80.0% of independent primary care physicians say they worry about their practice's financial stability over the next several years, according to Elation Health's 2026 Primary Care Pulse survey. Only 2.0% of those same physicians say they are considering leaving primary care.
A second 2026 study points at the same gap from a different angle. The Physicians Foundation's 2026 Survey of America's Physicians, run with Medscape, found that employed physicians report more burnout than independent physicians, while independent physicians report far more worry about money. The split is worth tracking because employment status itself has shifted fast: more than 80.0% of U.S. physicians were employed by a hospital, health system, or other corporate owner in 2026, up from 25.0% in 2012, according to Healthcare Dive's reporting on the same survey.
Where employed and independent physicians differ
The Physicians Foundation surveyed 1,000 U.S. physicians in August 2026 on well-being, autonomy, and practice conditions. Debilitating stress in the past year hit 62.0% of employed physicians, against 51.0% of independent physicians. Ask what drives that stress and the two groups reverse. Independent physicians named financial pressure, meaning pay, job stability, or whether the practice stays open, as a top driver of distress at 37.0%, more than double the 16.0% rate reported by employed physicians.
Employed physicians pointed to organizational policy and productivity targets instead, cited by 34.0% of them versus 13.0% of independent physicians. Half of all physicians surveyed, 50.0%, said they had considered or made a major career change in the past year over well-being concerns. Another 40.0% turned down extra responsibilities or a leadership role for the same reason. Healthcare Dive's coverage of the survey also found that physicians younger than 45 reported more distress than older colleagues, and that female physicians reported burnout more often than male physicians.
| Distress driver | Employed physicians | Independent physicians |
|---|---|---|
| Debilitating stress, past year | 62.0% | 51.0% |
| Top driver: financial pressure | 16.0% | 37.0% |
| Top driver: organizational policy | 34.0% | 13.0% |
Source: The Physicians Foundation, 2026 Survey of America's Physicians with Medscape, 1,000 U.S. physicians surveyed August 2026.
What the financial worry is actually about
Elation Health polled 280 primary care clinicians on its own platform between January 31 and February 23, 2026, for its first Primary Care Pulse report. More than 80.0% said they were concerned about their practice's financial stability over the next one to three years. Asked to name the biggest pressure, 64.0% pointed to reimbursement from government and commercial payers. Staffing costs, technology spending, and overhead followed as the next layer of pressure in the same report.
These were not physicians new to running a practice. 70.0% had been practicing for 11 years or more, and 52.0% described their practice as fully unaffiliated with any health system, IPA, CIN, or ACO. That profile matches a practice owner reading a monthly P&L more closely than it matches a resident weighing career options, which is part of why the financial worry reads as specific rather than general anxiety about the profession.
How independent practices are responding
The worry has not turned into an exit. It has turned into a change in how these practices get paid. 27.0% of Elation Health's respondents already run a membership or cash-pay model alongside insurance billing, and 18.0% have moved to a value-based payment arrangement. Another 69.0% said they are building a plan to address the financial pressure, and 67.0% of that group expect to have it running within two years.
AI tools show up in the same data. 58.0% of respondents called AI essential to the future of primary care, and more than 65.0% already use AI tools in the practice. Among the physicians using AI, 98.0% reported a positive effect, 72.0% reported less time spent on documentation, and 35.0% reported lower burnout. None of these figures describe physicians retreating from running their own business. They describe physicians adjusting the mechanics of it, from how a visit gets billed to how a note gets written.
Why so few are heading for the door
Only 2.0% of Elation Health's respondents said they are considering leaving primary care. The report contrasts that figure with other national physician surveys, where the share weighing an exit has run as high as 44.0%. 93.0% of respondents said they remain committed to primary care despite the financial pressure, and 80.0% said they feel joy in their work daily or through most of the week.
The mental health data points in the same direction. In the Physicians Foundation survey, 71.0% of physicians said stigma around seeking mental health care is still present in medicine, a number that has moved little even as wellness programs have spread across health systems and practices. For a practice administrator or billing partner working with independent physicians, the two surveys together say something specific. The independent physicians on staff are not worn down by policy or productivity targets the way their employed peers are. What keeps them up at night is the math on the P&L, and 64.0% of them point straight at reimbursement as the reason.
Sources
- The Physicians Foundation, "New Survey of America's Physicians Finds Practice Conditions Are Driving Physician Distress," 2026
- Healthcare Dive, "Mental health gap widens between employed and independent physicians: survey," September 17, 2026
- Elation Health, "Elation Survey Reveals 8 out of 10 Primary Care Physicians Are Concerned About Long-Term Financial Sustainability," 2026
- Medical Economics, "80% of independent PCPs are worried about money. Only 2% are considering leaving," August 20, 2026
- Medical Economics, "On National Physician Suicide Awareness Day 2026, 71% of physicians say mental health stigma persists," 2026
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