“Independent” has become one of the most loaded words in physician practice. As hospitals, health systems and private equity firms have absorbed practices over the past two decades, the label has come to signal a practice that has stayed outside all three.
Siddharth Tambar, MD, a rheumatologist and physician owner of Chicago Arthritis and Regenerative Medicine, questions how much that label actually describes.
“I understand what people mean when they say independent practice, right? That you’re not part of a large either group system, hospital system, PE-owned system,” Dr. Tambar told Becker’s. “So I get that, but realistically, if you are part of the American healthcare system, if you accept insurance, you’re part of these large networks. You’re part of these flows of how patients get to you, and so I don’t think any of us are truly independent in that regard.”
Physicians have little leverage inside those networks. Only 5% of physicians report significant negotiating leverage in private-payer contract talks, and more than 40% report none, according to a Medscape‘s report, “Private-Payer and Government Insurance Report 2026: Medicare, Medicaid, and More,” published Oct. 2.
Referrals are one example. Between 2019 and 2023, the share of physician practices owned by hospitals, health systems or other corporate entities jumped from 39% to 59%, according to a Progressive Policy Institute report. Once employed, many physicians lose control over where they send patients: Around 61% of employed physicians said they have moderate or no autonomy to make referrals, according to a NORC at the University of Chicago survey.
“If you were part of a referral system and those physicians have either been bought out or have moved to another system, those flows affect you, and so even if we say we’re independent, we’re still closely aligned to what happens to our colleagues and the other health systems,” Dr. Tambar said.
Health system staffing decisions are another area of interconnectedness between independent physicians. Becker’s has reported on more than 60 hospitals and health systems have announced job cuts so far in 2026.
“If a particular hospital system decides to fire off all their doctors in department X, those doctors have to go somewhere, or those patients definitely have to go elsewhere,” he said. “Even for those of us that consider ourselves to be independent, we are massively affected in good ways and bad ways from everything else that’s happening out here.”
That raises a practical question for practice owners.
“From the standpoint of how do you manage all this as an ‘independent practice?’ You can’t be standing alone,” Dr. Tambar said. “You have to be affiliated with other people in terms that offer value, right?”
Coverage is shifting on the regenerative medicine side of the practice in particular.
“Treatments that were previously only cash pay are now progressively slowly starting to become funded by employer plans now. Still a small number, but it’s a significant number of our patients because of our affiliation with Regenexx and their corporate plan,” he said. “I think on the rheumatology side of things, it’s an expansion of our treatments that go from just using medical benefits to even using pharmacy benefits,” Dr. Tambar said.
How patients find the practice has changed, too.
“In the past, physicians got all of their patients from other physicians, and now at least what I’ve seen is that it’s 50% from other physicians, and 50% people come on their own, because of either messaging or content they’ve seen from us, or AI’s directing them,” Dr. Tambar said.
That makes it more important than ever before for physicians to be present in their communities and to put themselves directly in front of patients.
“You have to be present in all the communication channels that the general public utilizes, because that’s what they trust and that’s how they come to you,” he said.
Despite continuous shifts in the structures and regulations shaping the physician practice space, Dr. Tambar maintains that strong patient relationships and a desire to stay connected to them is what will keep practices growing in the future — regardless of their independence.
“Long term, obviously, if you’re offering good care to patients, ethical care, that’s how you maintain, right?” he said. “As a physician or as an owner, you have to keep on finding ways to offer value to patients, and whatever treatments are new that can be helpful for the patients, you have to find a way to somehow introduce them and stay relevant and stay present in their minds.”
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