80% of independent PCPs are worried about money. Only 2% are considering leaving

Independent primary care physicians are deeply worried about the financial health of their practices. They are also, for the most part, staying put.

That’s the picture that emerges from Elation Health’s inaugural Primary Care Pulse survey, released April 16. The company polled 280 primary care clinicians on its platform between Jan. 31 and Feb. 23, 2026, and found that more than 80% are concerned about their practice’s financial stability over the next 1 to 3 years.

Just 2% said they are considering leaving primary care — a figure that Elation contrasts with national surveys that have placed the share of physicians contemplating departure as high as 44%.

The independent primary care physicians who are staying in the field, Elation argues, are pushing back against the idea that consolidation is the only viable path. Instead, they’re adopting new payment models, moving into artificial intelligence (AI) faster than many of their peers and holding on to the patient relationships that drew them to primary care in the first place.

“Independent primary care physicians aren’t waiting for the system to change; they’re already taking action,” said Sara Pastoor, M.D., M.H.A., FAAFP, head of primary care advancement at Elation Health, in a statement accompanying the survey’s release.

Reimbursement remains the top concern

Payer rates were the pressure most often cited by respondents. Sixty-four percent identified reimbursement from government and commercial payers as their No. 1 financial concern, followed by staffing costs, technology spend and general overhead.

Those numbers track with what we’ve heard from physicians for some time.

During a Medical Economics and Physicians Practice panel on independent practice in October 2025, David Eagle, M.D., a medical oncologist with New York Cancer & Blood Specialists and president of the American Independent Medical Practice Association (AIMPA), said inflation updates to the Medicare Physician Fee Schedule are the most important structural change Congress could make.

"They call it the ‘Physician Fee Schedule,’ but I think they should call it the ‘Physician Practice Fee Schedule,’ because the payments we get are used to pay for our employees," Eagle said. "There's been this massive burst of inflation over the past four years. Our employees need and deserve higher salaries, and we just can't do that without an inflation update with the fee schedule."

Melissa Lucarelli, M.D., FAAFP, who runs a rural solo practice in south-central Wisconsin, said during the same panel that a nearly 3% Medicare reimbursement cut at the start of 2025, combined with inflation, made the past year one of the most difficult she has had to budget for in more than two decades of practice.

New payment models take hold

Rather than ride out the pressure, the physicians who responded to Elation's survey are actively changing how they get paid.

Twenty-seven percent have already incorporated a membership or cash-pay component into their practice, and 18% have adopted a value-based payment structure. Sixty-nine percent said they are actively developing plans to address their financial concerns, with the most commonly reported strategies being increased marketing (35%), adding clinicians or clinic locations (31%) and expanding service offerings (28%). Most expect to implement those plans within two years.

Mara McDermott, J.D., CEO of Accountable for Health, told Medical Economics that the window for moving into value-based arrangements is more favorable than it has been in years.

"2025 was a pretty great year from a policy perspective for primary care clinicians," McDermott said. "We are really seeing the administration lean in on primary care, changes in the physician fee schedule that support primary care. And I think there's a ton of opportunity with new models for primary care clinicians to either continue on the path of value-based care, or to get on that path."

McDermott acknowledged that instability and complexity have kept many small practices from participating. She pointed to the Centers for Medicare & Medicaid Services' 10-year Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) and Long-term Enhanced ACO Design (LEAD) models and to the administration's burden-reduction work as signs that federal officials are trying to give independent practices longer runways and fewer administrative obstacles.

Andrew Hertz, M.D., co-founder and president of the physician-owned Zest Pediatric Network, said he sees the direction of travel shifting. "After years of a declining number of independent practices, I think that pendulum is finally swinging back in the other direction," Hertz said during the October panel, adding that management services organizations can help lower the operational barriers that have historically pushed smaller practices toward hospital employment.

AI adoption continues to climb

The report's most striking data may be on AI. Sixty-five percent of respondents said they are already using AI tools, and 98% of those users reported positive effects on their practices. The most commonly cited benefits were reduced documentation time (72%) and lower burnout (35%). Fifty-eight percent said AI is essential to the future of primary care.

That level of adoption contrasts with the cost barriers Lucarelli described during the fall panel. She said ambient AI scribing integrated with her electronic health record would run roughly $500 per provider per month — an expense she couldn't justify for a three-provider practice.

"$1,500 a month is a lot for a practice my size, so we elected to hold off," Lucarelli said, adding that she expects AI functionality to eventually be bundled into electronic health record (EHR) pricing, the way search and consumer software have been.

Related content: Take note: The AI scribe era is here

Among Elation respondents using AI, physicians with more than 11 years of experience were more likely to cite diagnostic support as the area where trusted AI would be most valuable, whereas those with 10 years or less were more likely to cite billing support.

The top AI use cases named by respondents were clinical documentation and ambient scribing, chart review and previsit charting, patient education, and inbox message triage.

Billing friction and pajama time

Other findings point to the operational friction that continues to weigh on independent practice.

Fifty-two percent of respondents said they complete EHR work after hours daily or almost daily. Sixty percent said managing patient messages adds to their after-hours workload. And although 80% of respondents use an integrated billing solution, only 34% of those on nonintegrated systems reported satisfaction with their billing setup.

Sixty-two percent overall said billing and revenue cycle tasks get in the way of patient care.

Interoperability is another sore spot. Seventy percent of respondents rated cross-EHR data exchange as extremely or very important, but 56% said it is difficult or very difficult in practice.

Related content: The dirty secret: Why your EHR still can’t talk to other systems

The policy backdrop

The policy environment around independent primary care is also in motion. Loren Adler, M.S., a fellow and associate director at the Brookings Institution's Center on Health Policy, told Medical Economics that hospital employment — not payer or private-equity acquisition — remains the dominant factor pulling physicians out of independent practice.

"Still, by far the biggest parent company of primary care, or the biggest employer of primary care clinicians, is hospitals," Adler said. "The health systems are still the main driver here." He pointed to Medicare payment differentials and the 340B drug discount program as structural features that continue to favor hospital ownership.

Christopher Whaley, Ph.D., an associate professor at the Brown University School of Public Health, made a similar point in a recent Medical Economics interview, calling site-of-care payment differences "the arbitrage opportunity within health care."

Whaley said the 2026 Hospital Outpatient Prospective Payment System (OPPS) rule, which begins phasing out the inpatient-only list and introduces site-neutral payment for drug administration, represents the strongest move in that direction he can recall, though it still covers only a fraction of the procedures that could qualify.

A specific slice of the market

It should be noted that Elation's survey population skews toward experienced, highly independent physicians. Seventy percent have been practicing for more than 11 years, and 52% reported no affiliation with any health system, independent practice association, clinically integrated network or accountable care organization (ACO).

Elation acknowledges that the data reflects clinicians already on its platform and does not speak for the full primary care workforce.

The findings nonetheless track with the wider industry sentiment: independence is harder than it used to be, but it is not disappearing. What it requires, experts emphasize, is operational discipline and a willingness to share infrastructure with other physicians.

"Independent practice requires devout attention to detail," said Paul Merrick, M.D., chief physician executive and chairman of Duly Health and Care. "There's no margin for error."