Unlike in the past, however, hospitals now are offering other options that give doctors some autonomy while providing the financial benefits of being affiliated with a bigger player in the health-care industry.

Akron General's new venture allows physicians to roll their practice under the hospital's umbrella for purchasing supplies, buying malpractice insurance, implementing electronic medical records and negotiating with insurance companies for better payments.

But the trend could result in less patient choice as well as higher costs, said Don Pirc, director of professional contracting for Medical Mutual, one of Ohio's largest insurers.

If doctors and hospitals team up to demand higher payments from insurers, he said, patients will end up footing the bill with higher insurance premiums.

On the other hand, Pirc said, patients could end up benefiting if aligned doctors and hospitals team up with insurers to eliminate duplicated tests and provide coordinated care for people with chronic illnesses.

Ultimately, hospitals need doctors to survive. After all, they rely on physicians to care for their patients, train their future caregivers and refer customers through their doors, particularly in competitive markets.

Stover said physician payments from insurance companies and government programs aren't keeping pace with rising costs -- particularly malpractice insurance premiums.

But hospitals that learned from their previous mistakes ``are doing a nice job of trying to be creative to find ways of partnering with physicians,'' he said.

But for those doctors with private practices, Summa is offering to employ the physicians and pay them to manage the practices independently, said Dr. T. Clifford Deveny, vice president for physician alignment.

Akron Children's Hospital also has been employing more doctors in recent years to compete for hard-to-find specialists needed for patient care.

``Pretty much across the board in the pediatric sub-specialties, there are considerable imbalances between the emerging supply and the current and future demand,'' said Bob Howard, director of planning.

Dr. Bradford Fenton gave up a solo OB-GYN practice in rural southern Texas and took a job as a hospital-employed doctor at Summa's Akron City Hospital.

His wife, a pediatric endocrinologist, also opted for a staff position at Akron Children's Hospital rather than trying to run her own practice in town.

Fenton now spends his time training future doctors, conducting research and treating female patients in a program devoted to handling complicated cases of pelvic pain.

His initial meetings with patients often take two hours or more -- time he says he never could have afforded to devote while in private practice.

Though he probably could earn more money running his own practice, Fenton said he's glad to leave the business end of medicine to the hospital.

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