Understanding Your Options

Independent Practice vs. Large Health Systems — Who's Actually Making Decisions About Your Care?

The main difference between an independent practice and a hospital-owned or corporate health system comes down to one question: who does your provider answer to? In an independent practice, the provider answers to you — the patient. Clinical decisions are made based on your individual needs. In a hospital-owned or corporate system, providers answer to administrators, efficiency targets, and system-wide protocols. The care may still be good. But it is structurally different — and research shows patients feel that difference. Burds Family Practice is independently owned — and that's a deliberate choice.

Side by Side

What Each Model Looks Like in Practice

✦ Burds Family Practice
Independent Practice
Who makes clinical decisions Your provider — based on your history, your goals, and your needs. No external protocol required.
Who owns the practice A healthcare provider. At Burds, an ARNP/FNP who built this practice from the ground up and lives in this community.
Time with your provider As long as your visit requires. The schedule is built around patients, not productivity metrics.
Provider continuity You see the same provider. They know your name, your family, your history, and your preferences.
Community accountability Your provider is your neighbor. The success of this practice depends entirely on the trust of this community.
Billing and costs Transparent pricing with no surprise charges. No facility fees added to your bill.
Provider burnout Independent providers report significantly lower burnout — which directly affects the quality and consistency of your care.
VS
Hospital / Corporate System
Large Health System
Who makes clinical decisions Your provider — but within system-wide protocols, prior authorization requirements, and productivity expectations set by administrators.
Who owns the practice A hospital system, insurance company, or private equity firm. Ownership priorities are financial and organizational, not clinical.
Time with your provider Structured around efficiency. Studies show hospital-employed providers average 13.3 minutes per visit — compared to 18.5 in independent practices.
Provider continuity High turnover in employed settings. You may see a different provider at each visit, or your provider may leave the system entirely.
Community accountability Decisions are made at the system level — often by administrators in another city — not by someone invested in your specific community.
Billing and costs Hospital-owned practices often add facility fees to standard office visits — charges that don't appear in independent practices. Patients are frequently surprised.
Provider burnout 100% of health system-based providers surveyed reported some level of burnout, vs. 15% of independent providers who reported none at all.
What the Research Shows

The Numbers Are Clear

This isn't opinion — patients and providers consistently experience independent practices differently than large health systems. Here's what the data shows.

26%
Higher patient satisfaction rates reported at independent practices vs. hospital-owned practices
HBK Healthcare, 2025
18.5
Average minutes per visit in independent practices — vs. 13.3 minutes in hospital-owned settings
2023 independent practice study
78%
Of patients who prefer independent practices cite a stronger doctor-patient relationship as the reason
Software Advice / Medical Economics, 2026
60%
Report greater trust in independent practices
vs. hospital-owned or corporate practices, among patients who have a preference
57%
Say quality of care is higher at independent practices
Among patients surveyed who had experienced both settings
100%
Of health system providers reported some level of burnout
Compared to 15% of independent providers who reported no burnout at all — burnout affects the care you receive
37%
Of physicians considering leaving large health systems want to move to independent settings
The trend toward consolidation is beginning to reverse as providers seek autonomy and patient-centered practice
What's Been Happening

The Consolidation Problem — and Why It Matters to You

Over the past decade, independent medical practices have been disappearing at a significant rate. In 2012, nearly half of all physicians owned or worked in an independent practice. By 2022, that number had fallen to 30%. By early 2024, over 77% of physicians were employed by a hospital, health system, or corporate entity.

This shift wasn't driven by patient preference — it was driven by financial pressure, administrative burden, and aggressive acquisition by hospital systems and private equity firms. And it has had real, measurable effects on patient experience.

What typically happens when an independent practice is acquired
At acquisition
Practice branding and signage changes. Administrative staff are replaced or reduced. Billing is consolidated into the system.
Within 6–12 months
Facility fees appear on your bill. Hospital-owned practices can charge a facility fee on top of the standard office visit charge — a fee that didn't exist before acquisition and that most patients don't notice until they open their explanation of benefits.
Appointment access
Patient panels increase as the system optimizes for volume. Wait times grow. Visit durations shorten. Your provider is seeing more patients in the same amount of time.
Clinical decisions
Prior authorization requirements increase. System-wide formularies restrict prescription options. Referral decisions are influenced by which specialists are in the system's network.
Provider turnover
Physicians employed by hospital systems report significantly higher burnout. Many leave — and the provider you chose is replaced by someone who doesn't know you.
Full Breakdown

Independent vs. Health System — Complete Comparison

Factor Independent — Burds ✦ Large Health System
Ownership Healthcare provider — ARNP/FNP who built this practice Hospital system, private equity, or corporate entity
Who clinical decisions serve The patient — individually The patient — within system protocols and efficiency targets
Average time per visit 18.5 minutes average — as long as the visit requires 13.3 minutes average in hospital-owned settings
Provider continuity ✓ Same provider, long-term relationship Variable — high turnover in employed settings
Facility fees None — no facility fees ever Common — charged on top of standard office visit fees after acquisition
Prior authorization burden Minimal — provider decides, not a committee High — system-wide requirements add delays
Provider burnout Significantly lower — affects consistency of your care 100% of health system providers report some burnout
Community rootedness ✓ Provider lives here, is invested here Decisions made at the system level, often remotely
Patient satisfaction 26% higher than hospital-owned practices Lower — particularly on relationship and trust measures
Flexibility in care approach ✓ Provider adapts to your needs Constrained by system-wide standardized protocols
Same-day access ✓ Same-day appointments available Variable — often days to weeks
Why This Matters Here

In Eastern Iowa, Independent Practice Means Something

🌾

Small-town healthcare deserves small-town accountability.

In rural and small-town communities, the stakes of consolidation are higher. When a large health system acquires the only primary care practice in a community, patients have nowhere else to go — and the system knows it. At Burds Family Practice, we are independently owned because we believe your provider should be accountable to you — not to a board of directors in another city. We built this practice in Peosta because this is our community. The mission of bringing quality healthcare to the community we call home isn't a tagline. It's why we structured our practice the way we did.

Healthcare consolidation has been particularly aggressive in Iowa and the Midwest. As hospital systems expand their footprint in smaller markets, independent practices become increasingly rare — and increasingly valuable. Choosing an independent practice isn't just a personal preference. It's a vote for the kind of healthcare your community keeps access to.

Common Questions

Frequently Asked Questions

What is the difference between an independent medical practice and a hospital-owned practice?
An independent medical practice is owned and operated by a healthcare provider — not a hospital system, insurance company, or private equity firm. The provider makes clinical and operational decisions based on patient needs. A hospital-owned or corporate practice operates under the priorities of a larger organization, where standardized protocols, productivity metrics, and system-wide financial goals influence how care is delivered. Research shows patients of independent physicians report 26% higher satisfaction rates and spend significantly more time with their provider per visit.
Do patients get better care at independent practices?
Research consistently shows that patients at independent practices report higher satisfaction, stronger provider relationships, and more time with their doctor. A 2023 study found that physicians in independent practices spend an average of 18.5 minutes per patient visit compared to 13.3 minutes in hospital-owned practices. Among patients who prefer independent practices, 78% cite a stronger doctor-patient relationship, 60% report greater trust, and 57% say the quality of care is higher.
Why are so many doctor's offices now owned by hospitals or corporations?
The percentage of physicians in independent practice declined from 48.5% in 2012 to 30.1% by 2022, driven largely by financial pressure, administrative burden, and the rising cost of running a practice. Hospital systems and private equity firms have aggressively acquired independent practices over the past decade. As of January 2024, 77.6% of physicians were employed by hospitals, health systems, or corporate entities. However, the trend has begun to slow as more physicians seek to return to independent or physician-led settings.
Is Burds Family Practice an independent practice?
Yes. Burds Family Practice in Peosta, Iowa is independently owned and operated — not affiliated with a hospital system, insurance company, or corporate entity. Clinical decisions are made by the provider based on patient needs, not system-wide protocols or productivity metrics.
What happens to patient care when a practice is acquired by a hospital system?
When an independent practice is acquired by a hospital system or corporate entity, patients typically experience longer wait times, shorter appointment durations, and facility fees added to billing that didn't exist before. Clinical decisions may increasingly reflect system-wide protocols rather than individual patient needs. Provider turnover often increases as physicians in hospital-employed settings report significantly higher burnout rates.

Healthcare that answers
to you — not a system.

Burds Family Practice is independently owned, community-rooted, and built around your needs. Accepting new patients.

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