Community hospitals, especially, those serving rural or medically disadvantaged populations face significant challenge recruiting physicians. The credit squeeze, falling investment income and worsening bad debt situation point to even more difficult days ahead. Besides making the case for special payments, how can financially strapped hospitals recruit physicians, especially, in competitive specialties like radiology, cardiology and orthopedics without incurring excessive debt?    

I was left quite uncomfortable by the slide presentation's assertion that "Capital Budgeting occurs after Strategic Planning, Operational Planning and Operational Budgeting."  Perhaps it is necessary to explain Capital Budgeting utilizing this linear approach....

In my consulting practice I frequently encounter hospital organizations that fail to consider Capital Budgeting constraints (i.e. debt service capacity) during the Operational Planning phase.  The result is that major capital budget purchases (such as major building projects)cannot be afforded even though they were well planned.  I have to wonder how many of us have experienced capital projects being planned but never coming to fruition (lets discount the unusual fiancial circumstances of the past year from answers) due to insufficient funds?  Simply stated Capital Budgeting on the Macro Level (i.e. Capacity - must be determined early in the planning process.  I do agree that the micro level can be done sequentially as was demonstrated in the slide presentation.

Thoughts anyone?