Independent medical practice challenges are intensifying in 2026. Rising costs, medical billing challenges, and disconnected systems are putting pressure on even the most established practices.

But there's a clear divide emerging.

Practices that rely on fragmented tools are struggling with healthcare administrative burden, while those using integrated practice management software and EHRs for small practices are reducing rework, improving collections, and scaling more efficiently.

Tebra’s recent State of the Independent Practice survey of 100+ providers reveals exactly where practices feel the most pressure, and what’s helping them stay independent. 

In this article, we zero in on the 3 biggest pressure lines and how practices like yours are solving them by connecting clinical, billing, and patient workflows.

Independent practices are facing a convergence of external pressures reshaping the healthcare landscape. Unlike in previous years, these pressures are compounding, making it harder for practices to stay profitable and independent over time.

Operating expenses continue to climb, from staff wages to technology investments and overhead. Many practices are feeling margin pressure even as patient demand grows.

Hiring and retaining qualified staff remains difficult. As teams stretch thinner, administrative work increases, adding to burnout and reducing efficiency.

At the same time, reimbursements are becoming more complex and less predictable. Frequent claim denials and payer requirements are making revenue harder to collect.

Together, these forces are changing the economics of independent care and forcing practices to rethink how they operate.

While external pressures are increasing, the real impact shows up in day-to-day operations.

This is where most private medical practice challenges take shape: in the workflows, systems, and processes that keep a practice running.

Based on Tebra’s latest research, three operational challenges consistently stand out:

These challenges don’t just exist alongside each other; they reinforce one another. Rising costs limit hiring. Staffing gaps increase administrative burden. And when teams are stretched thin, billing errors and missed reimbursements become more common.

The result is a cycle that slows growth, reduces profitability, and puts long-term independence at risk. Here’s where practices feel the impact most and how leading teams are responding:

The good news is that practices solving these challenges aren’t working harder; they’re working differently. The difference comes down to how their systems are structured.

Across all three challenges, one pattern stands out: 

Disconnected systems create friction. 

Connected systems create momentum.

Practices that unify clinical, billing, and patient workflows are able to reduce administrative burden, improve collections, and scale without adding staff. Instead of layering more tools onto existing processes, they’re simplifying how work gets done by removing manual steps, reducing errors, and allowing information to flow automatically.

A connected healthcare system brings together your core workflows, EHR, billing, and patient experience into a single, unified platform.

Instead of:

You get:

In practice, this means less time spent on administrative tasks and more time focused on patient care and growth.

To overcome today’s biggest independent medical practice challenges, practices need to focus on simplifying and connecting their workflows.

That starts with:

These changes help practices:

Here’s how these challenges — and solutions — play out in real-world practices:

Tebra’s recent survey shows that practices’ desire to remain independent is still strong, with 67% of respondents planning to stay the course. But that confidence is waning. Only a small share of providers report the model is ‘hardly threatened,’ down significantly from 2024. 

What’s causing this sentiment? Financial and administrative burdens are testing the limits of what any one small practice can reasonably manage, and whether independence is really sustainable in the long-term.

When asked about the biggest threats to independence, providers cited: 

The solution is connected infrastructure; systems that reduce manual work instead of adding complexity.

At Arjun Reyes, MD and Associates, growing patient demand was colliding with a heavy documentation burden. With 8 providers serving more than 5,000 clients across Southern California, each clinician was spending 3–5 hours a day on notes alone.

By moving to Tebra’s EHR and adopting AI Note Assist, the practice reduced manual work and saved an estimated $750,000 annually in provider time. The added capacity directly supported growth, including the opening of a second location.

Independence is still possible, but only when the work itself becomes easier to manage. When routine tasks live in a connected EHR and manual work is minimized, staff spend less time chasing information and more on revenue-generating work.

Practices are delivering great care, but do payments follow? The challenge is often the gap between revenue earned and revenue collected. Claims are submitted, services are delivered, but payments are delayed, denied, or never fully recovered.

More than half of practices (53%) report clean-claims rates below 90%, meaning a significant share of claims require rework before they’re paid. 

And 28% of practices spent 21+ hours per month on rework, time that could otherwise be spent on higher-value work.

The impact goes beyond lost revenue. Reworked claims create a cycle of: 

It’s no surprise, then, that 60% of providers say improved collections would most increase their confidence in staying independent. 

At Celebrations Speech Group in Northern California, manual billing processes made it difficult to consistently track claims and payments. Revenue was slipping through the cracks. The practice had grown from a solo pediatric speech therapist making house calls to a 3-location, 20-provider practice. 

With Tebra's connected platform, including features like text-to-pay and automated billing, staff regained time, and the practice began saving over $5,000 every month.

Clean claims and faster payment cycles are within reach when billing tools are integrated. Smarter workflows reduce preventable errors and stabilize cash flow without adding staff or complexity. 

This means less pressure on the front desk and billing teams and fewer unexpected denials, delays, and revenue gaps.

If automation is supposed to make work easier, why are so many practices still hesitant to adopt it?

Fewer than half (45%) of providers say they’re considering automation but haven’t taken the leap, due to concerns about: 

For practices that have adopted automation, a lack of integration is one of the biggest reasons tools fall short. When new workflows sit on top of disconnected systems, staff are left to check, correct, and re-enter information: the very work automation is meant to eliminate.

According to Tebra’s survey, 63% of respondents report that automation saves fewer than 5 hours per week, which is a limited return on tools meant to reduce workload. 

The key? Time is recovered only when automation is built into workflows, not layered on top of them.

At Optimal Psychiatry and Wellness, a Maryland-based psychiatry practice, growth was the goal. But as the practice scaled from 1 provider to 10 serving more than 2,500 patients, disconnected systems risked operational chaos. 

By bringing digital intake, e-prescribing, eLabs, and automated reputation management into a single platform, the practice created fully connected workflows. 

Automation works best when it removes steps, not adds them. When systems share data automatically, work moves forward without handoffs, re-entry, or constant checking. That’s when automation actually saves time.

Across all three pressure points, the pattern is clear. When systems don’t talk to each other, work slows down and friction builds. When they do, teams regain momentum. 

The practices highlighted here saved time, recovered revenue, and scaled without adding staff, not by working harder, but by letting connected systems do the heavy lifting.

Not every practice feels the same pressure. The key is recognizing where your practice feels it most.

Ask yourself:

Once you’ve identified the main source of pressure, focus on connecting the systems that support it. Time and again, it’s been shown that practices that integrate EHR, billing, and patient experience tools reduce rework and recover time and revenue, creating a more stable foundation for independence. 

The challenges facing independent practices are real, but also solvable.