Solo Practice Is Dying. It Doesn't Have To.

In 2012, 53% of U.S. physicians owned their practice. By 2024, it was 35%. For the first time in history, most doctors are employees.

This isn't because solo practice is a bad idea. It's because the overhead became unbearable.

A solo clinician in 2026 needs an EHR ($200–400/mo), a billing service or biller ($2–4K/mo), a receptionist ($3–4K/mo), malpractice insurance, credentialing, compliance, IT support. Before you see a single patient, you're spending $8–10K a month just to keep the lights on.

So you join a health system. You trade autonomy for infrastructure. Somebody else handles the phones, the billing, the software. In exchange, you see the patients they tell you to see, in the time they give you, using the templates they chose. Your lunch break disappears. Your notes follow you home anyway.

The squeeze

It's not just overhead. Reimbursements have been flat or declining for a decade while costs climb. Adjusted for inflation, Medicare physician payment has dropped 33% since 2001, according to the AMA. Private payers follow Medicare's lead. Meanwhile rent, staff, and malpractice all go up.

The math stopped working. Not because clinicians aren't good at their jobs, but because the business of running a practice now requires a small army of people doing work that isn't medicine.

Who loses

Patients do. When your doctor joins a hospital system, wait times go up, visit lengths go down, and costs increase. Multiple studies in JAMA have found that practice acquisitions lead to higher prices with no improvement — and sometimes worsening — of quality.

Communities lose their local doctor. Rural areas lose access entirely. The clinician who knew your family for 15 years becomes a name on a rotating schedule.

The way back

Here's what's interesting: the clinical work hasn't changed. A solo clinician is exactly as capable as they were 20 years ago. What changed is everything around the clinical work — the admin, the paperwork, the phone calls, the follow-ups, the billing dance.

That's all work a machine can do now.

When your receptionist is AI, your scribe is AI, your follow-up coordinator is AI, and your EHR actually helps instead of hindering — the overhead math changes completely. A solo practice doesn't need five staff. It might need one, or zero.

Independent practice becomes viable again. Not as a nostalgic throwback, but as the most efficient way to deliver high-quality, personal care.

That's worth building for.