hospital. “Although we have no plans to join a system, I believe that eventually we will join a system or help form a one,” he says.
Learn more about Northwest Community Hospital.
