“High expectations are the key to everything.”


Sam Walton, the Walmart founder who turned a lone Arkansas five-and-dime store into the global retail empire that now generates more than $500 billion annually, famously attributed success to this mindset. And nearly 60 years after he opened his first store, that same business advice may help hospital executives address one of their biggest challenges today: A lack of accountability in the emergency department.

With more providers now opting for traditional employment with hospitals and health systems, physician practice owners recently became a minority among their peers for the very first time: Today, six percent of physicians are independent contractors, while the remaining 94 percent are split evenly between practice ownership and traditional employment arrangements, according to an American Medical Association study. In contrast, as recently as 2014, private practice physicians still accounted for a narrow majority in the profession; in 1983, 76 percent of physicians owned their practices. A lot can change in a generation.

As with all change, growing pains are to be expected; namely, meeting typical management challenges associated with traditional employment, issues like culture, accountability and talent retention. For hospital CEOs, the reality has already set in: According to a recent American College of Healthcare Executives survey, three of the top 11 challenges they face — personnel shortages, physician-hospital relations and partnerships — undoubtedly are attributed in this shift to traditional employment.

Even more, at nearly 20 percent, employment turnover overall in hospitals is at a five-year high, according to a new survey by Nursing Solutions, Inc. The same study also found that an average emergency department today has 100 percent staff turnover every five years, second only to behavioral health.

An innovative partnership model that blends the accountability of local physician ownership with the technology resources and integrative capabilities of a large organization offers a solution. Here’s the thesis: On issues big and small, business owners typically act in the best interests of their investments. It’s human nature — and physicians are no different.

An equity stake fosters a culture that safeguards the hospital contract by treating physicians as stakeholders and emphasizing coaching, leadership and performance-based compensation. For example, with a significant financial stake hanging in the balance, an individual physician is typically more likely to be engaged on an issue like clinical integration and alignment than a contractor or a traditional employee. Even more, each poor online patient review literally puts that individual physician one step closer to losing a hospital contact. Physician owners inherently care about these issues because they can’t grow their businesses if they can’t keep their contracts.

Interested in learning more about how the right partnership can create accountability in your emergency department? Let’s talk. Progressive Emergency Physicians (Progressive) is an emergency medicine group with a unique partnership model that attracts clinicians seeking a culture of accountability and innovation necessary to meet today’s healthcare challenges. We deliver great evidence-based and data-driven solutions implemented by clinicians whose goals and incentives are aligned with the needs of our partner hospitals. Our culture of accountability will continue to reach and surpass target goals and enact meaningful change to better serve our partner hospitals and patients for which we care.

Founded and headquartered in New York, Progressive is positioned to provide you with the customized services that truly matter to your institution. Our leadership team has extensive knowledge, experience and is keenly aware of the current issues that hospitals and their emergency departments face. Our ownership structure drives a culture of alignment with your hospital’s needs as we craft customized solutions for your institution.

Our services include:
• Emergency medicine
• Observation medicine
• Urgent care
• Critical care
• Aftercare
• Risk management
• Quality management
• Ultrasound
• Revenue cycle management
• EM physician residency
• EM ultrasound fellowship
• Observation medicine fellowship
• Administration and leadership EM
• PA fellowship



1 https://www.ama-assn.org/practice-management/economics/first-time-physician-practice-owners-are-not-majority
2 https://www.ache.org/learning-center/research/about-the-field/top-issues-confronting-hospitals/top-issues-confronting-hospitals-in-2018
3 http://www.nsinursingsolutions.com/Files/assets/library/retention-institute/2019%20National%20Health%20Care%20Retention%20Report.pdf

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