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."
(Arch Intern Med. 1990;150:1621-1623)
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 5
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.