Is Your Small Independent Practice Join a Large Health System?

Should Your Small Independent Practice Join a Large Health System?

It may be a small world after all, but is that always a good thing? Sure, it can be great to be a small fish in a big pond, but there are other times when it can feel like you are swimming upstream just trying to stay afloat. Doctors at small, independent practices are often faced with similar emotions when deciding whether they should join a large health system.

While there is always the joy of providing quality medical care, the administrative burdens of a private practice can be overwhelming. It can be challenging to find a work-life balance, and fulfill the dreams of why you became a doctor. If the opportunity to join a large allied health system comes along, you might think carefully about taking that leap.

What are Small Independent Practices?

In its 2020 biennial analysis of physician practice arrangements, the American Medical Association (AMA) found that the majority of patient care physicians now work outside of physician-owned medical practices. This is the first time the figure has dropped below 50 percent since the AMA first began its analysis. The 2020 Physician Practice Benchmark Survey cites COVID and economic forces as contributing factors in this decline.

The AMA benchmark survey revealed that 49.1 percent of patient care physicians work in physician-owned practices, down from 54 percent in a two-year period. A similar increase in the share of doctors in practices with at least 50 physicians increased to 17.2 percent in 2020, up from 14.7 percent in 2018. Despite the trend toward larger practices, 53.7 percent of physicians still work in small practices with 10 or fewer doctors. Those over the age of 55 were significantly more likely to work in small practices than doctors under age 40.

What are the Pros of Small Independent Practices?

There are many reasons that a large number of physicians still choose to remain in small, independent practices with five or fewer colleagues, including:

Direct Patient Care

Many doctors find that a small, independent practice allows them to achieve their aim of working directly with patients and building long-term relationships. They feel valued by patients for the care they provide, and enjoy getting to know others in the family as the years go on.


A private practice has less authority from above, and more independent autonomy. Physicians can control their office hours, determine how they will spend their days, choose their own team members, and decide for themselves what level of care they want to provide.


Being part of a smaller practice gives many physicians the ability to become more involved with their local communities. They support local organizations and serve on committees that work to improve community health.

What are the Cons for Small Independent Practices?

Although the ideal of a small practice is quite appealing, the reality can be a bit more challenging. The practitioner is often forced to wear multiple hats, and spend time on administrative tasks that take away from patient time. Some cons of private practice include:

Administrative Tasks

As part of a small practice, the physician is often forced to deal with patient scheduling, staffing, billing, facility, and supply issues that he/she has really not been trained to manage. These unfulfilling tasks take away from patient care, and detract from the work-life balance they are trying to achieve.

Data Management

In a small practice, the physician is also the person in charge of data management. Trying to select and manage Electronic Health Records, patient portals, population health data, billing software and practice management platforms to streamline workflow can actually consume time that is better spent with patients.

Lack of Variety

Over time, many practices can fall into a “rut,” where the provider is seeing the same patients and treating the same cases. This routine can sometimes seem boring compared to the variety of care opportunities in a larger setting.


Managing a smaller practice requires that a great deal of the income goes back into building, insurance, staffing, and computer expenses. Depending on the size of the patient base, these can drain a budget, leaving little flexibility for provider compensation.

What Are Large Allied Health Systems?

A large allied health system often consists of a group of medical practices that form under one umbrella to save administrative expenses or a hospital setting, sometimes with site clinics where patients are seen. The physicians are more involved in patient care, while administrative teams handle the day-to-day details.

What are the Pros of Large Allied Health Systems?

With their size, the large allied health systems can offer many benefits to physician members, including:


Starting salaries in a large allied health system are likely to be higher than what can be realized by an independent physician struggling to start a private practice. Overtime compensation, retirement benefits, and healthcare options can be very appealing, although the physician is not able to accumulate the long-term equity that a private practice can bring.


Although there is less opportunity to control your own schedule, the large allied health systems usually run 24/7, meaning more available billing hours for members. There is more job security as the large system protects doctors from the economic factors that buffet independent practices.


The large allied health system manages all the administrative tasks, thereby freeing the physicians to perform more hands-on medical care.

What are the Cons of Large Allied Health Systems?

Although the benefits are appealing, there are still many cons that go along with a large allied health system, including:

Lack of Control

Decisions come down from above, often with a focus on money over patient care. Individual doctors have little say in the direction the allied health system is taking. A constant focus on productivity over quality care can be exhausting for providers.


Although more hours are available, they might not be the ones physicians want to work. Being part of a large allied health system often means longer work schedules, more nights and weekends, and less control over vacation and personal days.

Key Takeaways

As with any work situation, there are pros and cons to both small practices and large health systems. The choice of which road to take really depends on the preferences of the individual physician. They must decide what kind of work environment is best, and what types of patient relationships they wish to form over the years. As you weigh the pros and cons of independent practice, the experts at Amazing Charts can help relieve some of the administrative burden, so your small practice can survive and thrive.

Amazing Charts Helps Independent Practices Compete

Amazing Charts offers solutions specifically designed to help your private practice survive and thrive. Rated #1 for ease of use, our Electronic Health Record (EHR) was designed by a doctor to be easy to use and affordable. It includes a Patient Portal that helps you work with your patients electronically to exchange messages, share visit summaries, test results and educational materials.

Amazing Charts was founded in 2001 by a practicing family physician, and has grown consistently since then by creating easy-to-use solutions for delivering patient care. Today, we offer a variety of capabilities, including Electronic Health Records (EHR), Practice Management, Medical Billing Services, Population Health and Remote Care. Call 866-382-5932 or visit our website to learn about our products, schedule a practice consultation, arrange a free trial, and find more tips to help your private practice stay relevant and competitive.

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