Physician ownership has been in decline for more than a decade. Just 42.4% of physicians worked in private practice as of 2024, down from 60.1% in 2012, according to the American Medical Association’s Physician Practice Benchmark Survey.
Additionally, between 2019 and 2023, physician employment by hospitals, health systems or other corporate entities jumped from 62% to 78%, according to a Progressive Policy Institute analysis.
But a growing number of physician groups across specialties are rejecting the idea that those are the only two options. Rather than selling to a private equity-backed platform or becoming employed, they are building, or joining, management services organizations, clinically integrated networks and joint ventures designed to preserve ownership while still delivering the scale, contracting leverage and back-office support that made those other paths attractive in the first place.
“There’s been criticism of that model — I think some people see that as consolidation, but they missed the point,” David Eagle, MD, president of the American Independent Medical Practice Association, told Becker’s, referring to MSOs. “We’ve already consolidated so much care under the hospital [model] and MSOs are really a vehicle for maintaining independent practices.”
Becker’s has tracked at least 16 MSOs or similar ownership structures that launched in the last two years alone built around physician ownership and autonomy.
Cardiology, one of the specialties private equity has targeted most aggressively, offers a clear example of groups choosing to stay independent outright. Vance Chunn, CEO of Mobile, Ala.-based Cardiology Associates, has fielded, and turned down, multiple private equity bids for his 54-provider group.
“For us, the big thing is controlling our own destiny,” Mr. Chunn told Becker’s. “I know a lot of cardiology groups that have integrated with hospitals. I’ve never heard anyone come back and say, ‘That was the best thing I ever did.’”
Not every group has the scale or capital position to remain fully independent the way Cardiology Associates has. That gap is exactly what the new MSO and clinically integrated network models are built to close.
“Independent physicians are really in a squeeze right now,” Mark Langston, chief development officer at Raleigh, N.C.-based Compass Surgical Partners, told Becker’s. “If you have an independent surgery center, it’s tough. If you’re in an independent practice, also tough. If you’re doing both — good luck in today’s world.”
In anesthesia, that squeeze has taken a specific shape: groups that sold to national platforms during the 2015-2019 consolidation wave are now reversing course, buying back their independence and reforming inside networks rather than rebuilding management infrastructure from scratch. Stan Morton, CEO of Copractica, a Dallas-based clinically integrated network for independent anesthesia practices, told Becker’s that one member group did just that after selling six or seven years ago.
“They’ve been able to get their independence, autonomy and control back,” Mr. Morton said, “and from a revenue standpoint, they have not had to take a pay cut to be able to go do that.” Erik Hemingway, Copractica’s CFO, said the model avoids the cost layer that comes with a PE-backed structure: “There’s no Wall Street payment off the top.”
The same pattern is showing up outside anesthesia. Pelto Health Partners, a platform born from a collaboration among Durham, N.C.-based Emerge Ortho, Indianapolis-based OrthoIndy and Seattle-based Proliance Surgeons, was built to support small and midsized orthopedic and gastroenterology groups struggling with vendor negotiations, nonclinical administrative burdens and infrastructure costs, the same pressures that push practices toward a sale.
The common thread across cardiology, anesthesia, orthopedics and gastroenterology is not that physicians are rejecting scale. It’s that they’re finding ways to access it without giving up equity or decision-making authority. According to a Bain & Co. survey, 81% of physicians in physician-led organizations reported satisfaction with their role in strategic decision-making, compared with just 50% of those in hospital-led practices, a gap that helps explain why the infrastructure workaround has found so much demand.
Whether that model can scale to match the pace of private equity and health system acquisitions remains an open question. But for the physicians building it, the calculation is less about resisting consolidation than about deciding who holds the equity when it happens.
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.