Has your medical group's board evolved alongside the governance issues in practices today? Fewer physicians remain in private practice than a decade ago,¹ more groups now operate inside hospital-owned, private-equity-backed, MSO-supported, or joint-venture arrangements, and even practices that remain fully independent are dealing with more payer complexity, more technology risk, and more pressure to make decisions quickly.

MGMA polling shows how fast the leadership agenda has shifted: 

1. AI became the top technology priority for medical practice leaders in January 2025, 71% of practice leaders reported some AI use in patient visits by August 2025,² and leadership succession planning remains weak, with only about one-third of groups reporting a formal plan as recently as February 2026.³ 
2. Cybersecurity has moved up the same ladder. The Change Healthcare cyberattack showed that one digital failure can quickly become an access, claims, and cash-flow crisis for ambulatory practices.⁴

Governance cannot be treated as a legacy structure you revisit only when there is conflict. Practically speaking, governance is the system that decides what belongs to the owners, what belongs to the board, what belongs to management, and which issues need deeper committee work before they reach either of those bodies. Board and committee design determines whether finance, compliance, quality, workforce, and technology get addressed together or drift into silos.⁵ Governance determines how a practice creates disciplined oversight without pulling day-to-day management back into the boardroom.

What effective governance is supposed to do

An effective governance structure does four things well. It sets direction, assigns authority, creates accountability, and makes it possible to act at enterprise speed. That sounds obvious, but many medical groups still operate with a structure built for a much simpler practice — fewer sites, fewer shareholders, less technology exposure, no separate MSO, and much less need for governed information flows across entities. When that older structure remains in place while the practice becomes more complex, the result is familiar: the board spends too much time on operational detail, management spends too much time seeking permission, and important decisions stall because no one is fully sure who owns them.⁶

For independent and private practices, the hardest part is often separating ownership from governance from management. Physicians who own the group are often also the clinicians generating revenue, the informal leaders shaping culture, and the people most affected by compensation changes, site changes, call coverage changes, and staffing decisions. Those realities are legitimate, but they do not erase the need for role separation. In a board meeting, the governing question is what best serves the practice as an ongoing enterprise — clinically, financially, operationally, and strategically — which is a different question from what current owners happen to prefer. That distinction is the starting point for better governance in physician-owned groups.