Physician independence vanishes as corporate medicine swallows up U.S. health care

Just 18% of physicians are practicing medicine in physician-owned settings, a new low as consolidation continues across U.S. health care.

A full 82% of practicing doctors were employed by hospitals or corporate entities as of the start of 2026, according to the findings from Avalere Health, which compiled data for the nonprofit Physicians Advocacy Institute (PAI).

After tracking eight years of health care consolidation, the figure represents a new high for physician employment and a new low for doctors owning their own practices.

“The corporate takeover of physician practices continues unabated, causing fundamental changes in how physicians practice medicine in this country,” Kelly Kenney, J.D., CEO of PAI, said in a news release.

“Whereas corporate owners have a fiduciary responsibility to their shareholders, physicians always have an ethical responsibility to their patients,” Kenney said. “Now is the time to adopt policies to protect against corporate interference in physicians’ medical decision-making. Corporate profits must never take precedence over patients.”

For comparison, 25% of doctors were employed by hospitals in 2012. The latest figure contrasts with 52% of physicians employed by hospitals or corporate entities at the start of 2018, the start of the study’s eight-year focus period.

The numbers behind the shift

The data paint a stark picture of how dramatically the landscape of medical practice has changed in less than a decade. The review found 550,494 physicians were employed by hospitals or corporate entities as of Jan. 1, 2026, an increase of more than 253,000 since 2018, representing an 85.1% rise over the full study period. The number of physicians practicing independently fell to just 120,900, down by 152,200 over eight years.

In 2024 and 2025, the two most recent years studied, hospitals and other corporate entities added roughly 48,100 physicians to their employment rolls, a 5.6% increase.

Those same entities acquired 13,900 additional physician practices during that period, a 9.1% increase. Hospitals and corporate entities now own 63.9% of all physician practices in the United States, compared with 29.8% in 2018 — a 114.4% increase in the share of practices under non-physician ownership.

For physicians who remain independent, the picture is equally sobering: 81,100 fewer physician practices were independently owned over the eight-year study period, with 12,500 of those lost in just the past two years. As of Jan. 1, 2026, only 36.1% of practices remained physician-owned, down 48.5% since 2018.

Hospitals lead employment growth; corporations dominate acquisitions

The report draws a notable distinction between two types of non-physician owners. On one side are hospitals and health systems; on the other are what researchers call "corporate entities," a category that includes health insurance companies, private equity firms and large pharmacy chains.

Hospitals drove the majority of new physician employment. Over the two-year period ending in January 2026, hospitals added 44,000 physicians to their payrolls, an 8.2% increase, with 29,600 of those additions occurring in 2025 alone. Hospital employment of physicians has grown every year throughout the eight-year study period and has nearly doubled since 2018, rising from 219,712 to 400,938 physicians.

Corporate entities, by contrast, showed a diverging pattern: practice acquisitions surged even as employment growth slowed. Corporations acquired 8,000 physician practices in 2024 and 2025 — a 10.2% increase — outpacing hospitals, which added 5,800 practices over the same period (a 7.8% increase). Yet corporate physician employment grew by only 0.9% over those two years, adding just 4,200 physicians.

“This raises the question of whether private equity firms and other corporate owners are shedding physicians from practices post-acquisition,” Kenney said.

Rural communities not spared

Physicians and patients in rural areas have not been insulated from consolidation. As of January 2026, 80.2% of rural physicians were employed by hospitals or corporate entities. Rural practices have also become majority non-physician-owned, with 67.8% of rural practices now under hospital or corporate control.

In 2024 and 2025, 2,900 additional rural physicians, a 6.8% increase, became employees of hospitals or corporate entities, and 1,200 rural practices were acquired, a 9.8% increase.

A national trend with regional variations

Every region of the country has seen consistent growth in hospital and corporate employment of physicians and practice ownership, though the pace and composition of that growth vary. The Midwest leads all regions in total employment, with 86.9% of physicians there now working for hospitals or corporate entities. The West saw the fastest overall employment growth in the most recent two-year period, at 6.6%.

In terms of hospital employment specifically, 70% of physicians in the Midwest are now hospital employees, which was the highest regional share nationally. The South posted the fastest hospital employment growth in the last two years, at 10.8%.

Corporate ownership of practices shows similarly broad reach. The South has the highest share of corporate-owned practices, at 37%, and corporate entities in that region outpaced others in practice ownership growth over the full eight-year study period, with a 184.6% increase. The West also posted 184.6% growth in corporate practice ownership since 2018.

What it means for physicians and patients

PAI paired the Avalere data with survey results from NORC at the University of Chicago, which found that a majority of employed physicians believe ownership changes negatively affect both patient care quality and physician autonomy. An updated version of that survey is expected later this spring.

The report's authors and PAI advocates argue that the data underscore the need for policy intervention to protect clinical independence and patient-centered decision-making.

Avalere used the IQVIA OneKey database, which tracks physician and practice location information and hospital ownership. The study covers biannual data from January 2018 through January 2026. Physicians are defined as medical doctors (MDs) and doctors of osteopathic medicine (DOs); nurse practitioners, physician assistants and other non-physician clinicians are not included in the counts.