Why the Decline of Private Practice Matters for Every PA

Chart showing physician private practice declining from 60 percent in 2012 to 42 percent in 2024

If you caught my recent Reel, you know where this is going.

But a second 60 second video can only carry so much, and this topic deserves the full treatment.

Because the decline of physician private practice is not just a doctor problem. It is a barometer for how much trouble all of us are in, and PAs have more skin in this game than you realize.

The numbers, because I don't do vibes

In 2012, 60.1 percent of physicians worked in private practice. By 2024, that number had fallen to 42.2 percent, an 18 point drop in twelve years [1]. And the slide has not stopped. As of January 2026, only 18 percent of physicians practice in physician-owned settings, and non-physician entities now own 63.9 percent of all US medical practices, up from 29.8 percent in 2018 [2].

Put differently: nearly four out of five doctors in this country are now employees of hospitals, health insurers, private equity firms, or pharmacy chains [3]. In 2012 it was about one in four.

This did not happen because doctors suddenly lost interest in owning their work. It happened because the economics were engineered against them. Declining inflation-adjusted Medicare rates, consolidation among insurers and hospitals, crushing administrative overhead, and payer negotiations that structurally favor size [1]. Independent practices were not outcompeted. They were out-leveraged.

Why this costs you money as a patient

Here is the part that should make everyone angry, regardless of profession.A 2025 study from the National Bureau of Economic Research examined what happens to prices after a hospital acquires a physician practice. Within two years, physician prices rose an average of 15.1 percent. The researchers found no discernible improvement in quality. None.

What they did find was a 4.5 to 8 percent increase in cesarean section rates, a pattern often interpreted as physician-induced demand rather than better care [4].

Same doctor. Same procedure. Same outcomes. Higher price. The only thing that changed was the name on the paycheck.

The pattern holds across specialties. Hospital-affiliated specialists negotiate prices 16.3 percent higher for cardiology procedures and 20.7 percent higher for gastroenterology procedures compared to independent physicians doing identical work [5]. The Government Accountability Office reviewed the literature and reached the same conclusion: physician consolidation increases spending and prices with generally no change in quality of care [6].

And here is the kicker. An estimated 99.9 percent of these practice acquisitions fell below federal reporting thresholds for merger review. A trillion dollar industry was fundamentally restructured with virtually no antitrust scrutiny [4].

Why PAs Should Care

A focused surgical team works diligently in the operating room, utilizing advanced microscope technology to perform a delicate procedure.

This is where I want to slow down, because the connection between physician private practice and PA compensation is not obvious until you see it. Then you cannot unsee it.

1. Private practice is where your revenue is visible.

When you work for a surgeon who owns the practice, the economics are legible. The owner knows what you bill, what you collect, and what your presence makes possible. Every case you first assist, every clinic slot you cover, every patient you see shows up somewhere on a ledger that the person across the negotiating table actually reads.

That visibility is leverage. You can walk into a compensation conversation with your production numbers and have a real discussion between two people who both understand the math.

When you work for a health system with 40,000 employees, your revenue does not disappear. It just becomes invisible to you. It gets absorbed into a department budget, rolled into a service line, and reported to people you will never meet. Your compensation gets set by a salary band built from national survey data, administered by an HR committee that has never seen a patient in their life.

You are not negotiating against your value anymore. You are negotiating against a spreadsheet cell.

2. The employer that hides physician value hides yours too.

Physicians see their income decline by an average of roughly $2,987 after their practice is acquired, and independent physicians consistently out-earn their employed counterparts [7]. If the system compresses the compensation of the people with the most training, the most political capital, and the most direct billing authority in the building, what do you think it does one rung down?

PAs generate substantial, measurable revenue. In surgical settings especially, first assist fees, billable visits, and the throughput we enable are all quantifiable. But the more consolidated your employer, the more layers sit between the revenue you generate and the person who decides your salary.

Consolidation does not just raise prices for patients. It severs the link between production and pay for everyone who produces.

3. Fewer independent practices means fewer alternative employers.

Negotiation leverage is not just about your numbers. It is about your alternatives. When a market has thirty independent surgical groups, a PA with strong production data has thirty potential bidders. When those thirty groups get absorbed into two health systems, your outside options collapse, and now the surgeon has no hiring power and a lot of times your boss or their boss is a non clinical entity. Labor economics is not complicated here. Monopsony power suppresses wages, and healthcare consolidation is building monopsony power in market after market.

4. Independent practices are where PAs are more free to work up to their full scope

Small practices run lean. They cannot afford to have a PA functioning at half capacity, so they do not. You get scope, you get responsibility, and you get the case volume that builds both skill and negotiating position. Large systems, by contrast, often deploy PAs based on staffing grids and compliance comfort rather than capability. The decline of private practice is quietly shrinking the number of settings where PAs practice at the top of their license.

Beyond the paycheck

Compensation is where I live, but it is not the only thing on the table.

Consolidation reshapes the entire experience of being a PA, and most of it never shows up on an offer letter.

Collaborative Clinical Independence and how you actually practice.

Independent practices run on clinical judgment. Corporate systems run on protocols, order sets, and productivity dashboards and cookbook medicine.

The Physicians Advocacy Institute data shows this concern is not theoretical: employed physicians, especially in rural areas where 80.2 percent are now employed, report real erosion of autonomy and worry about impacts on patient care [2]. If the physicians are losing decision-making authority to administrators, PAs are not somehow exempt. From being forced to refer patients within the system, and not who is best qualified to receive the patient referral. All the way to edging out experienced clinicians and replacing them with green staff to keep costs down.

True mentorship in medicine is being strangled.

The same utilization committees, documentation mandates, and throughput targets land on us, often harder, because we have less institutional power to push back.

Burnout is a systems problem, and consolidation builds the system.

I wrote an entire toolkit on burnout, so let me be blunt about the mechanism. Burnout is not a resilience deficit. It is the predictable result of working in an environment where you have high responsibility and low control.

Consolidation is a machine for stripping control from clinicians: your schedule set by a staffing algorithm, your patient volume set by an RVU target, your clinical decisions second-guessed by prior authorization and internal utilization review. Every practice that gets absorbed converts a workplace where clinicians set the terms into one where they absorb the terms.

We are now forced to practice at the top of reimbursement, not at the top of our licenses.

Care quality, which is the whole reason we do this.

The evidence keeps landing the same way: after acquisition, prices go up and quality does not [4, 6].

Worse, some patterns move in the wrong direction, like the 4.5 to 8 percent rise in cesarean rates after integration [4] and emerging research on increased low-value care following hospital and private equity acquisition of primary care practices [5].

PAs became PAs to take care of people. Practicing inside a structure that is financially rewarded for doing more to patients rather than more for them is a moral injury generator, and it corrodes the profession from the inside.

Career pathways that consolidation quietly forecloses.

In an independent practice, a proven PA has trajectories that do not exist inside a health system: profit sharing, production bonuses tied to actual production, practice management roles, and in many states genuine ownership or partnership stakes. Some of the most financially free PAs I know built that freedom through equity in a practice, not through a salary. When practices consolidate, that entire ladder gets removed and replaced with a clinical ladder that tops out at a title change and a 3 percent bump.

Job security is worse than it looks.

Here is a detail from the 2026 PAI data that should stop you cold.

Corporate entities acquired more practices than hospitals did in 2024 and 2025, some 8,000 practices, yet their physician employment grew only 0.9 percent, raising real questions about post-acquisition clinician shedding [2]. Buy the practice, keep the patient panel and the referral streams, and quietly reduce headcount. If that is the playbook for physicians, PAs and the rest of the clinical staff are the easier line items to cut. A diverse market of independent employers is not just leverage. It is redundancy. It is your professional safety net.

Your patients, and your own family, pay the bill.

Every PA is also a patient. When physician prices jump 15 percent after acquisition [4], that flows into premiums, deductibles, and the facility fees that get bolted onto a visit the moment a practice becomes hospital-owned. You will pay for consolidation twice: once in suppressed wages and once in your own family's healthcare costs. And you will watch your patients delay care, split pills, and skip follow-ups because of prices that bought them nothing.

The Barometer

So when I say I am rooting for doctors in private practice, understand what I am actually saying. Independent practice is the last environment in medicine where the person doing the work and the person controlling the economics are the same person. Every practice that gets absorbed moves us closer to a system where every clinician, physician and PA alike, is a cost center to be managed rather than a producer to be compensated.

The docs are the canary. We are all in the coal mine.

What you can actually do about it

You cannot single-handedly reverse a decade of consolidation. But you can refuse to be invisible inside of it.

Whether your employer is one surgeon or one conglomerate, the first step is the same: know your numbers.

Calculate what you actually generate.

Track your cases, your billables, your first assist revenue.

Because the entire consolidation playbook depends on clinicians not knowing what they are worth. The moment you can put a number on your production, you have taken back the one piece of leverage no employer can absorb, acquire, or amortize.

You cannot negotiate what you cannot measure. So measure it.

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References

1. American Medical Association. "More physicians move to practices owned by hospitals, private equity." AMA Physician Practice Benchmark Survey, May 2025. https://www.ama-assn.org/press-center/ama-press-releases/more-physicians-move-practices-owned-hospitals-private-equity

2. Physicians Advocacy Institute / Avalere Health. Physician Employment and Practice Acquisition Trends, 2026 update. Coverage: Medical Economics, June 2026. https://www.medicaleconomics.com/view/physician-independence-vanishes-as-corporate-medicine-swallows-up-u-s-health-care

3. Physicians Advocacy Institute / Avalere Health. Updated Report on Physician Employment and Practice Ownership Trends, April 2024. Coverage: Healthcare Dive. https://www.healthcaredive.com/news/doctor-corporate-ownership-growing-hospital-insurer-pai-avalere/712988/

4. Cooper Z, Craig SV, Epanomeritakis A, Grennan M, Martinez JR, Scott Morton F, Swanson AT. "Are Hospital Acquisitions of Physician Practices Anticompetitive?" NBER Working Paper 34039, 2025. https://www.nber.org/papers/w34039

5. Health Affairs. "Hospital- and Private Equity-Affiliated Specialty Physicians Negotiate Higher Prices Than Independent Physicians." 2025. https://www.healthaffairs.org/doi/10.1377/hlthaff.2025.00493

6. US Government Accountability Office. "Health Care Consolidation: Published Estimates of the Extent and Effects of Physician Consolidation." GAO-25-107450, September 2025. https://www.gao.gov/products/gao-25-107450

7. Health Affairs analysis of physician income following practice acquisition; Becker's ASC Review, "50 stats behind the physician consolidation wave," December 2025. https://www.beckersasc.com/asc-transactions-and-valuation-issues/50-stats-behind-the-physician-consolidation-wave/