Physician transition journeys: Developing dual commitment on the road from private practitioner to employee

Competitive and regulatory forces have spurred the consolidation of health care provider and payer groups into large integrated care delivery systems that purchase freestanding clinics. Many private practitioners, unable to stand alone against these competitive pressures, are selling their practices and becoming employees, often for the first time in their careers. Consequently, many physicians are now embarking on transition journeys into dual organizational/professional careers. Anecdotal evidence suggests that many transitioning physicians feel alienated and are 'grieving' their loss of autonomy. Others, however, seem enthusiastic about employment and embrace their new organization. What explains these differences in physician transitions? In this chapter, we develop a model to explain the variation in transition experiences. We induce the components of this model from two sources. First, we use four case studies to illustrate themes that emerged from our interviews with 21 physicians recently employed by a large integrated health system. Second, we draw upon received theory from management literature, including research on career transitions and organizational and professional commitment. Integrating the concepts induced from the interviews and the literature, we specify a model of physician transition, in which dual commitment to both profession and organization serves as the key indicator of transition. We propose that transition to dual commitment is a function of: (a) individual differences in demographics and value orientation and (b) organizational characteristics such as hygiene factors and enablement. We also propose that dual commitment will produce benefits in terms of job satisfaction, patient satisfaction, and clinical quality. Finally, we discuss the model's implications for practice and theory.