Independent physicians—those neither employed nor affiliated with health systems and integrated delivery networks, or other corporate entities like payers, private equity firms, and large umbrella corporations—are becoming an endangered species. From 2019 to 2024, the percentage of US physicians remaining independent fell by about 40 percent, driven by a sharp increase in corporate employment during the pandemic’s peak and a steady growth in health system employment throughout the post-pandemic period. Although COVID served as a flash point, the forces driving the trend are not new—it’s increasingly expensive and administratively burdensome to operate a practice, rival providers and payers continue to amass scale, and the bidding war for physician talent has more buyers and fewer sellers than ever. Employment offers a reprieve, although not a panacea—there are still tradeoffs to giving up independence, which can differ based on one’s employer. As a general rule, health system employment offers stability and institutional support, while corporate employment comes with the aspiration of higher compensation generated by an increased emphasis on growth and profitability. Both options involve relinquishing some autonomy—but neither requires nor should result in forfeiting influence. In a market where physician scarcity is rising, clinicians have more than just economic value—they have leverage. That leverage can be used to structure true partnerships, not only to shape care delivery models and resulting compensation structures, but also influence governance, clinical priorities, and culture. As employment becomes the norm, physicians shouldn’t just settle for a seat at the table—they should insist on a voice that carries weight.