Independent practice in 2026 is not for the faint of heart. Between 2019 and 2023, the share of independent physician practices owned by hospitals, health systems or other corporate entities jumped from 39% to 59%. Over the same period, physician employment by these entities rose from 62% to 78%, according to a December 2025 report from the Progressive Policy Institute.
Yet some have managed to not only survive, but thrive, amid an onslaught of consolidation efforts by hospitals, health systems and corporate entities over the last decade. Chattanooga, Tenn.-based University Surgical Associates, for example, recently hit 50 years of independent practice. The once-small organization, founded by two physicians in 1976, has grown to include more than 30 surgeons and additional clinician team members.
University Surgical Associates’ CEO Katie Duffy, PharmD, recently joined Becker’s to discuss the keys to keeping an independent practice growing amid increased competition in today’s healthcare industry.
Editor’s note: Responses have been lightly edited for clarity and length:
Question: Independent practices across the country are fighting for survival in 2026. What has been key to keeping your organization not just surviving, but growing and thriving over the last 50 years?
Dr. Katie Duffy: We are fortunate that our founding mission is putting the patient first in everything we do. That principle guides every decision we make, from recruiting surgeons and selecting locations to technology investments. We believe this will never fall out of fashion, no matter how much the healthcare industry evolves. We have also formed longstanding partnerships with local hospital systems, as well as the region’s premier college of medicine to train the next generation of surgeons. These strategic partnerships, along with our team’s uncompromising commitment to quality care, are key reasons that University Surgical Associates is celebrating a golden anniversary in 2026 — while looking ahead to the next 50 years of serving this community.
Question: What trends do you see having the biggest impact on the industry over the next few years?
Dr. Duffy: AI is affecting every aspect of healthcare. We are leaning into it at USA. From ensuring our surgeons show up in AI searches when patients seek care, to automating the scheduling, registration, charting, and charge capture processes. We are leveraging these tools to modernize the patient experience, free our surgeons from administrative tasks, and run our practice more efficiently.
Question: What’s one piece of advice you’d give to someone looking to go into independent practice right now?
Dr. Duffy: Partnerships are a key to success for independent practices. It is almost impossible to survive in a silo with payers gaining more leverage, Medicare reimbursements flat or declining, and the costs to support a practice increasing every year. We work closely with other independent groups as well as all local hospital systems to ensure our patients have timely access to care and surgeons have the resources and support they need. From a physician’s standpoint, independent practice still provides a way to protect professional fulfillment and reduce burnout while empowering doctors to create a more efficient and patient-centered experience.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.