Many decision factors enter into making the right strategic choices in today's healthcare environment. Physicians have their perspective. Hospital managers may have a different perspective. Having worked on both sides of the equation, this author suggests that the successful design of an integrated healthcare system will depend on the ability of each to understand the other's agenda. Physician needs aren't necessarily incompatible with those of an organization and vice versa. Cultural differences aren't necessarily cast in stone. If hospital managers can develop an understanding of the physicians' decision factors and tailor a program around the key issues, there will be a greater likelihood of success. At the same time, physicians who are considering an alignment with a health system will need to understand what it will take to make the organization successful. The personal futures of these physicians may be at stake once they are in an integrated relationship. Finally, integrated systems will have new decision criteria for formulating strategy. Both sides should look forward to addressing mutual interests in creative ways.