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WHO OWNS YOUR DOCTOR?

How Government Rules Are Quietly Pushing Doctors Out of Their Own Practices — and What Could Fix It


Chauncey W. Crandall IV, MD, FACC, FACP
Concierge Medicine & Cardiology
Palm Beach, Florida
August 2026

The Short Version

Most Americans don’t know it, but the way doctors practice medicine has changed dramatically. A generation ago, most doctors owned their own practice. They set their own hours, made their own decisions, and answered to their patients. Today, that is no longer true. As of early 2026, 82 out of every 100 doctors in America work for a hospital or a large corporation instead of running their own office. Only about 18 out of 100 still own their own practice.

This didn’t happen because doctors stopped wanting independence. It happened because government rules make it very hard — and very expensive — for a doctor to stay independent. This paper explains, in plain language, what those rules are, how they push doctors into hospital jobs, what that means for patients, and what could be done to fix it.

“The doctor who once owned his own office, set his own hours, and answered only to his patients has, in one generation, become an employee of a large institution  and wallstreet and whose goals do not always match his patients’ best interests.”

1. A Quick History Lesson

In medieval times, a king or lord would let a farmer work a piece of land. In exchange, the farmer owed loyalty, labor, and a share of everything he grew. The farmer never really owned the land, so he had little reason to improve it or take risks. This system, called feudalism, lasted for centuries — not because it worked well, but because ordinary people were not allowed to own land or start a business on their own.

Feudalism eventually ended when regular people won the right to own property, start businesses, and keep what they earned. Once that happened, people had a reason to work harder, take risks, and build something of their own. Historians agree: locking people out of ownership holds a whole economy back. Give people ownership back, and things improve.

Why bring this up in a paper about healthcare? Because American medicine is starting to look a lot like that old system — just with hospitals playing the role of the lord, and doctors playing the role of the farmer who works land he doesn’t own.

2. The Numbers: What’s Actually Happening to Doctors

For most of the last century, American doctors were independent business owners. They ran their own offices, hired their own staff, and made their own medical decisions. That has changed fast.

According to the most recent nationwide study, released in 2026, 82 percent of doctors in the United States now work as employees of a hospital or a large corporation, rather than owning their own practice. That is an all-time high. Hospitals alone employ almost 6 out of every 10 doctors, and they’ve added roughly 44,000 newly employed doctors since 2024. Corporations — including insurance companies, investment firms, and pharmacy chains — employ another 1 in 5. This trend holds true in rural areas just as much as in big cities.

In the last two years alone, nearly 14,000 doctors’ offices were bought out — about 5,800 by hospitals and over 8,000 by corporations. Why would a hospital or corporation want to buy a small doctor’s office? Because it becomes a steady source of patients for their other, more profitable services — and because, as explained below, government payment rules make owning that office more profitable for a big company than it ever could be for the doctor who runs it.

3. Three Government Rules That Are Driving This

This didn’t happen by accident, and it isn’t simply that big companies offer a better deal. Three specific government rules make it very hard for a doctor to stay independent, no matter how good their care is.

Rule #1: “Certificate of Need” Laws

In about 35 states, a doctor cannot open a new surgery center, or even buy a piece of equipment like an MRI machine, without first getting permission from a state board. This permission is called a “certificate of need.” The problem is that existing hospitals are often allowed to weigh in on — or even help decide — whether a new competitor gets approved. As you might guess, they often say no. Studies going back decades, from government watchdogs in both political parties, have found that these laws lead to fewer facilities and higher prices, without improving the quality of care. The good news: this is starting to change. Tennessee passed a law in 2026 to phase these rules out, following South Carolina and Florida. States that have already dropped these rules, like Montana, have seen a real increase in the number of independent clinics available to patients.

Rule #2: Doctors Get Paid More If a Hospital Owns Their Office

Here is one of the strangest rules in American healthcare: Medicare and most insurance companies pay more — sometimes 125 to 300 percent more — for the exact same visit or procedure if it happens inside a building owned by a hospital, instead of an independent doctor’s office. This is true even if it’s the same doctor, in the same room, doing the same thing. Because of this rule, hospitals have a huge financial reason to buy up independent practices. Often the doctor and the office don’t change at all — just the ownership and the bill. Patients frequently find out only when a new “facility fee” shows up on their statement for a visit that used to cost less.

Rule #3: The 340B Drug Program

This program started in 1992 with a good goal: helping hospitals that serve a lot of low-income patients buy medicine at a discount. Qualifying hospitals can buy drugs at 20 to 50 percent off, then bill insurance or Medicare at full price and keep the difference. In 2024 alone, hospitals purchased $81 billion worth of drugs through this program. The problem is that studies have repeatedly found little connection between how much a hospital saves through this program and how much charity care it actually provides. Much of that money instead goes toward buying more buildings, more practices, and paying executives — not necessarily toward helping the low-income patients the program was designed for.

Put together, these three rules don’t just tilt the playing field — they largely decide who is even allowed to compete. A doctor who wants to open her own heart clinic isn’t just competing on skill and care. She’s competing against a set of rules built, in effect, to protect the big hospital system down the street.

4. What This Means for Your Doctor — and for You

When a doctor becomes a hospital employee, they usually get a steady salary, malpractice insurance, and less paperwork. In exchange, they’re often expected to send patients only to specialists within that same hospital system, to see a certain number of patients per day to hit productivity goals, and to follow computer systems and treatment guidelines chosen by the hospital — not necessarily the ones the doctor thinks are best for that patient. Doctors who push back can face pressure from administrators. Doctors who want to leave and start their own practice often find they’ve signed a contract that bars them from practicing anywhere nearby for a year or more.

This isn’t because hospital administrators are bad people — most are managing real financial pressures of their own. It’s because the rules reward size and control over the simple, direct relationship between a doctor and a patient. A doctor who wants to strike out on her own today needs more than skill and dedication. She typically needs the money and patience to survive a lengthy government approval process, plus years of being paid less than a hospital-owned competitor for the exact same care.

5. My Own Experience

I have practiced cardiology for more than three decades and have personally performed over 40,000 heart procedures — first inside large hospital systems, and for the past several years as the founder of my own independent practice in Palm Beach, Florida. The difference is not something you have to take on faith.

Running my own practice means I decide how long a patient visit should be, based on what that patient actually needs — not a quota set by someone else. I choose tests and treatments based on the evidence and the individual patient in front of me, not a list handed down by a hospital system. And, just like any other business, I answer to my patients directly: if they are not happy with their care, they are free to go elsewhere. That accountability keeps me sharp in a way that a hospital paycheck never could.

This isn’t a claim that every doctor should or could run a boutique, direct-pay practice like mine — that model serves a limited number of patients and isn’t a fix for the whole healthcare system. But it is real evidence that when a doctor gets out from under the employed, hospital-controlled model, most of the problems described above simply go away. What stops more doctors from choosing that path usually isn’t a lack of confidence. It’s the three rules described above, which make independence far more expensive to sustain than working for someone else — regardless of who provides better care.

6. What Could Fix This

If government rules and big wallstreet are the main reason doctors are losing their independence, then the fix isn’t more rules — it’s removing the ones that are causing the problem, and letting doctors and patients make their own decisions again. Here are five changes that would make the biggest difference:

  1. Get rid of “certificate of need” laws in every state. States that have already done this, like South Carolina, Florida, and now Tennessee, show it can be done safely — and states like Montana have seen more clinics open up, not fewer, after repealing these laws.
  2. Pay the same price for the same care, no matter who owns the building. Medicare and insurance companies should stop paying more just because a hospital owns the office. This single change would remove the biggest financial reason hospitals buy up independent practices.
  3. Fix the 340B drug discount program. Require hospitals to clearly show how their drug-discount savings actually help low-income patients, and put a stop to savings that don’t serve that purpose.
  4. Allow doctors to open and own their own hospitals again. Current federal law essentially blocks this. Studies of existing doctor-owned hospitals show strong quality and patient satisfaction at a competitive cost.
  5. Hold non-profit hospitals accountable for their tax breaks. Non-profit hospital systems receive an estimated $37 billion or more a year in tax breaks. They should have to prove, with real numbers, that they’re providing charity care worth at least that much in return.

None of these changes requires creating a new government program. Each one simply removes an existing barrier or closes a loophole — restoring the same basic idea that ended feudalism centuries ago: when people are free to own their own work and compete fairly, everyone benefits, including the patients who depend on them.

7. Bottom Line

Doctors didn’t choose to give up their independence. After three decades in cardiology — in both hospital systems and my own independent practice — I believe most doctors would choose to own their practice and answer directly to their patients, if the rules didn’t make that choice so costly. This isn’t really a story about ancient history. It’s a story about what happens, in any era, when government and wallstreet rules — rather than fair competition — decide who gets to provide a service and on what terms. The good news is that this can be fixed the same way it was fixed centuries ago: by removing the barriers, restoring ownership, and trusting that doctors and patients, given the freedom to deal with each other directly, will make better choices than any system built around them.

Sources

Chauncey W. Crandall IV, MD, FACC, FACP is a board-certified cardiologist and internist trained at Yale and Mount Sinai, with more than 40,000 cardiac procedures performed over a three-decade career. He is the founder of Crandall Concierge Medicine & Cardiology in Palm Beach, Florida, and the author of several books on cardiovascular health and healthcare policy.