Many physicians who could be thriving in the outpatient setting aren’t, according to Marcelo Hochman, MD.
Dr. Hochman, a Charleston-based independent physician and former president of the Independent Doctors of South Carolina, says it’s a psychological barrier that holds most physicians back, rather than clinical readiness or capital.
The most common mistake physician leaders make when considering moving their work outpatient is “thinking [they] have to replicate a big system,” Dr. Hochman told Becker’s.
“You don’t have to build a surgery center with ten operating rooms,” he said. “You can have a GI endoscopy suite with two rooms, or a birthing center instead of a giant labor and delivery unit.”
Smaller, single-specialty ASCs might even have a competitive edge in certain markets, Benjamin Stein, MD, an orthopedic surgeon who co-founded and is now chairman of ASC development group Capital Surgical Solutions, told Becker’s in 2024
“A lot of the larger surgery centers, many of them are broad, multispecialty centers, which I think is a significant flaw in some respects, because when you’re trying to get ahead, it’s all about routine,” he said. “If you look at it from a clinical perspective, catering to the clinical deployment of a single specialty means your staff — your sterilization departments, both operating room and recovery staff, anesthesia staff — will all be much more knowledgeable, efficient and targeted in the care they provide if they can focus on one specialty.”
That sharpened focus creates an opportunity for physicians to match infrastructure to their patient volume and specialty, without shouldering the overhead or complexity of a full-scale hospital department. But all-or-nothing thinking prevents some physicians from ever getting started, Dr. Hochman said.
“The perception that it’s either too risky or too operationally overwhelming — that you’d have to duplicate something massive — just isn’t accurate,” he said.
The second major misconception, Dr. Hochman said, is that physicians aren’t equipped for the business side of outpatient ownership. He acknowledges there’s a kernel of truth there — medical school provides little to no business training (only 18% of physicians receive executive or business training during medical school, according to 2024 survey by Jackson Physician Search and the Medical Group Management Association) — but maintains that the prerequisites for entry are surmountable.
The data support his point. Although consolidation is increasing, as of 2023, about 68% of ASCs remained independently owned, a sign that physician ownership at scale is achievable.
Other physicians echo the need for better preparation. When asked what gaps exist in medical school curricula, three physicians told Becker’s that communication skills and business sense were most sorely lacking.
Resources do exist for those willing to seek them out. In Kaiser Permanente’s integrated care model, for example, physicians have access to extensive leadership training spanning operations, management, healthcare finance, and change management through an internal “School of Leadership” that often pairs physicians and administrators side-by-side through coursework.
“It’s really about getting into the mindset of wanting to do it. It’s not a clinical decision — it’s a professional one. What kind of practice do you want to have?” Dr. Hochman said.
The consequences of discontentedly staying in a system-employed model can extend well beyond lost revenue and fuel burnout, Dr. Hochman said.
“Burnout happens when you lose autonomy,” he said. “It’s what people call moral injury: being forced to practice in a way that goes against what you would do if you had total control. Systems try to cure burnout with pottery lessons and work-life balance messaging, but that misses the point entirely. When you’re in control, things feel different.”
The data backs him up. According to a survey from consulting firm Bain & Co., average physician satisfaction in physician-led organizations ranges from roughly 70% to 90%, compared to 50% to 75% in health system-led practices. Nearly 25% of physicians in health system-led organizations said they were considering a change in employers — compared to just 14% in physician-led practices. Of those considering a switch, 37% said they were looking to move to physician-owned settings.
For Dr. Hochman, the question of outpatient migration ultimately comes down to how physicians envision their own careers, not just their clinical capabilities. The tools, partners, and models exist. The harder work is empowering physicians to harness them.
