Private practices have struggled to keep their doors open over the last decade as they face threats from corporate consolidation efforts and declining reimbursement rates.
Between 2019 and 2023, physician employment by hospitals, health systems or other corporate entities jumped from 62% to 78%, according to a December 2025 report from the Progressive Policy Institute. However, some physicians are considering a switch back to private practice as autonomy becomes a central concern for employed physicians and policymakers respond to independent physicians’ advocacy efforts.
Site-neutral payments
The need for financial security and more support from payers has long been a rallying cry for independent physicians concerned about the survival of their practice.
Site-neutral payments are one long-supported proposal that some independent physicians say could be key in narrowing the gap between hospital and independent physician payments.
Joshua Siegel, MD, director of orthopaedic sports medicine at Exeter, N.H.-based Access Sports Medicine and Orthopaedics, told Becker’s that site neutrality is already gaining momentum as a viable reform to physician payments.
“You’re starting to see a narrowing of those payment differentials from insurance companies,” he said. “Once that happens, hospitals are either going to lose the ability to provide those services and/or the independent ability to provide them is going to have to go up. There’s no way hospital rates will go down to what independent rates are, and there’s no way they’re going to jack up independent rates without trying to save money on the hospital side. I have a feeling this movement to the middle is going to benefit smaller independent practices, because they’re already profitable — sometimes making half of what hospitals get for the same services.”
Rural practices’ growing opportunities
The Rural Health Transformation Program, enacted under the One Big Beautiful Bill Act, has created funding opportunities for rural physician practices to access support needed to improve care quality and infrastructure in their communities.
The program created a $50 billion fund to distribute across all 50 states from 2026 to 2030. Half of the funding in fiscal 2026 was allocated equally across states. The remaining funds were awarded based on states’ rural population size, proposed policy actions and potential for impact. The average award was about $200 million, with the agency explicitly pushing for modernization and workforce development, and support in its funding methodology for the program.
Daniel Decker, MD, is a urologist and co-founder of Vitality Plus Urology Clinic in Mountain Home, Ark. Now in independent practice, Dr. Decker has worked in a variety of practice settings over the last decade and sees massive potential in the RHTP.
“This rural health deal, it was just like a slingshot of how quickly things happened,” he said, noting the various buckets of investment outlined in the program, including innovation, workforce support and expanded preventive care.
He added that rural practices, often smaller, may find themselves in an advantageous position over the next several years as their smaller operational teams make them more nimble and adaptable to the fast-moving healthcare environment of 2026. Despite having less access to resources than a hospital or health system, investments in rural ASCs — like that of the RHTP — also may have a bigger impact as money is more directly placed into the hands of physicians.
“There really is an opportunity for funding that can make a difference,” he said. He noted that administrative growth has long outpaced the growth of the physician workforce, which has resulted in valuable resources and funding often being placed in the power of nonpatient-facing roles.
A growing need for autonomy
Physician turnover risk remains lower than other clinical roles, but retention hinges less on workload and more on control, according to a new report from SullivanCotter and Lotis Blue.
In a survey of more than 1,000 clinicians, physicians ranked clinical discretion, the ability to exercise independent medical judgment, as the single most important factor influencing their decision to stay.
Sixty-five percent of self-employed physicians said autonomy was very important to them in Medscape’s Self-Employed Physicians Report 2025, published in November 2025. In Medscape’s Employed Physicians Report 2025, 48% of physicians said that diminished autonomy was the worst part of their job, demonstrating the value of autonomy for both independent and employed physicians.
:”In 2026, physician autonomy, in my perspective, is subject to competing incentives and regulatory requirements, creating a push-pull in decision-making,” Nagashree Gundu Rao, MD, system division chief for Fair Oaks, Va.-based Inova Endocrinology told Becker’s. “Physicians seek more control over clinical and professional decisions that directly impact their daily work and patient care. Physician burnout and turnover are also linked to their perceptions of autonomy.”
Increased visibility and recognition of physician autonomy’s importance may drive more physicians and their colleagues to take the leap towards independent practice through agreements with management services organizations and other third-parties that can provide financial support for their practices, Dr. Decker said.
“Ironically, strong mutually beneficial hospital/MSO partnerships are likely the key for physician autonomy moving forward. The days of the physician [saying,] ‘Listen to me because I know more,’ are over,” he said. “That is, autonomy is achievable through MSO arrangements that are much more available in 2026 for independent practices and now like-minded hospital partnerships for the employed offer similar autonomy.”
