One of the most widely accepted beliefs in healthcare goes something like this: "To survive, you have to be part of a health system. Or be owned by private equity."
I understand why people believe it. The numbers are real.
Trilliant Health recently found that about 59% of U.S. physicians are now employed by a hospital or health system. In Chicago, the commercial rate for a typical visit was $239 for hospital-employed physicians and $147 for independent ones.
That’s not a level playing field. But I keep coming back to my father.
He sold his practice to a hospital. And then he went out and started a new one.
That second practice has always told me something: selling isn’t necessarily the end of the story, and independence isn’t something you only get one shot at.
Here’s how I read the data.
It explains the pressure on independent practices. It doesn’t decide their future. The independent groups I see doing well aren’t waiting for the economics to get fairer. They’ve built strength they control: They know their numbers by payer, physician and site.
Their physicians aren’t the default administrators. They have leaders with real authority. And they’re strong enough that independence is a choice, not something they’re clinging to.
Some will still decide to sell or partner.
That’s fine.
I just want it to be a decision, not a default.
That’s the idea behind a new series I’m calling Look Again: taking something everyone accepts and asking whether it’s actually true.
So, first question: Is independence a choice your group is making? Or a default it’s drifting away from?
Source: Trilliant Health, August 27, 2026.
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