In our last issue, we talked about a subtle, shifting tide in private practice across the U.S. The gist of the comments were: “Independence seems increasingly futile.” 

The American Healthcare System seems to have a stranglehold on everything, including physicians’ ability to practice on their own terms. But is it true? Will it always be this way?

We briefly discussed the narrow avenues in which physicians are maintaining ownership from small wins like better reimbursements via ASCs and improving models for direct primary care, amongst others. Instead of trudging through economics research, however, I decided it would be more interesting to talk with physician-owners operating practices today.

But first..

Numerous articles have been written about AI in healthcare and how it changes the way physicians work in hospital settings. I want to focus on how it could directly change the math on staying independent.

Doximity's State of AI in Medicine 2026 report surveyed 3k+ physicians across 15 specialties. They reported that:

A study by IntuitionLabs and corroborated by AMA data found that roughly half of ambulatory practices report using at least one AI tool, with 22% of private-practice physicians using it specifically for documentation or coding. Of those using ambient scribes, two-thirds report saving 1-4 hours per day on paperwork.

For independent practices, the business implication is pretty clear. 

One reason small practices have been forced to sell over the last 15 years is due to administrative overhead they can't amortize across a large enough physician base. With tools like ambient documentation, AI-driven prior auth, and automated coding/billing work, physician owners can genuinely reduce the overhead that required a whole team.

If these tools enable you to see more patients and reduce administrative burden, does that make them more compelling?