You’re not imagining it: the business side of healthcare is swallowing the care side. Here’s what that means for you as a patient, and why choosing a small, independently owned practice is often your best move if you want doctors who put health over shareholders.

What “consolidation” in healthcare really means for patients: (Think AMAZON.COM vs. Your Local Store)

In plain language, consolidation means fewer, bigger players running more and more of healthcare:

  • Large hospital systems buying up local practices
  • Private equity firms (think venture capitalists and hedge funds) buying medical groups and squeezing them for profit
  • Insurance companies not just paying claims, but quietly shaping how, where, and if you get care

On paper, this can sound efficient. In real life, it often means:

  • Fewer truly independent doctors in your community
  • Less choice about where you can go, because your plan or network steers you into certain systems
  • Care that is increasingly designed around financial targets, not around you

Why so many doctors are leaving private practice

Fifteen or twenty years ago, being in private practice was the norm. Many doctors owned their own offices, set their own schedules, and had long-term relationships with families.

That world is disappearing because:

  • Payments for actual hands‑on care have dropped dramatically over the last decade and a half. Doctors and their offices are making far less than before
  • The cost to run a small office -staff, rent, technology, compliance – has exploded.
  • Young doctors finish training with huge student loans and feel they can’t risk the financial uncertainty of hanging out their own shingle. So they go to work for “The Man”.

So they take salaried jobs in large systems or corporate‑owned groups. They gain stability – but often lose autonomy over how they practice – more quotas, less time working with you.

How the business of medicine affects your care

When investors and giant insurers call the shots, the priorities shift:

  • Visit volume over visit quality: Shorter appointments, more patients per day.
  • Metric chasing: Doctors pressured to hit certain numbers (RVUs, “productivity,” downstream revenue) that may or may not align with what you actually need.
  • Ancillary revenue focus: More emphasis on feeding surgery centers, imaging, tests, and procedures because that’s where the margins are.

Many physicians now find they earn more from ownership in facilities and services attached to their practice than from the time they spend listening to you and examining you. That’s not necessarily because they don’t care – it’s because the system rewards everything around the visit more than the visit itself.

Why small, independent practices matter now more than ever

In this environment, small, unaffiliated practices are becoming rare – but they are also where some of the most patient‑centered care lives.

Here’s what you usually get from a genuinely independent office:

  • Clinical independence. Your doctor can choose what’s best for you without being pressured to keep referrals “in system” or to hit a corporate quota.
  • Relationship‑based care. You’re less likely to feel like a number. Staff know your name, your story, and your preferences.
  • Flexibility and common sense. Independents can often adjust scheduling, communication, and follow‑up more quickly because decisions are made in‑house, not by a distant committee.
  • Local accountability. If you have a concern, you’re talking to the actual people who own and run the practice—not a call center or a remote corporate office.
  • Less conflict of interest. When a practice isn’t owned by a hospital system or private equity group, there’s less pressure to steer you toward the most profitable setting or procedure.

In short: independent clinics survive only if patients feel cared for and come back. Their core “business model” is trust and outcomes, not stock price.

How to spot a truly independent, patient‑first office

If you want a doctor who focuses on health rather than shareholder value, here are questions you can ask (and even put on your checklist):

  • “Is this practice independently owned, or is it part of a hospital system or investor‑owned group?” FYI: More and more chiropractic and “functional medicine” clinics are owned by investor-groups, so be sure to inquire firmly if your preference is independently owned.
  • “Do you have any financial incentives to refer me to particular hospitals, imaging centers, or surgery centers?”
  • “How long are your typical appointments for new and follow‑up visits?”
  • “If I have a question, will I be able to reach someone who knows my case personally?”

You can also look for:

  • The practice name not matching a big hospital brand
  • Honest, clear communication about costs and options
  • Staff who aren’t afraid to say, “Let me check with the doctor,” instead of reading from a script

What you can do as a healthcare consumer

You may not be able to change the entire system, but your choices still matter:

  • Whenever possible, seek out independent practices for primary care and specialties, like chiropractic care.
  • Ask your insurer which independent offices are in network – and push back if your options are all system‑owned.
  • Support practices that give you time, listen carefully, and explain – not just those that feel “fancy.”
  • Share your positive experiences with independent offices; word‑of‑mouth helps them survive in an environment tilted toward giant systems.

In a healthcare world increasingly driven by spreadsheets and shareholders, choosing a small, independently owned office is one of the most powerful ways you can vote for care that puts you—as a human being—at the center.

Dr. Lou Jacobs, Chiropractor and acupuncturist in Portland, Maine, has been working with and specializing in the health and performance of musicians of all types, for nearly 24  years. His work has been highlighted in Guitar Player Magazine, and his client list is extensive, having worked with some of the best horn players in the world today. Dr. Lou is always accepting new patients and offers tele-consulting for musicians outside of Southern Maine. Dr. Lou also works with families and is board certified in chiropractic care for children and  pregnant moms.

Dr. Lou may be reached by calling (207) 774-6251 or by messaging his office manager, Sandra Escobar, at Sandra@DrLouJacobs.com. Take a virtual tour at the link below!

Jacobs Chiropractic Acupuncture is an independently owned, SMALL office with BIG heart. Dr. Lou offers very affordable prices, without pressure from corporate investors, for out of pocket payers or those with high deductible insurance. The intake and processing of new patients is fast and efficient, and we provide billing services for those who choose to use their insurance.  If you don’t see the difference between Jacobs Chiropractic Acupuncture and a “typical” chiropractic or medical office within 5 minutes of entering the office, then we’ll be happy to refer you out for an eye or ear exam, whichever is needed for you to understand the difference between our office and all others! 

*This blog post was inspired and influenced by an interview with Louis Levitt, MD in “Becker’s Hospital Review” about the state of Orthopedic medicine being overwhelmed by a “Tsunami” of corporate influence. Read the article HERE.