I would like to comment on the article “Making Sense of the Trend Toward Hospital Employment” [July/August 2013]. Here in my community, the internists at the large hospital in town came to realize in 2006 that they could not sustain adequate income given the economics of running private practices. They approached the hospital en masse indicating that they were considering moving elsewhere because of the financial climate. They had no issue with the hospital itself and the hospital, in fact, had a long tradition of not purchasing practices. Nevertheless, a hospital-financed, physician-directed group was formed and all the internists sold their practices to the hospital. In addition, once the ball was rolling, many family physicians (like myself) followed suit, as did some ob/gyn groups. We all had the same issues – diminishing insurance payments and increasing costs leading to stagnant or decreasing income. All was well initially, and I chose to move on to occupational medicine after six months due to personal issues. Since that time I have learned that the hospital has begun to look aggressively at productivity and expects the physicians to generate more gross income by seeing more patients (the usual approach) or by coding and doing procedures that accomplish the same goal. Some physicians have left the area, but the majority are just “sucking it up” and continuing in the brave new world in which they find themselves, largely because they only plan to practice five to 10 years before retiring. The last word: caveat emptor.