The Solo Practitioner
One Doctor, One Practice, Total Autonomy
Picture Dr. Sarah Chen. She’s a family physician in a small town in Ohio. She owns her practice outright — leases the office space, employs two medical assistants and a receptionist, handles her own billing through a small clearinghouse, and sees about 18–22 patients a day.
When the office computer system needs upgrading, she picks the vendor. When a patient needs extra time, she takes it. When she disagrees with an insurer’s coverage decision, she fights it herself. There’s no corporate compliance department, no regional vice president, no quarterly productivity reviews.
That’s solo practice. It’s the original model of American medicine, and it’s slowly disappearing.
What It Is
A solo practitioner is a single physician who owns and operates their own independent practice. They’re the owner, the clinician, the decision-maker, and the business operator — all rolled into one. They hire their own staff, choose their own EHR, set their own hours, and contract directly with insurance companies.
About 15% of U.S. physicians still practice solo, according to AMA survey data. That number has been declining for decades and continues to fall.
Why It Still Exists
Autonomy. That’s the core of it.
Dr. Chen doesn’t attend committee meetings. She doesn’t need approval to refer a patient to a specialist she trusts. She doesn’t have an employer telling her to see more patients per hour. She controls her clinical environment completely.
For some physicians — particularly in primary care, psychiatry, and certain procedural specialties — this freedom is worth the tradeoffs.
How It’s Organized
A solo practice sits at the very bottom of the healthcare organizational hierarchy. Dr. Chen is an independent business entity — usually a sole proprietorship or single-member LLC.
She contracts with insurance companies directly. She has admitting privileges at the local community hospital but isn’t employed by it. She might join an IPA for slightly better negotiating leverage with payers. She might participate in a CIN or ACO for value-based contracts. But she owns nothing and no one owns her.
The Tradeoffs
The upside is freedom. Complete clinical and business autonomy. Direct, long-term patient relationships. The ability to customize the practice to community needs without corporate approval.
The downside is vulnerability. Dr. Chen has zero negotiating leverage with insurers — she accepts whatever rates they offer. If she gets sick, the practice shuts down. She can’t afford the analytics platforms that larger groups use. And as health systems and PE-backed groups consolidate around her, her competitive position weakens every year.
The Bottom Line
Solo practice is the purest form of physician independence. It’s also the most fragile. The physicians who still choose it are making a deliberate trade: they’re giving up scale, leverage, and infrastructure in exchange for the freedom to practice medicine on their own terms. That trade gets harder to justify every year.