Where independent practice is declining most: A regional breakdown

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Acquisitions of physician practices by hospitals and health systems are occurring the most frequently in the Midwest, according to a report released by the Progressive Policy Institute in December 2025.

The report evaluated 70 economic studies that analyzed the impacts of hospital acquisitions on physicians, patients and communities. 

Here’s a breakdown of the decline in independent practices due to hospital acquisitions by region:

  • Western Midwest (Missouri, Iowa, Minnesota, Kansas, Nebraska, North Dakota and South Dakota): -38% decline
  • Eastern Midwest (Wisconsin, Illinois, Michigan, Indiana and Ohio): -31% decline
  • New England (Massachusetts, New Hampshire, Vermont, Rhode Island, Connecticut and Maine) : -37% decline 
  • Mid-Atlantic (Pennsylvania, New Jersey and New York): -28% decline
  • South Atlantic (West Virginia, Virginia, North Carolina, South Carolina, Georgia and Florida): -20% decline
  • Eastern South (including Tennessee, Kentucky, Alabama and Mississippi): -23% decline
  • South Central (including Texas, Louisiana, Arkansas and Oklahoma): -18% decline 
  • Mountain (New Mexico, Arizona, Colorado, Utah, Nevada, Idaho, Wyoming and Montana): -16% decline
  • Pacific (Washington, Oregon, California, Alaska and Hawaii): -15% decline
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