For generations, the independent physician practice was a cornerstone of American medicine. Today, it is nearly extinct.
Only 18% of physicians still practice in physician-owned settings as of January, with just 36.1% of practices remaining physician-owned — down by 48.5% since 2018 — according to a new report from the Physicians Advocacy Institute and Avalere Health tracking eight years of consolidation data.
The findings reveal a profession that has been fundamentally restructured, absorbed into hospital systems and corporate entities at a pace that shows little sign of reversing.
Editor’s note: The study’s methodology notes that physician-owned Professional Corporations may be miscategorized as “corporate-owned,” meaning the share of truly independent physicians could be higher than reported.
Here are 10 things to know:
1. Eighty-two percent of all practicing physicians are now employed by hospitals or corporate entities. Over the eight-year study period, the number of physicians practicing independently decreased by 152,200, and there are 81,100 fewer independently owned practices than there were in 2018.
2. Hospitals and corporate entities have been the primary absorbers of that talent, with 253,000 additional physicians becoming employed by hospitals or corporate entities since 2018. Hospitals alone added 181,200 physicians over the study period, while corporate entities, including insurers and private equity firms, grew their physician workforces by 92.3%, from roughly 77,800 to 149,600.
3. It isn’t just physicians being absorbed; it’s their practices too. Hospitals and corporate entities acquired 85,000 physician practices between 2018 and 2026, with the share of physician-owned practices dropping by 12.8% in the last two years.
4. The pace has not slowed. Since 2024, 48,100 physicians left independent practice and 13,900 additional practices were acquired. 29,600 physicians became hospital employees in 2025 alone.
5. Hospitals now employ nearly 6 in 10 physicians, and corporate entities now own more practices than hospitals — 33.2% vs. 30.6%. In rural areas, independent physicians fell below corporate-employed physicians for the first time in 2024, a threshold that underscores how far consolidation has reached beyond urban centers.
6. Many physicians say consolidation is likely to continue as running an independent practice becomes harder to sustain. Reimbursement pressure, administrative burden and rising debt loads are pushing more physicians toward employment, while large systems and private equity firms gain leverage through scale.
“Running an independent practice has become brutally difficult. Insurance billing complexity, low reimbursements, electronic records mandates, regulatory requirements, staffing challenges — all of it favors scale,” Alvaro Andrés Macias, MD, associate professor of clinical anesthesia at the University of San Diego, told Becker’s. “Young physicians graduate with $200,000+ in debt and often prefer a predictable salary over entrepreneurial risk. Large organizations negotiate better rates with insurers and spread administrative costs across more providers. It is a continuous loop that, for now, cannot be broken.”
7. Financial pressures on independent practices are acute. Only 24% of independent physician practices report high or complete visibility into where they’re losing revenue, according to a March 2026 report from healthcare technology company Veradigm, which surveyed 360 independent practice leaders. Some 54% of respondents said financial pressure increased over the prior 12 months.
8. Deteriorating reimbursement rates are a central driver. According to a 2023 American Medical Association news release, for 4 out of 5 physicians, the need for better leverage in payer negotiations was a very important or important factor in the decision to sell their private practice to a hospital or health system.
9. For physicians who do join hospital systems, a loss of autonomy often follows. The structural shift changes not just where physicians work, but how and for whom decisions get made.
“In the past, a hospital system could be looked upon like a pyramid, with a wide base and narrow top. The base represented all those carrying the weight of the system, including nurses and physicians and ancillary staff. The top of the pyramid could be considered to be the CEO, CMO, CFO and a few directors of services. Now that pyramid is looking more and more like it is inverted, with the narrow peak being on the ground, carrying all the weight, and being represented by the worker bees,’” Kenneth Candido, MD, CEO and president of Chicago Anesthesia Associates, told Becker’s.
10. Despite the numbers, a countercurrent is emerging. A new wave of physicians is returning to the ownership model, largely driven by concerns over autonomy, compensation and burnout. According to a 2024 survey by Bain & Company, 81% of physicians working in physician-led organizations reported satisfaction with their involvement in strategic decision-making, compared with just 50% in hospital-led practices. This gap suggests the appeal of independence hasn’t disappeared, even if the conditions to sustain it have.
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