TCU Student Article
By Prisca Mbonu, MS-IV
This article was originally published in the January/February 2026 issue of Tarrant County Physician.
During my medical school’s Preparation for Practice course, we examined the multidimensional aspects of the medical profession, which included everything from the business of medicine to health equity, patient safety, public health, and communication. One session, titled “Health System Structure and Why It Matters,” stood out as particularly interesting. In this session, we explored the complexities of health systems, such as the features, incentives, and organizational models that influence physician practice structures. We examined the advantages and disadvantages of various models from the perspectives of both physicians and patients, delving into topics such as compensation structures and the trade-offs of different practice settings.
There are various paths for physicians to consider when choosing their practice structure. Private practices offer autonomy but come with financial risks and administrative burdens. On the other hand, hospital or health system employment provides stability and resources, but often at the cost of clinical independence. Payer-owned practices emphasize cost-effective care but may create ethical tensions due to insurance policies, while corporate-owned practices promise growth and potential equality but can impose pressures to meet financial targets. Corporate entities like health plans, venture capital investors, private equity firms, and large employers are also rapidly acquiring physician practices, outpacing hospital ownership and fundamentally reshaping the employment model.1 By 2022, 26.4 percent of physician practices were owned by corporations, compared to 27.2 percent owned by hospitals.2 This shift is a game-changer both for how physicians practice and how patients receive care.
Physicians also have the option of working within nonprofit, for-profit, government-owned, or academic medical centers, each offering distinct advantages. Nonprofit institutions purport to prioritize community service while reinvesting surpluses into patient care and public health. For-profit institutions may emphasize efficiency and profitability, often with the goal of expanding services or increasing shareholder returns. Government hospitals emphasize serving specific populations, such as veterans, while academic centers integrate patient care with education, research, and innovation. Evidently, these organizational models encompass substantial variation in governance, incentive structures, and day-to-day clinical realities, requiring physicians to navigate differing priorities as they define their professional identities.
It is important to note, however, that the stated missions and structural principles of these practice and ownership models do not always reflect how organizations operate in practice. Considerable overlap and, at times, incongruence exist across settings. For example, nonprofit and academic centers may face financial pressures that shape productivity expectations and revenue-driven strategies, while for-profit or corporate-owned practices may support high-quality, mission-driven care despite profit-oriented frameworks. These dynamics are often influenced by broader market forces, regulatory constraints, leadership, and other contextual factors.
As a medical student preparing for my future, I find myself grappling with several important questions: Which organizational structure aligns best with my values as a physician and an individual? Should I work for someone else, or would I prefer to be “my own boss”? What will financially benefit me as a physician? How will my work-life balance be affected, especially as a woman considering starting a family? How will these choices impact my autonomy, how I’m able to practice my ethical values, and the care I can provide to patients? These questions loom large and require a great deal of nuanced thought. While I don’t yet have all the answers, I am grateful for the opportunity to begin to reflect on these questions as I plan my career trajectory.
In a world where medicine is increasingly intertwined with business, we can no longer shy away from conversations about compensation and career structure. Many of the physician-led panelists at the session emphasized how essential this knowledge is—something they wish they had received earlier in their training. For medical students who will likely graduate with substantial student loan debt, these conversations also carry important financial implications. Overall, the course session on health system structures provided insights into the diverse organizational and financial models shaping both our future careers and patient care. Understanding these options is crucial in helping us determine not only how we want to work, but who we want to be as physicians and individuals.
References:
- AHA Center for Health Innovation, Evolving Physician-Practice Ownership Models: Implications and Considerations for Hospitals and Health Systems, Market Insights Report (2021), https://www.aha.org/system/files/media/file/2020/02/Market_Insights_MD_Ownership_Models.pdf
- Dailey, Eliza, and Sarah Roller. “Implications of the New Era of Physician Employment: 2023 Update on the Physician Landscape.” Advisory Board. April 1, 2023. Updated May 12, 2023. https://www.advisory.com/topics/physician/2023/04/a-new-era-of-physician-employment
Tarrant County Physician Online 