The Private Practice Resurgence: Why Physicians Are Staying Independent in 2026

For the last 15 years, the narrative was clear: private practice was dying. Consolidation was inevitable. Physicians would either sell to private equity or get absorbed by hospital systems. The only question was when.

That narrative is breaking down.

In 2024, for the first time in a decade, the percentage of physicians in independent practice stopped declining. According to the American Medical Association, 42.2% of physicians now own or lead their own practices, up from a low of 38% in 2021. Smaller practices are growing faster than large ones. Physicians who sold to PE-backed platforms are buying back their independence. The resurgence isn't universal, but it's real.

This isn't nostalgia. It's economics.

Why the Narrative Changed

The PE acquisition wave of 2015-2020 was built on a simple theory: consolidation creates efficiency, efficiency creates margin, and margin creates returns. The theory had merit. Consolidation does create some efficiencies. But it also creates costs that PE models didn't fully account for.

When a PE firm acquires a practice, they typically implement standardized systems, centralized management, and aggressive revenue targets. On paper, this looks like optimization. In reality, it often feels like loss of autonomy to the physicians and staff who built the practice in the first place.

The result has been predictable: physician burnout, staff turnover, and patient dissatisfaction. A 2023 Bain & Company study found that physician satisfaction in PE-backed practices declined significantly in the first two years post-acquisition. The practices that performed best were the ones that gave physicians autonomy within a framework of operational discipline.

The Data

The AMA's 2024 Physician Practice Characteristics report shows:

• 42.2% of physicians are in independent practice (up from 38% in 2021)
• Solo and small group practices (2-10 physicians) are growing at 3.2% annually
• Physician-owned practices report higher satisfaction scores than hospital-employed or PE-backed peers
• Practices that stayed independent during the consolidation wave report stronger financial performance

The GAO's 2025 Healthcare Consolidation report noted that PE-backed practices have higher physician turnover, higher patient complaint rates, and lower quality scores on several metrics compared to independent practices.

What This Means for Your Practice

If you're independent, the resurgence creates opportunity. The market is no longer asking "should you stay independent?" It's asking "how do you stay independent well?" That's a different question, and it has an answer.

If you're considering a PE offer, the data suggests you should think carefully. PE isn't the only path to growth or capital. Physician-led partnerships, strategic partnerships with other practices, and retained earnings are all viable alternatives.

The practices that will thrive in the next decade are the ones that choose independence intentionally and build the operational foundation to sustain it.