Reimagining the Future of Medical Practice: How Independent Practices Can Thrive without Consolidation

By: Alex Barrett, CPA, CEO Meroka and N. Adam Brown, MD MBA, CMO Meroka

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A recent Wall Street Journal article painted a contentious picture: older doctors see medicine as a calling, while younger doctors want it to fit into a balanced life. Unfortunately, this construct oversimplifies the realities of today’s healthcare landscape. Younger doctors still want medicine to be a calling, but the reality is that systemic challenges have strained this noble profession.

The pressures facing healthcare today, which are driven by consolidation, acquisition, and corporatization, have fundamentally altered the practice of medicine, stripping physicians of autonomy, escalating burnout, and reshaping the doctor-patient relationship into an uncomfortable, transactional exchange. 

While acknowledging that reality, at Meroka we believe physicians can have both a purpose and a life beyond their practice. We will get to how shortly, but first let’s further explore the reality facing many physicians. 

A Loss of Autonomy and Growing Administrative Burden

Consolidation has been the name of the game in healthcare for the last decade. As private equity firms and large hospital systems acquired independent practices, physicians often found themselves with reduced decision-making power, increased administrative tasks, and mounting responsibilities that were once managed by dedicated support teams. The independent practice model in which physicians were both caretakers and entrepreneurs has been displaced by a system where physicians are employees who do not dictate policy or the practice of medicine. 

This phenomenon changed the nature of the job from a calling to a transaction and removed many of the personal and professional rewards that once defined the field.

On top of this consolidation, payer and Centers for Medicare and Medicaid Services (CMS) reimbursements consistently declined, imposing new financial constraints on practices. With less money coming in, doctors have had to take on more administrative tasks. They spend more time on paperwork, prior authorization, and documentation,  and less time with patients, a problem that erodes both their sense of purpose and their connection to their patients. 

At Meroka, we believe providing patient care can still be a fulfilling endeavor, even for physicians who want to own their own practices. So now let’s explore how that magic can continue to happen. 

The Path Forward: Addressing Core Challenges

At Meroka, we see three primary issues plaguing independent practices.

First, are the reimbursement problems mentioned above. Small practices struggle to negotiate favorable rates with payers that typically prioritize larger, consolidated groups. This imbalance puts independent physicians at a financial disadvantage, making it difficult for them to sustain their practices.

A second factor is high operating costs. As a percentage of revenue, operating costs are rising. Smaller practices also lack the scale to centralize core functions or access economies of scale, placing them in a constant financial squeeze.

Finally, independent practices need help finding and retaining talent since they often cannot offer competitive salaries or the flexibility and security that larger organizations provide. Additionally, potential hires may view small practices as risky or less appealing career choices.

Meroka’s Solution: Strengthening Practices without Consolidation

At Meroka, we restore joy to independent practice ownership by tackling the core problems, outlined above, that drive small practices toward consolidation. 

To improve bargaining power and win larger reimbursements, we have taken lessons from flexible ownership models. For example, through a model where physicians "stake" their clinical workflow to a larger medical group while keeping their practice intact, independent physicians can retain autonomy while accessing better payer contracts, ACO (Accountable Care Organization) participation, and value-based care opportunities. By partnering under a single tax identification number, these physicians gain negotiating strength without losing ownership.

Meanwhile, technology, particularly artificial intelligence (AI), can help small practices arrest rising operating costs. With a robust, AI-enabled operating system many of the tedious administrative tasks that burden clinicians can be streamlined or automated, returning the joy of operating a practice. This “Shopify for healthcare” approach allows independent practices to leverage scale without consolidation, helping them remain financially viable while improving efficiency and quality of care.

Great people are the flywheel of success. Meroka’s Employee Stock Ownership Plan (ESOP) structure provides independent practices with a compelling way to attract and retain talent. By granting employees a stake in the practice, ESOPs offer financial rewards, instill a sense of ownership, and increase commitment across the team. Our unique model allows physicians to retain control while distributing ownership to their employees, creating a culture that is both financially rewarding and mission-driven. 

Take a Step Forward with Meroka

The Wall Street Journal may argue younger doctors simply want work-life balance and view medicine differently from previous generations, but that is not really what is happening. Driven by pressures from consolidation, financial strain, and a shift toward transactional care models, younger doctors are burnt out and seeking reform. 

Medicine can be both a calling and a sustainable career that respects physicians' need for balance. By addressing the core issues driving doctor dissatisfaction, the healthcare community can protect the future of independent practice and help physicians reclaim their role as both clinicians and business owners.

Specifically, Meroka’s model empowers physicians to reclaim their autonomy, fosters a rewarding workplace culture for practice employees, and allows doctors to continue their vital work as caretakers within their communities. We envision a healthcare system that supports physicians in their calling without forcing them into consolidation. By tackling reimbursement, operating costs, and staffing challenges, we are laying the groundwork for a new era of independent practice — one where medicine is still a calling and independence is a realistic choice.