Small Practices Are the Backbone of U.S. Healthcare: The Automated Healthcare Practice Can Keep Them Thriving

For decades, small and independent medical practices have formed the backbone of U.S. healthcare. They are often where patients first enter the system, where longitudinal relationships are built, and where continuity of care is strongest. Despite repeated predictions of their decline, these practices have endured, adapting to new payment models, evolving patient expectations, and expanding regulatory and operational demands.

Administrative work has grown. Staffing is harder to find and retain. Financial margins leave little room for error. Consolidation continues to accelerate, often driven not by a loss of commitment to independence, but by the operational burden required to sustain it.

What deserves closer examination is why this burden has become so overwhelming. For most practices, the challenge is not delivering care. It is how the patient visit flows, or fails to flow, through the electronic health record and the systems that surround it.

The future of independent medicine does not require small practices to become larger organizations. It requires a more intelligent, automated approach to how technology supports clinical and administrative work.

Small Practices Are Essential, but Under Strain

Independent practices continue to play an outsized role in U.S. healthcare delivery. According to the American Medical Association’s Physician Practice Benchmark Survey, nearly half of U.S. physicians continue to practice in groups of 10 or fewer, even as consolidation pressures persist. Small practices remain especially critical to primary care access, continuity, and community-based care.

Yet the operational environment surrounding them has changed dramatically.

Administrative burden has continued to rise, with multiple studies finding that clinicians and staff spend substantial portions of their workday navigating EHR-related administrative tasks.  This contributes directly to stress, inefficiency, and burnout.

Practice administrators face a similar imbalance, as scheduling complexity, eligibility verification, billing follow-up, quality reporting, and payer communications consume a growing share of limited staff time.

Staffing shortages compound the problem. The Medical Group Management Association continues to report persistent and worsening shortages across front-office, billing, and clinical support roles, with small and independent practices reporting the greatest difficulty recruiting and retaining staff.

The resulting financial pressure from rising labor costs, delayed reimbursements, and increasing administrative complexity leaves little margin for error. Against this backdrop, acquisition by a larger health system can feel less like a strategic choice and more like an operational necessity.

What is often overlooked is that these challenges share a common cause: the way administrative work is handled by the systems practices rely on every day.

The Real Problem Isn’t Care Delivery, it’s Administrative Work

Physicians aren’t burning out because of patients.

Studies and surveys continue to show that burnout is driven primarily by administrative and clerical workload, not clinical care itself. A 2021 review published in JAMIA supports the association between EHR-related administrative burden and physician well-being.

Much of this work is unavoidable. Healthcare requires documentation, billing accuracy, and accountability. The problem is not what must be done, but how it is done.

Over time, EHRs have evolved into data repositories. They became effective at capturing information but far less capable of managing work. Tasks that could have been automated instead became alerts to acknowledge, dashboards to monitor, and manually managed queues.

Rather than eliminating administrative work, the EHR redistributed it, placing increasing responsibility on clinicians and other clinical staff.

The result is a work environment where volume alone leads to increased work without regard to value. As patient panels grow or care becomes more complex, administrative work grows in parallel. For most practices, this model is unsustainable.

Why Traditional EHRs Can’t Fix This on Their Own

The industry has responded with add-on tools, third-party integrations, and incremental improvements. Yet the underlying architecture has remained largely unchanged.

Automation within traditional EHRs is often partial. Systems generate notifications instead of acting when appropriate. They surface insights instead of resolving issues. They flag documentation gaps rather than ensuring documentation supports downstream workflows automatically.

Each new layer introduces more complexity, additional logins, more interfaces, and more reconciliation. Large health systems might absorb this complexity by adding dedicated teams to manage the work. Ambulatory practices cannot.

Incremental improvement cannot solve a structural problem. A system designed primarily to document care cannot, through bolt-on solutions alone, become a true engine of work. At some point, the model itself must change.

Introducing The Automated Healthcare Practice™

The Automated Healthcare Practice is not a futuristic concept. It is a practical redefinition of how technology should function in care delivery organizations, particularly independent ambulatory practices.

At its core, an automated practice is one in which routine clinical and administrative tasks are handled end to end with minimal manual intervention.

This shift reflects broader industry thinking. Reducing clinician burnout and improving operational performance requires moving beyond documentation-centric systems toward workflow-oriented design.

In The Automated Healthcare Practice:

• Clinical documentation supports coding and charge capture automatically
• Scheduling, reminders, and follow-ups occur based on patient context
• Eligibility checks, claims submission, and payment posting proceed with minimal manual effort
• Care gaps surface proactively within daily workflows

The EHR becomes the orchestrator of work, not just the system of record.

What Intelligent Automation Looks Like in Practice

In this context, intelligent automation does not mean removing clinicians from decision-making or obscuring how work is performed. It refers to the use of modern technology, including rules-based automation and emerging forms of artificial intelligence, to manage routine clinical and administrative tasks in a transparent, predictable, and supervised way.

Without this level of support, physicians often complete charts after hours, staff manually chase denials and unpaid claims, and gaps in care are identified retrospectively through reports rather than addressed during care delivery.

With intelligent automation, documentation supports billing in real time, claims move cleanly without routine staff intervention, and care gaps surface during care delivery. Staff can focus on patient engagement rather than transaction processing.

These capabilities are achievable today, provided that intelligent automation is treated as a foundational design principle rather than an optional enhancement.

How The Automated Healthcare Practice Protects Independence

Independence has always meant control over clinical decisions, patient relationships, and organizational culture. It is increasingly threatened by operational dependency.

Automation reduces reliance on labor-intensive workflows and external vendors. Practices operate leaner, absorb change more effectively, and maintain flexibility in the face of evolving reimbursement and care models.

In this sense, automation is not merely an efficiency strategy. It is an independence strategy.

Why Automation Must Be Built Into the EHR

Fragmented tools create fragmented work. Disconnected systems require reconciliation, erode trust, and increase cognitive burden. True automation must be native and embedded within the EHR where clinical, financial, and operational data already reside.

For practices with limited resources, this distinction is critical.

At Greenway Health, we believe the industry must move beyond layering tools onto legacy architectures and instead re-architect the EHR itself to function as a true engine of work.

Automation Is No Longer Optional

Staffing shortages are not temporary. Administrative demands continue to rise, while expectations around access, quality, and performance also continue to increase.

Without automation, burnout worsens and consolidation accelerates.

With automation, ambulatory practices can regain control.

The Future Is The Automated Healthcare Practice

To continue to be successful, small and mid-size ambulatory practices do not need to expand. They need to become automated.

The next era of healthcare will be defined not by scale, but by design, allowing technology do the work it always promised.

The Automated Healthcare Practice is not a distant vision. It is achievable today.