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)
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