Surgeon-owners have been the beating heart of ASC growth over the last several decades as more physicians look to make a shift towards independent practice, bringing surgical cases with them to the center. But that exchange depends on a steady supply of physicians who are free to make it, and that supply is shrinking fast.
By January 2026, 82% of practicing U.S. physicians were employed by hospitals or corporate entities, up from 52% at the start of 2018, according to an Avalere study sponsored by the Physicians Advocacy Institute. The number of physicians practicing independently fell by 152,200 over that period, to 120,900, and just 36.1% of physician practices remained independently owned.
The study’s methodology notes that physician-owned professional corporations may be miscategorized as corporate-owned, meaning the share of truly independent physicians could be higher than reported. Still, ASC leaders now point to accelerating physician consolidation, rather than reimbursement reform or new technology, as the next major disruption to the industry.
“The most consequential disruptor shaping the ASC landscape over the next several years will be the accelerating shift from independent surgeons to employed physician models, particularly health system and large multispecialty group employment,” Tammy Smittle, RN, CEO of Stonegate Surgery Center in Austin, Texas, told Becker’s.
Surgeons’ restrictions in an ASC often boil down to the specifics of their contracts. Hospitals have relied heavily on employment agreements with no-leakage clauses that keep employed surgeons’ cases inside the system, narrowing the pool of surgeons available to freestanding centers.
“The hospitals have spent the last decade getting physicians under one roof, and now many surgeons are contractually obligated — no case leakage allowed,” Tom Valentine, president of Wellbridge Surgical, told Becker’s.
ASCs are feeling that pressure in their recruiting. Sixty-one percent of ASCs identified recruiting new surgeons as their biggest physician-related risk for 2026, according to a VMG Health survey. A separate Medscape report found 63% of physicians see a shortage of qualified applicants in their local market.
Yet the employed model may not be holding physicians as firmly as the numbers suggest. In a Bain & Co. survey, average satisfaction at physician-led organizations ranged from roughly 70% to 90%, compared to 50% to 75% in health system-led practices. Seventy-eight percent of physicians in physician-led practices said their organizations have effective processes and workflows, compared to 59% in health system-led ones.
The policy environment is shifting as well. In 2025, 37 state bills related to consolidation and competition were enacted, and Becker’s has reported on at least 18 emerging platforms that aim to reduce nonclinical burdens on physicians.
“I don’t think physicians are giving up control completely — I think it’s evolving,” Brandon Ortega, MD, an orthopedic spine surgeon at Long Beach (Calif.) Lakewood Orthopaedic Institute, told Becker’s.
For many ASCs, that evolution may run through the same organizations absorbing their surgeons. In a VMG Health survey, 59% of independent ASCs said they would consider a strategic partnership rather than a full sale. Among those open to partnerships, 71% would consider partnering with a health system, 31% with a management company and 29% with a private equity group.
Health systems are interested in return. In a 2024 VMG Health survey of 141 health system executives, outpatient surgery ranked as the top service line for joint venture partnerships, with more than 60% of respondents indicating ASCs were a top interest for growth.
Others see room for independent groups to reclaim ground as payment models change.
“Looking ahead, as healthcare transitions more toward value-based care, independent groups will lead that charge,” Frank Aluisio, MD, of EmergeOrtho, told Becker’s.
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.
