You can work for a large hospital system, or you can work for a large private practice group that is owned by private equity, or soon will be. Pick your poison, because both come with their own set of problems. On one side you have hospital systems, notorious for their bureaucracy, inefficiency, and endless layers of administration. On the other side, you have massive private groups owned by investors whose primary motivation is not patient care, but profit extraction. Neither option offers much freedom or fulfillment for physicians.
So what happened to the traditional small group practice or the independent solo doctor’s office? For decades, these were the backbone of American healthcare. Patients knew their doctors, doctors knew their patients, and medicine was still rooted in personal relationships. But health insurance companies slowly eroded this model until it became nearly impossible to sustain.
The problem came in two forms. First, the administrative burden grew to unbearable levels. Insurance companies created hoop after hoop to jump through: prior authorizations, coding requirements, quality metrics, documentation checklists, and compliance audits. To handle the workload, practices had to hire more and more non-clinical staff just to keep up with paperwork. Second, while expenses went up, reimbursements steadily went down. Doctors were working harder for less pay, all while being buried in red tape. The math simply didn’t work, and many small practices either sold to hospitals, merged into larger groups, or closed entirely.
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But here’s the good news: once you take health insurance out of the equation, the independent model actually becomes viable again. Direct care practices (whether direct primary care or direct specialty care) have been quietly flourishing all across the country. Freed from the shackles of insurance, doctors can focus on practicing medicine again. Overhead is lower because you don’t need an army of billing staff. Visits can be longer, care more personalized, and decisions made between doctor and patient rather than dictated by an insurance company.
Patients often benefit financially as well. Without the convoluted insurance system, prices can be transparent and surprisingly affordable. Many direct care practices offer memberships or straightforward cash rates that end up costing patients less than their “covered” visits under a high-deductible insurance plan. It’s a win-win for both sides.
The small group and solo practice model isn’t dead. It was just suffocated by insurance. Now, with the growth of direct care, we’re seeing a resurgence. Doctors are reclaiming their independence, patients are regaining access to personalized medicine, and the old-fashioned doctor-patient relationship is alive again. Health insurance may dominate the headlines, but it doesn’t have to dominate healthcare.
Once you take health insurance out of the equation, the independent model actually becomes viable again.
