The American Medical Group Association (AMGA) 2026 Annual Conference late last month brought medical group leaders to Las Vegas for several days of programming across value-based care, workforce, AI, financial sustainability, and the regulatory landscape. Across the sessions on access, AI, and the economics of independent practice, four themes stood out as likely to shape the strategic agenda for physician groups over the next twelve to eighteen months.
1. Access is becoming a redesign question as much as a recruitment question.
The workforce gap facing primary care is well documented. The Health Resources and Services Administration’s (HRSA’s) designated primary care shortage areas now cover roughly 92 million Americans, and family medicine supply is projected to grow at a fraction of the rate of demand this decade. Projections from integrated systems continue to point to the need for thousands of new physicians and advanced practice providers by the early 2030s. The underlying drivers - an aging population, rising chronic disease, retirements, training bottlenecks, and student-loan economics - are largely structural and not within the control of any single organization.
Against that backdrop, there is growing recognition that recruitment alone will not close the gap. GME expansion, retention investment, and onboarding improvements remain important, but they are no longer treated as sufficient on their own. The conversation is shifting toward care model redesign: team-based care that distributes appropriate work to APPs, pharmacists, and nurses; dedicated clinicians managing in-basket and asynchronous work; redesigning physician incentive programs to reward value-based outcomes; telehealth across state lines; and ambient documentation that reclaims clinician time. The operative question is becoming which patients should be seen, by whom, and where. That question carries significant legal and regulatory dimensions, including credentialing, scope of practice, reimbursement parity, and supervision rules. How those frameworks evolve will shape how quickly care-model redesign can translate into measurable access gains.
2. The near-term impact of AI in clinical settings will depend on regulation as much as on technology.
At the leading organizations, clinical AI has moved well past the experimentation phase. Ambient listening, in-basket triage, remote patient monitoring, and deeper EHR automation are already deployed at scale. Technology is increasingly not the limiting factor. The more important conversations at the conference centered on trust, clinician autonomy, and regulatory permission.
One recent development discussed at the conference is particularly worth noting. In January 2026, Utah’s AI Learning Lab regulatory sandbox (created by the Utah legislature in 2024) approved a twelve-month pilot permitting an AI platform to autonomously handle routine medication refills within a defined set of parameters (191 chronic-condition medications, exclusion of controlled substances and short-course antibiotics, and physician review of initial renewals in each drug class before full autonomy).[1] The scope is deliberately narrow, but the structure is significant. Views at the conference on the pilot’s longer-term role varied: some participants saw it as a meaningful template for how states might responsibly extend autonomous AI into other clinical domains, while others expressed concern about the pace, the implications for clinician oversight and patient safety, and the risk of regulatory fragmentation if similar sandboxes proliferate on diverging terms. State-by-state decisions of this kind are likely to set the pace at which autonomous AI expands into other areas of clinical practice.
3. For independent physician groups, diversification and innovation are increasing the strategic frame.
Consolidation pressure on independent physician groups continues to intensify. A clear majority of cardiologists are now hospital-employed, and private equity ownership across several specialties continues to grow. Radiology remains more fragmented, with hospitals, PE-sponsored medical groups, and independent physician practices each still holding a meaningful share of the market. Gastroenterology, urology, and several other specialties show significant private equity penetration, though that penetration tends to be concentrated in particular markets rather than uniformly nationwide. Independent groups simultaneously face payor denials, impending Medicaid cuts, AI-assisted downcoding, flat commercial rates, and what panelists described as unfair hospital competition, including 340B pricing, site-of-service payment differentials, nonprofit tax status, and certificate-of-need regimes.
The groups sustaining independence are doing so increasingly through deliberate diversification rather than operational cost control alone. Retaining ancillaries in-house (labs, imaging, ASCs, infusion), building real estate holdings, launching management services organizations, participating in clinical research networks, entering co-branded health plan arrangements, participating in ACO and ACO REACH and LEAD structures, and establishing direct-to-employer relationships all recurred as elements of the playbook. In parallel, many groups are continuing to deploy advanced practice providers (APPs) in more deliberate, team-based models—expanding and optimizing APPs’ scope of practice to improve access, extend physician capacity, and support more efficient, scalable care delivery. Several groups described explicit targets, including deriving a defined percentage of revenue from auxiliary businesses, that reflect how structured and intentional this work has become.
4. Physician and APP unionization is a warning sign for health systems.
Physician and APP unionization came through at AMGA as an important warning sign for health systems, especially around workload, autonomy, and trust. Speakers framed the current moment as a post-pandemic “third wave,” driven by burnout, productivity pressure, and a sense that clinical autonomy is narrowing as more physicians practice inside larger, more standardized corporate systems. The trend line shared was meaningful: physician unionization has moved from low single digits in the late 1990s to roughly 8% (about 72,000 physicians) in 2024/2025, alongside increased organizing activity across a wider range of specialties and care settings. Importantly, the motivations discussed were not just compensation. They also included governance and voice in decision-making, workload and staffing expectations, and, in some organizations, concerns about technology-driven standardization, including anxiety about AI.
The case examples highlighted how quickly unionization momentum can build after trust fractures and during periods of uncertainty. At one large health system in the Pacific Northwest, organizers gained traction following pandemic-related strain, a high-profile proposed merger, and ongoing compensation restructuring efforts, which leaders described as having a compounding effect on institutional trust. The bottom-line takeaway was that the best strategy is to address underlying physician concerns early and directly, before frustrations harden into an organizing campaign. Concrete “union prevention” actions might include expanding meaningful physician leadership and shared governance, giving clinicians real agency over work design and clinical standards, and treating compensation as a transparent, collaborative discussion rather than a top-down announcement. Health systems that foster and improve existing physician alignment structures, maintain regular listening channels, and consistently follow through are better positioned to avoid the drift toward an “us versus them” dynamic that can make unionization feel like the only path to voice and accountability.
Looking Ahead
These four themes—patient access, AI, innovation, and clinician alignment—were prevalent in many of the conference's sessions and they are likely to demand continued leadership attention moving forward.
FOOTNOTES
[1] See “Testing the Boundaries of Artificial Intelligence in Care Delivery: Utah’s Prescription Renewal Pilot Program,” Sheppard Healthcare Law Blog, Feb. 13, 2026.