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-Studies should avoid over-adjustment for light intensity activity when studying the relationship between sedentary behaviour and health, as light intensity activity is by definition almost the inverse of sedentary behaviour.

-Studies testing the independent association between sedentary behaviour and health are advised to adjust for total volume of physical activity (in mg or counts, not minutes), not just time spent in MVPA. Otherwise the resulting association may simply be reflecting the beneficial effects of doing more light intensity activity, not the detrimental effect of more time spent sedentary.

MH would like to thank wordsmiths Dr. Brad Metcalf and Dr. Richard Pulsford for their editing skills in the section written by MH.

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Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated.

Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, the Netherlands
Sydney School of Public Health, University of Sydney, Camperdown, Australia
College of Life and Environmental Sciences, University of Exeter, Exeter, UK
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International Journal of Behavioral Nutrition and Physical Activity

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Executive Summary

How can hospitals and health systems generate a return on their investment in their physician enterprises? According to themost recent figures, from the American Medical Association, over 25% of U.S. physicians practiced in groups wholly or partly owned by hospitals in 2016 and another 7% were direct hospital employees. Yet, according to the Medical Group Management Association, hospitals’ multi-specialty physician groups lost almost $196,000 per employed physician. As a result, some larger health systems’ physician operations are generating nine-figure operating losses, which are major contributors to thedeterioration in hospital earnings. It is time for hospitals or health systems to rethink their strategy for their physician enterprises.

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How can hospitals and health systems generate a return on their investment in their physician enterprises? According to the most recent figures , from the American Medical Association, over 25% of U.S. physicians practiced in groups wholly or partly owned by hospitals in 2016 and another 7% were direct hospital employees. Yet, according to the Medical Group Management Association, hospitals’ multi-specialty physician groups lost almost $196,000 per employed physician.

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. It is time for hospitals or health systems to rethink their strategy for their physician enterprises.

Let’s first revisit why independent physicians were receptive to becoming employees and why hospitals and health systems felt the need to hire them.

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