Physician alignment frays when every decision is pushed to headquarters
As health systems move farther into the ambulatory setting, the old habit of directing physician groups from a distant center is losing its force. At Westchester Medical Center Health Network, Sean Tedjarati, MD, said buy-in falls apart when clinicians feel their work is being steered by a “mothership” that does not understand daily practice on the ground.
His point is practical. A health system can share a name, a mission, and a patient experience across sites, yet still fail if local leaders cannot make decisions quickly enough to fit their own communities. In a network that spans academic and community settings, that tension becomes unavoidable: the brand may be unified, but the patients, staffing patterns, referral flows, and access barriers are not.
Dr. Tedjarati, who serves as executive vice president, chief physician ambulatory officer, and CMO of the medical groups at the Valhalla, N.Y.-based network, oversees roughly 1,100 to 1,200 academic and community practitioners. He described “oneness” as a shared identity, not a command structure. The distinction shapes whether physicians feel part of a common enterprise or merely managed by one.
If physicians think every choice must be cleared centrally, alignment weakens fast.
Local authority carries more weight than centralized messaging
The network needs a consistent patient experience, but that consistency cannot erase local judgment. Some WMCHealth communities are rural and face access problems that require different recruitment strategies and different models of care than those used at the academic hub. Compensation may differ. Office workflows may differ. Even the way clinicians deliver care may need to differ.
That flexibility is not a philosophical preference; it is how physician organizations survive real-world variation. A cardiologist recruiting into a dense academic center does not face the same market as a radiologist practicing in a setting shaped by remote work, new technology, and the changes accelerated by the COVID-19 era. The script that worked a decade ago no longer speaks to what many candidates want now, especially as generational expectations around lifestyle and time at home reshape what counts as an attractive offer.
For physician leaders, that means the central office can set direction, but local leaders must be trusted to steer execution. If they are forced to wait for approval from headquarters on every staffing model, compensation nuance, or office process, the organization loses speed precisely when the ambulatory market demands agility.
Ambulatory growth is rewriting the operating model
WMCHealth is not making a small adjustment. The system receives about 15,000 transfers a year, a volume Dr. Tedjarati said is among the highest in the country, and it has historically run with an inpatient-centric mix close to 80/20. The medical group is now moving toward something closer to 50/50 or 60/40 ambulatory while also shifting from Cerner to Epic and tightening its templates and call center operations.
That kind of transition changes everything about physician recruitment and retention. An organization built around the inpatient side of medicine often recruits for a different rhythm, a different workload, and a different set of expectations than one trying to expand ambulatory access at scale. The move also changes what physicians need from the institution: quicker scheduling, smoother patient flow, cleaner handoffs, and enough operational support to protect clinic time.
The leadership problem is not abstract. If ambulatory growth is the goal, the system has to recruit people who want that work and then build the environment that lets them do it well. The same physician who thrives in a high-acuity inpatient environment may not respond to the same management model, compensation arrangement, or time structure in outpatient practice.
Recruitment now depends on market-specific language
The physician labor market has become more segmented, and leadership teams that rely on a single national benchmark can miss the reality in front of them. Dr. Tedjarati said sources such as MGMA offer a starting point for compensation, but not a complete answer. Benchmarking may anchor a package, yet it cannot replace a system’s own knowledge of what particular specialties, geographies, and practice models require.
Radiology offers a clear example of how quickly the market can move. Remote work and technology have altered what physicians expect from the role. Cardiology is also changing. Oncology used to be recruitable with a relatively stable message, but even that has become more complex because physicians are evaluating more than salary alone. They are weighing predictability, support, and family life with far more scrutiny than many health systems are used to addressing.
The result is a more demanding recruitment conversation. Leaders need to know exactly who they are speaking to and what those physicians value, rather than recycling an old pitch aimed at an older physician cohort. A single message may sound efficient from the headquarters perspective, but it can feel detached from the realities that shape a specialty’s labor market.
Compensation works only when productivity has room to happen
Rebuilding compensation in this environment means balancing security with accountability. Dr. Tedjarati described a model that includes some “skin in the game” on productivity, paired with the organization’s obligation to give physicians the infrastructure to be productive. That includes OR access, outpatient efficiency, and the operational support required to keep patients moving.
This is where compensation and operations intersect. A physician cannot be held to a productivity standard if the system makes it difficult to schedule patients, complete visits, or access the tools needed to work efficiently. In ambulatory medicine, the gap between a well-designed compensation plan and the actual clinic environment can become wide very quickly.
The network’s challenge is not just to pay physicians competitively. It is to create a structure in which local leaders can tailor practice conditions without losing the larger institutional identity. Shared mission matters. So does the freedom to adapt when one community needs a different recruitment approach, another needs a different office model, and another needs a different compensation mix.
WMCHealth’s experience is a reminder that physician alignment fails when central leadership tries to substitute control for trust. A unified system can still be locally responsive. If it cannot be, the ambulatory shift will expose that weakness long before any branding campaign can cover it.
The unresolved question is how much standardization a large network can sustain
The article leaves a practical pressure point in view: large health systems need common identity, yet physicians will not accept a model that treats every site as interchangeable. The more an organization expands into ambulatory care, the more it has to decide which elements must stay standardized and which ones should be left to local leaders who understand the market.
That balance will shape recruitment, compensation, and patient access across the network. It also determines whether physicians see the system as a partner or as a remote authority asking them to fit an impossible template.