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Building the Best Team

David B. Nash, MD, MBA; and Ira S. Nash, MD
[+] Article, Author, and Disclosure Information

Thomas Jefferson University Hospital, Philadelphia, PA 19107 (D. B. Nash). The Mount Sinai Medical Center, New York, NY 10029 Requests for Reprints: David B. Nash, MD, MBA, Office of Health Policy and Clinical Outcomes, Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA 19107. Current Author Addresses: Dr. D. Nash: Office of Health Policy and Clinical Outcomes, Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA 19107.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1997;127(1):72-74. doi:10.7326/0003-4819-127-1-199707010-00012
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The executives of a major medical center meet with the physician leadership to discuss the formation of their new physician hospital organization (PHO). The Vice President for Managed Care explains that a PHO is a necessary vehicle for entering into at-risk capitated contracts with local managed care organizations and employers, but then he adds that the current mix of primary care providers and specialists on the staff is ill-suited to capitated contracts. “Look,” he says, “it's as if we have a sports team made up only of guys with big salaries and narrow talents and there's a new league limit on team salaries. Our medical ‘team’ is keeping our costs too high for us to be competitive. We need to build a team of versatile players-we'll need fewer of them, we can pay them less, and we'll be able to respond more flexibly to changing situations.” The uncomfortable silence is broken when the Dean asks, “But can a team like that win?”

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