Eighty-two percent of practicing physicians in the U.S. are now employed by a hospital, health system or other corporate entity, a shift that has moved a widening set of clinical decisions out of physicians’ hands alone, including where to send a patient next.
The Physicians Advocacy Institute, working with Healthsperien’s Center for Health Research, Policy & Strategy, surveyed more than 1,000 employed physicians for its 2026 Employed Physician Survey and found 63% face corporate barriers when they want to refer a patient out of network. Fifty-nine percent said they feel pressure to keep patients inside their own health system regardless of where they believe the best care is available, and 47% said they frequently feel pushed to prioritize patient volume over what they consider optimal care.
Seventy-two percent of respondents said they have only ever practiced under a corporate employment model. Of the smaller share who have also worked in a physician-owned setting, 35% cited a loss of clinical autonomy as a reason they’d consider leaving their current job — a comparison point that wouldn’t exist for most of the workforce if corporate employment weren’t now the default rather than the exception.
PAI frames the pattern as a shift in whose interests come first when a referral decision gets made, with corporate ownership pulling that decision toward keeping the patient — and the associated revenue — inside the system rather than sending them wherever the evidence points.
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