Corporatization of Academic Medical Centers and Its Impact on the "Esprit-De-Corps" of Surgical Teams.

Abstract

Accelerating corporatization of US healthcare has reshaped academic medical center governance, with for-profit investor-owned organizations comprising 23.7% of market share in 2,023 and 56.1% of hospitals owned by corporations with 3 or more hospitals. Although intended to enhance financial sustainability, centralized, productivity-driven management may conflict with the professional culture underpinning high-performing surgical teams. Narrative perspective synthesizing literature in health policy, organizational psychology, and surgical culture to examine how corporatized governance interfaces with surgeon intrinsic motivation and team performance. Surgical identity centers on mastery, autonomy, and purpose-constructs aligned with self-determination theory. Evidence from organizational psychology associates erosion of intrinsic motivation with burnout, reduced engagement, and diminished performance. Surgeons increasingly report productivity pressure, reduced control over operating room resources, and administrative encroachment into clinical domains. Physician burnout has been associated with higher medical error rates, lower patient satisfaction, and reduced productivity. The "Teams of Teams" governance model-emphasizing shared consciousness, empowered execution, and relational trust-is proposed as an alternative framework aligning fiscal stewardship with professional autonomy. Corporatization that undermines surgeon autonomy, mastery, and purpose risks degrading team cohesion, clinical performance, and institutional sustainability. Governance models that distribute authority while preserving accountability may better support surgical excellence and long-term viability of academic medical centers.