Physician autonomy has become a growing flashpoint for both independent and employed physicians as the practice of medicine becomes more intertwined with politics, finances and technology.
Five physicians recently joined Becker’s to discuss how they’re defining autonomy in 2026.
Editor’s note: Responses have been lightly edited for clarity and length:
Richard Chazal, MD. Medical Director of Heart Health, Lee Health Heart Institute (Fort Myers, Fla.): Increasing pressure on physician practices has resulted in a migration away from independent practice toward employment or partnership models. This trend isn’t likely to disappear and will continue to impact physician autonomy. While infrequently discussed, many believe that one of the motivating factors for pursuing a career in medicine is the desire for some degree of control, which is eroded in newer models. For physicians seeking a sense of control over their practice … and especially for those accustomed to such … this can be discouraging when migrating to a system where decisions are now made without practitioner input. For many, the partial solution has been an effort on the physicians’ part to inject themselves into the planning and decision process, rather than solely practicing medicine. This involves extra effort but can reduce frustration. Such efforts are, however, dependent upon the system in which one labors. Some organizations may not wish to cede any control to employed physicians. Others may appreciate the benefit of input from interested and educated clinicians … and the potential for improved workforce satisfaction and stability.
Daniel Decker, MD. Urologist (Mountain Home, Ark.): Physician autonomy in 2026 is complex and constantly evolving. As hospital systems increasingly move toward physician consolidation, autonomy is on the decline unless those physicians are in a unique system or independent. Physicians must maintain leadership roles in employed models to maintain a seat at the table. 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. 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.
Joe deKay, DO. Family Practice Physician (Hiram, Maine): Physician autonomy lives in leadership as one increasingly has to be at the table in negotiations.
Nagashree Gundu Rao, MD. System Division Chief, Inova Endocrinology (Fair Oaks, Va.): In 2026, physician autonomy, in my perspective, is subject to competing incentives and regulatory requirements, creating a push-pull in decision-making. 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. Independent practices preserve autonomy but may be subject to lower reimbursement rates, rising operating costs and limited negotiating leverage with payers. A few organizations, including Inova Health, fortunately, value physician leadership. The lack of perceived physician autonomy in favorable settings, can, however, be an unintended consequence of administrative hierarchy. As leadership layers increase, clinical insight is diluted before reaching decision-makers. Leadership rounds do offer opportunity to solicit critical feedback from frontline physicians. However, how often do executive leaders engage in a discussion with a specific physician group, gather feedback before announcing decisions that directly impact patient care and workload of physicians? I am excited to see an increasing number of physicians with strong business acumen or “medically trained entrepreneurs,” administrators with nursing backgrounds or administrators who understand the realities of care delivery. With this cross-over of skills, I hope to see an increase in physician autonomy. Increased use of AI in 2026 and beyond will continue to impact physician autonomy. While ambient AI documentation helps decrease administrative burden, AI-driven algorithms and standardization may potentially oversimply complex clinical care.
Rhett McLaren, MD. Premier Pediatric Consultants (San Antonio):
As a young medical student and pediatric resident in the 1990s, I recall hearing older physicians complain about clinical pathways as “cookbook medicine” and diagnosis-based payments as the “end of medical care.” At the time, I felt senior physicians’ concerns were over-stated and reactionary. Most of my career since then I felt that those worst case scenarios did not materialize and the essence of being a physician was preserved.
Unfortunately I cannot say the same about the last five to seven years of my career. The introduction of the electronic healthcare record has facilitated ever increasing levels of administrative and third-party payer oversight and documentation requirements that have eclipsed the practice of medicine beyond what I could have ever imagined. This is combined with shrinking formularies and increased administrative barriers to the ordering of imaging, procedures and testing.
Added to the constraints imposed by third-party payers now is the acquisition of healthcare entities by investors. Investors by definition are only interested in increasing revenue for themselves through whatever means possible. In my personal experience, this means increasing the number of patients seen in a given period of time, ordering testing and screening beyond what is indicated or needed, and assigning diagnoses that are not relevant and were not addressed during patient encounters. All of this while being provided marginally qualified staff of diminishing numbers.
I am not optimistic about any changes to these trends for 2026. In fact, as the payers assert more control over spending and investors make more acquisitions and mergers these headwinds are set to accelerate to the point that physician autonomy will be relegated to stories of the long past from senior physicians.
