This has important implications for physician employment and subcontract relationships. A medical group that works carefully to establish a premier reputation, join the most progressive and highest-quality alliances, and negotiate favorable, semi-exclusive arrangements with a handful of quality managed care plans must take particular care to ensure that its physicians do not leave the group and then compete with it. Otherwise, the departed physician will undermine the arrangements the medical group has nurtured over the years. If a number of patients previously seen by the medical group want to switch over and follow the departing physician, this will hurt not only the medical group’s revenues but also its status with its alliance colleagues and managed care plans. In general, as the market evolves, providers will find themselves in a small number of highly leveraged affiliations. This means that almost any competitive effort by a departed physician to encroach on those established affiliations will economically harm that physician’s former employer.