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For the better part of a decade, the story in medicine was simple: doctors were leaving private practice in droves. The administrative burden was too heavy. The reimbursement rates were too low. The stability of a hospital paycheck was too appealing to turn down.
By 2024, nearly 78% of physicians were employed by hospitals, health systems, or other corporate entities. Private practice ownership had fallen to its lowest point in modern history.
But something is changing.
A growing number of employed physicians are looking back toward ownership — and many of them are actively buying practices. Not because the challenges of running a business have disappeared, but because the tradeoffs of employment have become harder to ignore.
What pushed doctors toward employment in the first place
To understand why physicians are reconsidering ownership, it helps to understand what drove so many of them away from it.
The shift started well before the pandemic. Medicare reimbursement rates were cut repeatedly, adjusted for inflation, physician payments declined by more than 29% between 2001 and 2024. At the same time, the cost of running a practice kept rising. Rent, staff wages, malpractice insurance, EHR systems, compliance requirements, all of it got more expensive every year.
For a solo practitioner or small group, absorbing those increases while also negotiating with large insurance networks became nearly impossible. Hospitals could negotiate better rates, spread costs across more physicians, and offer doctors a guaranteed salary in exchange for giving up ownership. For many physicians, that deal made sense.
Add in the administrative complexity of running a small business, something medical school does not prepare anyone for, and the appeal of just showing up, seeing patients, and letting someone else handle the rest became very strong.
Why that deal is looking worse now
The problem is that what hospitals and health systems offered in exchange for ownership didn't fully deliver on its promise.
Employment was supposed to mean less stress. For many physicians, it has meant a different kind of stress, more bureaucracy, less say over how they practice, and pressure to see more patients in less time. Survey data consistently shows burnout running higher among employed physicians than among those in physician-owned settings. One study found burnout rates of 62% among employed physicians, compared to 13.5% in independent practices.
The stable paycheck came with a cost that wasn't in the contract: your autonomy.
Nearly 25% of physicians currently working in hospital or health system settings say they are thinking about making a change. And of those, more than a third say they want to move toward physician-owned practice, not toward another employer. That’s a significant number of doctors who have tried employment, found it lacking, and are now looking at ownership as the answer.
What ownership actually offers that employment doesn't
The doctors moving back toward ownership are not doing it because they think it’ll be easy. They’re doing it because they’ve run the math, financially and personally, and the calculus has changed.
The income argument
Employed physicians receive a salary. Practice owners receive the profits of a business. In a well-run practice, those can be very different numbers.
Research consistently shows that physicians in private practice out-earn their employed peers over the long run, particularly in surgical specialties. Surgeons in private practice earn roughly 11% more on average than those employed by hospitals. In some specialties, the gap is wider.
More importantly, ownership builds equity. A hospital paycheck stops when you stop working. A practice, built and run well, is an asset that can be sold. That's a retirement strategy that employment simply cannot replicate.
The autonomy argument
This one is harder to put a number on, but it may be the most important factor for many physicians. When you own your practice, you decide how long appointments are, which patients you take, which procedures you offer, and how your staff is treated. You set the culture.
In an employed setting, those decisions are made by administrators, operations teams, and executives whose priorities may not align with yours or your patients'. For physicians who went into medicine to practice medicine a certain way, that loss of control is deeply frustrating, and it compounds over time.
The burnout argument
This one surprises people. The assumption is that ownership is more stressful — more responsibility, more risk, more things that can go wrong. And that's true. But the research suggests that the type of stress matters as much as the amount of it.
Physicians in independent settings report higher levels of professional satisfaction and lower rates of burnout than their employed counterparts. The leading theory is that autonomy, having control over your work, is a buffer against burnout in a way that a salary and benefits package simply isn’t.
Why buying an existing practice beats starting one
For an employed physician who decides ownership is the right move, the question quickly becomes: build or buy?
Starting a practice from scratch has appeal. You get to design everything from the ground up. But it also means 12 to 18 months of building a patient base before the revenue catches up to the overhead. Most physicians who have been employed for years don't have the financial runway to absorb that kind of delay — and don't want to.
Buying an existing practice solves the hardest part of that problem. You walk in with patients already scheduled, staff already trained, and a revenue stream that starts on day one. The practice has a reputation in the community. The systems are already in place. What you're buying is a head start and for most employed physicians making this transition, that head start is worth a great deal.
It also changes the financing equation. Lenders are more willing to finance the acquisition of an established, cash-flow-positive practice than they are to fund a startup with no track record. SBA loans and physician-specific lending programs are designed for exactly this scenario, and the terms have been favorable for qualified buyers.
What the market looks like for buyers right now
The timing is worth paying attention to. A significant wave of physician retirements is underway, the average physician in the U.S. is in their mid-50s, and the number of practice owners approaching exit age is substantial. Many of these sellers have spent decades building something they care about, and they want to sell to someone who will continue practicing in the same community, with the same patients, in the same spirit.
An employed physician making a transition to ownership is, in many ways, an ideal buyer for that seller. Not a private equity group looking to roll up locations. Not a DSO trying to extract margin. Just a doctor who wants to run their own practice and take care of patients.
That alignment of values can actually be a negotiating advantage. Sellers who care about their legacy, not just the highest bid, will often prefer to sell to a physician buyer, sometimes at terms that reflect that preference.
What to think through before you make the leap
Ownership is not the right move for every physician. And buying a practice is not a decision to make quickly. But if you're an employed physician who has been thinking about this — even quietly, even just as a hypothetical — there are a few things worth working through before you dismiss it.
Do the financial math honestly. Map out what your income looks like in year one, year three, and year five under ownership versus continued employment. Account for the debt service on the acquisition, the overhead of running the practice, and what the equity in the practice is worth at exit. Most physicians who do this exercise are surprised by how the numbers compare.
Think about what you want your day to look like. Ownership means more decisions, not fewer. But they're your decisions. If the loss of control in your current employment is what's driving you toward this, be honest about whether you're ready to trade one set of constraints for a different kind of accountability.
Get your advisory team in place early. A healthcare attorney, a CPA with practice acquisition experience, and a lender who specializes in physician financing are the three people you need before you get serious about a specific opportunity. Having them in place before a deal emerges puts you in a much stronger position to move quickly when the right practice comes along.
Start looking before you're ready. The market for established practices is active. The best opportunities don't always wait for perfect timing. Browsing listings, understanding what's available in your market, and getting a sense of what practices are valued at — even before you're fully committed — is time well spent.
What to Take Away
The shift away from private practice ownership wasn't about doctors not wanting to own practices. It was about the math not working and the support not being there. For a lot of physicians, that calculation is changing.
Reimbursements haven't been fixed. The administrative burden hasn't disappeared. But the costs of employment, the burnout, the loss of autonomy, the income ceiling, the absence of equity, have become more visible. And the tools available to physicians who want to make the transition, from marketplace platforms to physician-specific financing, have gotten better.
The doctors who are doing this aren't naive about the challenges of ownership. They just decided the tradeoff is worth it. And a growing number of them are turning out to be right.
Looking to grow through acquisition in today’s competitive market? VentureCare helps buyers identify high-quality opportunities, navigate complex transactions, and execute with confidence. Connect with our team to explore your next investment.
