title: Understanding specialist sharing: A mixed-method exploration in an increasingly price-competitive hospital market.
abstract: Medical specialists seem to increasingly work in- and be affiliated to- multiple organizations. We define this phenomenon as specialist sharing. This form of inter-organizational cooperation has received scant scholarly attention. We investigate the extent of- and motives behind- specialist sharing, in the price-competitive hospital market of the Netherlands.
  
  
  
  A mixed-method was adopted. Social network analysis was used to quantitatively examine the extent of the phenomenon. The affiliations of more than 15,000 medical specialists to any Dutch hospital were transformed into 27 inter-hospital networks, one for each medical specialty, in 2013 and in 2015. Between February 2014 and February 2016, 24 semi-structured interviews with 20 specialists from 13 medical specialties and four hospital executives were conducted to provide in-depth qualitative insights regarding the personal and organizational motives behind the phenomenon.
  
  
  
  Roughly, 20% of all medical specialists are affiliated to multiple hospitals. The phenomenon occurs in all medical specialties and all Dutch hospitals share medical specialists. Rates of specialist sharing have increased significantly between 2013 and 2015 in 14 of the 27 specialties. Personal motives predominantly include learning, efficiency, and financial benefits. Increased workload and discontinuity of care are perceived as potential drawbacks. Hospitals possess the final authority to decide whether and which specialists are shared. Adhering to volume norms and strategic considerations are seen as their main drivers to share specialists.
  
  
  
  We conclude that specialist sharing should be interpreted as a form of inter-organizational cooperation between healthcare organizations, facilitating knowledge flow between them. Although quality improvement is an important perceived factor underpinning specialist sharing, evidence of enhanced quality of care is anecdotal. Additionally, the widespread occurrence of the phenomenon and the underlying strategic considerations could pose an antitrust infringement.
authors.affiliation: Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands. Electronic address: d.westra@maastrichtuniversity.nl.
authors.forename: Daan
authors.initials: D
authors.lastname: Westra
authors.affiliation: Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands. Electronic address: federica.angeli@maastrichtuniversity.nl.
authors.forename: Federica
authors.initials: F
authors.lastname: Angeli
authors.affiliation: Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands. Electronic address: e.jatautaite@student.maastrichtuniversity.nl.
authors.forename: Evelina
authors.initials: E
authors.lastname: Jatautaitė
authors.affiliation: Department of Organization and Strategy, School of Business and Economics, Maastricht University, Tongersestraat 53, 6211 LM, Maastricht, the Netherlands. Electronic address: m.carree@maastrichtuniversity.nl.
authors.forename: Martin
authors.initials: M
authors.lastname: Carree
authors.affiliation: Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands. Electronic address: d.ruwaard@maastrichtuniversity.nl.
authors.forename: Dirk
authors.initials: D
authors.lastname: Ruwaard
mesh_terms: D000328:Adult; D005260:Female; D017048:Health Care Costs / Q000592:standards; D019981:Health Care Sector / Q000191:economics; D006755:Hospital Shared Services / Q000379:methods; D006761:Hospitals / Q000639:trends; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000639:trends*; D008511:Medicine / Q000379:methods / Q000639:trends*; D008875:Middle Aged; D009426:Netherlands; D009935:Organizational Affiliation / Q000639:trends*; D000078329:Workforce
keywords: Antitrust; Collaboration; Healthcare competition; Medical specialists; Quality of care; Social network analysis; Specialist sharing; The Netherlands