Independent practices: Evolving to stay strong

Private practice isn’t dead — it’s fighting to survive and evolve

You didn't go into medicine to spend your evenings buried in administrative tasks. You didn't build your practice to watch reimbursements shrink year after year while bigger health systems and private equity-backed groups gobble up market share. And you certainly didn't spend decades earning your patients' trust only to wonder whether you can afford to keep the lights on.

But that's exactly where a lot of independent physicians find themselves today. The share of physicians in private practice has dropped from 60.1% in 2012 to just 42.2% in 2024 — the lowest level on record.¹ In our own 2026 Physician Sentiment Survey, 8 in 10 physicians at practices of five or fewer clinical providers said they're worried about financial sustainability.²

That's not a niche concern. That's a crisis hiding in plain sight.

And yet, independent practices are still here. Still showing up. Still delivering the kind of personalized, relationship-based care that larger systems simply can't replicate. The question isn't whether independent practice is worth saving — it's how.

We built The Staying Independent Playbook to answer exactly that. Here's a preview of what's inside.

Independence doesn’t mean going it alone.

Let's start with a mindset shift, because it matters.

For a long time, "staying independent" has been coded as "doing everything yourself." But that framing is part of what's making independence feel impossible. The practices that are thriving aren't the ones white-knuckling it in isolation — they're the ones who've built the right operational foundation and brought in the right support, without ceding what actually matters: clinical control, patient relationships, and the freedom to practice medicine on their own terms.

The playbook is built around two paths.

Path One: Thriving on your own terms

Path One is about operational strength — the foundational work that determines whether your practice is sustainable long-term.

Technology that gives you time back.

If your EHR is why you're still charting at 10 p.m., that's not a feature — it's a problem. The right tools automate the administrative drag: ambient documentation that captures notes during visits, patient self-scheduling that cuts no-shows, and billing tools that collect revenue without your staff chasing every claim.

Data that works for you at the negotiating table.

Larger systems walk into payer negotiations with rooms full of analysts. You don't have that luxury — but you can have dashboards that translate your quality and cost performance into a clear, compelling story. Knowing your numbers means knowing your worth and being able to prove it.

Systems that talk to each other.

When lab results flow directly into patient charts, eligibility checks happen automatically, and referral notes don't require a phone call to track down — your staff gets hours back every week. Interoperability isn't a nice-to-have. For independent practices, it's a competitive necessity. 

Risks managed before they become emergencies. 

Compliance deadlines, cybersecurity vulnerabilities, malpractice gaps in value-based arrangements — these are the things that can take a practice down fast. The playbook includes a practical safety checklist to help you audit your exposure before something goes wrong. 

For many practices, Path One is enough. But for others, the pressure eventually outpaces the resources — and that's where Path Two comes in. 

Path Two: Independence, amplified 

Path Two isn't about giving up. It's about getting strategic — exploring organizational models that bring in support without surrendering ownership or clinical autonomy.

Three of the most effective models:

Independent Practice Associations (IPAs) are networks of independent physicians who collaborate without merging ownership. By pooling resources, you can negotiate more effectively with payers, access shared services, and participate in value-based care — while day-to-day decision-making stays entirely in your hands. 

Physician-led Accountable Care Organizations (ACOs) provide the infrastructure needed to succeed in value-based care: care coordination, quality reporting, and the opportunity to share in savings generated by improved outcomes. Research consistently shows physician-led ACOs outperform hospital-led counterparts in cost savings.³ 

Management Services Organizations (MSOs) handle the non-clinical side of running a practice — billing, credentialing, HR, compliance, IT — freeing you to focus on care. Because MSOs operate as a service partner rather than a purchaser, you remain independent while gaining the benefits of scale and operational expertise. 

Before joining any of these models, the playbook walks you through the right questions to ask: How are clinical decisions made? How is revenue shared? What are the exit terms if the partnership isn't working? Getting clear on those answers upfront is what separates a partnership that strengthens your independence from one that quietly erodes it. 

There's no failure in moving from Path One to Path Two. It's a progression, not a retreat. 

Your independence is worth protecting 

Community-based independent practices aren't just good for patients — they're essential to a healthcare system that actually works for people. But protecting that model requires more than commitment. It requires a strategy. 

The Staying Independent Playbook brings together insights from thousands of independent practices across the athenahealth network, including real examples of how practices have built resilience, stabilized their finances, and reclaimed the joy of practicing medicine. 

Whether you're firmly on Path One or starting to wonder if Path Two is on the horizon, this resource meets you where you are — and helps you figure out where to go next.