Workload, Reduce Payment: Dissatisfaction with Independent Practice

Doctors in the United States do more work than ever before – but they are paid less.

This month, consulting firm Kaufman Hall released new research on the relative value unit of work or WRVU for American physicians and senior practitioners. This metric tracks provider productivity by measuring the number of clinical work performed, such as patient visits, procedures, and other billable services, and is adjusted for complexity and time. There is a relevant WRVU for each visit or service, and by adding and dividing all of these values ​​by the number of full-time providers, healthcare organizations can find a consistent way to track and compare the clinical workload of providers.

In the second quarter of 2025, WRVS per physician was converted to 6,449 and 5,030 per pre-practice provider, meaning physician productivity increased by 12% compared to 11% for senior practitioners, compared to 11% two years ago.

However, the reimbursement rate has not risen at the same rate – the salary of doctors visited by each patient has dropped by 33% since 2001. This payment gap will only widen as more and more patients begin to lose insurance in the coming months of a large beautiful bill.

Experts have called for physician payment reforms, saying it is the only measure to preserve independent physician practices and slow the wave of mergers.

Smaller, independent practices tend to feel the greatest impact of rising workloads and stagnant reimbursement. Unlike large hospital networks, they have fewer resources, which makes it more difficult to hire enough support staff, invest in efficient technology and establish alternative sources of income.

More work, less support

Even as doctors work more and more, their support staffing levels are declining, he noted Matthew Bates, Managing Director and Head of Physician Enterprise Services Line, Kaufman Hall.

He noted that staffing levels in support roles such as front desk staff and medical assistants have dropped by 13% over the past two years. Bates said this imbalance of imbalance — a 13% reduction in support of work — is the main driver of the provider’s ongoing stress and burnout.

In his opinion, AI has not offset the burnout and staff shortage. He said AI tools, such as environmental scribes, mainly reduce the provider’s after-hours charts or “pajama time” rather than reducing the amount of work in the clinic.

The ongoing care backlog also increases the pressure on providers. Bates added that many electives have been delayed after the pandemic, creating months-long waitlists where physicians must work to clear while still keeping up with new demand.

“I have a lot of clients with three, six to nine months waiting lists for colonoscopy. We're working to get through that backlog – we've given up on thousands of screening colonoscopy, which takes a long time to back up,” he said.

All this stress – the heavier workload, the shrinking support team and a large backlog of patients – is a blend of today’s burnout crisis.

For Bates, physician burnout stems from systemic workload and staffing issues. He claimed that discussions about burnout are often attributed to EHR, but the core issue is that doctors do more with less help.

“If UPS handed them to their employees and said, 'I need you to offer 10% more packages over the next two years than you have done in history,' that would be hard for them to do and the union would be rightly delayed.”

Medicare can't keep up with inflation

Dr. Bobby Mukkamala, president of the American Medical Association, pointed out that even if operating rents, operating expenses for hiring employees and medical supplies (payment of rent, hiring staff and medical supplies), physician salaries are falling.

“It's more expensive to do this job, and we have much less work, and the work among us isn't enough. It's just the complete secret to worsening health care in our country,” Dr. Mukkamala declared.

He believes that payment reform is urgently needed – Medicare must be the first goal.

Medicare sets a repayment baseline through its annual fee schedule. Private payers almost always pin their payment rates to the schedule of health insurance, usually paying a small portion above or below it.

Dr. Mukkamala said the entire system followed suit because Medicare's reimbursement rate failed to keep up with inflation.

He also noted that millions of Americans are expected to lose Medicaid coverage due to a large bill. He explained that this will cause patients to delay care until their condition worsens, increasing reliance on the emergency department and increasing pressure on the already heavy system.

Dr Mukkamala added that without reform, private practice would be forced to run for skeleton staff. Such cost-cutting measures often result in longer waiting times, more administrative burdens fall on doctors, and greater risk of burnout.

For smaller or independent practices, financial compression can become so severe that they shut down completely or sell themselves to large health systems.

The uncertain future of independent practice

Meade Monger, CEO of Healthcare Data Company’s omniscient health, said Meade Monger, CEO of Healthcare Data Company’s omniscient health, said Meade Monger, CEO of Healthcare Data Company’s omniscient health, said the capabilities of healthcare data company’s omniscient health pose a huge threat.

Omniscient released a report this month that shows that traditional health insurance payment rates for outpatient procedures have been declining every year since 2016, down 10% cumulatively. This is even worse for Medicare Advantage, where doctors are estimated to pay 10-15% less than traditional Medicare pays.

Monger noted that in order to cope, many doctors have begun to treat more commercial insurance patients, which reduces the care opportunities for Medicare beneficiaries.

However, most doctors cannot give up health insurance completely.

“To compensate for the decline in Medicare reimbursement rates and rising costs, providers have been forced to take deep cost measures to cut performance and quality bones,” Monge said.

He said the shrinking reimbursement rate and rising costs will continue to erode the traditional independent practice model.

Monger notes that a large amount of independent practice has been incorporated into larger systems. For example, more than 60% of doctors have their own practices in 2012, and by 2022, that number has dropped below 46%.

Larger systems can do better, better negotiate better reimbursement contracts and allocate fixed costs, making integration an increasingly common avenue for physicians seeking financial stability.

Monger said that to protect the future of independent practice, the industry needs to undergo a “full overhaul” of the Medicare reimbursement process.

He believes that the work should focus on increasing reimbursement for physicians, denial and timely payments for Medicare Advantage programs, and the promotion of stricter standards for alternative payment models.

“While CMS and other stakeholders have begun to take action on these areas, progress needs to be accelerated,” Monger declared.

Unless reforms are made, reducing wages and increasing pressures will only exacerbate physician burnout – driving more providers to leave independent practice or full careers.

Photo: Xavier Lorenzo, Getty Images