The story most physicians hear about independent practice is that you shouldn’t do it. “Independence is dying, hospitals are eating everything, and your only choices are sell or get crushed.”

The data tells a more interesting story.

Private practice is shrinking in some places, growing in others, and continually rebuilding itself. If you're running an independent practice or thinking about transitioning to one, here are some things to consider.

There’s a headline number that’s often quoted:

And according to the GAO's report on healthcare consolidation, hospital-employed or hospital-affiliated physicians went from under 30% in 2012 to at least 47% by 2024.

By specialty, private practice ranges from 30.7% (cardiology) to 46.9% (radiology). But survey-level data shows ophthalmology still at 70% private, orthopedic surgery at 54%, and surgical subspecialties at 51%.

Procedural specialties with strong ambulatory surgery center economics are better positioned to “hold the line.” These practices can capture revenue from both professional services and facility ownership.

Site Neutral Payment reforms could further change those economics.

These policies generally reduce the higher reimbursement attached to certain hospital outpatient services when the same care can be delivered safely in a lower-cost setting:

Remember that Medicare reimbursement tends to create downstream effects on healthcare prices nationwide.

Despite this, cognitive specialties dependent on E/M reimbursement and infusion margins are not as insulated from changing economics. Even with updated payment models it’s well known that the physician independence movement tends to come in waves.

Hospital acquisitions accounted for only 10% of physician practice purchases after 2019. Private equity accounted for 38% of purchases in that same timeframe.

PE-owned practices went from 4.5% of physicians in 2022 to 6.5% in 2024.

In specialties like dermatology, gastroenterology, and ophthalmology, PE involvement now exceeds 30%.