Emergency Medicine

Employed to outsourced: Collaboration and trust-building bring positive change


After more than a decade of success with Sound’s hospital medicine program, a Southwestern U.S. hospital system awarded Sound Physicians the emergency medicine (EM) and hospital Medicine (HM) service lines for another of its hospitals. As with any transition from employed to outsourced groups, issues may arise. This hospital transition — which included the EM and HM physicians who were previously part of the hospital’s multispecialty group — presented a few of those challenges:

  • The 90-day transition period would take place over the traditional holiday months of November, December, and January. During these months, key facility credentialing and medical staff leadership committee meetings are often postponed or canceled.
  • Several hospital leaders were hesitant to bring on outsourced programs.
  • Among the hospital’s employed EM and HM physicians, there was uncertainty regarding Sound’s culture and commitment to patient-centered care.
  • The emergency department medical director resigned ahead of the start date, and the HM program lacked a medical director altogether.

In addition, the hospital’s intensive care unit (ICU) closed the prior year. Hospital leaders expected Sound to collaborate on its re-opening within months of the transition. This required agreement by the emergency physicians to perform certain procedures in the ICU setting for an indefinite period.


With their work cut out for them — emotionally and operationally — the Sound team rolled up their sleeves and got to work under the tight organization and steady guidance of their implementation lead. The team knew they must keep to the timeline, win hearts and minds, and — with determination and grit — exceed expectations.

Retention and leadership
  • Sound offered the incumbent physicians W2-employed positions to bridge their existing benefit packages
    to Sound’s, as well as increased compensation for physicians and advanced practice providers (APPs).
  • Sound began simultaneously recruiting for an EM and HM medical director, with the goal of establishing
    these roles coincident with the start date.
  • Sound recruiters and physician leaders rapidly initiated email and cell phone communications with the
    incumbent EM and HM physicians and APPs, emphasizing Sound’s commitment to retaining them and
    fully supporting their work.
  • Daily staffing calls led to populating the clinical schedules for the first three months post-transition.
  • The One Sound process facilitated the merging of the EM and HM physicians and APPs into one
    collaborative team, with emphasis on transparency and clarity of goals.
Integrity and innovation
  • To win over skeptics, Sound’s team demonstrated its ongoing commitment to physician leadership and
    clinician input, as well as its patient-first approach.
  • The Sound team worked with the hospital’s CEO and chief medical officer to open an on-site Sound
    staffing office to expedite credentialing.
  • With support from the hospital administration, the Sound team worked day and night and through
    holidays, holding ad hoc and virtual meetings, and taking an all-hands-on-deck approach to meet tough
    credentialing deadlines.
Employed to Outsourced


With the hospital’s decision to bring Sound on board, the team recognized its biggest hurdles were instilling
confidence, building trust, and supporting the incumbent physicians and APPs throughout the transition. The
Sound team worked intentionally to demonstrate good faith in all phases of the transition, providing assurance
to the physicians and APPs that they would be kept whole — financially and emotionally.

Six months post-launch:

  • The team maintains its focus on robust staffing, clinician satisfaction, and superb patient care.
  • High-quality medical directors for both the EM and HM service lines are leading their respective teams.
  • Through a concerted effort between the integrated Sound EM and HM physicians, the hospital was able to reopen its ICU within months of Sound’s start date, with EM and HM physicians responding to procedural needs in the ICU and emergency department. This collaboration will lead to an ICU with HM physicians fully capable of performing procedures.
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To learn more, reach out to

Dr. John Birkmeyer