Orthopedic practices are increasingly feeling the strain of remaining independent. Practice owners are faced with growing pressure from local hospital systems to acquire them or to subsidize IT expenses by rolling practices into their IT system. If this approach is not the right direction for your practice, you’re not alone. Thirty-five percent of all orthopedic surgeons are part of a private independent orthopedic practice. Even if you have a strategic plan to remain independent, now might be the right time to ask yourself these questions: These questions may just be the beginning of a bigger conversation or they may be a continuation of a broader view that’s been in place for some time. Either way, you should reflect on what’s working and what isn’t. Strong leadership is key to remaining independent and growing your orthopedic practice. You need to cultivate your natural leaders. These individuals are at ease leading a team forward while encouraging those that exhibit confidence, humility, and the ability to see beyond their personal goals to make decisions that help the practice grow.. It is also important to have a plan in place to mitigate the risks and issues if there are changes in leadership. The strength of independent practices and the key to future independence is in the ability to make decisions for the betterment of the whole practice and not just the individuals.