Adil Ahmed, MD, is opening a solo orthopedic practice in Houston at a time when physician independence is moving in the opposite direction.
The decline has been steady and well documented. By January 2026, 82% of practicing U.S. physicians were employed by hospitals or corporate entities, up from 52% at the start of 2018.
The American Medical Association’s Physician Practice Benchmark Survey shows the share of physicians in private practice falling from 60.1% in 2012 to 42.2% in 2024. Orthopedic surgeons have held on longer than most, with 54% still in private practice, second only to ophthalmologists at 70.4%.
Dr. Ahmed, an upper extremity surgeon, is leaving academic medicine to open Houston Upper Extremity Center. He earned his medical degree from Baylor College of Medicine in Houston, completed his orthopedic surgery residency at the University of South Florida in Tampa and went on to complete two fellowships, one in hand surgery and one in shoulder and elbow surgery.
Academic medicine was his first stop after training. After his fellowships, he returned to Baylor College of Medicine in Houston to join the academic faculty.
“That was really my three-pronged reason for wanting to go into an academic model at the beginning: the challenging cases from the start, resident education, fellow education, and then the research aspect,” Dr. Ahmed told Becker’s. “And it was great for a while.”
Asked what led him to leave, Dr. Ahmed began with the compensation model. He said there was no single breaking point. Instead, he found that academic medicine looks very different from the attending’s side than it did during training, largely because of how attendings are paid.
“There’s no incentive, at least financially, to do anything other than see more patients and do more surgery, because there’s no base salary, there’s no guarantees. It’s just an RVU-based production model, which honestly is the exact same incentive model someone has in private practice,” Dr. Ahmed said.
Then there was the question of who actually ran his clinic. He expressed frustration over his lack of control over administrative and staffing decisions.
“On paper it was my practice. But it was my practice, kind of,” Dr. Ahmed said. “It was my practice with an asterisk because the institution still controls who my staff is.”
The same dynamic played out in the operating room. Dr. Ahmed said the hospital went out of its way to accommodate outside private practice groups because every case they brought in generated a facility fee without the hospital paying the surgeon. From the hospital’s perspective, he said, that was an even better deal than keeping its own employed physicians busy.
The result, he said, was less decision-making power in both the clinic and the OR, while the accountability stayed with him.
“You’re still the one that the patients take it out on because they see that this is your practice, your name,” he said.
That tension shows up in national survey data. Employed physicians reported more debilitating stress over the past year than independent physicians, 62% compared to 51%. Independent physicians, meanwhile, were more than twice as likely to name financial pressure as a top source of distress.
Dr. Ahmed is heading into the financial side of that trade-off with his eyes open.
“I would say 90% excited, and also 10% very openly nervous,” he said. “It’s a big undertaking. I’m building every piece of it from scratch.”
He has also fielded the obvious question from colleagues.
“I had a lot of people ask me, am I crazy for doing this? And maybe,” Dr. Ahmed said. “This was very well researched by me. I talked to so many people across the country that I know who have started their own practices. I got legal advice, bankers’ advice, accounting, every little bit of it before I really crystallized my decision that this is actually something that has a high chance of success. It wasn’t made on a whim at all.”
Some of that research started in his social media inbox. He said it may seem “silly,” but his outreach through Instagram direct messages allowed him to gain insights from other private practice owners. He said it was important to hear from people who had built successful practices, not just those who doubted his decision.
“Don’t believe the naysayers because the naysayers haven’t done it.”
For physicians weighing the same move, the steps themselves can be the hardest part to see from the outside.
“You’ve got to really understand the process and know the major steps. Because until you do that, you really don’t know what your timeline is. You have no idea how far in advance you need to give notice to resign, or how much financial headway you need, like savings to budget for your family’s life for how many months? Three months, six months, nine months until your insurance payments start coming in.”
Dr. Ahmed said physicians do not need an MBA to start a solo practice. All it takes is an entrepreneurial mindset.
“I think, in fact, the vast majority of small business owners across every single industry and sector are not formally trained. They just learn it because they believe in themselves, and they think about it. They work hard,” he said.
For Dr. Ahmed, the case for independent practice ultimately comes back to patients.
“Patients need care now. They don’t need care in six months when we have a committee meeting and decide,” he said. “When you’re in a small practice, by nature you’re more efficient. Your decision making doesn’t have to go through 15 other people and a series of emails and a set meeting two months from now.”
He is also happy to leave academic medicine without burning bridges, something he believes is important for physicians looking to explore other options.
“I personally don’t feel any animosity. I believe I’m leaving on good terms,” Dr. Ahmed said. “This world of orthopedics is a small community. People know each other.”
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