It was a dream of Dr. Brian Ackerman to hang a shingle. Immediately after residency, he did what most physicians do – he opened an independent practice. For a while, things were great: patient satisfaction helped him persevere as he navigated years of technology innovation, reimbursement mechanisms, the Affordable Care Act, as well as new federal mandates for Electronic Medical Records and MACRA compliancy. However, the increasing complexity of running an independent practice was taking its toll. The pressures exerted by the system to deliver cost-effective care became impossible to sustain.