title: The impact of economic and noneconomic exchange on physicians' organizational attitudes: The moderating effects of the Chief Medical Officer.
abstract: BACKGROUND
  Hospital-physician relationships are critical to hospitals' organizational success. A distinction can be drawn between economic and noneconomic physician-hospital exchange. Physician senior leadership could be an important component of managerial strategies aimed at optimizing hospital-physician relationships.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the moderating role of the quality of exchange with the Chief Medical Officer (CMO) in the relationship between economic and noneconomic exchange and physicians' key organizational attitudes.
  
  
  METHODS
  Self-employed physicians practicing at six Belgian hospitals were surveyed. Economic exchange was conceptualized by the concepts of distributive and procedural justice, whereas noneconomic exchange was conceptualized by the concepts of administrative and professional psychological contract. Our outcomes comprise three key organizational attitudes identified in the literature (job satisfaction, affective organizational commitment, and intention to leave). The moderating role of leader-member exchange with the CMO in these relationships was assessed.
  
  
  RESULTS
  Our results showed a relationship between both psychological contract breach and organizational justice and physicians' organizational attitudes. The quality of exchange with the CMO buffered the negative effect of psychological contract breach and reinforced the positive effects of organizational justice with respect to physicians' organizational attitudes.
  
  
  CONCLUSIONS
  Our results demonstrate that both economic and noneconomic aspects are important when considering physicians' key organizational attitudes. The reciprocity dynamic between physician and hospital can be enhanced by high-quality exchange with the CMO.
authors.affiliation: Jeroen Trybou, PhD, is Assistant Professor, Department of Public Health, Ghent University, Belgium. E-mail: jeroen.trybou@ugent.be. Paul Gemmel, PhD, is Professor, Department of Management, Innovation and Entrepreneurship, Ghent University, Belgium. Lieven Annemans, PhD, is Professor, Department of Public Health, Ghent University, Belgium.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Trybou
authors.forename: Paul
authors.initials: P
authors.lastname: Gemmel
authors.forename: Lieven
authors.initials: L
authors.lastname: Annemans
mesh_terms: D001291:Attitude of Health Personnel; D001530:Belgium; D006739:Hospital Administration; D006801:Humans; D007400:Interprofessional Relations; D007588:Job Satisfaction; D007857:Leadership; D015279:Organizational Culture; D008486:Physician Executives; D010820:Physicians / Q000191:economics / Q000523:psychology*; D011795:Surveys and Questionnaires