Physician independence in orthopedics isn’t dying, but it is being redefined. For surgeons, it no longer means a solo practice and a handful of insurance contracts. It means owning the facility, controlling the decisions and building the scale to survive.
The pressure is coming from multiple directions at once. Hospital employment of orthopedic surgeons has grown steadily, private equity consolidation has accelerated and payers are pushing harder on utilization and reimbursement for high-cost procedures. The practices holding their ground are the ones that have built ownership stakes in facilities, invested in data infrastructure and figured out how to carry operational scale without losing clinical control.
Ask Orthopedic Surgeons is a series of questions posed to orthopedic surgeons and leaders around the country about clinical, business and policy issues affecting orthopedic care. Becker’s invites all orthopedic surgeons and specialists to respond.
Next question: How are you navigating the tension between spinal fusion as a default and the growing clinical and payer pressure to use it less?
Please send responses to Cameron Cortigiano at ccortigiano@beckershealthcare.com by 5 p.m. Central time on Nov. 2.
Note: Responses were lightly edited for clarity and length.
Question: What does physician independence actually look like in 2026, and is it still a realistic goal?
Evalina Burger, MD. Chair of the Department of Orthopedics at the University of Colorado Anschutz (Aurora): Orthopedic practice and research face potential ethical risks from large industry payments that may influence implant selection, kickback arrangements disguised as consulting contracts, and misconduct such as ghostwriting, data or image manipulation, and biased or inaccurate citations. The new technology is slow to catch up mainly as insurance does not allow us to use it so we can evaluate the products in a timely manner.
Amit Jain, MD. Spine Surgeon and Vice President of Care Transformation at Johns Hopkins Medicine (Baltimore): Independence today is no longer about isolated solo practice; it means clinical autonomy backed by aggregated operational scale. It remains realistic only if physicians master value-based risk contracts and data infrastructure rather than clinging to purely transactional fee-for-service models.
Farzin Kabaei, MD. Orthopedic Surgeon at Docs Health (Los Angeles): It is realistic, but not alone. The solo surgeon with one office and a handful of insurance contracts is close to extinct. Independence in 2026 means a group of physicians who own the practice, own the surgery center and make the clinical decisions themselves. That is what we built at DOCS Health. We own our surgery center, we are building a second one and we are building our own hospital. Ownership of the facility is what makes the rest possible. It gives you control over cost, quality and your own schedule. Being in private practice is extremely difficult. It is still the best way I know to take care of patients.
Leo Spector, MD. Orthopedic Spine Surgeon and CEO of OrthoCarolina (Charlotte, N.C.): In 2026, physician independence means the physicians who deliver care are the ones who own and control how that care is organized, where it is delivered and how it is paid for. That is the best model for patients because it puts decisions about cost and quality in the hands of the people who see their impact firsthand, both in the clinic and in the operating room. When physicians are the decision-makers, incentives are naturally aligned. There is no gap between the people setting the strategy and the people accountable for outcomes.
Independence in 2026 does not mean isolation. The strongest independent practices are those that know how to build meaningful relationships while maintaining ownership of the decisions that matter most.
OrthoCarolina’s clinical affiliation with Advocate Health is an example of what that can look like in practice. The affiliation allows us to collaborate more closely on research, education and care coordination in ways an informal relationship could not, while our physician partners retain full ownership and control of the practice. Most importantly, clinical decisions remain with our physicians.
Independence is a realistic goal, but it takes scale, operational discipline and a clear sense of what you are and are not willing to compromise. Practices that build those things can stay independent and grow. That is the path we are on, and I am confident it is the right one.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
