I’m a physician
Explore your capacity, professional independence and possible participation in a physician-governed team.
Physician resources →Could direct clinical partnerships make more possible?
Could direct institution-to-physician partnerships, above the payer level, help modest hospitals establish and sustain more specialty access?
Here, the institution funds agreed clinical capacity directly; payer reimbursement for encounters is a separate matter.
Could physician-governed nodes create durable fractional specialty supply for modest hospitals—and maintain it over years without returning the staffing burden to the institution?
Might restored sovereignty and sufficient economic margin create more room for voluntarily chosen benevolence?
These are hypotheses. The proposed pathway needs testing.
Choose your starting point
Clinical Capacity Institute (CCI) offers how-to guides and resources to help physicians and institutions explore the model.
I represent an institution
Clarify your specialty requirement, preparation horizon and readiness to fund continuing coverage.
Institutional resources →What the listing cannot do on its own
Establishing specialty access is a beginning. Keeping it available takes preparation.
For physicians
- A physician-governed team with defined commitments.
- Node responsibility for primary coverage, backup, leave, physician replacement and succession throughout the agreed term.
- Fair compensation for required work and availability.
- Physicians govern their team so they can organize the coverage, backup and replacement the institution needs.
For institutions
- Define scope, hours and response expectations.
- Demonstrate willingness and ability to fund the obligations.
- Agree fair compensation for the requested capacity.
- Prepare for leadership changes, renewal and transitions.
Who undertakes the promise?
The proposed contracting supplier is the physician-governed node. Before signing, the parties must identify its legal entity, authorized signatory and accountable leadership, and define each participating physician’s duties. Node coverage obligations and individual clinical responsibilities must be distinguished explicitly.
The legal and operating structure remains part of what the pilot must test. Replacement duties, limits, funding conditions and the response if coverage cannot be maintained must be agreed—not assumed.
Before coverage begins
- Licensure: participating physicians hold the licenses required for the agreed work.
- Institutional credentialing and privileges: applicable approvals are completed.
- Malpractice coverage: identify who obtains and pays for coverage, the required limits, and tail coverage where applicable.
- Funded agreement: define scope, hours, fair compensation, secured funding, backup, replacement, notice and transition obligations.
A planning guide for aggregate demand
An initial rule of thumb is 1.5 full-time equivalents (FTE) of compatible aggregate demand across institutions—60 hours per week under a 40-hour planning convention. This is not a minimum for an individual posting, physician or hospital, and it does not by itself establish backup or durability.
The physician node and institutions negotiate the viable scale, funded obligations and staffing design. Actual work, reserved availability, backup and replacement commitments must each be accounted for.
The full lifecycle
- Discover & define: clarify demand, physician interest and institutional readiness.
- Form & fund: establish the node, coverage term, replacement responsibility, backup, agreements and secured commitments.
- Prepare & begin: complete credentialing, clinical workflows and readiness checks.
- Maintain & adapt: review obligations, funding, coverage and leadership transitions.
- Renew, transition or exit: follow agreed notice and patient-transition responsibilities.
Organize independently
Physicians and institutions may use the public principles and arrange formation and continuing responsibilities themselves. The same preparation, review and transition work still needs an identified owner. Hiring CCS* is optional.
Optional support, freely chosen
You are welcome to use the public resources and build your own arrangement. You never have to hire Clinical Capacity Stewardship (CCS) to use this board or explore the model.
Clinical Capacity Stewardship (CCS) helps examine two foundations: whether the institution has accounted for the actual work and reserved availability it requests, and whether the node has a credible plan to maintain coverage throughout the agreed term.
Fair compensation for required time and availability—the Plumber Principle*—belongs within that preparation, including backup, leave and replacement duties. A benchmark salary alone does not account for the whole obligation.
*Plumber Principle: compensate the professional for the work and availability required, including necessary work outside encounters.
CCS can facilitate formation and provide continuing stewardship services. Before agreement: clarify requirements, readiness and reciprocal expectations. During the term: support records, scheduled reviews, funding verification and emerging concerns. At renewal, transition or exit: support leadership handoffs, reaffirmation and agreed transition processes. The parties retain their own responsibilities.
Choose support early, if you want it.
If you would value formation and continuing stewardship support, explore it before agreements are signed and coverage begins. That gives the parties time to build sound funding, responsibilities and transitions together.
You remain free to organize independently. An independently formed arrangement does not create a later obligation for CCS to repair or take it over; CCS generally works with foundations it helped establish. Immediate coverage emergencies belong with emergency staffing or locums providers.
Shared resources are offered to help you succeed, whether or not you ever engage CCS.
CCS facilitates and stewards the arrangement; it is not the clinical supplier, physician manager or guarantor of coverage.
CCS helps preserve the conditions under which continuity becomes possible. It does not promise the outcome.
Explore the philosophy behind this approach →
This is a hypothesis. The proposed pathway needs testing.Explore the pilot →