Our aspiration is to make direct, fractional, potentially remote specialty care with durable institutional relationships possible—without forcing a choice between employment and building an entire practice. Keep your current job while you explore; an illustrative start may be 18 months away.
Exploratory only. No active physician positions, participating institutions, guaranteed compensation, or coverage commitments are being offered.
You might remain a solo independent physician, contribute a defined fraction to an existing arrangement, join trusted colleagues, or help quarterback a new physician-governed team. A hospital expanding established specialty capacity—for example, from 1.5 to 2.0 FTE—might create a fractional opportunity without requiring a new node.
Where a team is appropriate, our aspiration is for physicians to choose colleagues they know, trust, and want to work with—not to be assigned strangers to complete a roster. No particular organizational form is compulsory.
Today: Keep your existing position. Explore whether the idea could fit your professional and household priorities. There is no immediate clinical commitment.
Over an illustrative 18-month preparation horizon: institutional demand, physician participation, agreements, funding, insurance, licensure and credentialing can be developed in stages. The aim is to make the roadmap understandable without shifting the coordination burden onto an interested physician.
At a future start date: participation begins only if the actual arrangement is ready, the physician is eligible and the agreed terms are acceptable. The timeline is a planning illustration, not a guaranteed launch date.
For the proposed new-node pathway, our working formation threshold is at least 1.5 full-time equivalents (FTE) of aggregate in-state physician capacity, supported by sufficient funded demand from multiple institutions. That threshold is not a universal requirement for solo physicians or expansion of existing arrangements. You would not be expected to find hospitals yourself, and no individual hours or launch date are promised.
Institutions must collectively support the agreed capacity at a defensible specialty-market reference, with separate recognition of additional responsibilities. A physician would not be asked to begin clinical coverage before the necessary agreements, funding, licensure, credentialing, privileges and professional liability arrangements are resolved.
For illustration, a 0.5 FTE role could mean approximately 20 scheduled hours per week, with any additional availability, call or response obligations explicitly bounded and compensated. This is the defined professional commitment—not a claim on everything else you might choose to do with your week.
Physician clinical judgment is not simply a unit of labor or a collection of encounters. The aim is to fund the professional capability and availability that an institution needs, while preserving your authority over clinical decisions and your other legitimate commitments.
Market reference: relevant specialty compensation surveys are a starting point for assessing fair market compensation, not an automatic rate or contractual promise. The parties must assess actual duties, time, geography and applicable legal requirements.
Availability has value: the Plumber Principle recognizes that professional readiness, agreed response time and reserved capacity have economic value even when no patient encounter occurs. Availability is bounded and negotiated—not unlimited unpaid call.
Additional responsibilities deserve explicit funding: team-level backup, leave, coverage maintenance, recruitment, replacement and succession may require resources beyond the baseline clinical contribution. The team must assess and price those obligations separately; no particular premium is guaranteed.
Above-payer capacity: the institution funds the capability it requests directly, while encounter reimbursement follows the separately agreed billing arrangement. Clinical judgment remains with the responsible physician.
Your individual scope, schedule, availability, response latency, call obligations, documentation and compensation would be stated before commitment. You are not automatically responsible for every colleague’s call or the team’s entire obligation. Fractional participation is not an agreement to be permanently on call.
A team assembled from colleagues who choose to work together—not strangers assigned to a roster—must plan how it can satisfy its contractual coverage, backup, leave and transition obligations. Governance and member rights require their own agreements.
No. Do not resign in anticipation of this proposal. Explore privately and gradually, subject to existing employment agreements, conflicts, and professional duties. Any future transition would be your decision, made only after a concrete opportunity and its prerequisites have been independently evaluated.
Exploration creates no obligation to participate. Physicians must be able to evaluate conflicts with existing employment, professional standards, household needs, and clinical or ethical commitments before signing. The terms governing a later departure or disagreement must be explicit and reviewed with appropriate counsel.
Nothing here is a substitute for individualized legal, tax, insurance or professional advice. The design is under development and requires real-world validation.
We want real physician pushback as this aspiration develops. Which assumptions seem unrealistic? What would you need to know before considering a fractional role? What alternatives should we explore?
We welcome candid, asynchronous discussion, including reasons you would decline. A formal feedback form is not open yet; this is an invitation to help shape the questions, not a request to commit.