This whitepaper presents findings from a national survey conducted by Veradigm, involving 360 leaders from independent ambulatory practices in the United States. The research focuses on the current state of independent practices, highlighting the financial pressures, administrative burdens, and operational challenges they face. Despite 69% of respondents expressing confidence in their ability to remain independent over the next three to five years, the survey reveals that nearly all are experiencing increased pressures. A significant 94% of practices reported being approached about acquisition or consolidation, indicating a trend of external interest in independent practices. The paper details how larger practices are particularly affected by financial strain, while smaller practices face heightened administrative burdens. The findings underscore the need for independent practices to enhance financial visibility, reduce manual processes, and adapt operational strategies to maintain independence in a complex healthcare environment. The study aims to inform practice leaders on necessary adaptations for sustaining independence amidst these challenges.