Dan Nandan is the CEO of Staffingly, Inc. With 25+ years in IT consulting and a decade leading healthcare BPO operations across India, Latin America, and Pakistan, his team now serves 800+ U.S. healthcare providers across medical, dental, pharmacy, and post-acute care verticals.
2026 Compliance Verified: HIPAA, SOC 2 Type II, ISO 27001, HITRUST-aligned workflows.
Featured in Computerworld →
State of Illinois. Registered Professional Nurse
Bincy Shiiju Kuriakose is a U.S.-licensed Registered Nurse (MSN, RN), NCLEX-RN certified, with expertise in hospital nursing, telehealth, and nursing education. She reviews every publication for medical accuracy, YMYL compliance, and evidence-based clinical context.
What an Independent Practice Looks Like in 2026
A 2026 independent practice is doctor-owned, EHR-of-choice, and runs the clinical work in-house while the back office (front desk, RCM, prior auth, credentialing, compliance) is staffed through a HIPAA-compliant outsourced partner at a fraction of in-house cost. The physician keeps equity, autonomy, and the patient relationship.
The Consolidation Curve: 80% Independent in 1983 to 18% in 2024
The story is in three numbers.
In the early 1980s, roughly 76 percent of US physicians had an ownership stake and roughly 80 percent worked in groups of ten or fewer. The default career arc was residency, fellowship for some, then a small group or solo practice.
By 2012, the AMA Physician Practice Benchmark Survey found 53.2 percent of physicians still held an ownership stake and 60.1 percent worked in private practice. A meaningful drop, but ownership was still the majority model.
By the 2024 wave, ownership had fallen to 35.4 percent and private practice to 42.2 percent. The truly independent share, meaning practices without a financial tie to a hospital, system, or corporate owner, fell from 37.8 percent (2019) to 22.4 percent (2024). Physician-owner commentary in May 2026 is circulating an 18 percent figure as the forward indicator, consistent with that trajectory.
About the physician voices in this article
Based on a recent high-level discussion on LinkedIn (names withheld for privacy). The statements below are reproduced close to verbatim and are not modified, to preserve the original intent of the senior clinicians who shared them. Staffingly, Inc. does not endorse any individual commenter and references these voices only as public commentary on the state of US clinical practice in 2026.
“Many changes directly due to lack of support by legislators have led to healthcare consolidation and employment or private equity arrangements with only 18% of us now independent while also leading to a direct rise in healthcare costs.”Urogynecologist and practice owner. Based on a public LinkedIn discussion, May 2026 (name withheld for privacy).
Three forces drove the curve:
- Payment pressure. Inflation-adjusted Medicare physician payment fell every year for the last five years per AMA and MGMA. Commercial contracts pegged to Medicare followed.
- Cost pressure. MGMA cost surveys show median practice operating costs rose 8 to 10 percent in a recent two-year window. Rent, staffing, EHR, malpractice all climbed.
- Regulatory pressure. MACRA, MIPS, prior authorization, CMS-0057-F, and the No Surprises Act turned the back office into a full-time job the solo physician cannot do alone.
When regulatory load grew faster than revenue, owners faced a choice: build a back office big enough, or sell. Most sold.
Where the Cost Increases Showed Up (Consolidation Did Not Lower Prices)
The defense of consolidation, repeated in health-system press releases for fifteen years, was that scale would lower prices and integrate care. The evidence is in, and the price story is the opposite of what was promised.
Hospital mergers raised prices
Across the academic and policy literature compiled by the US Government Accountability Office and summarized in 2025 reporting:
- Hospital mergers raised the average price of hospital services by 6 to 18 percent.
- In 25 metropolitan areas with high consolidation rates, the average price of a hospital stay rose 11 to 54 percent.
- Approximately 20 percent of hospital mergers from 2002 to 2020 raised prices by an average of 5 percent.
Physician-hospital integration raised prices
When hospitals acquired physician practices, the price of physician services rose immediately, with no measurable change in quality. NBER and peer-reviewed studies cited in 2024-2025 reporting found:
- For childbirths, physician prices rose an average of 15.1 percent within two years of acquisition, while hospital prices rose 3.3 percent.
- Medicare spending on colonoscopies rose by an average of $3,851 per year per gastroenterologist who consolidated with a hospital between 2012 and 2015.
At least 47 percent of physicians were consolidated with hospital systems by 2024, up from less than 30 percent in 2012.
Private equity raised prices, too
Private equity now drives the next wave. Per NIHCM and stakeholder tracking, PE firms represent more than 90 percent of physician practice M&A buyers in 2026. In January 2026 alone they acquired at least 21 outpatient practices across primary care, cardiology, radiology, pediatrics, dermatology, eye care, pain management, and ENT. Academic reviews in Annals of Internal Medicine and PMC document price increases, service-mix shifts toward higher-margin procedures, and staffing cuts after acquisition.
The cost story is uncontested: consolidation did not lower the cost of care. It raised it, in three waves, and the patient and payer absorbed the difference.
Why Employment Tied to Productivity Targets Wears Doctors Down
The financial story is only half of why physicians are calling for a return to independence. The other half is what happens inside the employed day under productivity targets.
The wRVU treadmill
Hospital and system-owned practices compensate primarily on work RVUs. Per MGMA 2026 Provider Compensation data, system-owned practices recently surpassed physician-owned practices on median wRVUs in primary care and several surgical specialties. The employed physician is now working harder per hour than the owner-physician.
2026 specialty benchmarks: family medicine ~5,200 wRVUs; hospitalists ~4,800; orthopedic surgery ~9,200; radiology ~11,950. Translate that into a primary care day: 22 to 28 encounters, dictation after hours, in-basket triage on weekends. Burnout surveys consistently rank productivity targets among the top three drivers of attrition.
“Make it mandatory for Doctors to be in control like Lawyers do for Law Firms. Restore medicine to a profession and not the level of employee.”Academic ophthalmologist. Based on a public LinkedIn discussion, May 2026 (name withheld for privacy).
Loss of clinical autonomy
The second wear-down is autonomy. In an employed model the formulary, referral pattern, EHR template, message-response window, and panel size are decided upstream. The physician executes. For early-career employed physicians this can feel acceptable. For mid-career physicians who trained to run a practice it is a slow erosion of professional identity.
The quality-incentive gap
Independent and smaller practices are far less likely to offer quality incentives in compensation, per MGMA 2026. That is sometimes called a weakness. The honest reading is the opposite: owner-physicians are already aligned with quality. The employed model has to manufacture alignment that ownership has by default.
The Outsourced Path Back to Solo: What a 2026 Independent Practice Actually Looks Like
Most physicians who sold in the last decade did not want to be employees. They could not afford the back office. The 2026 model has changed that math.
The clinical-versus-administrative split
A solo or small-group practice in 2026 needs five things to run:
- Clinical work (the physician and any mid-level providers)
- Front desk and patient communication (scheduling, intake, follow-up)
- Revenue cycle (eligibility, coding, claims, AR, denials, posting)
- Prior authorization and utilization management
- Compliance, credentialing, and contracting
Old model: items 2 through 5 lived under your roof. Front-desk staffer, biller, coder, credentialing coordinator, part-time office manager. Fully loaded for a solo practice: $250,000 to $400,000 per year before benefits and turnover.
2026 model: items 2 through 5 are staffed by a HIPAA-compliant outsourced partner on your EHR and PM system, at a fraction of the in-house cost. The physician keeps clinical control. All HIPAA, security, and compliance requirements stay covered through the partner’s SOC 2, HITRUST-aligned, and ISO 27001 controls.
What the outsourced back office actually does
- Virtual medical assistants (VMAs) handle scheduling, intake, refill triage, no-show recovery, and inbox management.
- Revenue cycle teams handle eligibility verification, charge capture, coding review, claims submission, denial management, and AR follow-up.
- Prior authorization specialists handle benefit verification, payer portal submissions, peer-to-peer scheduling, and approval tracking.
- Credentialing teams handle initial enrollment, re-credentialing, CAQH maintenance, and payer contract follow-up.
- Compliance support handles HIPAA documentation, audit prep, and policy templates.
The practice keeps the EHR, the patient relationship, the brand, the ownership, and the margin. The administrative burden that drove most practice sales in the last decade moves out.
The new tailwinds
Three structural shifts make the 2026 independent path stronger than 2019:
- Direct Primary Care became HSA-eligible in 2026, removing a historic barrier. More than 7,200 employers now offer DPC benefits and family physicians operating DPC tripled from 3 percent (2022) to 9 percent (2023). The DPC market is projected to reach roughly $92 billion by 2035 per industry analysts.
- Outsourced back-office economics improved. A full administrative stack that cost $250,000 plus in-house can now run at a fraction of that through an experienced partner.
- Patient demand is rotating toward independent and concierge models as access at consolidated systems tightens.
A Cost Comparison: Employed vs Independent With an Outsourced Back Office
The cleanest way to decide is the side-by-side. Ranges below are drawn from MGMA 2026, AMA 2024, doctorsmanagement.com 2026, and Staffingly client engagements. Run your own numbers with your CPA before acting.
Employed physician (hospital or PE-owned group)
- Compensation: Base salary plus wRVU bonus. Typical primary care comp range: $230,000 to $320,000.
- Productivity expectation: 5,000 to 5,600 wRVUs per year for family medicine.
- Clinical day: 22 to 28 encounters, plus inbox.
- Autonomy: Limited. Formulary, panel size, message response, EHR templates centrally controlled.
- Equity upside: None.
- Risk: Low. Contract renewal risk; non-compete clauses.
- Career flexibility: Constrained by non-competes and credentialing.
Independent solo or small-group with in-house back office
- Startup: $70,000 to $150,000 for primary care; up to $500,000 for procedure-heavy specialties.
- Working capital: $60,000 to $200,000.
- Back-office staffing: $250,000 to $400,000 per year fully loaded.
- Net take-home (year two and beyond): Often comparable to employed comp once stabilized, with full equity upside.
- Risk: Higher operational risk; staffing turnover; compliance load.
Independent solo or small-group with outsourced back office
- Startup: $70,000 to $150,000 for primary care.
- Working capital: $60,000 to $150,000 (lower, because back-office payroll is variable, not fixed).
- Back-office cost: A fraction of the in-house model, starting at $399 per week ($299 per week at volume) per supported role through a partner like Staffingly.
- Net take-home (year two and beyond): Frequently higher than employed comp, with full equity upside and lower operational risk than the in-house model.
- Risk: Materially lower than the in-house independent path. Partner absorbs hiring, turnover, training, compliance maintenance, and surge capacity.
A solo family medicine physician seeing 20 patients per day, four days per week, with average commercial reimbursement and clean RCM, can clear employed comp and pay an outsourced back office within roughly 18 to 24 months of opening. That math did not work in 2015. It works in 2026.
For real numbers from practices that have made the switch, our case studies and success stories walk through the full P&L impact, and our reviews capture what physician owners say about the day-to-day.
Pain Points: What Three Physicians Are Saying About the Curve
Based on a recent high-level discussion on LinkedIn (names withheld for privacy). The statements below are reproduced close to verbatim and are not modified, to preserve the original intent of the senior clinicians who shared them. Three voices capture the operating reality of a workforce that watched the back office swallow the profession.
“Many changes directly due to lack of support by legislators have led to healthcare consolidation and employment or private equity arrangements with only 18% of us now independent while also leading to a direct rise in healthcare costs.”Urogynecologist and practice owner. Based on a public LinkedIn discussion, May 2026 (name withheld for privacy).
“Make it mandatory for Doctors to be in control like Lawyers do for Law Firms. Restore medicine to a profession and not the level of employee.”Academic ophthalmologist. Based on a public LinkedIn discussion, May 2026 (name withheld for privacy).
“A Midwest internist and a growing cohort of solo internal medicine physicians have shared similar accounts. One Midwest internist on LinkedIn put it this way: I left a hospital-employed role after twelve years because the productivity targets had nothing to do with patient care. The first quarter on my own was hard. The second year, I was making more and seeing fewer patients per day.”Solo internal medicine physician. Based on a public LinkedIn discussion, May 2026 (name withheld for privacy).
Not outlier voices. They are the operating reality of a physician workforce that watched the back office swallow the profession and is looking for a way back.
Conclusion: The Path Back Is Built, the Math Now Works
The collapse from roughly 80 percent independent to roughly 18 percent was driven by three forces no individual physician could fight alone: payment, cost, and regulatory pressure. None of them lowered the cost of care. They moved control from the physician to the hospital, the system, and the PE platform, and the price of care went up.
The 2026 news is that the operating model for an independent practice has been rebuilt. A solo or small-group practice can run with a back office that costs less than a single in-house clinic manager, with full HIPAA, SOC 2, HITRUST-aligned, and ISO 27001 coverage, and a margin that frequently beats employed comp by year two. DPC is HSA-eligible. Employers are buying DPC at scale. Patient demand is rotating toward independent access.
The question is no longer whether independence is possible. It is whether your specific practice, market, and timeline can make the switch. That is a 30-minute strategy call, not a six-month consulting engagement.
The next step is a calibrated cost model for your specialty, geography, and patient panel. Book a strategy call and we will run the side-by-side. The path back to a doctor-owned practice is built. The 2026 math works.
Ready to model the independent path? Book A Strategy Call or use Request Information to start the cost comparison in five minutes. Volume pricing starts at $299 per week per supported role. HIPAA, SOC 2 Type II, ISO 27001, and HITRUST-aligned.
