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Hospitals and health systems are well served by proactive strategic planning and processes with respect to physician alignment, both for employed and independent physicians.  This article points out some common problems and solutions to becoming a more purposeful organization with respect to physician alignment. Problem Many hospitals are reactive in determining where resources are best spent around physician alignment.  Often, a physician group will approach a hospital looking to be acquired or to enter into a contractual arrangement, such as an on-call deal, and the hospital will immediately begin working with the group to reach an understanding or accommodation.  This reactive approach can waste time and resources on low-impact results or low-priority relationships. Solution Hospitals need to develop a clear strategy around physician alignment and implement a unified process around affiliation activity