Can Independent Rheumatology Still Win?
Rheumatology hasn’t been “gobbled up” yet (Thanksgiving pun fully intended), but after reading the latest Becker's Healthcare’s analysis on physician M&A, it’s clear we’re on the menu. A handful of massive healthcare organizations are redrawing the physician landscape through aggressive acquisitions, vertical integration and high-stakes partnerships.
Here’s the part that should make every independent rheumatologist sit up.
Cardinal Health, historically a drug and medical product distributor based in Dublin, Ohio, has moved hard into physician services. In just the last two years, it has inked three billion-dollar physician deals, including a 2024 majority stake in GI Alliance, one of the largest gastroenterology groups in the country.
Cardinal already controls about 28% of the U.S. prescription drug wholesale market, and the company isn’t slowing down. It announced plans to acquire Solaris Health (now Urology Alliance), a large urology management services organization, for $1.9 billion in cash, on top of earlier deals for Urology America and Potomac Urology Center.
It also launched The Specialty Alliance in 2025, a national multispecialty MSO platform that pulls these acquisitions under one vertically integrated umbrella. United Rheumatology (A Specialty Networks Company) was acquired by The Specialty Alliance which then got acquired by Cardinal.
Zoom out and the pattern gets even more concerning for independent physicians. As of early 2024, 77.6% of U.S. physicians were employed by hospitals, payers or other corporate entities, and nearly 60% of practices were owned by them. UnitedHealth Group’s Optum arm now directly employs or contracts with more than 90,000 physicians, about 10% of the entire U.S. physician workforce.
On the pharmacy side, the vertical stack is just as tight. CuraScript SD by Evernorth is a wholly owned subsidiary of Express Scripts Pharmacy, which sits inside Evernorth Health Services, part of The Cigna Group.
McKesson, another independent giant, distributes about one-third of all pharmaceutical products used in North America and is among the 10 largest U.S. companies by revenue.
These are not small players circling the edges of our ecosystem. They are the ecosystem.
Rheumatology is following oncology’s path into medically integrated dispensing and specialty pharmacy. McKesson, Cardinal and others now actively market “medically integrated dispensing” models to physician offices and pushing into specialties that rely on high-cost biologics and complex therapies.
On one level, practices are building in-office dispensing to survive: to keep care local, support adherence and create a margin that offsets shrinking reimbursement. On another level, payers, PBMs, distributors and private equity are building vertically integrated empires to control the entire revenue stream around those same drugs.
So when I say my passion is protecting private practice, this is what I mean. If we wait until rheumatology looks like GI, cardiology, oncology or primary care in 2025, we’ll be reacting to a landscape that has already shifted under our feet.
Here’s my ask of fellow rheumatology leaders: Invest in your own data, pharmacy strategy and partnerships now. Pay attention to who is acquiring what in your market. And keep educating legislators and regulators so they understand that “convenient” vertical integration can quickly become an oligopoly that squeezes out independent practices and, ultimately, patient choice.
We are moving into medically integrated dispensing to stay alive. Many of the largest corporations in healthcare are moving into it to own the future of American healthcare.
Those are not the same motives.
If you’re an independent rheumatology practice trying to navigate this, I’m always happy to compare notes, share what I’m seeing on the road and brainstorm ways to keep private practice not just alive, but competitive.
