05/11/2026
Why our office is a dying breed!
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You called your doctor and they told you the next opening is in nine months.
It's not a doctor shortage. It's a small-office shortage. And there's a reason nobody at the front desk is allowed to say it out loud.
Fifteen years ago, 75 percent of US physicians were in private practice. Today, only about 25 percent are. The rest have been absorbed into hospitals and corporate health systems. And every door that closes makes the line longer for the rest of us.
Scott Tzorfas, a solo neurologist who has held out for 30 years, joined The Podcast by KevinMD to explain exactly how it happened.
Hospitals get paid two to three times more than independent doctors for the same office visit. For an echo or an MRI, three to five times more. Same physician work, same patient, completely different check, just because of the address on the door.
Then come the prior authorizations. His office spends hour after hour getting basic things approved. Generic headache medicine. Generic medications that did not need approval five years ago. Every MRI he orders. There are commercial insurers in his area that will approve a lumbar spine MRI but refuse a cervical spine MRI, the one that can cause paralysis if missed.
He says a typical small practice now does about 40 prior auths a week, and most of the denials come from algorithms, not from a doctor in his specialty. There is often no human on the other end of the line who can override anything.
This is what physician burnout in private practice actually looks like. It is not drama. It is the slow, deliberate strangling of the small office by paperwork until the doctor sells to a hospital, sells to private equity, or just retires. And then your wait gets longer.
Scott took a different path. He dug in. He runs his practice with his wife. He is busier now than he was 15 years ago because patients keep searching for someone who will actually look at them instead of clicking boxes.
Send this to the family member who is still waiting on a callback from a specialist. Send it to the friend who got denied an MRI last month. Send it to the new doctor in your life who has not yet been told that private practice is even an option.
Listen to the full conversation on The Podcast by KevinMD. Link in the comments.
What is the longest you have ever waited to see a specialist?
