Physician ownership is steadily giving way to hospital systems, private equity and large corporate platforms, but many physicians say control over care decisions does not have to disappear with it.
Twelve physicians joined Becker’s to share how they see power, autonomy and influence in medicine shifting over the next few years.
Question: How do you see the balance of ownership and control in medicine shifting over the next few years?
Editor’s note: Responses have been lightly edited for clarity and length.
Michael Boczar, MD. Former Emergency Physician and Chair of Contracting at Hurley Medical Center (Flint, Mich.): The loss of independent practitioners secondary to private equity and giant healthcare corporations will continue to accelerate. Over my clinical career, there has been a significant shift in who gets to be the decision-maker. As a physician, I understand this may be a biased stance, but the pendulum of the extraordinary power non-physicians have in practicing medicine needs to swing in the opposite direction. Without governmental intervention, patients will continue to have their care dictated by numerous entities, not their care provider. I was never a proponent of a single-payer system until I undertook the role of negotiating contracts. The obscene profits raked in by these companies diverts money away from patient care. People used to say that owning a NFL team was a “license to print money.” I would include starting a healthcare insurance company in that category.
George Chiang, MD. Neurologist at Rady Children’s Hospital-San Diego: Given the continued decrease in healthcare funding at the federal and state level, I don’t see how physician ownership is even possible. Certainly we are seeing attempts at safeguards in the role that PE can take, but the control and ownership will continue to shift towards the larger integrated healthcare delivery networks.
Sandeep Goyal, MD. Medical Director, Cardiac Electrophysiology Labs at Piedmont Heart (Atlanta): Traditional independent ownership will continue to decline in many markets due to reimbursement pressures and administrative complexity. However, physicians who develop operational, financial and service-line leadership expertise will retain meaningful influence within larger organizations. While ownership may become more institutional, strategic control will increasingly rest with physicians who understand both clinical outcomes and system economics.
Mara Hermiston, MD. Chief Medical Officer of Avera Medical Group (Sioux Falls, S.D.): Healthcare has become too complex for any single discipline to govern effectively. As ownership in medicine continues to consolidate among health systems, the distinction between ownership and control becomes increasingly important. At Avera, we have long embraced dyad leadership as a foundational operating principle. Within a dyad, physicians leverage their clinical knowledge and understanding of workflows. Administrative leaders, in turn, work on behalf of physicians to design systems at scale which enable clinical priorities.
Alvaro Andrés Macias, MD. Associate Professor of Clinical Anesthesia at the University of California San Diego: I see a continued drift toward corporate control. The data about this is very clear: A generation ago, most doctors owned their practices. Today, roughly 70% work as employees of hospitals, large groups, or private equity-backed organizations. That number keeps climbing, and I don’t see it reversing.
What’s driving consolidation:
Running an independent practice has become brutally difficult. Insurance billing complexity, low reimbursements, electronic records mandates, regulatory requirements, staffing challenges — all of it favors scale. Young physicians graduate with $200,000+ in debt and often prefer a predictable salary over entrepreneurial risk. Large organizations negotiate better rates with insurers and spread administrative costs across more providers. It is a continuous loop that, for now, cannot be broken.
Private equity has poured billions into healthcare over the past decade, acquiring physician practices in specialties from dermatology to anesthesiology to emergency medicine. Their playbook is familiar: consolidate, cut costs, boost revenue, sell in five to seven years. This is what is also driving the shortage and burnout.
Expect 75% to 80% of physicians to be employed by 2030. Independent practice will increasingly survive only in niches — concierge medicine, specialized procedures, rural areas where big systems haven’t expanded.
Some countervailing forces exist. Regulatory scrutiny of PE healthcare investments is growing. The FTC’s crackdown on noncompetes could increase physician mobility. Younger doctors prioritizing work-life balance may sustain locum and part-time models that offer more autonomy than traditional employment.
We doctors may have less say over scheduling, referrals and time per visit. Decisions about staffing flow from administrators and spreadsheets rather than clinical judgment. Consolidation reduces competition, which rarely benefits consumers in terms of price or choice. The physicians who thrive in this environment will be those who understand they’re in the healthcare business and negotiate accordingly.
Tom McGue, MD. Former Physician in Newport, R.I.: Private practice will continue to evolve toward concierge services in affluent areas. Merging of practices will occur as large corporations and hospital systems acquire independent physician practices.
Jean-Perre Mobasser, MD. Neurologist at Goodman Campbell Brain and Spine (Carmel, Ind.): The balance of ownership and control in medicine has historically functioned like a pendulum. Decades ago, physicians held nearly total control but perhaps took that autonomy for granted, failing to anticipate the growing need for systemic financial oversight. In the vacuum that followed, insurance companies and government entities asserted control, implementing top-down solutions to address inefficiencies. Unfortunately, this shift has often prioritized administrative metrics over clinical ones, resulting in deteriorating physician satisfaction and, more importantly, compromised patient care.
I believe we are at a turning point where physicians must reclaim their roles as the primary leaders in healthcare. To resolve the current financial crisis, we need leadership that understands the nuances of patient care. Currently, the U.S. spends significantly more than other industrialized nations while achieving poorer outcomes. To stabilize the system, physicians must lead the transition toward value-based care, emphasizing preventive medicine and healthy lifestyles. By integrating clinical expertise with meaningful financial stewardship, we can move away from the current administrative-heavy model and back toward a system that prioritizes the patient-physician relationship.
Kian Modanlou, MD. Hepatobiliary Surgeon at Surgone (Englewood, Colo.): I feel that there will likely be a backlash from the consolidation of practices into corporate and private equity interests, which will create issues for healthcare delivery. We are already seeing this in anesthesia, where some of the top performers are leaving groups and going for big money in desperate markets.
Brandon Ortega, MD. Orthopedic Spine Surgeon at Long Beach Lakewood Orthopaedic Institute: I think consolidation will continue, particularly as hospitals, payers and private equity groups bring capital and contracting leverage that individual physicians often cannot match alone. That said, I don’t think physicians are giving up control entirely, I think it’s evolving. More physicians are becoming intentional about maintaining ownership in areas that drive long-term financial stability, such as ASCs, ancillary services, digital care platforms and MSO-style infrastructure. I suspect the future will look more like hybrid alignment models where physicians may be clinically employed or partnered with larger systems, but still retain ownership interests that allow them to participate in the economic value they help create.
Neil Parikh, MD. Gastroenterologist at Connecticut GI (Farmington): Care delivery will decentralize. The primary force for decentralization away from hospital-driven inpatient care will be cost. Home-based care, virtual care, remote patient monitoring is just the start. You will continue to see a shift in site-of-care where traditional hospital-based procedures will be done at ambulatory procedure centers.
Joshua Siegel, MD. Director of Orthopaedic Sports Medicine at Access Sports Medicine and Orthopaedics (Exeter, N.H.): [I am] hoping that the pendulum has swung as far as it will and that physicians will recognize the vast opportunities outside of corporate or large hospital ownership. I think we will start to see physicians take back their independence and offer new and emerging delivery models. The hospital-employed physician has a role in medicine and will always exist, yet it is a dinosaur that has created “waiting” rooms and undecipherable billing and collection practices, obscured pricing, crazy “pre-approval” processes, “prior authorizations” and the like. The accountability in that system, like it or not, is based on the entity paying and when that is the insurance company rather than the patient. Therefore, the provider ends up consciously or subconsciously working within the framework insurances have provided rather than the best interest of the patient. New physicians who grow up in a new model of patient-focused service will want closer relationships, less obstructions, more time and better pay. These are all value opportunities that private or semi-private practice can offer.
Frank Vrionis, MD. Neurosurgeon at Baptist Health South Florida (Boca Raton): Clearly the balance of ownership and control in medicine has been in favor of hospitals and private equity. This is a trend that has been in place for over 10 years and is likely to accelerate. It is necessarily an unwelcome transition as it offers physicians financial stability, call coverage, fewer hassles with practice management and overhead but at the price of reduced autonomy. Many physicians would consider it a fair trade at this point.
Opinions expressed by Dr. Vrionis are his own.
