Independent medicine is often described as nostalgic, a relic of a prior era in which physicians owned small practices and made decisions without corporate oversight. But independence is not nostalgia; it is infrastructure.
Today, nearly 75 percent of physicians in the United States are employed by hospitals, health systems, or corporate entities, according to the American Medical Association. In 2012, that number was closer to 50 percent. Private equity investment in physician practices has accelerated sharply over the past decade, particularly in procedural specialties.
The illusion of consolidation
Consolidation was sold as a solution to rising costs and fragmented care. Yet health care spending has continued to climb, reaching nearly 18 percent of U.S. GDP. Meanwhile, studies have shown that hospital acquisition of physician practices is usually associated with higher prices for the same services, without clear evidence of improved outcomes.
For patients, consolidation often translates into fewer choices and higher facility fees. For physicians, it frequently means diminished autonomy, productivity quotas, and administrative directives that supersede clinical judgment, leading to moral injury.
When physicians lose the freedom to question, to decline unnecessary directives, or to design systems around the needs of their own communities, something fundamental shifts. We risk becoming technicians rather than independent professionals accountable first to patients.
This is not an argument against employment. Many physicians thrive in employed settings, and large systems provide valuable services, particularly in tertiary and quaternary care. But independence, whether in solo practice, group ownership, or hybrid models, serves a stabilizing function within the broader ecosystem of health care.
The role of distributed infrastructure
Independent practices typically deliver lower-cost outpatient services. They can move more nimbly in response to community needs. During the COVID-19 pandemic, many independent physicians collaborated outside hospital systems to secure and distribute protective equipment, keeping local practices open when supply chains faltered. In the case of a cyberattack or failure, independent electronic health records (EHRs) are more resilient than giant linked systems.
In South Carolina, recent policy shifts reflect this tension. The repeal of certificate of need (CON) laws has reduced barriers to entry for outpatient facilities. Legislative scrutiny of noncompete clauses has increased. Conversations about economic credentialing and hospital consolidation are no longer confined to academic panels; they are occurring in statehouses and exam rooms.
These developments are about resilience rather than ideology.
Independent medicine functions as distributed infrastructure. It provides redundancy when centralized systems strain. It preserves direct accountability in the physician-patient relationship. It offers young physicians an alternative career pathway at a time when burnout and moral injury remain pervasive.
Stewardship and the future of practice
The question is not whether every physician should own a practice, but whether the profession benefits from maintaining meaningful independent pathways. If independence disappears entirely, so does leverage in negotiations, in policy discussions, and in shaping the future of care delivery.
There is an ancient teaching that states: “It is not your duty to finish the work, but neither are you free to neglect it.”
Health care reform will not be completed in one legislative session or solved by a single business model. But physicians retain agency in how they practice, how they mentor younger colleagues, and how they participate in policy discussions that shape the profession.
For those who are independent, stewardship matters. For those who are employed, engagement matters. Asking questions about contracts, governance, transparency, and patient access is not disloyal; it is professional responsibility.
Independent medicine is not a rejection of modern health care. It is one of the pillars that keeps it balanced. And balance, in any complex system, is what allows it to endure.
Through my work advising physicians exploring transitions into private or hybrid practice models, I have seen firsthand that independence today looks different than it did a generation ago. But it remains viable and, in all communities, essential.
Marcelo Hochman is a facial plastic and reconstructive surgeon.
