The new partnership between Community Health Network and Wishard Health Services could put a third health care entity in an awkward position: the Indiana University School of Medicine.

Virtually all of the nearly 1,100 physicians who practice at Wishard Memorial Hospital and its community clinics come from the IU medical school.

But with many of those med school docs joining a venture with the Indianapolis-based hospital system Indiana University Health—a rival of Community Health—the relationship is complex at best and tense at worse.

Wishard and Community announced Monday morning that they have entered a joint operating agreement to work together to serve patients throughout Marion County.

Matt Gutwein, CEO of the Health and Hospital Corporation of Marion County, which owns Wishard, said he expects Wishard’s relationship with the IU medical school physicians to endure—and perhaps even to grow.

“We have every intention to continue to support their mission and purpose. Our venues will continue to be fully available” to them, Gutwein said following a press conference announcing the Wishard-Community agreement. He added, “The doctors who work for us do so because they want to.”

Gutwein also said Community is interested in offering its hospitals and health care facilities as additional sites where the IU medical school physicians could see patients and teach med students.

Gutwein also said that Dr. Craig Brater, dean of the IU medical school, told Wishard and Community “that he completely supports us.”

IU medical school spokeswoman Margie Smith-Simmons wrote in an e-mail, "If and/or how this partnership affects the IU School of Medicine's relationship with Wishard has not yet been determined."

Messages left at IU Health were not immediately returned on Monday.

IU Health and the IU medical school, which are two separate organizations, formed a joint venture four years ago to bring all their employed physicians into one entity.

That organization, now called IU Health Physicians, has more than 1,000 doctors on its payroll, many of whom are professors at the IU medical school, but some of whom practice elsewhere in the IU Health hospital system.

IU Health Physicians started with aspirations of employing as many as 1,500 doctors.

As hospital systems have employed more physicians in recent years, they increasingly have pushed doctors to work with only one hospital system. For example, Central Indiana Cancer Centers sold its practice to IU Health in 2011, saying that its source of referrals was drying up as primary care doctors were increasingly loyal in their referrals to the hospital systems that employed them.

Community’s new partnership with Wishard will create a primary care behemoth that the systems argue will put them in the best position possible to handle the changes coming from federal health reform.

The two Indianapolis-based hospital systems announced Monday morning that they have formed a joint operating partnership, which will coordinate the operations of their hospitals and health care facilities.

The two systems combined will have 29 health centers providing primary care and 29 locations providing behavioral health care.

“We are by far the largest organization in those two areas,” said Community Health CEO Bryan Mills, who also will lead the new joint-operating entity.

The combined entity will be governed by a seven-member board, with four members coming from Community and three from Wishard.

Wishard,  the county-owned health system, will change its name to Eskenazi Health in 2014. Wishard is building a downtown hospital that will be the premier trauma center in Indiana as well as handle a large portion of Marion County’s indigent patients. The hospital is set to open in December.