Which specialties are losing private practices fastest

Cardiology, gastroenterology and primary care are among the specialties moving away from independent practice the fastest, according to data and studies cited by Becker’s Physician Leadership. The trend is being driven by Medicare payment erosion, private equity consolidation and pressure from hospital acquisitions.

Across all specialties, the share of physicians working in private practices fell by 18 percentage points between 2012 and 2024, dropping from 60.1% to 42.2%, according to the AMA’s Physician Practice Benchmark Survey. But the specialty-level picture is more pronounced than the overall decline suggests.

Cardiology has the lowest private practice rate of any specialty tracked by the AMA, at 30.7%. That means nearly 7 in 10 cardiologists now work outside a physician-owned setting. The financial pressures on the specialty have been building for years. From 2005 to 2021, Medicare payments for cardiology fell by about 29%, while hospital facility payments rose nearly 70% over the same period. That widening gap has made it harder for independent cardiology groups to compete with hospital-based practices.

Private equity activity has also expanded in cardiology. A 2024 study published in the American Journal of Managed Care found 342 outpatient cardiology clinic acquisitions in the past decade, with about 94% of those deals taking place since 2021. A 2024 KPMG Corporate Finance report said the number of PE-backed cardiology platforms has more than doubled since 2022. Those platforms are now operating in nearly 20 states, with particularly heavy activity in Florida and Texas. The American College of Cardiology has said more than 70% of cardiologists are now employed by hospitals or large systems.

General surgery and emergency medicine round out the specialties with the lowest private practice rates. General surgery stands at 31.7%, while emergency medicine is at 33.2%. Both face structural challenges that make independent practice difficult. General surgeons need access to hospital operating rooms, and independent groups are increasingly unable to secure that access on favorable terms. Emergency medicine, meanwhile, has been consolidated aggressively by large staffing groups.

Gastroenterology is not included in the AMA’s specialty-level private practice breakdown, but acquisition data points to growing consolidation. A 2023 study published in the National Library of Medicine found gastroenterology PE penetration rose from 7.6% to 13.1% across metropolitan statistical areas studied between 2012 and 2021, the steepest increase among specialties tracked. A 2025 study in JAMA Health Forum added more detail, analyzing more than 1.1 million patients undergoing 1.3 million colonoscopies. The study found that colonoscopy prices, spending and utilization increased at private equity-acquired gastroenterology practices, with no associated change in quality.

Primary care specialties have not fallen as sharply as cardiology or surgery, but the direction is similar. Private practice rates remain in the high 30% to low 40% range, with pediatrics at 38.1%, internal medicine at 38.9% and family practice at 42.2%.

Physicians surveyed by the AMA pointed to financial concerns as a major reason for selling. In the survey, 70.8% said the need to better negotiate higher payment rates with payers was important or very important in the decision to sell. The data suggest that, for many specialties, economic pressure continues to push practices toward larger systems and away from independent ownership.