This is a continuation of the exploration that began with physician and hospital leadership retreat at Babson College in November 2006 and subsequently involved a discussion with a Chicago based law firm as to whether a clinically integrated organizational strategy would be sufficient to ensure a vibrant medical community for the years ahead. This analysis concluded that the clinical integration model did not adequately address core issues related to physician recruitment and growth, practice management support and leadership, service orientation as to where ancillary services should be located, and system/network influence among others.  Based on this exploration and further discussion, our leadership group has determined that a more economically integrated organization is likely the most viable option for the future.