For much of the past decade, the story of physicians’ practice has moved decidedly away from independence.
Hospital and corporate employment of physicians climbed from 62% to 78% between 2019 and 2023, and private practice fell from 60% of physicians in 2012 to just 42% in 2024, according to data from the Government Accountability Office.
But 2026 is producing early signs that the pendulum may be swinging back, not toward the traditional solo practitioner model, but toward a new one built around management services organizations, physician practice networks and other arrangements designed to help physicians reclaim ownership and autonomy without giving up the scale and capital that made employment attractive in the first place.
Joshua Siegel, MD, director of orthopaedic sports medicine at Access Sports Medicine and Orthopaedics in Exeter, N.H., has watched that shift firsthand.
“What you’re seeing now is a lot of doctors coming out and getting burned. They’re working for two, three years. They have a hard time renegotiating. A lot of what was promised isn’t materializing. Some of their salaries, they have to either make them, or they’re responsible to, in some way, pay them back. So this great deal all of a sudden turns into these handcuffs. And the docs leave,” Dr. Siegel told Becker’s earlier this year,
CMS advanced site-neutral payment policy in its 2026 Hospital Outpatient Prospective Payment System rule, narrowing the reimbursement gap between hospital outpatient departments and independent settings for comparable procedures.
“There’s no way hospital rates will go down to what independent rates are, and there’s no way they’re going to jack up independent rates and not try to save money on the hospitals,” Dr. Siegel said.
For physicians drawn back to independence, the return rarely means going it alone. Surinder Devgun, MD, managing partner of Rochester Gastroenterology Associates, said the decision to align with an MSO is rarely one-size-fits-all.
“These are particularly effective platforms when you have smaller practices, or if you have a very fractured market where you need to align yourself somehow,” Dr. Devgun told Becker’s. “You have to look at your own situation. So, for example, if you have a mega group and you’re a dominant player in town, this may not be the right fit for you.”
Minneapolis-based Pelto Health Partners is one of the platforms trying to prove that the model can work at scale. Founded three years ago by three physician-owned orthopedic groups, Pelto has since added several more independent practices and, in February, launched an ASC ownership platform aimed at helping members develop and manage their own surgery centers rather than sell into someone else’s.
Rachel Uzlik, Pelto’s fractional CEO, told Becker’s the company was built specifically to avoid the trade-offs physicians associate with traditional MSOs.
“We believe that autonomy and choice are so critical to independent practices, and we knew one size wasn’t going to fit all,” Ms. Uzlik said. “Flexibility and autonomy are the heartbeat of independent practice.”
Two member practices using Pelto’s surgery centers have generated more than $1.2 million in annual savings through supply chain optimization, implant procurement and capital equipment negotiations, with the returns flowing back to the physicians rather than an outside owner.
Rural practices are finding their own version of that leverage. Daniel Decker, MD, a urologist and co-founder of Vitality Plus Urology Clinic in Mountain Home, Ark., pointed to the Rural Health Transformation Program, a $50 billion federal fund established under the One Big Beautiful Bill Act to support rural providers from 2026 through 2030.
“Autonomy is achievable through MSO arrangements that are much more available in 2026 for independent practices,” Dr. Decker told Becker’s.
The broader consolidation trend has not reversed course entirely. Hospital systems, insurers and private equity firms have continued pursuing large practice acquisitions this year, including MUSC Health’s $111 million purchase of Palmetto Primary Care Physicians and Humana’s roughly $1 billion acquisition of primary care network MaxHealth.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
