Physicians in organizations. Dilemma of the academic VA staff physician.

More physicians are assuming salaried positions within large health care organizations. In this report, we discuss the influence of such organizational changes on physician behavior in one large health care system--the Department of Veterans Affairs (VA) system--which employs more than 14,000 physicians. Conflicting pressures on these physicians in VA facilities affiliated with academic medical centers include differences between professional and organizational needs plus differences between the roles of the VA hospital and of the affiliate academic medical center. An analysis of these issues, based on organizational theory, suggests that these clashes are consequences of fundamental differences between the parties involved. Because the outcome of the conflicts may be fatal to the organizations, they must be managed, not ignored. This involves recognizing the existence and the nature of the differences as well as actively sharing the responsibilities and the issues usually charged to one of the two conflicting groups to form a conjoint organization between the "two sides of the street."