By Francesca Mathewes

Autonomy is a core issue for both independent and employed physicians as they navigate an increasingly complex, corporate and politicized healthcare system.

Here are five notes regarding how physicians feel about their level of autonomy in different practice settings and how those perceptions continue to shift and change.

1. Sixty-five percent of self-employed physicians said autonomy was very important to them in the Self-Employed Physicians Report 2025, published Nov. 11. In the Employed Physicians Report 2025, 48% of physicians said that diminished autonomy was the worst part of their job, demonstrating the value of autonomy for both independent and employed physicians.

2. Benjamin Levy III, MD, a gastroenterologist at University of Chicago Medicine, said that preserving physician autonomy means having physicians directly in leadership positions.

“It’s important for vertically integrated payer-provider organizations and private equity owned groups to maintain leadership with a diverse representation of gastroenterologists, each with a different strength: years of experience, public health background, business background (perhaps someone with a MD, MBA), interest in cutting-edge technology, artificial intelligence, data science, and ethics,” he said. “Including input from gastroenterologists is the most ideal way to lead an organization together with the company’s business and management leaders. When gastroenterology practices increase in size, physicians may start to feel like a number – especially when they aren’t well-represented on management committees.”

3. Cost-containment strategies, if designed without physician input, can also contribute to diminished feelings of autonomy for physicians, Dr. Levy said.

“Consolidation could place physicians at risk for feeling constrained by cost-containment strategies and requirements to hit productivity benchmarks,” he said. “Vertically integrated payer-provider organizations might dictate specific referral pathways within their own network. Furthermore, physicians may feel at risk-for feeling rushed if organizations start prioritizing productivity in a cookie-cutter manner by overscheduling. It’s important to note that some physicians are slower due to keyboarding skills or being thorough – and shouldn’t be rushed; instead organizations should appreciate the exceptional care they are providing.”

4. Physician autonomy has also been a key driver of an uptick in unionization efforts by physicians that has developed over the last several years. According to a study published in 2024, fewer than 10% of physicians in the U.S. are unionized, but the number of union drives from 2023 to 2024 alone represented 3,523 new physicians, almost the same number represented by unions over the last 22 years.

5. Management services organizations and hybrid ownership models have also become popular strategies among physicians and healthcare organizations who want to gain the benefits of employed practice without sacrificing their autonomy and independence. This publication has also reported on at least 13 MSOs with physician-centered philosophies.

“The MSOs are kind of the new avenue and it is by far the best way for practices to preserve their autonomy and independence compared to the other two choices,” said David Eagle, MD, president of the American Independent Medical Practice Association referring to a corporate entity or a hospital.