Independent physician practices are rapidly disappearing as hospitals and corporate entities accelerate acquisitions across the U.S.
“Physicians’ abandonment of independent practices will continue and probably accelerate over the next decade, despite its undesirable impact on autonomy,” Shadi Jarjous, MD, chief of the division of hospital medicine at Lehigh Valley Health Network, told Becker’s. “This is mainly due to the unsustainable increased demand on physicians regarding productivity, efficiency, and fiscal responsibility with less resources, which is driven by the continuous decline in payment and the increase in cost of overhead and supply chain. This disparity has a net negative impact on the work-life balance for physicians, a group that historically has always been asked to stretch their limits, to generate an adequate margin to sustain their business.”
New data shows the shift is hitting rural communities and certain specialties especially hard, reshaping how and where physicians practice medicine.
Here are 10 things to know about the disappearing independent physician:
1. Ownership and employment are consolidating fast
Between 2019 and 2023, the share of independent physician practices owned by hospitals, health systems or other corporate entities jumped from 39% to 59%. Over the same period, physician employment by these entities rose from 62% to 78%, according to a December 2025 report from the Progressive Policy Institute.
2. Rural practices are disappearing faster than urban ones
Hospital acquisitions have had an outsized impact in rural areas, where independent physician practices declined 34%, compared with a 22% decline in urban markets. The steepest drops occurred in the western Midwest and New England.
3. Larger practices are prime acquisition targets
Hospitals tend to acquire larger physician groups to quickly establish or expand market share in key specialties. From 2019 to 2023, large independent practices declined 45%, while medium-sized practices fell 36%.
4. Merger enforcement remains relatively weak
Federal scrutiny of hospital and ASC transactions remains below average. From 2017 to 2024, 51% of hospital deals and 26% of ASC deals received federal clearance, well above the 13% clearance rate across all industries.
5. Rural independent physicians are vanishing
The number of independent physicians practicing in rural areas declined 43% over five years, dropping from 21,956 in January 2019 to 12,467 in January 2024, according to an Avalere study sponsored by the Physicians Advocacy Institute.
6. Nearly 9,500 rural physicians left independence
Almost 9,500 rural physicians exited independent practice during that period. Ten states, including Indiana, Iowa, Maine, Massachusetts and Minnesota, saw declines exceeding 50% in their independent physician workforce.
7. Private practice is no longer the norm
In 2024, just 42% of physicians worked in private practice, down from 60% in 2012. Nearly half (47%) were employed by or affiliated with hospitals, according to a Government Accountability Office report.
8. Corporate and private equity influence continues to grow
Corporate entities, including insurers and private equity firms, employed 23% of physicians in 2024, up from 15% in 2019. Private equity-owned practices now account for 6.5% of physicians and control more than 30% of physicians in specialties such as gastroenterology, dermatology and ophthalmology.
9. Regional declines tied to hospital acquisitions
Independent practices declined across every region due to hospital acquisitions, led by:
- Western Midwest (Missouri, Iowa, Minnesota, Kansas, Nebraska, North Dakota and South Dakota): -38% decline
- Eastern Midwest (Wisconsin, Illinois, Michigan, Indiana and Ohio): -31% decline
- New England (Massachusetts, New Hampshire, Vermont, Rhode Island, Connecticut and Maine) : -37% decline
- Mid-Atlantic (Pennsylvania, New Jersey and New York): -28% decline
- South Atlantic (West Virginia, Virginia, North Carolina, South Carolina, Georgia and Florida): -20% decline
- Eastern South (including Tennessee, Kentucky, Alabama and Mississippi): -23% decline
- South Central (including Texas, Louisiana, Arkansas and Oklahoma): -18% decline
- Mountain (New Mexico, Arizona, Colorado, Utah, Nevada, Idaho, Wyoming and Montana): -16% decline
- Pacific (Washington, Oregon, California, Alaska and Hawaii): -15% decline
10. Certain specialties are being absorbed faster than others
Independent practices declined most sharply in:
- Anesthesiology: -4%
- Internal medicine: -16%
- Neurology: -19%
- Gastroenterology: -20%
- Family practice: -21%
- Obstetrics and gynecology: -25%
- Cardiology: -31%
- Oncology: -39%
- General surgery: -42%
