A few years ago (2022), I wrote an article called The Life and Death of the Private Practice Physician. I borrowed the framing from Jane Jacobs’ The Death and Life of Great American Cities, one of my favorite books.

Jacobs wrote about what cities lose when they are designed around cars, traffic, and business efficiency. Wider roads may help people in cars and trucks move faster, but they can also weaken the sidewalks, neighborhood stores, and repeated interactions that make a community feel like a community.

I think medicine has gone through a similar transition. Private practice physicians once functioned like local institutions. They knew their patients incredibly well, built relationships across generations, and developed reputations within their communities. That version of medicine is becoming increasingly rare.

By January 2026, 82% of practicing physicians were employed by a hospital or corporate entity. The local physician group is increasingly owned by a health system, insurer, private equity firm, or another corporation several layers removed from the exam room.

In this article, I’ll break down the latest physician employment and practice ownership data from the Physicians Advocacy Institute and Avalere Health, explain the forces driving continued consolidation, and discuss what this shift means for patients, physicians, and the healthcare system. I’ll also consider whether new technology could make physician independence more viable again.

The shift toward physician employment is still moving in the same direction. The Physicians Advocacy Institute and Avalere Health analyzed eight years of physician employment and practice ownership data, from January 2018 through January 2026. Over that period, hospitals and corporate entities continued to employ more physicians and acquire more medical practices.

The report tracks two related measurements:

These two measurements describe different parts of the market. By January 2026, only 18% of physicians practiced in physician-owned settings, while 36.1% of physician practices remained independently owned. The former describes where physicians work, while the latter describes who owns the practices themselves.

In January 2018, 52% of physicians were employed by hospitals or corporate entities. By January 2026, that figure had reached 82%.

In absolute terms, the number of employed physicians increased from 297,473 to 550,494—an 85% increase over eight years. Meanwhile, the number practicing in physician-owned settings fell from 274,104 to 120,864.

Hospitals account for most physician employment today. They employed 400,938 physicians by January 2026, representing 59.7% of practicing physicians. That share was 38.4% in 2018.

Other corporate entities (insurers, private equity firms, and other parent companies) employed another 149,556 physicians, or 22.3% of the physician workforce. Their share was 13.6% in 2018.

The broader ownership data follows the same direction. Hospitals and corporate entities owned 157,165 physician practices by January 2026, representing 63.9% of all practices in the dataset. In 2018, they owned 72,151 practices, or 29.8%.

The most recent two years make the role of hospitals especially clear. From January 2024 through January 2026, 48,100 additional physicians became employed by a hospital or corporate entity. Hospitals accounted for roughly 44,000 of them. Their share of physician employment rose from 55.2% to 59.7% over that period.

Corporate employment was relatively flat. Corporate entities added approximately 4,200 physicians, but their share of the physician workforce slipped from 22.5% in January 2024 to 22.3% in January 2026 after peaking at 22.7% in 2025. If you look at the graph, this appears to be more of a plateau rather than a reversal. Corporate entities still employ far more physicians than they did eight years ago, but hospitals are currently driving most of the growth.

Practice acquisitions also continued. Hospitals and corporate entities added approximately 13,900 practices from January 2024 through January 2026. Corporate entities accounted for about 8,000 of those practices, while hospitals accounted for approximately 5,800.

This creates an interesting split in the data. Corporate employment has leveled off, but corporate practice ownership continues to grow. Ownership and operational control can keep consolidating even without a proportional increase in the share of physicians categorized as corporate employees.

The Midwest had the highest level of consolidation by January 2026: 86.9% of physicians were employed by hospitals or corporate entities, and approximately 72.6% of practices were owned by them.

The West had the fastest recent growth in hospital or corporate physician employment, while the South had the highest share of physicians employed specifically by corporate entities at 25.9%.

Rural communities are following the same path. By January 2026, 80.2% of rural physicians were employed by hospitals or corporate entities, and 67.8% of rural practices were owned by them. During the most recent two years, rural areas added approximately 2,900 employed physicians and 1,200 hospital- or corporate-owned practices.

There are fewer parts of the country where independent practice remains insulated from these forces…