• Kirstin W Scott, E John Orav, David M Cutler, and Ashish K Jha.
• From Harvard T.H. Chan School of Public Health, Harvard Medical School, and Brigham and Women's Hospital, Boston, and Harvard University, Cambridge, Massachusetts.
• Ann. Intern. Med. 2017 Jan 3; 166 (1): 1-8.

BackgroundGrowing evidence shows that hospitals are increasingly employing physicians.ObjectiveTo examine changes in U.S. acute care hospitals that reported employment relationships with their physicians and to determine whether quality of care improved after the hospitals switched to this integration model.DesignRetrospective cohort study of U.S. acute care hospitals between 2003 and 2012.SettingU.S. nonfederal acute care hospitals.Participants803 switching hospitals compared with 2085 nonswitching control hospitals matched for year and region.InterventionHospitals' conversion to an employment relationship with any of their privileged physicians.MeasurementsRisk-adjusted hospital-level mortality rates, 30-day readmission rates, length of stay, and patient satisfaction scores for common medical conditions.ResultsIn 2003, approximately 29% of hospitals employed members of their physician workforce, a number that rose to 42% by 2012. Relative to regionally matched controls, switching hospitals were more likely to be large (11.6% vs. 7.1%) or major teaching hospitals (7.5% vs. 4.5%) and less likely to be for-profit institutions (8.8% vs. 19.9%) (all P values <0.001). Up to 2 years after conversion, no association was found between switching to an employment model and improvement in any of 4 primary composite quality metrics.LimitationsThe measure of integration used depends on responses to the American Hospital Association annual questionnaire, yet this measure has been used by others to examine effects of integration. The study examined performance up to 2 years after evidence of switching to an employment model; however, beneficial effects may have taken longer to appear.ConclusionDuring the past decade, hospitals have increasingly become employers of physicians. The study's findings suggest that physician employment alone probably is not a sufficient tool for improving hospital care.Primary Funding SourceAgency for Healthcare Research and Quality and National Science Foundation Graduate Research Fellowship.

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