Physicians today face enormous challenges in order to remain independent and, for private-practice OB/GYNs, it’s about to get harder. Come January 1, 2027, obstetrician-gynecologists across the country will see a significant restructuring of maternity care services codes. The specialists’ longstanding billing model will become more encounter-based, creating a greater number of individual billing events. This transition will offer more opportunities to appropriately capture the care OB/GYNs provide, but it will also make documentation, coding, and revenue cycle increasingly important, adding to independent practices’ already significant burdens.
Escalating reimbursement pressures and administrative needs have driven growing numbers of OB/GYNs and other physicians to forgo their independence and join private equity-backed medical groups, hospitals, and health systems. A report from the Physicians Advocacy Institute shows the stark consequences of this trend: As of January 2026, only 18 percent of physicians nationwide still practiced in physician-owned settings, with just 36.1 percent of practices remaining physician-owned, down by 48.5 percent since 2018.
These independent physicians were once the cornerstone of American medicine, and guardians of the relationship between patients, families, communities, and the medical establishment. Today, they’re increasingly being compelled to trade that calling for what comes with large-scale ownership: namely the billing clout of a large network and dedicated administrative support.
Yet even with these benefits, physicians who work for large employers are deeply dissatisfied. According to an American Medical Association (AMA) survey of more than 37,000 physicians from 2022 to 2024, 22.5 percent in the final year intended to reduce their clinical hours within the next 12 months, and 15.1 percent intended to leave their institutions within the next 24 months. A separate AMA study found that inadequate control over key aspects of work, including patient loads, team compositions, and clinical schedules, strongly influenced these intentions.
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This is deeply concerning given Centers for Medicare & Medicaid Services projections that indicate sustained growth in demand for physician care. With experts predicting that administrative, regulatory, and financial pressures will grow, we will likely see more physicians burn out, retire early, or leave medicine mid-career at a time when demand already exceeds the available workforce. I fear the January 1 billing code change will prompt more OB/GYNs to follow this same path away from independent care delivery.
A new way forward for private practices
Allowing physicians to focus their energies on patient care, with greater control over their practices, is key to maintaining and ultimately expanding the country’s capacity to deliver health care. Meeting this objective means shaping the future of independent medicine in ways that support physicians while granting them more individual autonomy.
Instead of forcing current and future MDs to choose between consolidation and independence, new models now offer an important third option. These models provide stronger leverage in payer negotiations and contracted administrative support while preserving physicians’ control over their own schedules, staffing, branding, and clinical decisions.
Beyond access to contracted management services organizations that negotiate for better rates and provide needed, valuable business support, the most forward-looking such models allow physicians to serve as members and owners in their own vetted groups. This structure allows physicians to retain decision-making authority while connecting them with fellow MDs who share similar quality standards and values. That sense of community fills a void in private practice that often goes unaddressed.
Professional community and the future of care
This kind of close-knit community has become increasingly vital amid rapid industry evolutions. Greater opportunities for collaboration help independent practices stay ahead of disruptive forces such as retail health care and AI. It further helps physicians better understand how to reach patients who too often seek medical advice from their friends and social media networks rather than medical doctors.
I am part of a physician-run, physician-led organization in Florida that offers physicians the benefits of consolidation along with the freedom to make their own clinical and business decisions. Guided by a shared mission to preserve the private practice of medicine, independent physicians are supported through a contracted management services organization (MSO) that negotiates favorable rates and delivers administrative solutions, tackling such issues as the OB/GYN billing change.
The model benefits physicians like myself in obstetrics and gynecology, as well as multi-specialty providers across primary care, women’s health, pediatrics, dermatology, urology, allergy, and surgical specialties. In advocating for this approach, physicians are empowered to thrive in private practice and focus their attention on patient care.
Yet this represents only the beginning. Our country needs far more organizations championing this work, as well as physicians who value independence but seek support to help their practices thrive.
Through their uniquely patient-focused approach to medicine, physicians in private practice play a fundamental role in our medical system. Offering models that empower more physicians to live the calling that first drew them to medicine will help the United States meet rising health care demands while empowering physicians to run financially sustainable, independent practices, and continue doing the work they love.
Edward M. Fidalgo, MD, is a founding member, executive board member, and vice president of VitalMD. He sees patients at an independent medical office, Miami OB-GYN, LLC.
VitalMD is a physician-run, physician-led organization offering physicians the benefits of consolidation along with the freedom to make their own clinical and business decisions. Guided by its mission to preserve the private practice of medicine, VitalMD supports independent physicians through a contracted management services organization (MSO) that negotiates favorable rates and delivers administrative solutions.
In championing this model, VitalMD empowers physicians to thrive in private practice and focus their attention on patient care. Since 2004, VitalMD has grown from a handful of practices to nearly 300 clinical centers with more than 850 multi-specialty providers who serve collectively as owners and members.
