Physician practices have been struggling against a rising tide of consolidation efforts by a range of corporate entities, including hospitals, health systems, private equity and insurance companies.
At the same time, some physicians are taking the leap into independent practice as they seek more autonomy and flexibility in their practice. As a result, many have shifted to new practice models that include joint ventures and hybrid ownership through management services organizations.
Reeti Joshi, MD, a rheumatologist in Beaumont, Texas, told Becker’s that she first made the jump to independent practice in 2017 — and has since been constantly evolving her practice model to meet the needs of her community.
“I wanted to explore private practice options for more autonomy and flexibility,” she said. The biggest shift she sought through private practice was a need for better patient advocacy, enhanced access to services and improved outcomes,” she added.
“Those were some things that are actually much easier to do when you’re in private practice,” Dr. Joshi said. “You can work with a bigger institution, and they have their own advocacy arm, but what a small practice of rheumatology needs, you can actually do much better when you’re solo or a smaller one- or two-group practice. Your patient goals align very closely with the autonomy of your practice, and I feel that we in solo practice deliver excellent, high-quality care at a fraction of a cost that they would get in a giant, hospital-acquired center.”
Hospital acquisitions of physician practices have been associated with higher prices and little to no improvements in patient care, according to a July 2025 study by the National Bureau of Economic Research. The study found that two years post-merger, prices increased by 3.3% for hospital services and 15.1% for physician services, with no measurable improvements in quality. Mergers with high potential for foreclosure (where physicians refer patients to the acquiring hospital) and recapture (where insurers must accept bundled “all-or-nothing” contracts for hospital and physician services) saw the largest price hikes.
Dr. Joshi said her practice became “very busy, very fast,” as word spreads quickly in smaller, suburban communities like Beaumont and there is a tight-knit community of referring physicians and subspecialists.
“I did traditional solo practice rheumatology for about seven years, and then last year, I decided to start evolving my practice to include additional aspects,” she said. Dr. Joshi recently added cardiovascular and metabolic health services, shifting her focus toward preventive care — which also drove her to explore new practice models altogether.
“I felt that it was necessary to provide a nontraditional model, rather than a traditional model, because I simply was running out of time to provide good quality care,” she said.
“I wanted to spend time improving their health and trying to do preventive medicine rather than just reactionary medicine, which there is a lot of in rheumatology,” she said. “By the time you see a patient, they’ve already developed an autoimmune disease, and at that point in time, is essentially a lifetime of medication.”
Dr. Joshi now operates a membership-based rheumatology practice. Her practice’s membership model differs from concierge medicine in that fees are not retainers — patients can still use insurance, but pay a membership fee to cover procedures and treatments their insurance otherwise might not.
“It allows me to spend a significant amount of time treating them for conditions that would be aggravated by their autoimmune disease or have been directly linked to their autoimmune disease, other than just providing the biologics for their autoimmune disease,” she said.
The extra time carved out by the membership model has a dual effect on a practice operating in a smaller community where word travels fast: Dr. Joshi often works with entire families, and is now able to dig further into family histories and other data that allows her to catch autoimmune diseases earlier in life.
“So in that sense, it does help you to be a better rheumatologist,” she said, adding that the benefits are evident for patient experience.
“[Appointments] are unrushed now. We are not cramped for time. They have the ability to get ahold of me after hours, which makes it easier to consolidate patient care,” Dr. Joshi said. “We are able to save them time and prevent a lot of ER visits or urgent care visits, because we could handle things very quickly on the phone.”
While she described this model as “specialty agnostic,” she believes its impacts on rheumatology are exponential.
“There is an unmet need. I do believe that this may be the way forward for solo rheumatologists to continue their autonomous practice,” she said. “However, if you were to implement it on a bigger scale, I believe it would only be more successful.”
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