It’s no secret that fewer residents are matching in pediatrics these days, with the percentage of pediatric-residency positions filed through National Residency Match Program® (NRMP) falling from 97% in 2023 to 92% in 2024. But since these numbers reflect the full spectrum of residents, they don’t tell the whole story. Some residents will go on to pursue important tasks like pediatric research, while others will enter hospital systems. Even fewer will choose independent practice. According to PCC’s Chip Hart, independent practice owners should take note. Here’s why.
Fewer Residents for Private Practice
Chip Hart is a pediatric practice management consultant for PCC, and well-known in the industry for his talks on improving practice culture and running a successful independent practice business. He’s a self-described data nerd, which means he’s been paying close attention not only to the Match program’s numbers, but what they tell us.
In 2025, the NRMP filled 2,988 of 3,135 available Pediatrics (categorical) positions, or a 95% match.
“But of those 3,000 positions, not all of those go into direct care,” Chip says.
“Broadly speaking across the United States, there is a deficit of pediatricians,” he explains. “There are surely parts of the country, like Boston and New York, where there are plenty, but overall, there are not enough pediatricians to support the work that needs to be done to take care of children. Of those 3,000 matched positions, maybe half come out of residency programs per year and do direct, ambulatory care. And of course, of that half, over 60% of them end up working for large healthcare systems. So really, out of the 3,000 people who matched, we might get 500 to 800 into practices and independent spaces. Maybe. I bet therehere are twice as many pediatricians leaving the market this year.”
Obviously, there is a supply and demand issue — fewer pediatricians overall means fewer physicians to provide children with the specialty healthcare they need. But it’s more than that for independent physicians, Chip says.
“Any sort of succession planning depends heavily on having people who are willing to come do your work. Existing practices need to care about residents because these are the people who are going to replace them and take over their patient base.”
A practice that sells to a hospital system when it can’t find a succession partner scatters an entire patient base to the wind; some patients may find other independent practices, some will follow the practice into the hospital system, and yet still more may fall through the cracks, especially if there are changes to support systems like CHIP and Medicaid. Proposals to shrink these support systems are currently supported by the Trump administration, which has proposed budget cuts to eliminate waste and fraud, rather than cutting benefits directly.
Chip raises another concern: when independent pediatric practices are taken over by large healthcare systems, quality of care goes down while expenses go up. He speculates that because hospital and large healthcare systems execute “top-down” approaches to care that treat all physicians the same, employed pediatricians may find themselves with overclocked patient loads that make it all the more difficult to lay the foundations of personalized, engaged relationships with patients, which establish patients’ trust and can lead to improved outcomes.
Where are the early-career independent pediatricians?
It makes sense to think that residents simply prefer the stability of an employed position; fresh from medical school, they’re eager to pay down their debts, establish families and careers, and not worry about running the “business” side of pediatrics — which they didn’t learn in residency, anyway. This may be true, depending on the person. What isn’t true is that residents prefer pediatrics in a hospital setting.
This study found that residents found both a hospital-based continuity clinic and office-based residency under a preceptor to be beneficial for their residency experience. The 47 participants surveyed reported that they learned more about practice management, business aspects, and adolescent care at the private practice, and more about complex cases and infant care at the hospital’s continuity clinic.
So, where are the early-career independent pediatricians?
Chip says it may be a matter of lack of training and the way that many residency programs are structured. Because many are based in hospital systems, it stands to reason that hospitals don’t encourage the disruption of the pathway from resident to potential employee. This checks out with Chip’s personal experience.
“I have a presentation called 'The Things We Wish Every Resident Would Learn Before They Graduate'. It's about financial management and your career path after residency and so forth.
“I took a part of it from an AAP guide explaining a resident’s choices after school. And they describe one end of the spectrum, solo practice, and at the other end of the spectrum, working for a large healthcare system with spots in between for different sized practices or systems.” Chip explains that before giving this talk to residents, one residency director pulled him aside. “Hey, your handout looks great. But can you take out that part about starting up a practice, because you can't do it anymore.”
Chip was nonplussed. “PCC has had more startup practices since COVID than we had during all of the aughts, easily, and yet that is the pushback I get repeatedly [from residency programs]. ‘Don't tell them they can go into business by themselves. Don't tell them that they can join independent practice.’ Residency programs are designed to turn out employees. The residency programs are run by hospitals that consider every doctor to be a future employee. And so their position is: Doctors work for you, doctors can’t be independent. So, that's why we should care.”
The Future of Pediatrics
There will always be independent-minded physicians who want to practice on their own. Whether fresh from school or dissatisfied with employment where their choices and income are limited, there are early-career doctors ready to take on the challenge of independent practice. Chip has advice for them:
“Work hard when you get out of residency, and the question you have to answer is: ‘How prepared are you to do this work for yourself?’ Not everyone is, and I'm not advocating that everyone start a business. But you do have to have a sense of who you're working for, and an independent practice might have a better vision, mission, and view of what they want to accomplish than the hospital does, and it may be more aligned with what you want as a career.”
One early-career physician we spoke to said that it was a combination of autonomy and patient relationships that led her to choose to join an independent practice, despite completing her residency in a hospital. “If you know the patient, you know when they’re sick; you know when they’re healthy. Being able to differentiate that is what helps make someone a really good clinician.” She also says that getting the benefits of independent practice before residents – continuity of care, career and schedule flexibility, and out-patient exclusivity, among many – could help more residents choose independent practice.
Learn more about Dr. Hardy’s story over at The Independent Pediatrician, the PCC-sponsored magazine where independent pediatrics is explored from real stories from physicians like Dr. Hardy.
