The pressure is on to join larger health systems. With increasing regulation and declining reimbursement, many physicians relinquish independence and let an employer handle the business of healthcare. It’s easy to see why—with an array of possible concerns—from reimbursement reductions to losing referral sources, the pressure to give up autonomy is on. But independence is like a drug—hard to give up. Providing care on your terms, managing your business your way—allows you the greatest control over how you practice medicine. Running a profitable practice requires increasingly more effort and a thoughtful strategy that balances care, quality, and costs with a fine-tuned level of efficiency. Value-based reimbursement exacerbates the challenge of profitable independence The shift to value-based reimbursement has exacerbated the challenge of independence. The struggle to meet strict, burdensome and ever-changing federal regulations is exhausting. It requires an infrastructure that collects, manages, and reports data—without overwhelming amounts of staff time.