The Small Independent Group (2–10 Physicians)
Partners Who Share the Burden
Dr. Chen from the last post has a problem: she’s on call every night. She can’t afford a dedicated billing specialist. And Blue Cross just offered her a 3% rate cut — take it or leave it.
Now picture three family physicians who solve those problems by forming a partnership. They share a lease, split the cost of an EHR, hire a shared billing team, rotate call coverage (each doctor only takes call every third night), and negotiate with insurers as a group.
That’s the small independent group. It’s the most common practice structure in American medicine.
What It Is
A small independent group is a physician-owned practice with 2 to 10 doctors sharing overhead, infrastructure, and payer contracts. It’s typically organized as a partnership, professional corporation (PC), or professional limited liability company (PLLC).
About 30% of all U.S. physicians work in practices of 10 or fewer, according to the AMA’s Physician Practice Benchmark Survey. This includes both solo practitioners and small groups.
Why It Exists
Small groups solve the three biggest pain points of solo practice without requiring physicians to give up ownership.
Call coverage. Three physicians rotating call means two nights off for every one night on. That alone prevents burnout.
Shared overhead. Splitting the cost of office space, staff, EHR, and billing reduces per-physician costs by 20–40%.
Slightly better negotiating position. A three-physician group isn’t going to push UnitedHealthcare around, but it’s a more credible counterparty than a solo doc.
How It’s Organized
Small groups are independently owned entities. The physicians are typically equal (or near-equal) partners who share profits according to some agreed-upon formula — usually based on productivity (RVUs generated) plus some component for shared responsibilities.
Like solo practitioners, they sit at the base of the organizational hierarchy. They may affiliate upward with IPAs, CINs, ACOs, or health system networks. Many participate in MSO arrangements where a management company handles their back-office operations. But the physicians own the clinical entity.
Governance is consensus-based. With 3–5 partners, this works. With 10, it starts to strain.
The Tradeoffs
The upside is balance. Shared overhead, call coverage, and peer support without the bureaucracy of a large organization. Physicians keep ownership and most of their autonomy.
The downside is fragility. Partnership dynamics can turn toxic — compensation disputes are the most common source of conflict. Succession planning is difficult (how do you value a buy-in for a new partner?). Capital constraints limit major investments. And these groups are prime acquisition targets for health systems and PE-backed rollups.
The Bottom Line
The small independent group is the workhorse of American medicine. It solves real problems — isolation, overhead, burnout — through simple partnership. But it also sits in the crosshairs of consolidation. The forces pushing physicians into larger structures haven’t stopped; they’ve accelerated. The small group’s challenge is staying viable in a system that increasingly rewards scale.