Physician consolidation has defined much of the past two decades in healthcare. Independent practices have folded into hospital systems, private equity firms have accelerated acquisitions and employment has replaced ownership for a growing share of physicians.
In 2024, 42.2% of physicians worked in private practice, down from 60.1% in 2012, according to the American Medical Association. Private equity acquisitions of physician groups also rose more than 600% from 2012 to 2021, according to a Health Affairs analysis.
But physicians told Becker’s the story isn’t purely linear. Even as consolidation continues, countervailing forces are emerging as regulatory scrutiny, shifting workforce expectations and hybrid ownership models reshape what control looks like in the next era of medicine.
Alvaro Andrés Macias, MD, associate professor of clinical anesthesia at the University of California San Diego, said consolidation remains powerful, but it is no longer unchecked.
“Some countervailing forces exist,” he said. “Regulatory scrutiny of private equity healthcare investments is growing. The FTC’s crackdown on noncompetes could increase physician mobility. Younger doctors prioritizing work-life balance may sustain locum and part-time models that offer more autonomy than traditional employment.”
States are also taking a more active role. In 2025, 37 state bills related to consolidation and competition were enacted. California, for example, passed a law prohibiting private equity firms, hedge funds and their affiliates from interfering, contractually or otherwise, with clinicians’ judgment, including decisions involving tests, treatment options, patient volume and referrals.
Noncompetes are shifting as well. States are increasingly restricting physician noncompetes through income caps, time limits and specialty carve-outs. Arkansas and Wyoming recently enacted full bans, while other states have adopted targeted restrictions. Oregon voided many physician and healthcare provider noncompetes in 2025, and Pennsylvania capped enforceability at one year only if a physician voluntarily leaves.
Dr. Macias said these policy shifts could alter bargaining dynamics. As restrictions tighten, physicians may gain negotiating leverage in markets long dominated by large systems and national platforms.
Jean-Pierre Mobasser, MD, a neurologist at Goodman Campbell Brain and Spine in Carmel, Ind., told Becker’s the deeper issue is leadership.
“I believe we are at a turning point where physicians must reclaim their roles as the primary leaders in healthcare,” he said. “To resolve the current financial crisis, we need leadership that understands the nuances of patient care.”
He pointed to the paradox of U.S. healthcare spending as the country spends more per capita than other industrialized nations while often producing poorer outcomes.
“To stabilize the system, physicians must lead the transition toward value-based care, emphasizing preventive medicine and healthy lifestyles,” Dr. Mobasser said. “By integrating clinical expertise with meaningful financial stewardship, we can move away from the current administrative-heavy model and back toward a system that prioritizes the patient-physician relationship.”
For some physicians, loss of control is the enemy, rather than consolidation.
Brandon Ortega, MD, an orthopedic spine surgeon at Long Beach (Calif.) Lakewood Orthopaedic Institute, told Becker’s that while he expects consolidation to continue, particularly as hospitals, payers and private equity groups bring capital and contracting leverage, he does not see physicians surrendering influence entirely.
“I don’t think physicians are giving up control completely — I think it’s evolving,” Dr. Ortega said. “More physicians are becoming intentional about maintaining ownership in areas that drive long-term financial stability, such as ASCs, ancillary services, digital care platforms and MSO-style infrastructure.”
Rather than full independence or full employment, he anticipates hybrid alignment models in which physicians partner with larger organizations while retaining ownership stakes tied to the economic value they help create.
“The future will look more like hybrid alignment models where physicians may be clinically employed or partnered with larger systems, but still retain ownership interests that allow them to participate in the economic value they help create,” he said.
Some groups are also organizing to sustain independence without a traditional acquisition. Becker’s has reported on at least 13 emerging platforms that aim to reduce nonclinical burdens, strengthen contracting and support infrastructure investments while keeping practices physician-led.
Pelto Health Partners, for example, was born from a collaboration among Durham, N.C.-based Emerge Ortho, Indianapolis-based OrthoIndy and Seattle-based Proliance Surgeons. The platform is designed to support small to midsized independent groups, particularly those strained by vendor negotiations, operational complexity and capital needs.
“Looking ahead, as healthcare transitions more toward value-based care, independent groups will lead that charge,” Frank Aluisio, MD, of EmergeOrtho, who now serves as chair of Pelto’s board, told Becker’s. “It’s hard to do alone, but, by combining efforts through Pelto, we can survive and lead the way forward.”
Joshua Siegel, MD, director of orthopedic sports medicine at Access Sports Medicine and Orthopaedics in Exeter, N.H., hopes the pendulum has already swung “as far as it will,” and that physicians will recognize opportunities outside corporate or large-hospital ownership.
Dr. Siegel argues that hospital employment has entrenched operational friction — from opaque billing to prior authorization burdens — that distances physicians from patients.
“The hospital-employed physician has a role in medicine and will always exist, yet it is a dinosaur that has created waiting rooms and undecipherable billing and collection practices, obscured pricing, crazy pre-approval processes, prior authorizations and the like,” he said.
In large systems, he added, accountability is often oriented toward insurers rather than patients, with physicians “consciously or subconsciously working within the framework insurances have provided rather than the best interest of the patient.”
He predicts that new physicians raised in alternative delivery models, such as direct-pay, will pursue closer patient relationships, fewer administrative barriers and compensation structures tied more directly to service value.
