Gill S L
Physician Exec. 1987 Sep-Oct;13(5):11-6.
The working relationship between physicians and health care organizations has dramatically changed since the introduction of competitive factors. Fifer suggests that future doctors may have as many as five or six economic relationships with their associated health care system, in contrast to the singular role as admitting physician of the past. The physician will continue to admit patients, but may also belong to an HMO or some other joint venture (freestanding ambulatory care center, outpatient laboratory, etc.), be salaried part time for leadership roles, be a leader in some other parallel economic venture, etc. Physicians are already assuming multiple roles as health care providers, private entrepreneurs, and joint venture partners with hospitals. Hospitals and health care systems also continue to change through vertical and horizontal integration. Traditional clinical departments are becoming blended into product line entities, and a sophisticated executive team of market-oriented specialists now augments the traditional administrative leadership. So, from a tradition of predictable roles, relationships, and authority structures, we are now attempting to thrive and prosper with many new partners in an integrated, complex, and conflict-ridden set of interrelationships.
自引入竞争因素以来，医生与医疗保健组织之间的工作关系发生了巨大变化。菲菲尔指出，与过去作为收治医生的单一角色相比，未来的医生与其相关医疗保健系统可能会有多达五到六种经济关系。医生将继续收治患者，但也可能隶属于健康维护组织（HMO）或其他一些合资企业（独立门诊护理中心、门诊实验室等），担任领导职务并获得兼职薪水，在其他一些平行经济企业中担任领导等。医生已经在承担医疗保健提供者、私人企业家以及与医院的合资伙伴等多重角色。医院和医疗保健系统也在通过纵向和横向整合不断变革。传统临床科室正逐渐融入产品线实体，并且一支由面向市场的专家组成的成熟管理团队如今增强了传统行政领导力量。所以，从可预测的角色、关系和权威结构的传统模式出发，我们现在正试图在一套整合的、复杂的且充满冲突的相互关系中与众多新伙伴共同蓬勃发展。
