The shift was subtle at first. Jila Senemar, an OBGYN and women's health specialist, noticed it not in a memo or a policy change but in the exam room itself, where time had quietly been reclassified. "Time became a liability instead of an asset," she said. Productivity metrics were climbing the priority ladder, and clinical judgment was being asked to move over.
Her patients, many of them navigating complex hormonal, metabolic, and menopausal concerns, needed something the system was no longer willing to budget: space to ask questions, to understand their options, to work through the kind of layered health picture that rarely resolves in a fifteen-minute visit. Senemar found herself expected to move patients through faster than their needs warranted, in a structure that, as she describes it, rewarded volume over thoughtful care. Education, root-cause thinking, prevention: all of it was getting squeezed.
The broader pattern she was experiencing is not unique to her specialty. Hospitals, staffing groups, and entire medical practices have been absorbed into corporate and private-equity portfolios at a pace most patients have little awareness of. What changes, in practical terms, is who sets the terms of care. When ownership is primarily financial, the organizing logic of a practice tends to follow.
"I refused to believe better medicine meant less time with patients. That tension ultimately led me to build an independent practice where clinical decisions are guided by patients' needs, not productivity metrics."
What Senemar built in response was a practice organized around a different premise. Independence, in her framing, means protecting clinical judgment and preserving the physician-patient relationship. It also means accepting that the conventional practice model may need to be rethought entirely. "Independence means protecting clinical judgment, preserving the physician-patient relationship, and creating sustainable models where quality, prevention, and outcomes matter as much as efficiency," she said. The word she keeps returning to is courage: the willingness to build care around patients rather than reimbursement, even when the system pulls in the other direction.
She believes the independent physician still has a future, but she does not describe that future as inevitable. It depends on whether physicians are willing to restructure how they practice, and whether patients continue seeking care on those terms. "Patients are looking for that kind of care," she said, "and physicians should have the freedom to provide it." That freedom, for Senemar, is not a perk. It is the condition under which medicine, as she understands it, is actually possible.
