The Independent Doctor Who Turned Down Three Health Systems
Jonah Reyes has built a 22-provider primary care group in Colorado, and refused to sell it three times.
Jonah Reyes leads one of the largest remaining independent primary care groups in Colorado. He has been approached by three health systems in eight years. He turned each of them down and structured his partnership model to make sure the next generation of clinicians could do the same.
Physician independence is an operating problem, not a political one. Jonah has designed a compensation structure that keeps clinicians in ownership rather than employment.
- 01Independence is a daily choice, not a status.
- 02Compensation design is culture design.
- 03Partner tracks must be visible from the first year, not the fifth.
- 04The billing team is a clinical decision, not a back-office one.
- 05Ownership by many is the only ownership that lasts.
Why independence
The industry narrative is that independent practices cannot survive. That is not true. The industry narrative is that scale requires system ownership. That is also not true. What is true is that you have to design for independence deliberately, because everything about the reimbursement environment pulls you toward acquisition.
"If you pay per visit, you incentivize short visits. If you pay for panel margin, you incentivize keeping people healthy."
Compensation design
When I took over as managing partner, we redesigned the compensation model. We pay clinicians a base plus a share of the panel margin, not the visit volume. It sounds simple. It changes everything. If you pay per visit, you incentivize short visits. If you pay for panel margin, you incentivize keeping people healthy.
"No health system can promise clinical autonomy in year five. That is not how systems work."
Partner track
Our associates see the partner track in year one. Not in year five. They know exactly what the buy-in looks like, what the earnings look like, and what the vote structure looks like. When the health systems come calling, our associates already have a stake.
What we said no to
The first offer was a lot of money. The second offer was more. The third offer came with a promise that clinical decisions would remain with clinicians. We said no because no offer can promise that in year five.
Dr. Jonah Reyes's operating principles, distilled.
Hire on values first, on training second. Show the partner track in year one.
If this decision moves us closer to being a health system, we should not make it.
Clinical autonomy. Partner-vote governance. Panel-margin compensation.
Panel size, patient continuity rate, partner-track progression.
Waiting too long to add behavioral health. Should have done it three years earlier.
Design the exit you want people to reject.
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