Incorporating an understanding of independent practice physician culture into hospital structure and operations.

The culture values that have dominated the independent practice physician community in the United States include a set of "shared understandings" (individual autonomy, the fact that physicians relate best to other physicians, belief in science, and humanitarian ideals) that affect physician beliefs and values. Given that the current evolution of the health care system inevitably will draw physicians closer to corporate settings, corporate managers will benefit from gaining an explicit understanding of the origins and ramifications of these shared understandings. Managers can then establish organizational environments that effectively reduce the tensions between cultures of the physician and the organization. This article develops a framework of these "shared understandings" and proposes a range of managerial actions to reduce the tensions between the cultures.