It’s no secret that private practices are a dying breed. In 2025, the percentage of clinicians in private practice plummeted to 45%… and I can’t imagine that percentage will increase anytime soon. As the landscape evolves, hospital systems are monopolizing.
The Rise of Hospital Systems
Across the country, large hospital systems and corporate entities rapidly are acquiring independent practices. The way medicine is practiced is changing.
According to the American Medical Association’s report, three primary forces are pushing private practices to sell:
- Payment Negotiation Power
Independent practices lack leverage when negotiating with insurance companies. Larger systems, on the other hand, can command higher reimbursement rates simply due to their size.
- Access to Resources
From advanced technology to staffing infrastructure, larger organizations provide tools that are often out of reach for smaller practices.
- Administrative Burden Management
Billing, compliance, prior authorizations, and regulatory requirements have become overwhelming. For many clinicians, the administrative load is no longer sustainable without institutional support.
At its core, this shift symbolizes one truth: The people that hold the money hold the power.
The Benefits of Private Practice
When physicians own the practice, they get to make the calls. There is no corporate directive making decisions for us- nobody pushing their financial motives on us. In hernia care, that’s a big deal. As many of my previous blogs outlined, robotics and other high tech resources are not what’s best for patients. On top of that, we get to form relationships with the people who matter most… the patients. We create and manage our schedules, leaving time to answer questions, form connections, and reassure patients. Private practice allows us to maintain our patient-centered focus.
What Does This Shift Mean For Private Practice?
Well, it means we have to restructure in order to survive. At Boston Hernia, this means we have opted out of most insurances. With little payment negotiation power, insurances put up barriers that are hard to cross. If we cannot support the practice, we cannot take care of patients.
And it’s not just about reimbursement, it’s about the cost of getting paid.
Prior authorizations, endless denials, and increasing reliance on AI-driven decisions have made the process more impersonal and more difficult. In many cases, there’s no one to speak to, no real recourse, and no physician-to-physician discussion.
Meanwhile, operating costs continue to rise while reimbursement stagnates—or even declines.
So the pressure is coming from both sides: higher costs and harder access to payment.
Final Thoughts
Private practice isn’t just a business model. It’s much deeper than that. It’s a philosophy of care.
And while the system may be shifting away from it, those who remain are being forced to rethink, rebuild, and redefine what independence in medicine looks like. All for the benefit of the patients.