Fewer physicians hold equity in their ASCs than a decade ago. But for the ones who still do, that stake is worth more than ever.
Physician ownership has always set ASCs apart from hospital-owned outpatient departments. It gives physician-owners a direct stake in the efficiency they help create. That ownership base isn’t disappearing, but it is shrinking as a share of the total market, even as the dollars attached to it climb.
The ownership-side numbers are incremental, not dramatic. MedPAC’s March 2025 report to Congress found that corporate presence in ASCs grew from 20% of centers in 2018 to 21.1% in 2023. Within that group, the five largest corporate operators — United Surgical Partners International, AmSurg, Surgical Care Affiliates, HCA Healthcare and Surgery Partners — grew their combined facility count from 1,152 to 1,333 over the same five years, a 15.7% increase. Most ASCs nationally still have at least a partial physician stake, per MedPAC, but the corporate share has climbed steadily for years.
The bigger shift is happening a level up, in how many physicians hold equity at all. The share of physicians in fully independent private practice fell from 60.1% in 2012 to 42.2% in 2024, according to the American Medical Association’s Physician Practice Benchmark Survey. The share of physicians employed by hospitals or corporate entities rose from 62% to 78% between 2019 and 2023, per an analysis from the Progressive Policy Institute. Fewer independent physicians means fewer natural buyers for ASC ownership units. The pool of physicians positioned to hold direct equity is thinning, even at centers that stay physician-friendly.
Meanwhile, the price acquirers pay for that equity keeps rising. VMG Health’s 2026 Healthcare M&A Report put the median total invested capital-to-EBITDA multiple for ASC deals at 7.9 times in 2025, the highest VMG has recorded in at least eight years. Multiples vary by center type, per Scope Research’s 2025 review of ASC valuation trends: single-specialty ASCs typically trade at 5x-to-8x EBITDA, multispecialty centers at 6x-to-10x, and larger regional platforms at 11x-to-17x. Best-in-class centers with strong physician alignment and clean revenue-cycle performance increasingly land at the top of those ranges or above them, valuation advisers at VMG Health and Vertess both said in recent guidance to sellers.
Public comparables tell the same story. Surgery Partners, the largest publicly traded, pure-play ASC operator, has been valued at 12.7 to 14 times projected 2025-2026 EBITDA, above HCA Healthcare’s roughly 9.8x-to-10x and Tenet Healthcare’s 6.8x-to-7x, per VMG Health’s data.
Capital is still chasing that trade, just less of it than at the peak. Private equity investment in ASCs totaled $19.7 billion in 2024 and $18.9 billion in just the first half of 2025, per Sullivan Cotter and Colliers data compiled for industry trackers. Ascension acquired AmSurg’s ASC portfolio for roughly $3.9 billion, one of the sector’s largest deals.
But physician-practice-management deal volume broadly is on track to run at about half of 2025’s pace in 2026, down from a peak of 851 deals in 2021 to 105 in the first half of this year, per PitchBook’s second-quarter healthcare services report. PitchBook and healthcare attorneys attribute the slowdown chiefly to new state oversight laws, not fading buyer interest.
Fewer independent physicians are positioned to buy into new centers, while multiples paid for the centers themselves sit at an eight-year high and strategic buyers keep showing up with capital, even as overall deal counts cool. Satisfaction data hints at why current owners are unlikely to sell that position cheaply. A Bain & Company survey found that 81% of physicians in physician-led organizations are satisfied with their role in strategic decisions, versus 50% in hospital-led settings.
None of this guarantees any individual physician’s buy-in units are worth more today than five years ago. Valuation still hinges on specialty mix, payer contracts and local competition. But as fewer new physician-owners enter the market and acquisition appetite for surgical-services platforms stays elevated, the ownership stakes physicians already hold sit at the intersection of shrinking supply and durable demand.
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.
