The basics:

• Author is vice president of health partner services at Holy Name
• Says physicians increasingly seek autonomy without administrative burdens
• Health systems must balance scale with clinical independence
• Technology can reduce administrative work, support patient relationships

The future of physician employment isn’t simply about independent practice versus large health systems. It’s about whether healthcare organizations can preserve the professional autonomy that physicians value while providing the scale modern medicine increasingly requires.

Recruitment conversations offer a perspective on the physician workforce that statistics alone cannot. Having helped conduct more than 120 physician interviews over the past 14 months, I have heard firsthand how strongly physicians want independence and purpose.

Despite frequent narratives about physician burnout and the decline of private practice, many early-career physicians still aspire to build something meaningful. They want to establish lasting relationships with patients, develop their own style of practice and exercise clinical judgment rather than simply execute organizational protocols.

New physicians often begin their careers in educational debt while facing the growing costs of operating an independent office alongside insurers’ reimbursement. Financial realities make private practice increasingly difficult to sustain. According to the American Medical Association, for the first time in history, fewer than half of U.S. physicians now practice in physician-owned settings. In Northern New Jersey, one of the most heavily populated markets, the traditional solo practice has become the exception rather than the rule.

The distinction that healthcare leaders too often miss is this: when physicians talk about independence, they are not asking to manage payroll, negotiate payer contracts, or spend evenings buried in compliance paperwork. What they want is ownership of their clinical practice, which includes the ability to make decisions they believe are best for their patients. They also want opportunities to build relationships with their patients, to shape how they practice medicine, and to feel genuine ownership of their work. Too often, large health systems solve the administrative burdens of medicine only to strip away the professional autonomy that physicians value most. Then they express surprise when recruiting and retaining top physicians becomes a challenge.

Scale that comes at a cost

The defining question for today’s health systems isn’t whether to pursue scale, but how to achieve it without sacrificing physician autonomy. It’s refusing to accept that one must come at the expense of the other. Modern health systems should deliver both by absorbing the administrative complexity of medicine while preserving the professional independence that allows physicians to thrive. Scale is a powerful advantage, but only if it strengthens the physician-patient relationship rather than weakens it. When scale comes at the expense of autonomy, organizations don’t just lose their personal touch, they lose their best physicians.

Large health systems understandably emphasize efficiency, standardization, and operational consistency. Those capabilities create real value, allowing organizations to invest in technology, negotiate with payers, recruit specialists, and provide infrastructure that individual practices cannot replicate.

Scale has become essential, but it can come at a cost if it erodes the sense of ownership physicians feel over their work. When physicians lose meaningful input into clinical practice or organizational decision-making, the efficiencies that large systems create may be outweighed by declining engagement and retention. The challenge is not eliminating variation for its own sake but distinguishing between standardizing operations and standardizing the practice of medicine itself.

Recruiting, retaining top talent

Organizational structure also influences how physicians evaluate potential employers. Some health systems operate with relatively short investment horizons, where future ownership changes are expected and organizational priorities may shift accordingly. Others remain committed to long-term independence and deep ties to the communities they serve. Physicians increasingly recognize the difference. Stability, local governance, and the ability to make decisions close to where care is delivered can become meaningful advantages in recruitment and retention.

Institutional structure matters. Independent health systems like Holy Name have a unique opportunity to combine the advantages of scale with the agility physicians often find lacking in larger organizations. A physician network anchored by a single hospital can make decisions closer to where care is delivered, reducing layers of bureaucracy and accelerating innovation. Good ideas move from conversation to implementation in weeks rather than months, giving physicians confidence that their expertise will shape the organization rather than disappear into it.

Creating long-term value

The same philosophy shapes our strategic priorities. Primary care and maternal-child health may not always produce the highest financial margins, but they create the greatest long-term value. They are the front doors to the health system, the first meaningful relationship many families establish with their healthcare providers, and often the moment they decide whether they’ve found a trusted medical home. These services are the foundation on which lifelong patient relationships are built, that improve continuity of care and strengthen long-term community engagement.

Technology further reinforces this opportunity. By reducing administrative burdens and streamlining routine tasks, automation gives physicians more time for the conversations, relationships, and clinical judgment that no algorithm can replace. The goal of innovation isn’t to replace human interaction, but to create more space for it.

As healthcare continues to consolidate, the organizations that stand apart will not necessarily be the largest. They will be the ones that remember why physicians entered medicine in the first place. Scale should amplify great doctors — not standardize them. When it does, everyone benefits: physicians stay, patients receive better care, and health systems earn something far more valuable than market share; they earn trust.

Brendan Maron is vice president of health partner services at Holy Name, leading the growth and strategic development of the hospital’s physician enterprise, expanding access to high-quality care throughout northern New Jersey. He oversees the performance and expansion of the physician network, including the development of new services, physician recruitment, and more than 80 Holy Name-affiliated medical offices beyond the system’s flagship Teaneck campus. His focus is building a strong, accessible, and connected network that meets patients’ needs today while positioning Holy Name for the future.