Can this marriage be saved

ITEM: D.S. is an orthopedic surgeon.He does most of his work in a state-of-the-art ambulatory surgery center, where he has more control over his schedule -and sees paying patients who have insurance."It's not that I didn't like working in the hospital," he explained."It's that I don't need to anymore."ITEM: F.B. is an internist.In the late 1990s he grew tired of HMOs telling him whom he could and couldn't see in the hospital, so he and other physicians formed a local hospitalist group and contracted exclusively with a Valley hospital to provide inpatient services."I wasn't in charge in the outpatient setting," he said."In the hospital I treat more patients, have fewer administrative hassles, and get to practice medicine the way I was trained to do.It's like being part of a family."Two different physicians, two stories and one overarching issue: the market forces in American health care that paradoxically are pulling physicians and hospitals apart and together at once.Every hospital needs physicians, but not every physician needs hospitals.Or do they?What are the forces and trends in health care that impact physicianhospital relationships?Is their long-standing marriage of interdependence and productivity destined to fail, or can it be saved and even strengthened by emerging delivery and governance models in the so-called "market revolution" of consumer-driven health care?What are the implications for health care policy and practice?These are issues we explore in this Arizona Health Futures Policy Primer

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