Part 1: How Physicians Organize Themselves
The 5 Models of Independent Practice — From Solo to Faculty
Before the networks, the systems, and the alphabet soup of ACOs and CINs, there’s a more basic question: how do doctors actually organize their practices?
Most people picture a physician as someone who works in a hospital. But the reality is more varied. About half of all U.S. physicians work in practices of 10 or fewer doctors. Many own their businesses. Some are solo operators running every aspect of a small company — from clinical care to payroll to IT.
This section covers five models, arranged from smallest to largest:
Solo Practitioner — One doctor, one practice, total autonomy. Still roughly 15% of physicians. Declining, but not gone.
Small Independent Group (2–10 Physicians) — The most common structure. Partners sharing overhead, call coverage, and contracts while keeping ownership.
Large Single-Specialty Group — Dozens or hundreds of physicians in one specialty (orthopedics, cardiology, anesthesiology). These groups can dominate a market and negotiate aggressively with insurers.
Multi-Specialty Group Practice — Multiple specialties under one roof and one P&L. When the cardiologist and the primary care doctor share the same organization, referrals stay internal and care coordination gets easier.
Faculty Practice Plan — The physician group at a teaching hospital. Doctors here split time between seeing patients, training residents, and doing research. The economics are unlike anything in private practice.
Why This Matters
Every other structure in healthcare — the CINs, the IDNs, the ACOs — is built on top of these foundational practice models. Understanding how physicians organize themselves is the prerequisite for understanding everything else.
The story of the last 20 years in healthcare is the story of independent physicians being absorbed into larger structures — acquired by health systems, rolled up by private equity, or organized into networks. But the underlying practice models haven’t disappeared. They’ve been layered over.
The next five posts take each model in detail.