Doctors Are Looking at Independence Again. But They Aren’t Going Back to the Old Private Practice.

For years, the direction of physician practice seemed fairly clear. Doctors left independent practices and moved into hospital systems, large medical groups, and other employment arrangements, for familiar reasons: running a practice had become more expensive, payer requirements had become harder to manage, and the administrative burden of staying independent was difficult for a physician to absorb alone.

The numbers show how far that shift went. According to the American Medical Association’s 2024 Physician Practice Benchmark Survey, 42.2% of physicians worked in private practice in 2024, down from 60.1% in 2012.

But there’s an interesting development in 2026. Industry observers are beginning to see renewed interest in independent practice. Becker’s recently described a potential “2026 comeback,” pointing specifically to greater availability of MSO arrangements and other infrastructure that can make independence more practical for physicians.

That doesn’t mean physicians are simply reversing the trend of the last decade. The more interesting possibility is that they’re changing the definition of independence — that a physician can own the practice without building every administrative function inside it. That may be the model worth watching.

Private Practice Is No Longer an All-or-Nothing Decision

The traditional choice was fairly stark. A physician could become employed and gain administrative support, or remain independent and take responsibility for most of the business infrastructure personally. For a small practice, that could mean hiring and managing people for billing, credentialing, HR, IT, compliance, scheduling, and financial operations, even when the practice was too small to have a full-time specialist in each area.

The newer model separates ownership from infrastructure. The physician can retain ownership of the clinical practice while using outside organizations for functions that are expensive or difficult to maintain internally, which can include revenue-cycle management, credentialing and payer enrollment, HR and payroll, technology and IT support, financial operations, purchasing, compliance support, and contracting and network services.

The practice remains physician-owned. The infrastructure doesn’t have to be.

MSOs Are Part of That Shift

Management Services Organizations are one way physicians can build this infrastructure without recreating a large administrative department inside every practice. An MSO can provide nonclinical services across multiple practices, allowing administrative costs and expertise to be shared.

For a physician considering independence, that changes the starting calculation. The question is no longer simply whether the physician can afford to hire a complete back office. It’s whether the physician can identify which capabilities need to be controlled directly and which can be purchased from a specialized organization. Independence has never really required a physician to do everything personally; what’s changed is the number of organizations willing to provide the infrastructure around an independent practice.

Becker’s recent reporting on the 2026 independent-practice trend specifically points to the increased availability of MSO arrangements as one reason autonomy may be more achievable for physicians today.

Revenue Cycle Is a Good Test of the New Model

Consider billing. An independent practice needs someone to handle claims, payment posting, denial follow-up, accounts receivable, eligibility, payer issues, and reporting, but that doesn’t mean the practice needs to employ a separate specialist for every function. A physician-owned group can outsource some or all of its revenue-cycle operations while retaining visibility into the financial performance of the practice.

That distinction is important. Outsourcing the work doesn’t eliminate the physician’s responsibility for understanding the numbers. A practice owner should still know how much is sitting in A/R, which payers are generating the most denials, how quickly claims are being submitted, how long outstanding balances remain unresolved, whether collections are meeting expectations, and what’s happening to the practice’s cash flow.

The administrative function can sit outside the practice. The financial visibility shouldn’t.

The Same Logic Applies to Credentialing

Credentialing is another example. A physician may not need an employee sitting in the office every day whose sole responsibility is payer enrollment and recredentialing, but the practice still needs someone to know which payers the practice participates with, when each provider’s enrollment needs to be renewed, whether applications are pending, which documents are expiring, and what happens when a payer relationship changes.

For an independent practice, a missed credentialing deadline can become a revenue problem very quickly. Outsourcing the function can make sense; outsourcing awareness of the problem doesn’t.

The Risk: Independence Can Become an Ownership Label

There’s a less comfortable side to this model. A physician can own a practice legally while depending heavily on outside organizations for the decisions and systems that determine how the business operates.

That makes the details of an MSO or other management arrangement important. Before signing an agreement, physicians should understand who controls the revenue cycle, who owns or controls the practice’s operational data, how management fees are calculated, what services are included, what services cost extra, what financial reporting the physician receives, who handles payer relationships and credentialing, what happens to outstanding A/R if the relationship ends, and how the practice transitions if the agreement is terminated.

These aren’t secondary administrative questions. They determine how much practical control the physician actually retains.

There’s a Regulatory Line, Too

A management arrangement can also create legal and compliance issues that vary considerably by state. Corporate-practice-of-medicine restrictions can affect how physician-owned entities and management organizations are structured, and depending on the arrangement, federal and state rules concerning fee splitting, physician compensation, referrals, and other relationships may also need to be considered.

An MSO model shouldn’t be evaluated only on the basis of administrative efficiency; the structure needs to work legally as well as financially. Physicians considering an arrangement should have the proposed structure reviewed by counsel familiar with healthcare transactions and the applicable state rules before implementation.

The New Independent Practice May Be Smaller on the Inside

This may be the most counterintuitive part of the trend. An independent practice doesn’t necessarily need to look like the independent practices physicians remember from earlier in their careers. It may have fewer administrative employees, rely on more specialized vendors, use centralized technology for functions that once required additional staff, and share infrastructure with other physician-owned practices — and it may still be independently owned.

In other words, the practice can be small in its internal administrative footprint without being small in its capabilities. That’s a meaningful change.

What Physicians Should Evaluate Before Going Independent

The decision to return to ownership should begin with infrastructure, not just clinical demand. A physician considering an independent practice should be able to answer a few practical questions.

• Who will manage the revenue cycle? Don’t stop at “Who submits the claims?” Understand who owns denial follow-up, A/R management, payer escalation, reporting, and performance monitoring.
• Who controls the data? Know where billing and operational data are stored, who can access them, and what happens to that access if a vendor relationship ends.
• Who handles credentialing? Payer enrollment should be part of the practice launch plan; delays in credentialing can delay revenue, particularly when a new practice is depending on a limited number of payer contracts.
• What exactly does the management fee cover? “Full-service management” can mean very different things. The agreement should make clear which services are included, which are separately charged, and which responsibilities remain with the physician-owned entity.
• What will the owner actually see? A physician shouldn’t have to request basic information about collections, A/R aging, denials, or payer performance every time a financial question comes up. If the physician owns the practice, the owner needs a clear view of how the business is performing.

Independence May Be Becoming a Platform Model

The private-practice comeback, if it develops further, is unlikely to look like a return to the old model. The AMA data make clear how far consolidation has already progressed: private practice accounted for 42.2% of physicians in 2024, while hospital-owned practices accounted for 34.5%, up from 23.4% in 2012.

Nothing in the current data suggests this consolidation has simply reversed. What’s changing is the infrastructure available to physicians who want another option. The independent practice of 2026 can be physician-owned while relying on outside expertise for billing, credentialing, technology, finance, and other administrative functions.

That creates a third option between two older models — employment with infrastructure, or independence without it. The emerging model is closer to ownership with infrastructure.

For physicians, that could make independence more achievable. For the organizations supporting independent practices, it raises the bar: the value is no longer simply performing an administrative task, but providing the systems, expertise, and visibility that let a physician remain an owner without having to become an expert in every administrative function.

That may be the more important story behind the private-practice “comeback.” Private practice may not be coming back in its old form. It may be coming back as a platform.

Sources

1. American Medical Association, Physician Practice Characteristics in 2024, based on the 2024 Physician Practice Benchmark Survey.
2. The report found that 42.2% of physicians worked in private practice in 2024, compared with 60.1% in 2012.
3. American Medical Association, Physician Practice Benchmark Survey, updated April 27, 2026.
4. Becker’s Physician Leadership, Independent practice’s 2026 comeback, August 13, 2026.
5. The article specifically discusses the growing availability of MSO arrangements and their role in physician autonomy.
6. Becker’s Physician Leadership, The infrastructure rebuilding physician independence, July 20, 2026.
7. U.S. Department of Health and Human Services, Office of Inspector General, federal physician fraud-and-abuse authorities.
8. Centers for Medicare & Medicaid Services, physician self-referral law (Stark Law) guidance.