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This article discusses six different items. First it reviews which areas are providing cash flow to surgery centers today, essentially reviewing today’s bread winners and cash cows. Second, it looks at the types of surgery centers that are likely to be bread winners tomorrow, where surgery centers may excel in the next few years. Third, it examines problematic situations for surgery centers, essentially which areas are difficult and challenging for surgery centers. Fourth, it looks at areas that are potentially positive for the next few years. Fifth, it discusses situations where we expect there to be growth in the surgery center business. Finally, sixth, this article examines certain weaknesses and challenges that the surgery center industry is facing. Here, it also touches on problem centers and issues that are symptomatic of such centers.