“Is It Time?” Why Staying Independent Is a Decision, Not a Holding Pattern
Joseph Jacot has heard the question so often he can see it coming. Every time his practice hits a rough patch (a payer change, a staffing crunch, a bad month in AR), the physician-owners turn and look at him. “Is it time?” As CEO of Michigan Vascular, a group founded in 1963, he described it as the looming eventuality in every discussion.
Most independent practice leaders know that look. In the 2026 survey of 360 independent practice leaders that Medical Economics fielded with Veradigm, 94% said they had been approached about an acquisition in the past two years. But 69% said they are confident they will stay independent. For most of them, staying is not something they fell into while waiting for a better offer. They decided to stay.
That gap is worth sitting with. There is a widely held sense that acquisition is the eventual end state for every independent group, that it’s only a matter of timing. The survey argues otherwise, and so did the panel.
So what are they choosing? On our recent panel, the two practice leaders gave answers that had nothing to do with money.
Independence means deciding where care happens
For Jacot, the reason is control over the patient’s path. “We can determine site of service because we’re independent,” he said. “We’re not forced to send them somewhere that we’re not confident in.” A vascular procedure might belong in the hospital, an ambulatory surgery center, or the office, and his physicians make that call one patient at a time, based on what is best and lowest-cost for that patient. If the patient has serious comorbidities, they go to the hospital. If they don’t, they don’t have to.
Underneath that is a mission his group has carried since 1963. Jacot described every decision as running through one filter: how does this affect patient care? That filter is what lets his team look at each patient experience and make the best, lowest-cost call for that person, without worrying about which bucket it falls into.
That is a quality argument and a cost argument at the same time, and it only works if the practice controls the decision.
Independence means moving faster
Dr. Jonathan Copeland, a family physician with a 30-physician group in United Physicians, put it in terms of agency. “We’re not waiting for an opportunity for private equity or corporate structure,” he said. “To me, independence really means physician agency and physician control.” When his group spots a problem, it doesn’t wait for a hospital system or three different committees to prioritize it. This year that meant advance care planning: they saw a gap, built a process, measured it, and kept refining it.
Part of what makes that possible is who gets a say. In a physician-owned practice, Dr. Copeland pointed out, the people actually caring for patients every day still have a meaningful voice in how that care gets delivered. Physician autonomy, in his telling, is less a philosophy than a decision-making structure.
Speed is easy to undervalue until you lose it. Inside a large system, the same change can take a year or more of negotiation.
Physician autonomy doesn’t mean doing it alone
The panel was careful not to confuse independence with isolation, and that distinction may be the most useful one for any practice weighing its options.
Dr. Copeland was direct about the competitive reality. His group operates alongside major hospital systems and larger specialty groups, so it still needs technology, analytics, and partnerships that provide scale and impact. His point was that all of it can happen without trading away ownership or physician autonomy. Scale and independence are not opposites.
He also pointed to structure. United Physicians, the physician organization his group belongs to in Detroit, advocates for and serves independent practices in both primary care and specialty. He raised the idea of extending that kind of arrangement nationally, arguing that demonstrating superior outcomes and quality measures collectively would give independent practices more power than any one small group has on its own.
His closing advice was simpler. Connect with other people doing the same work, and don’t live in a silo. Regional and cultural differences exist, but most of the problems are shared. “You don’t have to do it alone.”
The real threats are operational
None of this means the pressure is imaginary. Rising operating costs were the top threat to independence in the survey, and 48% of practices report rising denials. Jacot said he feels it most in accounts receivable: payers ask for more documentation, the practice changes its workflow to send cleaner claims, “and then the next week, it seems like the bar has changed or moved again.”
The survey puts numbers around the rest of it. Rising operating costs were named the top threat by 46% of respondents, 54% said financial pressure had increased over the past year, and scale didn’t insulate anyone: among the largest practices surveyed, 82% reported more financial strain.
Jacot can point to where the money goes. Staff costs keep climbing, and in a practice that performs a lot of in-office procedures, the variable costs of catheters and balloons have become a burden of their own.
Dr. Copeland added a point that complicates the usual framing. The idea that a practice has to pick between fee-for-service and value-based care, he said, is a myth. You have to do both well to stay independent, stay viable, and keep your staff. They are not mutually exclusive, and treating them as a choice is its own kind of trap.
What the panel agreed on is that the threats are about running the business, not practicing medicine. The practices that stay independent with confidence are the ones that manage the administrative and reimbursement work without letting it eat the margin. That is where technology, partners, and peers come in, and it is the subject of the next two posts in this series.
More than survival
Dr. Copeland closed the session with a bigger claim. “Independent practice is actually not just a survival proposition,” he said. In a system that keeps getting more fragmented and more expensive, he argued, independent practices are the ones close enough to their patients to change how care is delivered.
He was specific about why that falls to them. Hospital systems, payers, and large groups are not going to take it on. What independent practices have is proximity to patients, growing sophistication with technology, and a willingness to partner with each other.
So the next time someone asks “Is it time?”, the 69% have an answer ready: not yet.
See how your practice compares with 360 of your peers in the full survey, and watch the conversation on demand.