It’s a question South Carolina should be asking now- not after the fact.
The state’s two largest healthcare systems- Prisma Health and MUSC- together control roughly 65% of staffed beds across South Carolina. Combined, they hold more than $3 billion in debt, much of it backed by taxpayer-funded bonds and predicated on continual growth.
In any other industry, this level of market concentration would raise red flags. In healthcare, it raises the stakes.
Because when something goes wrong- financial strain, a cyberattack, an operational breakdown- it’s not shareholders who feel the pain. It’s patients. It’s doctors. It’s entire communities.
Independent Physicians: The Safety Net We Overlook
South Carolina still has approximately 2,000 independent physician practices, and while that number is shrinking, these practices remain one of the most vital stabilizers in our healthcare system.
Independent practices:
- Offer geographic and ownership diversification
- Are privately financed, reducing public exposure
- Provide more affordable care, with commercial prices 15–40% lower than those in consolidated systems (Health Affairs, 2017)
- Are more resilient in crises, able to rebound faster from disasters or system failures
These doctors are not tethered to multi-billion-dollar debt structures. Their clinics aren’t vulnerable to a single ransomware attack that could cripple a major network. They are a decentralized, flexible safety net- and they are rapidly disappearing.
Why the Exit Ramp Is So Crowded
The national trend is clear: over 74% of physicians are now employed by hospitals or corporate entities (Physicians Advocacy Institute, 2023). Many cite burnout, rising costs, and bureaucratic overload as the reasons they left private practice.
This might seem like a personal career decision- but it has systemic consequences.
Fewer independent doctors means:
- Fewer options for patients
- Fewer competitive pricing pressures
- More public liability when systems fail
And it eliminates one of the last real counterbalances in a system increasingly run like a business, not a mission.
But There’s Hope- If We Act Now
South Carolina is at a crossroads- but not without momentum. Several reforms are opening the door for a resurgence of independent, patient-first care:
- Certificate of Need (CON) Repeal The repeal of South Carolina’s CON law in 2023 eliminated one of the largest barriers to innovation, enabling new providers to open facilities without needing hospital system permission.
- Proposed Ban on Physician Non-Competes (S.46) Set for debate this legislative session, this bill would end restrictive non-compete clauses, giving physicians the freedom to practice where they’re needed most- especially in underserved areas.
- Upcoming Charity Care Tax Incentives A bill in the pipeline would reward independent physicians for providing uncompensated care, shifting the burden off the public and encouraging more private-sector compassion without public-sector bailouts.
We Need a New Mindset Around Medical Independence
This isn’t just about private practice- it’s about protecting patient choice, reducing systemic risk, and ensuring doctors can still practice medicine, not just deliver services under corporate direction.
If we want to future-proof healthcare in South Carolina (and beyond), we need to:
- Remove unnecessary barriers to launching and growing physician-led practices
- Incentivize charitable care and innovation
- Protect patient access by safeguarding physician mobility and autonomy
- Ask better questions about who benefits from consolidation- and who bears the risk
What Can You Do?
Whether you’re a policymaker, a fellow physician, or a concerned patient: Now is the time to speak up, show up, and push back on the idea that bigger always means better.
If you’re an independent doctor- or want to become one- reach out. I’ll connect you with the right tools, people, and data to help you protect your autonomy and your patients’ best interest.
If you’re a legislator or business leader, I welcome conversation. Let’s work together to ensure healthcare in South Carolina remains both innovative and resilient.
Because when monopoly medicine falters, independent physicians are the only circuit breakers we’ve got left. Want to continue the conversation or collaborate on this mission? Reach out directly at DrHochman@FacialSurgeryCenter.com on LinkedIn.
Let’s build a healthcare system that works- for patients, for doctors, and for South Carolina.
