The best argument for selling your practice is disappearing

There is a story that independent physicians have heard for years, usually from someone who wants to buy them. It goes like this: The economics no longer work at your scale, the operational demands are too heavy to carry alone, and sooner or later, everyone sells.

For primary care in particular, that pitch usually doesn’t come from private equity. It comes from the hospital system or health plan down the road — and it has already worked on a large swath of the market. In fact, the American Medical Association’s benchmark survey found that 42.2% of physicians worked in physician-owned private practices in 2024, down from 60.1% in 2012.

The trends here are real, but the conclusion to lean into selling one’s practice as the only choice is wrong. My wife is a practicing dermatologist, so I have been hearing versions of this pitch for years. This latest survey of dermatology practice owners is a good part of why I stopped believing the ending, and the lessons in it extend beyond specialty.

The visibility problem

While dermatologists may have a different “buyer” than primary care owners, they are facing very similar pressures (declining reimbursement, rising administrative burdens, etc.) and a similar opportunity to continue caring for patients as they see fit.

Running an independent practice of any type means leading both the clinical and business sides of the organization. Owners are clinicians, employers, recruiters, vendor managers and financial decision makers, often on the same day. It is not surprising that regular financial and operational review is often crowded out by the next urgent patient or staffing issue.

The survey linked above suggests that visibility changes what owners recognize. Owners who regularly review their financials tend to estimate greater revenue leakage than those who do not, likely because closer review exposes problems that would otherwise remain hidden. The lesson is not that reviewing the numbers leads to worse performance. It is that a busy practice can feel healthy while important problems remain invisible.

The lesson is not that practice owners should audit every claim. It is that activity and financial health are not the same thing. Revenue can leak through coding errors, underpayments, missed follow-up, unused capacity and operational friction that accumulates gradually enough to escape notice. Without a clear operating view, a practice can stay busy while becoming less resilient.

Why the sell-side argument is fading

Still, let’s look at why that gap has existed, because that is where the story breaks. For years, the strongest argument for selling was access to infrastructure. A larger platform could provide formalized reporting, professional management, recruiting support, technology and operating discipline that were difficult for a smaller practice to build alone. In the survey referenced above, operational support was the leading reason owners said they would consider a sale. That was a legitimate argument, and it persuaded many good doctors.

That advantage is narrowing. Independent practices can now assemble many of those same capabilities through more accessible technology and specialized partners. Better tools for scheduling, patient communication, financial reporting, staffing and revenue-cycle management can give owners a clearer view of the business without requiring them to give up control of it.

One caution, because I build these systems for a living: Artificial intelligence multiplies the judgment you already have. Point it at a practice that already knows which numbers matter, and it will find what no human reviewing reports by hand ever could. The tools are now cheap and everywhere, but judgment about which numbers matter in your specialty is not.

Independence from a position of strength

Today, independent dermatology is benefiting from meaningful tailwinds. Patient demand remains strong, supply has not kept pace in many markets, and dermatology has elective and cash-pay opportunities that many specialties do not. Those advantages do not eliminate reimbursement, staffing or administrative pressure, but they do give well-run practices room to grow on their own terms.

The practices best positioned to thrive won’t be the biggest or the best capitalized. They will be the ones who pair clinical demand with clear operating visibility, disciplined management and the right external partners. The infrastructural advantage that once belonged almost exclusively to larger platforms is becoming accessible to practices of every size.

What an owner actually controls

If you own a practice, your job is not to become an expert in every function. It is to see the business clearly enough to decide where to invest, what to fix and which partners to trust. A simple monthly operating review can start with a handful of measures:

• Demand: Track appointment volume, new-patient growth or days to next available appointment.
• Capacity: Track schedule use, provider use or exam room use, depending on where the practice is constrained.
• Growth: For practices with meaningful elective services, track consultation volume, treatment conversion or cash-pay revenue growth.
• Financial health: Track whether the work of the practice is converting into cash through measures such as collections per visit and receivables over 90 days.
• Accountability: When an important number moves, expect an explanation, a named owner and a plan.

The goal here is not to create a larger dashboard. It is to understand whether demand, capacity, growth and financial performance are moving in the right direction. Use technology to surface issues earlier, but keep a knowledgeable person accountable for resolving them.

For example, one multilocation practice we work with saw the cost of poor visibility firsthand. A modifier error at its previous billing vendor had reduced certain reimbursements by half and resulted in roughly $700,000 in underpayments before the practice’s billing manager identified it. The lesson is not that the physician-owner should have audited individual claims. It is that a problem of that magnitude should have been visible, escalated and addressed much earlier.

Independent practice still comes with real headwinds: staffing, reimbursement pressure and administrative complexity. But there are meaningful opportunities too, including durable patient demand, elective and cash-pay opportunities, better operating tools, and specialized partners that once existed only inside much larger platforms.

Staying independent no longer has to mean doing everything alone. Owners can assemble the capabilities they need while retaining control of the practice they built. That makes independence not only viable but also increasingly attractive.

Ashwin Krishnan is CEO and co-founder of Clarity RCM. Using the technical and operational background he developed at Apple and Airbnb, he started the company to be a billing partner for the independent dermatology practice of his wife, Dr. Lavanya Krishnan. Clarity RCM is now the revenue cycle partner trusted by hundreds of independent dermatology practices across the country.