Will physicians reclaim their autonomy, rewrite the playbook, and finally break free from administrative bloat?

I believe they will—and sooner than most expect. Over the next two decades, we could see a fundamental shift in how care is delivered. The catalyst? A growing movement toward direct care models and a deliberate step away from insurance dependency—except in cases of true medical catastrophe.

In this Huddle #Trends report, I’ll walk through the rise of corporatized healthcare, how it reshaped physician employment, and why we’re now seeing early signs of a course correction. I’ll end with a look at direct care models—including one I could see working in my own (future) pulmonary practice—and what they might mean for the future of medicine.

In the early 20th century, most physicians ran solo practices and knew every patient by name—often by knocking on their door.

Can you believe that?

House calls were the norm. A black bag, a stethoscope, and deep community roots—that was healthcare. It was personal, local, and relationship-driven.

Fast forward to the 1970s and 80s, and we saw the rise of Health Maintenance Organizations (HMOs). These introduced a more structured, cost-conscious approach. Efficiency and prevention became buzzwords. Physicians began joining group practices, drawn in by shared overhead, collaboration, and the promise of fewer administrative headaches.

Then came the 1990s and early 2000s—the era of Physician Practice Management Companies (PPMCs). Think of them as the first wave of corporatization, long before private equity entered the scene. These companies promised doctors administrative support and economies of scale. But many collapsed under the weight of poor execution and financial mismanagement.

At the same time, hospital employment gained steam. Stable salaries. Benefits. Work-life balance. It was a tempting offer—and many doctors took it.

But with that shift, something else changed: the physician’s role evolved from owner to employee. Independence gave way to hierarchy. And the stage was set for the corporate healthcare landscape we live in today.

Most physicians today don’t own their practices.

In fact, nearly 80% of U.S. physicians are now employed—either by hospitals, health systems, or corporate entities like insurers, private equity firms, or even retailers. And that number has jumped 25% since 2019.

When I read that, I see the ripple effects on autonomy, decision-making, and burnout. You probably do, too.

So what’s really driving this shift?

I like to think about it through the lens of root cause analysis—something we use in hospitals to trace errors or inefficiencies back to their origins. When you apply that framework here, the surface-level answer (“physicians want stability”) doesn’t go far enough.

Here’s what’s really going on:

So who’s employing four out of five physicians in the U.S.? The biggest employers of physicians are no longer just hospitals. They include:

Together, these three entities represent a huge force in American medicine, reshaping care delivery at scale.

When you dig deeper into the data, the trends become even clearer:

It’s a generational and structural shift. For many younger docs, the independent model doesn’t even feel like an option anymore—it’s just not on the menu. And in residency, the main choices are either stay in academics or leave to join a physician practice—no one is talking about starting their own practice.

But things may be starting to change.

A new generation of physicians (me? you? my friends?) is looking for a different way forward—one that blends autonomy with sustainability, technology with humanity.

And they’re finding it in a model that cuts out the middlemen, restores the doctor-patient relationship, and actually makes business sense.

Direct care models represent a shift away from the complex, insurance-dominated systems that define most of American healthcare. Instead of navigating co-pays, deductibles, and prior authorizations, patients in these models pay their physicians directly—usually through a monthly or annual membership. The goal? Simpler billing, more personalized care, and a restored physician-patient relationship.

Direct care is an old idea with a modern twist: patients paying their doctor directly for care, no middleman required. It’s a response to the inefficiencies and depersonalization that come with traditional fee-for-service and insurance-based care.

Rather than billing insurance companies for every visit or procedure, direct care physicians are compensated directly by patients through a fixed subscription or retainer fee. That means:

This dramatically reduces administrative overhead and lets physicians spend more time doing what they trained for: taking care of people.

Visualize it like this:

DPC is perhaps the most well-known version of direct care. Patients pay $50–$150/month for unlimited primary care services, including check-ups, chronic disease management, care coordination, and even some basic procedures or labs.

Importantly, DPC physicians don’t bill insurance. This eliminates the need to see 20+ patients a day just to keep the lights on. It allows for smaller patient panels, longer visits, and a deeper patient-provider relationship.

Concierge medicine also uses a membership model but often sits at a higher price point ($1,500–$10,000+ annually). These practices may still bill insurance for certain services, but the membership fee grants patients access to amenities like same-day visits, 24/7 communication, and even house calls. It’s healthcare with a white-glove feel, often aimed at high-income individuals.

Both DPC and concierge medicine fall under the broader umbrella of subscription medicine—and their popularity is growing rapidly.

The misconception is that direct care tries to replace insurance altogether. That’s not the case.

Insurance is essential—for unpredictable, catastrophic events like surgeries, hospitalizations, and cancer treatments. But using insurance for routine care is like using car insurance for oil changes. It adds cost and complexity to something that should be simple.

Direct care models argue that bread-and-butter medicine—preventive care, chronic disease management, and diagnostic workups—doesn’t require insurance. By carving out these everyday services and handling them through a direct relationship, patients can pair a direct care plan with a high-deductible catastrophic insurance plan and still be fully covered.

So what would a direct care model look like for my future pulmonary practice?

Think of it as Direct Specialty Care (DSC)—a variation on DPC but applied to chronic lung diseases like asthma, COPD, ILD, and sleep apnea. Patients pay a monthly fee ($100–$200 depending on complexity), and in return, they get:

Most importantly: no insurance billing. That means no prior auths, no fighting with payers to justify a 99214, and no six-month waits for an initial consult.

This isn’t for everyone—but it doesn’t have to be. Direct pulmonary care works particularly well for:

And let’s not forget: lung disease is one of the top contributors to morbidity and healthcare spending. There’s a real market here.

Right now, specialty access is broken. Patients wait weeks (sometimes months) for consults, only to get 15-minute visits and a follow-up in six months—if they’re lucky.

This model fixes that:

And it’s not hypothetical. Models like this are already popping up—in cardiology, GI, endocrinology, and yes, even pulmonology. The infrastructure is here. The playbook is being written.

We just have to be willing to turn the page.