Although staffing shortages and reimbursement pressure get a lot of attention in ASC conversations, Tom Valentine, the new president of Wellbridge Surgical, thinks the harder problem is physician recruitment in a rapidly consolidating workforce.
According to Mr. Valentine, hospitals have spent a decade locking up the surgeons independent ASCs need most, and the window to recruit them is narrowing.
“This is probably our biggest challenge,” Mr. Valentine told Becker’s. “The hospitals have spent the last decade getting physicians under one roof, and now many surgeons are contractually obligated — no case leakage allowed.”
The dynamic is most acute in orthopedics, he said. Orthopedic cases are longer, more profitable and more technically demanding than most ASC procedures, which is why health systems have prioritized locking them down. Employment contracts with explicit no-leakage clauses have become standard in markets where hospital systems have the leverage to demand them.
The share of independent physician practices owned by hospitals, health systems or other corporate entities jumped from 39% to 59% between 2019 and 2023, while physician employment by these entities rose from 62% to 78%, according to a December 2025 report from the Progressive Policy Institute.
The result is a shrinking pool of surgeons available to independent and free-market ASCs, oftentimes because some contracts prohibit the relationship. Mr. Valentine has found a narrow but existing recruiting window among surgeons in their 50s with business instinct to question whether hospital employment is actually serving them.
“The doctors who are most receptive are the ones in that 50-to-60 range — still have business savvy, have seen enough of the transition, and are starting to ask whether the hospital model is really serving them,” he said.
Wellbridge competes on three things: above-average surgeon rates, an in-house sales team that actively brings cases to the table, and an operational environment that is markedly simpler than a hospital system.
“The same person who takes you to pre-op is saying hello when you wake up from anesthesia,” Mr. Valentine said. “Surgeons who are used to navigating a hospital system to figure out what to do with a patient post-op are genuinely surprised. That experience — the simplicity of it — is one of our strongest recruiting tools.”
According to a survey from consulting firm Bain & Co., average satisfaction for physician-led organizations ranges from roughly 70% to 90%, compared to 50% to 75% in health system-led practices. Additionally, 78% of physicians in physician-led practices report that their organizations have effective processes and workflows, compared to 59% in health-system-led ones.
Other leaders are finding ways to fill in the gaps. Minneapolis-based Pelto Health Partners, for example, was formed to counteract the trend of small and midsized practices being pushed toward hospital employment or acquisition by private equity firms. For independent ASCs, groups like Pelto represent a potential pipeline in that surgeons who remain independent are far more likely to bring cases to a non-hospital facility
“We felt something needed to be done to keep independent groups independent, as many were being driven into hospital employment or selling to private equity,” Frank Aluisio, MD, of EmergeOrtho, who now serves as chair of Pelto’s board, told Becker’s. “Maintaining independence is important in prioritizing patients and the physician-patient relationship — not profits.”
The recruitment pressure is not limited to free-market operators. John Petroni, managing owner of Las Vegas-based Silver State Surgery Centers, told Becker’s that attracting the right physician partners has been difficult, with many physicians resistant to changing established habits and schedules.
“This reluctance can create a barrier to transitioning to a new ASC model,” he said. “We have also had challenges due to specialties that provide a variety of surgical services that are not reimbursed in an ASC environment.”
The data confirms the problem is systemic. Sixty-one percent ASCs identified recruiting new surgeons as their biggest physician-related risk for 2026, according to a VMG Health survey. In a separate Medscape report, 63% of physicians said they see a shortage of qualified applicants in their local market.
The surgeon lockup trend has consequences beyond individual ASC recruitment struggles. As independent ASCs find it harder to build surgical rosters, the competitive pressure on hospital systems eases. Fewer viable alternatives in a market means less incentive for hospitals to compete on price, quality or patient experience.
Mr. Valentine frames it as an industry-level problem that individual operators have to solve one surgeon at a time.
“A lot of ASCs that were physician-owned ended up going under hospital ownership precisely because they were clinically excellent but administratively underprepared,” he said. “That’s the gap I was brought in to close.”
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.