The Independent Practice in 2026: What's Squeezing Owners and What's Working

Running an independent medical or dental practice has never been simple, but the pressures in 2026 are unusually well documented. National surveys keep pointing to the same handful of problems: payment that hasn't kept pace with costs, paperwork that keeps growing, staff who are hard to find, and patients who expect the convenience they get everywhere else.

None of this is news to owners. What's useful is seeing how practices that are holding steady are responding.

Fewer owners, bigger groups

The long shift away from small, physician-owned practices is still under way. According to the AMA's Physician Practice Benchmark Survey, 42.2% of physicians worked in private practice in 2024, down from 60.1% in 2012. Over the same stretch, the share working in hospital-owned practices rose from 23.4% to 34.5%.

Size is moving in the same direction. In 2012, 61.4% of physicians worked in practices with 10 or fewer doctors. By 2024 that had fallen to 47.4%. Private equity is still a small slice, but it grew from 4.5% of physicians in 2022 to 6.5% in 2024.

The AMA also asked physicians who had sold their practices why. The most common reasons rated important were negotiating better payment rates with insurers (70.8%), getting access to costly resources (64.9%) and managing insurers' regulatory and administrative requirements (63.6%). The AMA notes that Medicare physician payment fell 33% from 2001 to 2025 once inflation is taken into account.

That context matters. Independent practices aren't losing ground because patients prefer big systems. They're losing ground because the business side has become heavy enough that scale looks like relief. The practices that stay independent tend to be the ones that find other ways to lighten that load.

The paperwork problem: prior authorization

Prior authorization remains the clearest example of administrative weight. In the AMA's 2025 prior authorization survey of 1,000 practicing physicians, respondents reported completing an average of 40 prior authorizations a week, taking about 13 hours of physician and staff time. Forty percent said they employ staff who work exclusively on prior authorization. Nearly a third (32%) said requests are often or always denied, and 74% said denials have increased over the past five years. Only about one in three physicians said they trust insurers' recent pledges to ease the process.

What changed in 2026

There is one genuine shift this year. Under the CMS Interoperability and Prior Authorization Final Rule, starting January 1, 2026, Medicare Advantage plans, Medicaid and CHIP programs and their managed care plans, and certain marketplace plans must give a specific reason for every denied prior authorization. Most of them must also decide urgent requests within 72 hours and standard requests within seven calendar days (marketplace plans are excluded from those timeframes, and drugs are excluded from the rule). These payers were required to post their first prior authorization metrics on their websites by March 31, 2026, and electronic prior authorization systems are required starting in 2027.

For a small practice, the practical step is to start keeping your own numbers. Track turnaround and denial rates by payer, and compare them with what those payers now publish. When a denial comes back with a specific reason, you have something concrete to fix or appeal. Some practices also route all authorizations through one trained person rather than spreading the work across whoever is free, so knowledge of each payer's quirks builds up in one place.

Staffing: every role is harder to fill

Staffing shortages hit small offices hardest, because there is no bench to absorb a resignation. Dental practices offer a clear picture. The ADA Health Policy Institute reported in April 2026 that only 60% of dentists have an adequate number of dental hygienists on staff, and 91% of dentists who were recruiting a hygienist described it as very or extremely challenging. Dentists named staffing as tied for their top concern for 2026, alongside dental insurance issues.

Interestingly, the supply side is growing: first-year enrollment in dental hygiene programs rose 16% from 2020 to 2025, and 2025 produced the most hygiene graduates ever. That suggests the problem is as much about keeping people as finding them.

Practices are responding on two fronts. The first is retention: predictable schedules, clear roles and fewer chaotic days. The second is taking repetitive work off people's plates. Every appointment confirmation, intake form or "what are your hours?" call that a patient can handle on their own is time a scarce front-desk employee can spend on the patient standing in front of them.

Access is the new competitive edge

When MGMA asked medical group leaders in December 2025 to name their top patient access priority for 2026, the answers split almost evenly: no-shows (27%), online scheduling (24%), phone access (22%) and wait times (21%). In other words, most practices are working on the same question from different angles: how easy is it to get in, and to actually show up?

No-shows are creeping up

In an August 2026 MGMA poll, 32% of medical groups said no-show rates were higher so far this year than in 2025, while 58% said they were about the same and 10% said they were lower. Leaders pointed to cost pressure, transportation, work conflicts and weather. MGMA connected some of that to 2026 changes in coverage: enhanced marketplace premium tax credits expired at the end of 2025, and citing KFF, MGMA reported that the average 2026 marketplace deductible rose 37% to $3,786.

The tactics practices use are familiar: text and phone reminders, confirmation calls, no-show fees (42% of practices used one as of January 2025), overbooking and waitlists. Groups that reported lower no-show rates also mentioned more same-day availability and help with transportation.

MGMA's recommendations are worth borrowing:

Track cancellations and no-shows separately, and measure how many missed visits are rebooked and completed within 30 days.
Talk about costs before the visit, including coverage checks, estimates and payment options.
Let patients cancel or reschedule directly from the reminder. One provider-and-patient survey cited by MGMA found that 69% of patients wanted to reschedule online without calling.

A reminder that only says "reply C to confirm" gives a patient with a conflict no good option except silence. A reminder with a reschedule link turns a likely no-show into a moved appointment.

Cost conversations are moving earlier

Patients are paying more out of pocket, and they increasingly want to know the price before they arrive. For patients who are uninsured or choose not to use insurance, this is already required. Under federal rules explained by CMS, providers must give these patients a good faith estimate of expected charges when care is scheduled at least three business days ahead (within one business day if scheduled three to nine business days out, and within three business days if scheduled 10 or more days out), or within three business days when a patient asks.

Practices that handle this well treat it as part of scheduling rather than a separate chore. Clear information about accepted insurance, self-pay options and what a typical visit involves helps patients plan, cuts down on surprised phone calls and supports the cost conversation MGMA recommends having before the visit.

Telehealth has found its place

After years of short-term extensions, Medicare's pandemic-era telehealth flexibilities have a longer runway. The Consolidated Appropriations Act, 2026, which ended the partial government shutdown in early 2026, extended them through December 31, 2027. That includes home-based visits without geographic restrictions, audio-only visits for certain services and a delayed in-person requirement for telehealth mental health care. Absent further action, most of these policies are expected to revert to pre-pandemic rules after 2027.

For most small practices, the takeaway is to treat telehealth as a useful tool for specific visit types, such as follow-ups and check-ins, rather than as a separate business line. It's worth keeping an eye on the 2027 deadline before investing heavily in workflows that depend on the current rules.

What steady practices have in common

Across these trends, the independent practices that seem to be coping best share a few habits:

They measure the basics: no-shows, cancellations, prior authorization turnaround and denial rates by payer.
They make the easy things self-service, so staff time goes to work that needs a person.
They talk about cost early and plainly.
They lean into what a small practice does best: continuity, familiarity and a phone that gets answered.

Independence in 2026 isn't about doing everything the way big systems do. It's about removing friction wherever a small team can, and keeping the personal care that brought patients in the first place.

Where we fit

At Yotta Design, we build websites and apps for independent medical and dental practices, with a focus on making it easier for patients to find you, book and show up. If you'd like to see what that looks like, you can browse our family dental practice sample site or read more about our work with medical professionals.

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