Independent Medical Practice Challenges, From 360 Leaders
Independent practices have rarely felt more pressure and rarely been more certain about where they want to go. The independent medical practice challenges shaping 2026 are real, and so is the resolve to work through them.
That tension sits at the center of our 2026 State of the Independent Practice survey, which gathered candid answers from 360 independent practice leaders about what it feels like to run a practice right now. The findings are not a story of decline. They describe practices under real strain that still intend to stay independent, on their own terms. Below, we break down the pressures leaders named most often, and where they are placing their bets in response.
Physician practice acquisition is now routine
Start with the number that stopped us.
In the past two years, 94% of practices said they were approached about acquisition. More than one in three were approached four or more times. Consolidation is no longer a distant industry trend discussed at conferences. Physician practice acquisition is arriving in physician inboxes and hallway conversations, at practices that never put themselves on the market.
And yet 69% of those same leaders remain confident they will stay independent. The interest in buying these practices is nearly universal. The willingness to sell is not.
What makes that resolve more striking is that most practices did not simply ignore the calls. 62% engaged in some level of discussion, and 26% advanced to serious negotiations before deciding to remain independent. These are not leaders who avoided the conversation. They had it, ran the numbers, and chose independence anyway.
The rest of the survey explains why that resolve is being tested, and what practices are doing to protect it.
The pressure is financial first
When we asked leaders to name the single biggest threat to their independence, the top answer was not competition or regulation. It was cost. 46% pointed to rising operating costs as the number one threat to staying independent. Running a practice has simply become more expensive, and those costs land directly on the margins that make independence possible.
The strain is widespread and growing. Over the past 12 months, 54% of leaders reported increased financial pressure. Among practices with more than 40 clinicians, that figure climbs to 82%.
Cost pressure does not stay inside the practice, either. It reaches the exam room. Cost is now the top barrier keeping patients from getting care, according to 57% of leaders. When patients delay or skip visits because of what care costs them, the practice feels it twice: once in the mission it set out to serve, and again in the revenue that never arrives.
Of all the independent medical practice challenges in this year’s data, cost is the one that compounds. It squeezes the practice and the patient at the same time.
The money is hard to see
If cost is the pressure, visibility is the blind spot. Only 24% of practices reported clear visibility into where their revenue leaks. Nearly half, 48%, said denials are rising. Most leaders know money is slipping away. Far fewer can point to exactly where.
That gap matters, because you cannot fix what you cannot see. A practice can work hard on the wrong problem for months, patch a single denial category, and watch the total number refuse to move. Visibility is not a nice report to have. It is the difference between managing revenue and guessing at it, which is why revenue cycle management has become a strategic conversation rather than a back-office one.
Every staffing role is hard to fill
Ask which roles are hardest to recruit and retain and there is no easy answer, because the answer is all of them. Physicians topped the list at 48%, followed by billing staff at 44%, clinical support at 42%, and nurses at 39%. Every staffing category in the survey was named by at least 31% of leaders.
When one role is hard to fill, work gets redistributed. When every role is hard to fill at once, strain spreads across the whole organization, and there is less capacity left for the process improvements that would relieve it.
The load shows up in the clinical day, too. Documentation outside patient visits takes an hour or more for 65% of clinicians, and one in four spend two hours or more. That is time nobody bills for and nobody gets back.
Technology is now the plan, not the afterthought
Here the survey turns from problem to intent. Practice leaders are not resigned to these pressures. They are betting on their operating model to answer them. Technology is critical to long-term stability, according to 79% of leaders, and 88% believe AI and automation could deliver at least moderate efficiency gains. More than half, 57%, think the impact could be significant.
That is a real shift in posture. For years, technology in the practice meant the system of record: the place you documented what already happened. What leaders describe now is different. They want a system of work, technology that carries the load, moves the day forward, and gives time back to the people doing the caring.
The move from a system of record to a system of work is the throughline of this year’s findings. It is how a practice absorbs rising costs without cutting corners, sees its revenue clearly enough to protect it, and stays independent on purpose rather than by luck. The growing role of artificial intelligence in healthcare is part of that shift, though leaders describe it first as an efficiency play.
What the numbers add up to
Read together, the 2026 findings tell a coherent story. The independent medical practice challenges leaders named are connected, not separate. Independence is under active pressure, most sharply from cost. The financial picture is harder to see than it should be. Staffing strain touches every role at once. And practice leaders, rather than accepting that as the price of staying independent, are looking to their tools and their workflows to change the equation.
None of that makes the path easy. It means practices know what they are up against and are choosing to face it with their eyes open.
Veradigm works with independent practices on the operational side of that equation, from practice management to revenue cycle visibility, so the daily work of running a practice takes less out of the people running it.
We built the full report to give you the complete picture: every finding, broken out by practice size and specialty, plus a two-minute benchmark that shows how your practice compares to the 360 leaders who took part.
Read the 2026 State of the Independent Practice and see where you stand