AOA Leaders Describe a Profession Moving Away From the Solo Shingle
Osteopathic medicine is growing, but the old image of a lone physician building a community practice from scratch is fading fast. In a wide-ranging conversation, American Osteopathic Association leaders framed the modern DO career around a stark set of choices: own a practice, join a larger employer, or try to preserve independence inside a system that increasingly rewards scale over autonomy.
The numbers matter. More than half of DOs, 55%, now practice in a primary care specialty, and the profession includes 151,240 practicing physicians. Those figures speak to a workforce still deeply tied to frontline care, especially in communities where osteopathic physicians have long held a strong presence. They also sit beside a more disruptive reality: employed practice has become the default path for many physicians, not an exception.
Employment Offers Stability, but Not Full Control
Kathleen S. Creason, MBA, described the association’s response as a practical one. As physician employment has expanded, the AOA has had to show prospective members that its value extends beyond the traditional independent-practice model. Products and services once aimed mainly at private practice now have to speak to employed physicians whose day-to-day concerns are different, even when the underlying professional pressures are the same.
Richard R. Thacker, D.O., MACOI, who practiced internal medicine for 23 years in Tallahassee, Florida, before moving into academia, drew the comparison in direct terms. Independent practice can still deliver a strong return on investment, but it also carries risk, long hours, and the burden of making a business work in real time. Physicians must share call, decide who covers nights and weekends, and manage the hard logistics of after-hours care, hospital admissions, staffing, and follow-through.
There is relief in the group model, and there is also cost. A physician who joins a larger organization may gain support with hiring, billing, payroll, scheduling, and vendor management. The tradeoff is an eventual ceiling on income and, for many, less freedom over how care is delivered.
One sentence from Thacker captures the shift plainly: the days of one doctor hanging a shingle are nearly gone.
That change is not simply cultural. It reflects the economics of modern medicine, where independent practice must absorb rising overhead while reimbursement often fails to keep pace.
Rising Costs and Flat Payment Are Reshaping Practice Decisions
The economic pressure on private practice came through clearly. Creason said osteopathic physicians in private practice are confronting lower payment rates at the same time that expenses continue to climb. Staff wages, technology, equipment, and administrative infrastructure all add to the burden. Medicare payment, adjusted for inflation, has decreased dramatically over the last 30 years, leaving physicians to operate in a financial environment where costs and compensation move in opposite directions.
For many doctors, that equation is no longer sustainable. The gap between rising overhead and declining payment does more than strain balance sheets; it changes behavior. It can push physicians toward employment, limit the time and energy they can devote to direct patient care, and make independent practice feel less like a professional ideal than a business gamble.
Thacker acknowledged the appeal of a larger system for younger doctors who want to focus on patients and avoid the details of billing and collections. He also noted that modern private practice rarely means stepping directly into ownership. New graduates are more likely to be employed by a private firm first and earn their way into partnership later, if that opportunity comes at all. More often, the employer is a larger entity.
Employed Physicians Gain Support, but Face New Pressures
Employment is not a cure-all. Creason described one of its central tensions: physicians may be able to concentrate more on the patient encounter and less on the business machinery of medicine, but they may also feel directed in how they practice. Employed physicians can face more rigid productivity expectations and more tightly defined requirements for patient volume than they ever encountered in private practice.
Those constraints matter because they touch the core of professional identity. A physician who is relieved of administrative work may still feel boxed in by scheduling quotas, documentation demands, and organizational rules. The shift from owner to employee can reduce operational stress while increasing pressure around time, throughput, and standardization.
For osteopathic physicians in particular, the choice has added weight because so many practice in rural and underserved areas. Creason said DOs tend to be represented at a higher percentage in those settings than allopathic physicians, and that reality has historically aligned them more often with private practice. Even so, a large share of the profession is now employed, and the association has had to adapt to that blend of practice models.
Certification, Policy, and the Future of Osteopathic Practice
The conversation also touched on the broader professional pressures surrounding certification and regulation. For physicians in both independent and employed settings, the burden of keeping up with credentialing requirements adds another layer to an already crowded work life. These obligations can fall especially hard on doctors who are trying to preserve autonomy while running a business and maintaining access for patients.
The policy context is equally important. Reimbursement trends, Medicare payment policy, and practice costs are no longer background details. They are active forces shaping where physicians work, how they organize care, and what kind of relationship they can sustain with their patients.
Thacker’s own career path reflected the range of options available to DOs. He moved from federal service in the National Health Service Corps to private practice, then to employment after his partners sold the practice to HCA, and later to academia. His experience suggests that a medical career can still move through several models, but it also shows how frequently ownership gives way to employment over time.
For today’s DOs, the central question is not whether one model is morally superior. It is which structure best protects professional sustainability while still allowing physicians to care for patients well. The article leaves that tension unresolved, and the numbers behind it are not abstract: 55% in primary care, 151,240 practicing physicians, and a reimbursement system that continues to pressure independent practices as costs rise around them.