As of January 2026, only 18% of clinicians in the United States still own their practices. That means more than four out of five clinicians now work within hospital systems, health networks, or other consolidated healthcare organizations.
For years, independent clinicians have faced increasing pressure to sell, merge, or join larger entities. Acquisition offers arrive regularly. Hospital employment opportunities promise stability. Private equity firms continue investing heavily in clinician practices across multiple specialties.
Yet 18% remain. And that number, small as it may seem, represents thousands of clinicians who continue to choose independence despite the challenges.
"18% is a small number. But it's not zero. And the individuals helping shape its future are worth recognizing."
The Reality Facing Independent Clinician Practices
The healthcare landscape has changed dramatically over the past decade. Independent practices are expected to deliver high-quality patient care while managing increasing administrative and financial responsibilities.
Regulatory burden remains a major concern. Industry surveys show that many clinicians believe administrative requirements continue to rise each year. At the same time, reimbursement has not kept pace with increasing costs. Rising labor costs, ongoing technology expenses, cybersecurity demands, and inflation are creating new financial challenges for medical practices.
Can independent medicine survive in today's healthcare environment? Thousands of clinicians say yes, and they're proving it every day.
The Financial Case for Staying Independent
The decision to remain independent isn't just philosophical; for many practices, it's a calculated financial one. Several factors are driving that math:
1. Higher reimbursement retention per visit.
When a practice is acquired, hospital systems typically take a cut of revenue in exchange for administrative and billing support, often 30–50% of collections, depending on the arrangement. Independent clinicians who manage their own revenue cycle keep a significantly larger share of what they bill, provided they have the systems in place to manage collections efficiently.
2. Avoiding the "facility fee" trade-off.
Hospital-employed clinicians frequently see patients billed at higher hospital outpatient rates, which can reduce patient volume as cost-conscious patients and payers push back. Independent practices billing at clinician-office rates often remains more price-competitive, which can support stronger patient retention and referral volume over time.
3. Direct control over overhead.
Independent owners set their own staffing ratios, vendor contracts, and technology spend, rather than inheriting a health system's cost structure. Practices that actively manage overhead (staffing efficiency, EHR/RCM automation, supply costs) can often operate at a lower cost basis than a comparable hospital-owned clinic.
4. Ancillary revenue streams stay in-house.
In specialties like allergy, pulmonology, and ENT, ancillary services, infusion, in-office testing,
DME, can represent a meaningful share of practice revenue. Independent practices retain 100% of this revenue; once acquired, ancillary margins are typically absorbed by the parent health system.
5. Faster reimbursement cycles with the right technology.
Modern RCM and practice management platforms have narrowed one of the biggest arguments for selling, administrative overhead. Practices using automated eligibility checks, denial management, and prior-authorization tools report shorter A/R cycles and reduced staff time spent chasing claims, which improves cash flow without giving up ownership.
6. Long-term equity and flexibility.
Independent owners retain the equity value of their practice and the flexibility to sell later, on their own terms, if circumstances change, rather than being locked into an employment contract with fixed compensation and limited upside.
Note: figures above (30–50% collections, cost structures, etc.) are illustrative ranges commonly cited in industry discussion, not sourced from a specific ModuleMD study. Before publishing, these should be swapped for verified statistics or attributed to a named source (e.g., MGMA, AMA benchmarking survey, or a specific industry report) to hold up to scrutiny and avoid unsupported claims.
Why Some Clinicians Continue to Say No
Despite the obstacles, thousands of clinicians continue to reject acquisition offers, hospital employment opportunities, and private equity partnerships. Because for many, independence represents something larger than ownership, and now, the financial case reinforces the philosophical one.
It represents autonomy and a direct line between good management and better margins.
The Challenges Independent Clinicians Worry About Most
While clinician burnout remains a significant concern, many independent practice owners point to other issues with more immediate operational impact:
These challenges affect everything from patient access and scheduling efficiency to financial performance and long-term sustainability. Yet many clinicians continue to view these obstacles as problems to solve, not reasons to abandon independence, particularly when the financial upside of ownership remains intact.
What Independent Practices Can Offer
The conversation around healthcare consolidation often focuses on economics. But for many clinicians, the decision to remain independent is deeply connected to how they want to practice medicine, and increasingly, to what they keep at the end of the month.
For patients, this can translate into continuity of care and stronger clinician-patient relationships. For clinicians, it can mean preserving the professional independence that inspired many of them to enter medicine and a larger share of the value they create.
Technology Is Helping Independent Practices Compete
While independent medicine faces undeniable challenges, technology is creating new opportunities for clinician-owned practices. Modern healthcare technology can help reduce administrative burden, improve operational efficiency, and support financial sustainability, often narrowing or eliminating the cost advantage that hospital systems historically offered.
The goal is not simply to do more, but to work smarter. By reducing time spent on administrative tasks, practices can focus more resources on patient care and strategic growth.
- Integrated EHR & practice management
- Workflow automation tools
- Analytics and reporting capabilities
- Revenue cycle management solutions
- Patient engagement technologies
- Prior authorization & documentation efficiencies
- Automated denial management to reduce lost revenue
- Real-time financial dashboards for margin visibility
The Future of Independent Medicine
Healthcare consolidation is likely to continue in the years ahead. However, independent clinician practices are unlikely to disappear entirely, particularly as technology continues to close the operational and financial gap that once made consolidation feel unavoidable.
For clinicians who choose to remain independent, success increasingly depends on operational efficiency, financial stability, and a strong technology foundation. They're not ignoring the realities of modern healthcare, they're adapting to them, and in many cases, coming out ahead financially for doing so.
Is a Small Number. But It's Not Zero.
The story of independent medicine is about autonomy, patient relationships, community-focused car, and, increasingly, about keeping more of the value clinicians create. All of it is worth protecting.
They're not doing it because it's easy. They're doing it because they believe the alternative is worse, not just professionally, but financially. As healthcare continues to evolve, the remaining independent clinicians offer an important reminder: clinician ownership may be less common than it once was, but it remains a powerful and profitable model for delivering patient-centered care.
See how ModuleMD helps independent practices reduce administrative burden while maintaining the autonomy and margins that matter most.
