Multispecialty practices (MSPs) continue to grow in number, size and influence as a component of the U.S. healthcare delivery landscape and have a range of affiliation models to consider in relation to local hospital or health system partners. Physician leaders, executives and board members alike will want to assess the pros and cons of initiating or maintaining a hospital affiliation as the strategic implications of such affiliations impact culture, scope of service, profitability and more. From total independence through employment, multispecialty groups have a spectrum of models available with regard to hospital or health system affiliation. At one end of the spectrum, physicians practice independently, unaffiliated with a hospital and providing surgeries and procedures in office-based or ambulatory settings. Next on the spectrum are independent practices with open referral relationships and admitting privileges to multiple hospitals, allowing maximum flexibility on how care is provided and the scope of services which can be performed in office, surgery center or inpatient settings. Tighter affiliation with one hospital system may enable participation in a hospital-sponsored, clinically integrated network to benefit from joint contracting, health system infrastructure, tighter referrals, data sharing, and care coordination services. At the other end of this spectrum are exclusive affiliation to one hospital system or ultimately employment of the group practice by the hospital or its medical group. Most independent MSP groups are not positioning themselves to health plans as an alternative delivery system that offers better outcomes at lower costs to bring long-term sustainable value to the patients they are serving. A study from the National Bureau of Economic Research published in 2019 found multispecialty practice “decreases Medicare-financed per capita annual medical expenditures by approximately $1,600 relative to [single specialty practice] SSP – a 36% reduction. The reduction is concentrated primarily on hospital spending and on patients with two or more chronic conditions. Taken together, these results suggest that MSP is more effective at keeping relatively sick patients out of the hospital. Our results also suggest that multispecialty group practice attracts less healthy patients.” In demonstrating value to health plans and patients, MSPs by design have the flexibility to develop clinical integration within their group, allowing tighter management of processes to refer patients seamlessly between primary care and the surrounding specialty services. Given that integration, there is less variation of quality and cost than specialists might experience if they are working in several hospitals.