Indiana University Health Physicians started as the Indiana Clinic three years ago with plans to employ at least 1,200 physicians by now. That hasn’t happened, but organization officials say they won’t stop adding doctors.

The physician practice, a joint venture of the IU Health hospital system and the IU School of Medicine, employed nearly 850 physicians at year end, and has “several dozen” more joining in January.

That’s more doctors than any other Indianapolis-area hospital system employs. Community Health Network employs roughly 550 physicians. St. Vincent Health, while it has about 600 in its physician network, employs a big chunk of them well outside the Indianapolis area.

Dr. John Fitzgerald, CEO of IU Health Physicians, said progress on the numbers has been slower than expected because he and his management team wanted to make sure the doctors joining the group were actually working as a team, not just wearing the same jerseys.

“We have been a lot more intentional on truly integrating the physicians as they come in, and so that’s taken a little more time and taken time away from recruitment,” Fitzgerald said. “That’s probably the biggest reason why we’re not larger than we are. But we’re pretty satisfied.”

Hospitals have been employing more and more doctors over the past three years as many physician groups faced big bills to meet federal demands to adopt electronic medical records. Many doctors also face flattening reimbursement rates from health plans.

Hospitals have been eager to acquire physicians to assure a steady stream of patients into their facilities, as well as to meet federal incentives to take responsibility for the health of patients and to coordinate care for them across many health care sites.

Fitzgerald believes the coordinated, integrated approach can lead to higher-quality care for patients at lower cost. But he also acknowledged that making it happen is easier to describe than do.

“Any time we’re bringing 30 different groups with their own culture into one organization, it’s always difficult,” he said.

IU Health Physicians has spent more time than expected getting the various physicians to commit to a common electronic medical record system and having meetings where the physicians worked out common protocols for treating patients, which it hopes will help streamline work flows and achieve economies of scale on supplies.

Also, IU Health Physicians has had to set up call centers to help communicate with patients on behalf of all its new physicians. IU Health is even assigning some personnel to do extra communication with chronically ill patients, to help them head off expensive hospitalizations.

“That’s just taken more administrative and management time, and it’s left less time to go out and meet with new groups,” Fitzgerald said.

While getting 850 doctors on board in three years seems impressive, it wasn’t as if IU Health started from scratch. The IU School of Medicine already employed 1,100 physicians, and IU Health, through its Methodist Medical Group subsidiary, employed another 300.

But some of those physicians have spurned the IU Health Physicians’ offer. For example, the dozen neurosurgeons in the IU med school’s Department of Neurological Surgery two years ago merged with Indianapolis Neurosurgical Group to form a practice called Goodman Campbell Brain and Spine.

The neurosurgeons practice in multiple hospitals, and were concerned that by joining IU Health Physicians, they would be limited to only its hospitals.

“One of the obstacles for groups aligning with a particular system is their own business model of trying to serve multiple health systems,” Fitzgerald admitted.

Fitzgerald isn’t issuing new predictions on the number of doctors he thinks IU Health Physicians will employ. He still expects most of the IU and Methodist physicians to join, but he acknowledges that integrating culturally means not every physician will fit.

“We didn’t want to bring people in for the sake of having them in a single group,” he said, adding, “We want to make sure that the doctors that we recruit are a good fit. That they buy in to the culture that we develop.”