A survey shows doctors increasingly work for hospitals or large practices. Is the small practice over?
A recent report from physician staffing company Merritt Hawkins finds the big recruiters of physicians are increasingly hospitals and large 
practices.
For example, among Merritt Hawkins' own searches in 2005/2006, 23% of assignments came from hospitals; by 2010/2011, that was up to 56%.
"Salaries have almost entirely replaced income guarantees (traditionally used to recruit private practice physicians) as a compensation model," Merritt Hawkins also finds.
CNNMoney hears from Merritt Hawkins' Travis Singleton:
In 2011, Singleton said just 1% of all searches it conducted for its clients were for solo physicians, down from 22% in 2004.
"This is the lowest level in the 28-year history of our firm," said Singleton.
"It shows that no one wants to hire a solo doctor, no one wants to be a solo doctor. This is a dying breed of physician that is quickly disappearing from the American landscape," he said.
Also, a recent MDLinx survey of <10-doc practices found 26.4% of those physicians "reported that given the financial environment, they could foresee closing their practices within the next year."
Hospitals, on the other hand, are "are clearly acquiring practices," reported a study in the New England Journal of Medicine last year: "A recent survey by the Medical Group Management Association shows a nearly 75% increase in the number of active doctors employed by hospitals since 2000, and recent hospital announcements suggest this trend is accelerating."
Part of the reason, authors Dr. Robert Kocher and Nikhil R. Sahni suggest, it that hospitals have the time and capital to invest in mainstreaming doctors over the long period of time it takes for them to become profitable. "After 3 years, hospitals expect to begin making money on employed physicians when they account for the value of all care, tests, and referrals," they report. "...Hospitals are willing to take a loss employing PCPs in order to influence the flow of referrals to specialists who use their facilities."
This isn't just medicine, though -- it's the modern world. A small number of corporations own an increasing number of businesses, and the pressure of a weak, Wal-Mart economy makes mega-companies a more attractive (and sometimes the only) employment choice for people of all kinds, not just doctors. If you choose to go it alone (or with a small group of partners), congratulate yourself on your rugged pioneer spirit. Lonely are the brave.