Now More than Ever, Cardiologists Should Stay Independent

At a time when vertical integration and specialty practice acquisitions are reshaping healthcare, why should cardiologists stay independent? For some doctors, becoming employed or seizing an exit strategy offers appealing incentives. Other cardiologists sense that giving up their autonomy would be a major loss—but feel pressured to follow the industry current of consolidation and resulting employment with the tempting promises of health systems or private equity roll-up firms looking for a quick ROI on their transaction.

The choice to remain independent is a highly personal one based on many factors. But as a physician who has spent my career advocating for other clinicians, I want cardiologists to understand the full range of options available to them. I believe that independence is professionally rewarding, but also a very viable path forward for many cardiologists. 

That said, tomorrow’s successful independent cardiology practices will, by necessity, look different from yesterday’s. In this article, I’ll offer a new definition of independence and outline the key components of a thriving independent cardiology practice, now and in the years to come.

Why Independence Matters

Fundamentally, independence means not being told what to do. The ability to control their own destiny is what drew many cardiologists to independent practice in the first place, and it’s one of the most compelling reasons to remain in private practice or branch out and leave an employed model.

Practicing on their own terms offers many advantages for physicians. Independent cardiologists have greater power over their career trajectory and can design a practice that aligns with their personal and professional goals. They can focus on the subspecialties and patient populations that interest them while controlling their schedule and work environment. They also have the potential to achieve higher earnings by managing their practice and retaining a greater percentage of revenue.

Importantly, independent cardiologists also have an advantage in terms of establishing trust and providing personalized care through long-term relationships. Small independent cardiologist groups can provide a “concierge” feel that many patients appreciate.

These benefits of independence complement an industry-wide shift toward personalized and patient-centered care. As the leading cause of death in the United States, cardiovascular disease is a significant component of medical expense. An aging population and rising rates of chronic diseases like diabetes and obesity are increasing the demand for cardiovascular care, including critical preventive care and supporting important lifestyle modifications. 

Cardiologists have a tremendous opportunity to drive better patient outcomes and reduce costs for both patients and the healthcare system. This opportunity underscores the need for cardiologists to adapt their practices to continue providing high-quality, affordable patient care with a focus on patient outcomes.

What We Get Wrong About Independence

While independence has clear benefits, clinicians shouldn’t conflate independence with running their practices completely on their own. Managing a cardiology practice is a complex effort that involves much more than patient care. From ordering equipment to hiring staff, running a practice involves many mission-critical tasks. 

But too many clinicians, including cardiologists, are saddled with inadequate operational and administrative support. Doctors can’t focus on patient care when they’re working with an inefficient technology platform, dealing with the complexities of revenue cycle management or balancing the daily needs of managing a busy staff.

And a medical degree doesn’t prepare physicians to tackle office administration, technology management, payer contracting or HR tasks. In a survey of final-year medical residents, only 10 percent of medical students said they were very prepared to deal with the business side of medicine, and nearly one-third said they were very unprepared for those responsibilities. 

This misguided notion of independence leads directly to physician burnout and business atrophy.

This misguided notion of independence leads directly to physician burnout and business atrophy. It’s a major reason why many doctors agree to employment or acquisition despite their personal and professional aspirations. They simply can’t see a future in which they’re sufficiently supported to do their best work. 

We need a new definition of independence. In this model, cardiologists retain ownership of their practices, while bringing in strategic partners to support their operations. They gain the infrastructure often reserved for a large health system, without becoming beholden to an employer or yielding control to outsiders. 

Acquisitions are Accelerating

Another challenge to independence is acquisitions. Cardiology is becoming heavily consolidated, making the question of independence more urgent. Those who remain independent work primarily in small practices. But research suggests that overall, cardiologists are increasingly working in larger practices, with a significant link between growth in cardiology practices and areas with high hospital market concentration. 

While cardiology has already shifted heavily toward health system employment models, private equity acquisitions in cardiology have accelerated over the last two years. With more than 30 transactions combined in 2021 and 2022, “cardiology consolidation in its early stages is outpacing the precedent set by other physician specialties,” according to research from Provident Healthcare Partners. 

“This momentum is expected to be sustained as there are a number of practices pursuing deals and several investors seeking platform investments into the specialty,” Provident notes. “With an estimated market size of $50.9 billion, private equity investment has only scratched the surface in the specialty."

In addition, the physician experience of independence has changed drastically in the past decade. Heavy workloads, mounting legal requirements and the mandate to reduce costs and improve outcomes all place disproportionate stress on independent cardiologists. Meanwhile, small independent practices struggle to compete with the technology budgets of large health systems.

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