Cardiology, gastroenterology and primary care are losing independent practices at a pace that separates them from the rest of the field, driven by a combination of Medicare payment erosion, private equity consolidation and hospital acquisition pressure.
Between 2012 and 2024, the share of physicians working in private practices dropped 18 percentage points, from 60.1% to 42.2%, according to the AMA’s Physician Practice Benchmark Survey. But the specialty-level breakdown tells a sharper story than the headline number.
Cardiology: 30.7%
Cardiology has the lowest private practice rate of any specialty tracked by the AMA, at 30.7%, meaning nearly 7 in 10 cardiologists now work outside a physician-owned setting. From 2005 to 2021, Medicare payments for cardiology fell about 29%, while hospital facility payments rose nearly 70% over the same period, widening the gap between independent and hospital-based practices. Private equity activity accelerated alongside that squeeze, with 342 outpatient cardiology clinic acquisitions in the past decade, approximately 94% occurring since 2021, according to a 2024 study published in American Journal of Managed Care.
The number of PE-backed cardiology platforms has more than doubled since 2022, according to a 2024 KPMG Corporate Finance report, with those platforms now operating in nearly 20 states, with particularly heavy activity in Florida and Texas. More than 70% of cardiologists are now employed by hospitals or large systems, according to the American College of Cardiology.
General surgery: 31.7% | Emergency medicine: 33.2%
General surgery (31.7%) and emergency medicine (33.2%) round out the bottom of the private practice rankings. Both specialties face structural headwinds that make independent practice economically difficult. General surgeons require hospital operating room access that independent groups increasingly cannot negotiate on favorable terms, while emergency medicine has been consolidated aggressively by large staffing groups.
Gastroenterology
While GI does not appear in the AMA’s specialty-level private practice breakdown, acquisition data points to increasing consolidation. Gastroenterology saw PE penetration rates rise from 7.6% to 13.1% across metropolitan statistical areas studied between 2012 and 2021, the steepest increase of any specialty tracked, according to a 2023 study published in the National Library of Medicine.
The academic evidence on what those acquisitions produce is now settled enough to cite. A 2025 study published in JAMA Health Forum analyzing more than 1.1 million patients undergoing 1.3 million colonoscopies found that colonoscopy prices, spending and utilization increased at PE-acquired gastroenterology practices, with no associated change in quality.
Primary care: 38.1%-42.2%
Private practice rates for primary care specialties sit in the high 30% to low 40% range, with pediatrics at 38.1%, internal medicine at 38.9% and family practice at 42.2%. These numbers reflect a slower erosion than cardiology or surgery, but the direction is the same. Physicians overwhelmingly attributed the shift to payment and financial issues, with 70.8% saying the need to better negotiate higher payment rates with payers was important or very important in the decision to sell, according to the AMA.
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