Around 77% of physicians have shifted away from independent practice and into employed models over the last decade, but some are unhappy with employment and are pivoting back to private practice.
According to consulting firm Bain & Co.’s "Frontline of Healthcare Survey," highlighted in an October blog post, nearly 25% of physicians in health system-led organizations are contemplating a change in employers, compared to just 14% in physician-led practices.
Notably, of those considering a switch, 37% are looking to move to physician-owned settings.
An increase in consolidation is often linked to a lack of physician autonomy — 61% of employed physicians said they have moderate or no autonomy to make referrals outside of their practice or ownership system, and 47% say that they adjust patient treatment options to reduce costs based on practice policies or incentives, according to a survey from NORC at the University of Chicago.
According to Bain's survey, 81% of physicians in physician-led organizations reported satisfaction with their involvement in strategic decision-making, compared to just 50% in health system-led practices.
Some surgeons and physicians are choosing to leave employed models to regain this control. Benjamin Stein, MD, who co-founded and is chairman of ASC development group Capital Surgical Solutions, is one of those surgeons.
He was propelled toward independence after witnessing the changes at a former employer when the organization was bought out by a larger company.
"It was an instant ignition for me," Dr. Stein told Becker's. "I knew it wasn’t good, and I knew other people felt the same way. So, I wanted to create a system that addressed those issues."
Dr. Stein has found that acceleration of practice acquisition has resulted in "a lot of mid-career physicians who are unhappy with their current situation," he said.
His new organization has seen a lot of success in both patient satisfaction and staff retention.
He's found that staff appreciate how his team "prioritize[s] listening to our teams, ensuring that management decisions, such as clinical services and operating times, are made in partnership with our doctors and staff."
Other physicians have taken a similar path. Susan Baumgaertel, MD, an internal medicine physician in Seattle, worked and had ownership stake at The Polyclinic in Seattle, a multispecialty physician practice now owned by Optum, for 25 years.
Following Optum's acquisition, "everything was always 'grow bigger, grow bigger, grow bigger,' because growing bigger meant that we would be a bigger fish in the pond, which means it would be more favorable when we negotiated contracts with insurers," she told Becker's.
As the practice grew, Dr. Baumgaertel felt an increasing lack of autonomy in her ability to make clinical or operational decisions in the best interest of her patients and staff, so she left The Polyclinic in 2021. Her new independent practice, myMDadvocate, serves as a multifaceted telemedicine and healthcare navigation hub.
Other employed physicians are pivoting to private practices as health systems shutter physician groups amid waning margins.
Spine surgeon William Bradley, MD, learned he lost his job early in 2024 after Salt Lake City-based Intermountain Health's physician group, Saltzer Health, closed its doors.
Dr. Bradley used the opportunity to strike out on his own. He saw his first patient at his new practice, Mountain West Spine Clinic, on May 1.
"It always was a consideration, but at the various times that I made career changes, there seemed to be other opportunities that were better," he told Becker's.
Resource access shows a significant disparity as well, according to the Bain survey. Among surveyed physicians, 87% in physician-led practices reported having access to necessary supplies and equipment, compared to 68% in health system-led practices.
Anecdotally, physician practices that have been acquired have faced issues in supply access. HCA Healthcare is facing mounting pressure to give up control of Asheville, N.C.-based Mission Health, which it acquired in 2019. Tim Plaut, MD, a physician who worked at the family practices that were shuttered by HCA after the acquisition, Mission Internal and Family Medicine and Mission MyCare Plus, told Becker's that resource access became an issue after HCA took over. For months prior to the closure, Dr. Plaut said he and his physician partner noticed it was becoming increasingly difficult to secure supplies and hire medical assistance.
HCA maintained that its primary care offerings remain robust in the region.
"We have invested more than $739 million in our facilities and to expand services in western North Carolina since 2019," Nancy Lindell, director of media and public relations for Mission Health, said in a statement shared with Becker's. "We continue to operate more than 100 physician practices. When we made the difficult decision four years ago to close two practices that were close to other locations, we notified patients and facilitated their transition to another Mission Health location for these services. In addition, we offered affected providers at the two locations other positions within our practices and facilities."
Small physician practices often struggle to reach margins in an increasingly consolidated healthcare industry. About 80% of physicians said the ability to negotiate higher payment rates with insurance companies influenced their decision to sell their practice, as well as the need to efficiently handle regulatory and administrative requirements from payers, according to a 2023 report from the American Medical Association.
Reaching margins in an increasingly consolidated healthcare industry is difficult for independent practices, so many are looking to alternative models to access economies of scale without giving up clinical autonomy.
For many, the solution is management services organizations.
David Fitzgerald, CEO of OrthoNY in Albany, told Becker's that MSOs, when "done right" is "private practice version 2.0."
"I'm actually more excited about the way that we're kind of moving to business platforms and how physician groups have decided we can't be just 'mom and pop' anymore. We can't compete against the consolidated hospitals, consolidated payers. We need to find ways to do that, yet be able to provide care locally with our own groups," he said. "You need to have the bigger organization … kind of be big and small. With private equity and the MSOs, that ability to professionalize the practice is really the opportunity to move it to that next level."
Charlotte, N.C.-based independent practice Tryon Medical Partners recently finalized a deal with private equity firm TPG in September, six years after breaking away from Atrium Health.
As healthcare consolidation continues, leaders remain focused on the decline of independent physicians and strategies to regain autonomy.
"I believe the biggest threat to physicians is the progressive loss of autonomy such that they are not making the decisions for the patients, but those decisions are made for reasons and by people for other than the patient's benefit," Cary Passik, MD, and chief of cardiothoracic surgery at Good Samaritan Hospital in Suffern, N.Y., told Becker's.