By Jasen Gundersen, MD
I speak with independent physicians across the nation every day. So I can say with certainty: The American Medical Association’s (AMA) recent report claiming that physician private practice is “unraveling” misses the mark.
The report states that low payment, high costs, and administrative burdens are causing more independent doctors to sell their practices to hospitals and private equity (PE) firms. But while the report is right about the numbers—noting that the percentage of private practices fell from 60.1% in 2012 to 42.2% in 2024—it’s wrong about the momentum.
Want to know why? Just talk to an employed physician. Odds are, you’ll hear the frustration in their voice as they mention their lack of clinical autonomy, limited face time with patients, and a rapidly diminishing work-life balance. These harsh realities are sparking a movement toward liberation, with employed doctors vigorously pursuing a return to private practice.
Don’t just take my word for it. We’re already seeing this play out in the market. Over the past year, our team at CardioOne have launched two physician groups (Cardiovascular Specialists of New England and CardioNow) from hospital-employed to private practice.
Here’s what the AMA report didn’t capture, and why I believe private practice remains a viable alternative to employment.
5 Reasons Why Private Practice is Making a Comeback
1. True clinical autonomy
Regardless of employment models, physicians ultimately control the care they deliver inside the exam room. But only independent practitioners have 100% autonomy to choose how they practice—how much time they spend with patients, which care models they adopt, which technologies to implement, and to whom they refer patients.
When physician autonomy is compromised, patient care suffers. Nearly 60% of employed physicians surveyed by the National Opinion Research Center say non-physician practice ownership reduces the quality of care. Additionally:
- 61% say they have moderate or no autonomy to make referrals outside their ownership system
- 47% say employer-driven policies or financial incentives influence treatment decisions, such as using lower-cost drug therapies
True independence also improves the physician experience. Provider satisfaction in physician-led organizations ranges from 70% to 90%, well above the 50% to 75% reported by health-system-led practices, per recent Bain & Company research. Doctors in physician-led practices also say they:
- Have better access to needed supplies and equipment (87% vs. 67% in health-system-led practices)
- Use more effective workflows (78% vs. 58% in health-system-led practices)
The AMA fully recognizes the inherent risks in employed physician models, strengthening its guidance on corporate relationships at its 2025 Annual Meeting. The updated recommendations call for physicians to reatin decision-making over how many patients they see daily, which diagnostic tests are approrpiate, and how coding and billing are handled.
Still, updated guidance alone can’t offset the ongoing strain of declining Medicare reimbursement and increasing administrative complexity. In employed settings, those economic pressures can translate into higher patient loads and shorter visits. Independent physicians, meanwhile, can protect their autonomy despite ongoing fee schedule challenges.
2. Greater earning potential
It’s too early to tell how the 2.83% across-the-board cut to the 2025 Medicare Physician Fee Schedule has impacted overall physician compensation. But recent studies continue to show favorable pay rates for independent practitioners.
In 2024, self-employed doctors out-earned their employed counterparts by 11%, with an average salary of $391,000 vs. $353,000, according to the Medscape Physician Compensation Report. Another study performed in 2022 showed that non-surgical physicians earned 35% more working in private practice than in hospitals. Doctors operating in single-specialty, solo practices, and multispecialty groups earn the highest across the board, says Doximity.
Salary is only one measurement of financial freedom for independent cardiologists. Another is the potential to expand practice income by adding ancillary services like advanced imaging. Most employed doctors are required to send their patients to hospital-based testing, which carries higher costs for patients and doesn’t drive any revenue to the practice. Independent practitioners with in-office imaging centers, however, can offer testing at a lower cost for patients while also retaining and reinvesting a percentage of their margin into their practice.
3. Stronger patient relationships
There’s no denying that greater physician autonomy creates more satisfied patients. Bain’s research reveals that physician-led practices outscore hospital-owned practices by an impressive 35 points in Net Promoter Score, defined as the likelihood of a patient recommending their doctor to others.
Why such a widespread discrepancy? One of the biggest reasons is that independent physicians spend more time with their patients, free from the constraints of visit time limits imposed by hospitals or private equity-backed employers. Data from the National Opinion Research Center survey results back up this trend: 70% of employed physicians say their employer either incentivizes them to see more patients in a day or penalizes them for not seeing enough.
Most physicians would agree that watching the clock is no way to manage patient care. Independent doctors spend roughly 40% more time with patients per visit than employed doctors. That extra time allows them to treat patients holistically and foster deeper connections.
4. Faster path to innovation
Smaller, physician-led practices can adopt new care models, use groundbreaking medical devices, or implement technology like artificial intelligence (AI) on their timeframe. Hospital-owned practices, meanwhile, typically must cut through organizational red tape, wait for system-wide rollouts, or hold off until the start of a new budget cycle to innovate.
One significant barrier, however, holds independent practices back: budget constraints. AMA data shows that 72% of employed physicians have already adopted AI vs. 64% of private practitioners, and cost is the biggest reason why. Independent cardiologists can overcome this challenge by partnering with a management services organization like CardioOne. Our Rhythm® integrated technology platform provides a best-in-class EHR platform, patient portals, integrated Revenue Cycle Management tools and other leading-edge technology, allowing practices to scale innovation on a budget.
5. Strength in numbers
Despite the multiple advantages we spell out here, there’s no denying that running an independent practice is challenging. In an era of declining reimbursements, negotiating payer contracts is a particular pain point. That’s where groups like the American Independent Medical Practice Association (AIMPA) aim to make a difference.
Formed just two years ago, the AIMPA is already 10,000 doctors strong. Its mission is to inform physicians, patients, and policymakers about the value independent medical practices provide to the U.S. healthcare system. AIMPA is actively advocating for legislation that can create a more even playing field for employed physicians, independent doctors, and health plans.
Thrive—don’t just survive—as an independent cardiologist
The number of independent doctors has declined over the past decade, but so has employed doctors’ dissatisfaction with their health system and corporate owners. Reclaiming independence is possible for cardiology groups, and the right partner can ease the transition.
Ready to regain your autonomy? Check out our step-by-step guide to becoming an independent cardiologist.