Last week, Charleston, S.C.-based Medical University Hospital Authority, part of MUSC Health, acquired Palmetto Primary Care, the largest independent physician practice in the state, for $111 million. The organization comprises 40 medical practices, 31 physicians and 95 advanced practitioners. For Marcelo Hochman, MD, a Charleston-based independent physician and former president of the Independent Doctors of South Carolina, the deal came as no surprise.
The acquisition is part of a broader national trend. As independent practices face rising costs and administrative burdens, hospital systems have steadily consolidated physician employment. Between 2019 and 2023, the share of physician practices owned by hospitals, health systems or other corporate entities jumped from 39% to 59%, while physician employment by these entities rose from 62% to 78%, according to a December 2025 report from the Progressive Policy Institute.
“We’re seeing it play out right here in Charleston,” Dr. Hochman said. “It happened about 15 years ago, and it just happened again.”
For some senior partners, the transaction may represent a lucrative exit. But Dr. Hochman is focused on what comes next for the physicians who had no stake in the deal.
“The younger physicians who didn’t have any participation — three or so years from now, when the practice starts changing, they’ll feel it,” he said. “The same thing happens when private equity buys up practices: they need to get a return on their investment, and primary care is not a very good investment. All of a sudden, you have to see more patients. You start losing autonomy again.”
It’s a cycle Dr. Hochman said he has watched repeat throughout his career: Fifteen years ago, a local hospital hired a group of pediatricians, then terminated their contracts three years later when the arrangement stopped making financial sense for the institution.
“The allegiance of the employer to the employee is much weaker than the other way around,” he said. “It’s just not under your control.”
Acquisitions, mergers and consolidations decrease autonomy and job satisfaction for physicians, according to a 2024 Physicians Foundation survey. The burnout can, in turn, compromise patients’ access to care. Only 14% of physicians in the survey agreed that PE funding was “good for the future of healthcare.” A study published in March 2024 in JAMA Internal Medicine found that physicians employed by private equity were less likely to report high professional satisfaction than their non-PE-employed counterparts (44.8% vs. 74.4%).
At the heart of the problem, Dr. Hochman observes, is a gap between what consolidation promises and what it delivers.
“The consolidation pitch is that it makes care more coordinated, convenient, more affordable — economies of scale, all those kinds of things,” he said. “But in practice, that really hasn’t turned out to be the case.”
Facility fees rise. Tiered pricing takes hold. And physicians, he said, are left with what he calls a false sense of security.
“The security of a reliable paycheck at some point gets supplanted by the feeling of not being in control,” Dr. Hochman said. “After a few years, you realize you’re a very small cog in a gigantic wheel.”
The cost consequences for patients are real, too. According to research published in 2023 in JAMA Network Open, the median negotiated price for surgical procedures was significantly higher at network hospitals than at independent ones, across 15 of the 16 procedures studied, including diagnostic colonoscopy, shoulder arthroscopy and prostatectomy.
He pointed to economist E.F. Schumacher — best known for the phrase “small is beautiful” — as a counterpoint to the prevailing logic of health system expansionism.
“That to me is the epitome of the opposite of what’s happened,” Dr. Hochman said. “That close doctor-patient relationship gets supplanted by bigger systems, and that distance just keeps widening. It’s not what doctors want, and it’s not what patients want.”
The consequences, Dr. Hochman said, extend well beyond finances. Physician burnout, he argues, is fundamentally a byproduct of lost autonomy.
“Burnout happens when you lose autonomy,” he said. “It’s what people call moral injury: being forced to practice in a way that goes against what you would do if you had total control. Systems try to cure burnout with pottery lessons and work-life balance messaging, but that misses the point entirely. When you’re in control, things feel different.”
The data backs him up. According to a survey from consulting firm Bain & Co., average satisfaction for physician-led organizations ranges from roughly 70% to 90%, compared to 50% to 75% in health system-led practices. Nearly 25% of surveyed physicians in health system-led organizations said they were contemplating a change in employers, compared to just 14% in physician-led practices, according to the Bain survey. Notably, of those considering a switch, 37% were looking to move to physician-owned settings.
The solution, he said, starts with a question every physician should ask themselves: “Do you want control over how you care for your patients? If the answer is yes, then you think about the logistics from there.”
Independent practice, he is quick to note, is not dead. While the share of independent physicians has dropped significantly — estimates range from 33% to 42% depending on the study — Dr. Hochman believes those who remain represent a vital and viable alternative worth fighting to preserve.
Maintaining and growing that share, he said, requires physicians to get organized and get loud. During his tenure as president of the Independent Doctors of South Carolina, Dr. Hochman helped push through the state’s elimination of certificate-of-need laws. A repeal of physician noncompete agreements is now working through the South Carolina legislature.
“Physicians need to get more organized, more vocal, highlight what isn’t working and offer alternatives,” he said.
The power, he said, is already there, but physicians and patients just need to harness it.
“Patients want to see their doctor, and patients need to start asking for alternatives,” Dr. Hochman said. “Right now, patients get herded around based on their insurance plan, and if their doctor leaves a system, they just get assigned someone new. Patients need to actually ask for what they want — and know that alternatives are out there.”
