The Physician Leader’s Guide to Affiliation Options

The ongoing growth of the healthcare industry provides ample reasons to write The Physician Leader’s Guide to Affiliation Options: Economics, Tactics, and Real-World Implementation . This book, therefore, focuses on the topic of affiliations with supplemental advice reflecting strategies and tactics that have emerged over time.

Healthcare providers, sponsors, patients, and third-party payers have discovered many keystone opportunities. Further, consolidation activity continues within the industry, with interest in the private sector, particularly private equity (PE)-backed firms. These influences provide an opportunity to present some relevant discussions and serve as a reference as we discuss new opportunities, scenarios, and situations.

Today’s affiliation structures are becoming more evident compared to yesterday’s. Specifically, PE firms have gained traction in healthcare through affiliation, integration, and alignment options, which is the main focus of the book. PE firms are real and maintain their market presence. In other words, PE-sponsored deals are continuing and perhaps even expanding in certain specialties, which we explore to update readers on available opportunities.

Hospitals and physician groups continue to form alignments. While employment remains the most prominent form of affiliation, professional services agreements (PSAs) continue to offer an excellent alternative. They are more readily accepted than ever before, and as such, we address PSAs at length.

With these key points in mind, what are our objectives and goals in expounding on the ways physicians are affiliating? Which applications are the best options for implementation for your practice?

The general answer is “we are reviewing everything.” Additionally, we explore new issues and facets of physician affiliation options. These options are not necessarily new in the sense of a structure that has never been previously applied, but different in the sense of how they affect the overall relationships going forward, from provider to payer to sponsor, owner, and more. We expand upon areas of interest, both new and old. We consider more detailed components of affiliation and provide updated examples.

The chapter descriptions follow.

Chapter 1 — Years and Counting of Affiliation Options. In this chapter, we briefly articulate various structures, models, and related descriptors of affiliation options for physicians. Then, we introduce the newer variations of affiliation between physicians and other parties.

Chapter 2 — Economic Drivers Today. While the economic drivers of earlier years remain, there are new approaches to consider.

Chapter 3 — Current Reasons for Affiliation. The reasons for affiliation remain unchanged, but some sectors have modified the original reasons for affiliation.

Chapter 4 — Review of the Models. Much of this chapter is a historical review of what has and has not worked within the broad definition of affiliation structures. Here, however, we focus more on specific models (such as professional services agreements) that have proven successful over time.

Chapter 5 — Health Systems’ Attitudes. While considering hospitals and health systems and their perspectives on physician affiliation, much has changed over recent years that warrant further exploration, discussion, and illustration.

Chapter 6 — Professional Services Agreements versus Employment. This tested option continues. While much of this chapter will entail review and compilation, we will explore the nuances between PSAs and employment today.

Chapter 7 — Private Equity Transactions. Is private equity (PE) alive and well within physician affiliation models, or is it a trend or a fad that will soon expire? We will consider PE in detail, with a look at specific specialties and current PE transaction structures.

Chapter 8 — Merging Practices. Do mergers work? Can they be done in today’s environment? Are they affordable? Do they prove worthwhile, both economically, operationally, and relationally? The discussion will consider these points.

Chapter 9 — Clinical Integration Update. Have clinical integration and related agreements morphed into something entirely different? Do they vary by specialty? What are the current trends? This chapter offers up-to-date information.

Chapter 10 — Payer Affiliation Perspectives. Are payers increasingly crossing over to providers? Do they have a prominent role (and will they in the future) in affiliation models with physicians? We will explore these questions.

Chapter 11 — Role of Advisers. Whether advisers are investment bankers, consultants, attorneys, or (most likely) a combination, how has the role of these advisers evolved relative to assisting physicians in affiliation transactions? This chapter looks at what the “quality of earnings process” currently entails.

Chapter 12 — U.S. Healthcare Industry Status. This chapter provides an industry update with regard to physician affiliation models.

Chapter 13 — Legal and Regulatory Update. Compliance and legal parameters are of utmost importance and consideration, calling for this summary of up-to-the-minute topics.

Chapter 14 — Transactions Update: Process, Order, and Other Matters. Some transactions have changed the way the process previously worked. This chapter provides a brief analysis of the typical process for completing these transactions.

Chapter 15 — Federal and State Governments and Healthcare. The government continues to play a huge role in the delivery of healthcare services, in addition to the insurance and reimbursement components. Rather than spending extensive time on what has not changed, we look at some recent changes relative to governmental influence and other issues.

Chapter 16 — The Future: “Clear as Mud.” We offer some suggestions and recommendations on how best to strategize the affiliation processes and options for physicians. Although we do not have a “crystal ball,” we submit our conclusions and forecasts for the future based on our nearly 40 years of experience working with physicians.

We are now several years post-COVID and hope such a traumatic experience never repeats itself. That could be a game-changer in relation to many of the subjects addressed in this book. We believe the opportunities will continue for all participants within our great U.S. healthcare delivery system.

Our primary purpose is to continue to lay a strong foundation for making sound decisions about the many available affiliation options for physicians. We trust that the readers will find value in this book, and we look forward to hearing about their experiences relating to affiliation options for physicians.

Excerpted from The Physician Leader’s Guide to Affiliation Options: Economics, Tactics, and Real-World Implementation (American Association for Physician Leadership, 2026).