Substantial economic pressures, mounting administrative burdens, and increasing regulatory demands continue to threaten the sustainability of private physician practices, driving a growing trend toward consolidation. According to an analysis conducted by the American Medical Association (AMA), an increasing percentage of physicians are working in larger, multispecialty practices owned by hospitals and private equity firms. As a result, the proportion of doctors in private practice is now at its lowest point ever.(1)
This shift toward hospital employment and corporate healthcare often results in diminished physician autonomy. Super groups, formed when independent medical practices consolidate under a single legal and governance structure, offer a strategy for sustaining physician autonomy while still realizing the benefits of consolidation.
Structure
Super groups represent a form of horizontal integration, with merged practices typically operating under a single tax identification number and governed by a unified leadership structure. They can be organized as either single-specialty or multispecialty entities. In super groups, physician ownership is typical, especially in groups formed to preserve independence. Super groups have, however, also generated interest from private equity firms, which perceive the financial opportunity to acquire a group and later sell it at a profit.(2)
In most cases, the partners from the merging practices become equity owners of the super group. Meanwhile, associate physicians are generally required to enter into employment agreements with the consolidated practice.(3) Administrative functions and resources are shared across member practices.
Super groups are frequently organized as separate and distinct divisions or “care centers,” reflecting the legacy organizations that have merged together. This model allows the former groups to retain a significant degree of autonomy while leveraging the benefits of membership in the unified super group.(3)
Drivers
Broader Trends
Decisions to form super groups are influenced by several drivers, many of which mirror broader trends in physician alignment. These include economic pressures, such as flat or declining reimbursement rates — especially Medicare rates — coupled with rising operational costs. According to the AMA, Medicare physician payments have declined 33% from 2001 to 2025 when adjusted for inflation in practice costs. This decline has influenced practice consolidation trends.(4)
Super groups can provide a mechanism for mitigating economic pressures like these. They provide greater access to capital and economies of scale, allowing physicians to negotiate better terms when purchasing medical supplies, equipment, malpractice insurance, electronic medical record software, and other essential resources. Additionally, since they represent a larger patient base, super groups command enhanced negotiating leverage with managed care payers and insurance networks.(5) These advantages, along with access to more advanced information technology and stronger clinical integration opportunities, can better position providers to succeed in an era of expanding value-based care models.
Compelling Alternative to Hospital Employment or Corporate Healthcare
Physicians may be drawn to super groups for reasons that diverge from traditional alignment models. A Bain & Co. survey found that physician satisfaction was consistently higher at physician-led organizations. Surveyed physicians cited a lack of autonomy as the primary reason for their discontent with management-led organizations (i.e., practices operated by hospitals, health systems, parent companies, or private equity firms).(6,7) For physicians concerned with preserving autonomy, affiliating with a super group can offer a compelling alternative, one that balances independence with the benefits of scale.
Super group affiliation can offer additional advantages compared to traditional hospital employment. Among them is an improved ability to invest in and capitalize on ancillary revenue opportunities while remaining compliant with Stark regulations, which prohibit physician self-referrals.(3)
Considerations and Challenges
While super groups offer a compelling strategy for preserving physician autonomy and achieving scale, they also present several challenges. Forming a super group can be costly and complex, requiring thoughtful planning and consideration. Successfully aligning cultures and practice values is a complicated undertaking, but it is critical for long-term success. Organizations should prioritize these factors when selecting merger partners, then build their relationship on a foundation of shared decision-making and transparent leadership.
Super groups have the potential to enhance care coordination while allowing physicians to retain autonomy over clinical decisions. Incorporation into a larger group, however, comes with the risk of losing the “personal touch” that defines many independent practices. The larger super groups become, the more complicated they are to govern. This increased administrative complexity can negatively affect organizational feel and patient satisfaction, a concern requiring active management.
Questions also arise about super groups’ long-term sustainability. While many are formed to preserve independence, they may ultimately serve as transitional models, attracting acquisition interest from other organizations such as private equity firms. Establishing a strong foundation that prioritizes shared governance, physician autonomy, and efficient, patient-centered care will help ensure a super group’s long-term success.
Future Trends
Statistics on physician super groups and practice mergers are limited. As of 2025, parties involved in mergers and acquisitions are not required to report transactions that fall below the statutory reporting threshold of $126.4 million to the Federal Trade Commission or Department of Justice.(8) As a result, it is difficult to quantify the number of independent super groups in existence or track their growth over time. There are indications, however, that super groups will continue to proliferate. In a survey conducted by EY Provider Pulse, for example, over half of all oncologists surveyed indicated they were changing the financial structure of their practice, with many indicating an increasing likelihood of joining an oncology super group.(9)
The prevailing market forces that reward scale and integration will likely continue to drive practice consolidations well into the future. Growing physician dissatisfaction with affiliation models that limit autonomy may further accelerate the shift towards super groups, which aim to offer greater control, shared governance, and strategic alignment. As private practices grapple with mounting pressures, super groups may offer a strategic solution that simultaneously preserves physician autonomy and leverages the advantages of scale.
References
Garvey G. Smaller share of doctors in private practice than ever before. American Medical Association, June 24, 2025. https://www.ama-assn.org/practice-management/private-practices/smaller-share-doctors-private-practice-ever .
Collins TR. Going solo: otolaryngologists share the benefits and challenges of private practice. ENTtoday, December 14, 2021. https://www.enttoday.org/article/going-solo-otolaryngologists-share-the-benefits-and-challenges-of-private-practice/ .
Frier DB. What you need to know about forming a medical super group. Medical Economics, December 4, 2020. https://www.medicaleconomics.com/view/what-you-need-to-know-about-forming-a-medical-super-group .
Henry TA. Medicare physician pay has plummeted since 2001. Find out why. American Medical Association, April 21, 2025. https://www.ama-assn.org/practice-management/medicare-medicaid/medicare-physician-pay-has-plummeted-2001-find-out-why .
Samii N. The rise of the orthopedic supergroup. Becker’s ASC Review, June 14, 2021. https://www.beckersasc.com/orthopedics-tjr/the-rise-of-the-orthopedic-supergroup/ .
Godla D. The pendulum swings: are physicians returning to independent practice? ThoroughCare, June 20, 2025. https://www.thoroughcare.net/blog/are-physicians-independent-practice .
Morrissette E, Brookshire M, Weisbrod J. Where does your organization stand with physician satisfaction? Bain & Company, July 2022. https://www.bain.com/insights/where-does-your-organization-stand-with-physician-satisfaction-infographic/ .
United States Government Accountability Office. Health Care Consolidation: Published Estimates of the Extent and Effects of Physician Consolidation. GAO-25-107450. United States Government Accountability Office, September 22, 2025. https://files.gao.gov/reports/GAO-25-107450/index.html .
Tuna M, Schur E, Nedev E. How to optimize account activation in the evolving us oncology ecosystem. AVBCC, October 13, 2025. https://avbcc.org/how-to-optimize-account-activation-in-the-evolving-us-oncology-ecosystem/