I’m an employed physician. And I’m happy about it. I have a great relationship with my hospital. I have tremendous autonomy over my schedule and my practice. Generally, I can choose when I operate. I’ve been able to build my practice around the procedures I enjoy and the patients I want to help. So, when I saw a recent headline from Becker’s Hospital Review that 82% of American doctors are now employed by hospitals or corporate entities, my immediate reaction wasn’t that physician employment is inherently bad.

But my second reaction was this: 82% is a staggering number.

Because regardless of whether you think doctors being employed is good or bad, we are witnessing a fundamental restructuring of the medical profession.

And that raises an important question: What happens when being employed doctors stops being one practice model among many and becomes the default?

The Numbers Are Pretty Incredible

The Becker’s article summarizes a new report from the Physicians Advocacy Institute and Avalere Health examining physician employment and practice ownership from 2018 through the beginning of 2026. And the numbers are striking.

More than 4 out of every 5 physicians are now employed by a hospital or corporate entity. Hospitals employ 59.7% of physicians, while corporate entities, including private equity firms and health insurers, employ another 22.3%. That 22.3% really surprised me and was more than I thought. Since 2018, 253,000 additional physicians have become employees while 152,200 fewer physicians are operating independently.

But there is another number that I think is just as important. Physicians now own only 36.1% of physician practices. In other words, only about 1 in 3 medical practices is still physician-owned. That number was 48.5% as recently as 2018.

And this shift isn't slowing much. Another 48,100 physicians became employed between 2024 and 2026 alone.

This isn’t a trend anymore. This is becoming the new structure of American medicine.

There Are Good Reasons Doctors Choose To Be Employed

Now, I think it is easy to look at these statistics and immediately conclude that this is terrible for physicians. But I don't think it is that simple.

After all, I'm part of the 82%.

And there are very real benefits to employed medicine.

Starting or buying a practice requires capital. You assume overhead. Plus you hire employees. You negotiate payer contracts. You manage billing. And you need to find office space. You buy equipment. And somehow you learn how to run a business while simultaneously trying to take care of patients.

Employment can remove a lot of that.

It can provide predictable compensation, benefits, institutional infrastructure, and less personal financial risk. Ideally, it allows doctors to spend more time actually being doctors.

My own experience demonstrates something else that I think is important…

Doctors being employed does not automatically mean a loss of autonomy.

I have maintained a huge degree of control over my schedule, my operative days, and the way that I have built my clinical practice. In fact, I’ve written previously about how employed physicians can intentionally build their perfect practice.

So I don't think the problem is necessarily that doctors are becoming employed.

The question that worries me is what happens when physicians have no realistic alternative to employment.

Where Does Physician Leverage Go?

A healthy employment relationship involves two parties who both possess leverage. The hospital or practice needs physicians. The physician values the hospital or practice's infrastructure. Both parties benefit from the relationship.

And, importantly, both parties have alternatives. But consolidation starts to change that equation. Imagine one or two large systems own most of the practices in your region. As a physician, you are theoretically still free to leave. But where exactly are you going to go?

This gets back to something I've written about before when discussing why doctors tolerate second-class treatment.

Physicians possess something incredibly valuable: our professional services. But that value only translates into leverage when we have the ability to decide where, when, and under what circumstances we provide those services.

As more physicians become employees, some of that leverage inevitably migrates from individual physicians toward the organizations employing them. That doesn't mean every hospital exploits its doctors. My own experience would argue strongly against making that blanket statement. But a great employer today does not guarantee a great employer tomorrow.

Leadership changes. Administrators change. Compensation formulas change. Productivity requirements change.

So ultimately, the best protection isn't benevolent leadership, it's leverage.

And an ecosystem in which only 18% of physicians remain independent inherently offers fewer alternatives than one with a thriving independent practice sector.

Patients Have Something at Stake Too

This is also where the conversation needs to move beyond physician compensation and working conditions. Because physician autonomy ultimately affects patients.

Large healthcare organizations can offer enormous advantages. They can provide sophisticated infrastructure, expensive technology, coordinated care, multidisciplinary teams, and administrative support that would be difficult for many independent physicians to replicate. But consolidation also creates the possibility that organizational incentives increasingly influence the practice of medicine. In fact, I believe that some of the reason that I still have so much leverage and autonomy as an employed physician is because the medical environment in Buffalo, NY where I practice remains relatively unconsolidated.

Consolidation impacts patients in a bunch of ways that could have negative implications for their care. Things like:

• How much time does a doctor get with a patient?
• Where do we deliver care?
• Who gets referred where?
• How is the clinic staffed?
• What productivity expectations are imposed?

Interestingly, a separate Physicians Advocacy Institute survey of 1,000 employed physicians found that more than half felt that changes in practice ownership had reduced the quality of patient care, while nearly half reported a negative impact on their relationships with patients.

Now, we need to put those numbers in the appropriate context

This was a survey of physicians reporting their own perceptions and experiences, not an objective measurement showing that employed practices deliver worse care.

Still, I don't think we should completely dismiss what physicians on the ground are reporting either. At minimum, it suggests that some doctors themselves perceive a tension between increasing consolidation and their ability to deliver care the way they would like.

And none of this means that these decisions automatically become inappropriate just because a physician is employed. But we should still ask, Who ultimately gets to decide how medicine is practiced? A physician can absolutely be an employee while maintaining meaningful clinical autonomy.

I know because I do it.

The challenge is making sure that remains an expectation of employed medicine rather than an exception.

Corporate Ownership May Be the Number We Really Need to Watch

There was another finding buried in these numbers that I almost missed. Corporate entities now own 33.2% of physician practices, compared with 30.6% owned by hospitals.

In other words, corporate entities now own more physician practices than hospitals do. Even though hospitals employ nearly three times as many physicians.

I think that's fascinating. And potentially important. “Corporate” is a broad category here and includes very different organizations and business models. It would be unfair to simply equate corporate ownership with private equity.

But it does raise a larger question. What happens when the organization controlling a medical practice becomes increasingly removed from the physicians actually delivering the care and more centered around turning a (bigger) profit?

Medicine is obviously a business. Anyone pretending otherwise isn't paying attention. But medicine is not only a business.

And I think preserving that distinction becomes increasingly important as ownership moves farther away from practicing physicians.

I Still Think Employed Medicine Can Work Extremely Well

Despite all of this, I have no immediate desire to leave employed medicine.

I enjoy practicing medicine. I enjoy operating. And my current arrangement largely allows me to practice the way that I want.

In fact, I've written about what it would actually take to make me walk away from surgery. Loss of autonomy ranks much higher on that list than simply being employed.

That's an important distinction.

Maybe the answer isn't recreating the private-practice landscape of 30 years ago. Maybe the future is building better employment models. Models where physicians retain meaningful clinical autonomy.

Where physicians participate in governance. Where we understand our economic value. A model where compensation is fair and transparent. And, importantly, where physicians retain credible alternatives if an employment arrangement stops working.

But for this to happen, doctors need a seat at the table. And we need to create our own leverage to do that…

Financial Independence Matters Even More in an Employed World

This is also where physician personal finance enters the equation. If 82% of physicians are employees, I would argue that financial independence becomes more important, not less.

Because financial freedom creates individual leverage when structural leverage is disappearing.

A physician who cannot afford to leave an employer has limited negotiating power. A physician who could leave, but chooses to stay, approaches that exact same employment relationship very differently.

This is one reason financial independence has never meant retiring from medicine to me. It means practicing medicine because I want to. It means being able to say no. It means having options no matter what the dominant medical practice model is at the time.

Because options may become increasingly valuable as the number of practice options available to physicians continues to shrink.

Employment Isn't the Enemy. Lack of Choice Is.

82% physician employment does not mean American medicine is doomed. My own career is evidence that employed doctors can be happy, productive, autonomous, and professionally fulfilled.

But 82% should still make us pay attention.

A profession functions differently when the overwhelming majority of its members work for increasingly consolidated organizations. So maybe the most important question isn't whether physicians are employed or independent.

It's whether physicians maintain enough autonomy, economic leverage, and professional voice to continue shaping the profession that we spent our lives training to practice. Financial freedom gives us the opportunity to do this at an individual level. Multiply that by all of the physicians in the country or world and we would have something very powerful…

What do you think? If you're an employed physician, has employment given you more freedom or less? And at what point does physician employment become too concentrated for the profession's own good? Let me know in the comments below!