A qualitative interview study of 30 U.S. primary care physicians identified five major themes regarding the day-to-day experiences of independent practitioners and those employed by health systems. Health system physicians reported less autonomy in scheduling and operations, but greater financial and legal protections. Health systems also offered embedded clinical support teams and easier access to specialists, while independent physicians managed needs with limited staff. Shared electronic health records and integrated networks in health systems facilitated care coordination and specialty care access. Independent physicians relied instead on manual outreach and professional relationships. Health system physicians worked within cultures emphasizing productivity and performance metrics. In contrast, independent physicians prioritized time and continuity with patients. Centralized communication structures hindered patient access in health systems, while patients of independent physicians were often able to reach a known staff member directly.
Implications: Currently, 55% of U.S. physicians are employed by hospital and health systems, representing a nearly 50% increase in health system employment since 2012. These findings highlight substantial contrasts and trade-offs in how physicians experience daily practice across the two organizational models.
Physician Experiences in Health System–Owned Practices and Independent Practices: Insights From Interviews With Primary Care Physicians
Corresponding Author: Justin W. Timbie, PhD, et al
RAND, Arlington, Virginia
Permanent link: https://www.annfammed.org/content/24/4/329
The Annals of Family Medicine
Primary Care Physicians Weigh in On the Trade-Offs Between Health System Employment and Independent Practice
27-Jul-2026