For the better part of two decades, consolidation has been a key part of healthcare, as private equity rolls up practices, health systems absorb independent physicians and physicians flock to the employed model.
Matt Mazurek, MD, assistant clinical professor of anesthesiology at St. Raphael’s Campus of Yale New Haven (Conn.) Hospital told Becker’s he thinks that story is starting to crack. And for the next generation of physicians, he said, the real opportunity may lie in building something new.
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.
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.
“I don’t think consolidation is working out as well as people thought it would,” he told Becker’s. “So, by the time some of today’s students graduate from medical school and residency, I honestly see more opportunities for physicians who are entrepreneurs — who are going to want to rekindle either private practice or some kind of shared, physician-owned model without the private equity element.”
Corporate entities, including insurers and private equity firms, employed 23% of physicians in 2024, up from 15% in 2019, according to the GAO report. 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.
His vision isn’t a return to the solo practitioner of the 1970s, rather a hybrid that offers scale while still giving physicians the autonomy of independence.
“I envision something like this: A specialist graduates from residency, doesn’t want to be employed, and joins a local or regional group — urologists, other specialty surgeons — that forms a kind of super group within a multi-state region,” Dr. Mazurek said. “They’re not really employees in the traditional sense. They become partners of a larger group that’s run by physicians.”
This structure is already beginning to emerge across several specialties. Minneapolis-based Pelto Health Partners, for example, was formed to counteract the trend of small and midsized practices being pushed toward hospital employment or acquisition by private equity firms. The group was born from a collaboration among three physician-owned orthopedic groups — Durham, N.C-based EmergeOrtho, Indianapolis-based OrthoIndy and Seattle-based Proliance Surgeons — each committed to supporting private practice sustainability.
“We felt something needed to be done to keep independent groups independent, as many were being driven into hospital employment or selling to private equity,” Frank Aluisio, MD, of EmergeOrtho, who now serves as chair of Pelto’s board, told Becker’s. “Maintaining independence is important in prioritizing patients and the physician-patient relationship — not profits.”
Another group is ReKlaim Health. Officially launched in May, ReKlaim seeks to build a “national coalition” of independent ASCs and physician-owned hospitals through physician ownership, shared infrastructure and “union-style economics,” ReKlaim’s founder, Dutch Rojas, told Becker’s.
Additionally, physicians working in physician-led practices also show higher signs of job satisfaction compared with their peers in health systems or corporate practices. Consulting firm Bain & Co. released its “Frontline of Health Survey” in October 2024, revealing that nearly 25% of physicians in health system-led organizations were considering changing employers, compared to 14% in physician-led practices. Among those in physician-led models, 81% said they were satisfied with their involvement in strategic decision-making, compared to just 50% in hospital-led practices.
When it comes to physician organizing more broadly, Dr. Mazurek is skeptical that unionization is the answer, despite its recent momentum.
“I would have predicted by now that unionization would have taken off, but I just don’t see it being effective,” he said. “I think it’s more realistic for physicians to group up in those kinds of units — big enough to have strength, but not so big that individuals feel like employees again.”
Becker’s reported on at least 38 healthcare strikes in 2025, as well as eight other union-related updates that specifically included physicians. According to a study published in 2024 by JAMA, fewer than 10% of physicians in the U.S. are unionized, but the number of union drives from 2023 to 2024 alone represented 3,523 new physicians, almost the same number represented by unions over the last 22 years.
The central barrier to physician independence, Dr. Mazurek said, is payment.
“Right now, with CMS not adequately valuing physician services, the economic pressures have created an environment where physicians have little choice but to become employed,” he said.
In 2025, CMS cut the Medicare conversion factor by 2.83% for the fifth consecutive year, a 10% decline since 2020. In 2026, the conversion factor for practitioners participating in a qualified alternative payment model jumped to $33.56, a 3.77% increase from 2025. Non-QPM practitioners’ conversion factor is $33.40, a 3.26% increase from 2025.
However, many physicians feel the jump is not enough to offset the rising cost of operations.
“While I appreciate the sentiment behind CMS’ proposed 3.6% increase in the physician fee schedule — especially as it relates to supporting primary care physicians — the reality is that this adjustment still falls short,” Triwanna Fisher-Wikoff, MD, family medicine physician at Fort Worth-based Texas Health Care, told Becker’s. “When measured against inflation and the rising costs of running a practice, the increase does not represent a true raise. Had CMS and Congress addressed the flaws in the sustainable growth rate formula over 20 years ago — ensuring physician payments kept pace with hospital reimbursements and inflation — this increase would be far more meaningful today.”
Not every specialty faces the same constraints. Hospital-based physicians — those in radiology, hospital medicine and ICU medicine — will have a harder time breaking away from employment models, Dr. Mazurek said. The economics of those fields are too tightly bound to institutional infrastructure to easily pivot to cash-pay or concierge models.
But primary care is a different story. According to a 2023 survey from the American Academy of Family Physicians, 9% of family physicians reported operating a DPC practice in 2023, up from just 2% the year prior. An additional 2% said they were in the process of transitioning.
“Primary care physicians, I think, are in the driver’s seat, if they want to be,” Dr. Mazurek said. “They’re the ones leading the formation of concierge and fee-for-service, cash-only practices, and I think that trend is going to continue to accelerate.”
Opinions expressed by Dr. Mazurek are his own.
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