At the end of the 1990s, physician employment was widely touted as a defensive strategic solution to the pressures of managed care. Treated as an end rather than a means, the strategy often lacked adequate engagement, infrastructure support, and strategic investment to ensure success. Today's imperative for performance is once again leading to physician employment strategies, but this time treated as a means to clinical quality, safety, and business performance improvement rather than an end. Explore the factors that leading hospitals are using to realize the potential of this strategy in today's environment.