In this era of intense competition, declining revenues, and escalating costs, hospital executives must challenge themselves to pursue innovative opportunities and affiliations that increase revenue and decrease cost. Developing and maintaining successful hospital - physician relationships are critical to not only survive, but, actually thrive in today’s unforgiving healthcare environment. Explore lessons learned from over 20 years of developing hospital-physician relationships within community hospitals, teaching hospitals and academic medical centers, and primary care and multi specialty medical groups.