Since January, at least 114 local doctors have traded their independence for steady paychecks from hospitals. The move, part of a nationwide trend, has wide implications not only for doctors but also for patients' pocketbooks. Often, patients don't realize their physician has become a hospital employee until they get their bill. These often will be higher because hospitals can negotiate higher reimbursement rates with insurers, according to comparisons on insurance Web sites. To help educate patients and represent their concerns to legislators, independent physicians and business leaders in Central Florida have banded together to form a trade association that may well be the first in the state, according to organizers.