Hospital job cuts are becoming less frequent in 2026 as health systems trim payrolls more selectively this year.
However, despite an overall decrease in layoffs, hospitals are shutting down entire service lines, particularly in rural markets. For physicians weighing where to practice and ASC operators weighing where to grow, the two trends are increasingly the same story.
1. Layoffs are less frequent than they were in 2025 — though that’s a low bar to clear. Forty-five hospitals announced workforce reductions through July, compared with 59 during the same stretch in 2025, according to Becker’s reporting. All of 2025 saw 93 hospitals reduce headcount, affecting roughly 18,000 employees; through July of this year, disclosed cuts totaled about 5,800 positions, down from roughly 13,850 a year earlier.
2. The average reduction size fell too, from about 235 positions per event in 2025 to about 140 in 2026. Two outsize events skew that comparison: Crozer Health’s closure eliminated 2,651 jobs across eight Pennsylvania facilities in 2025, and Mass General Brigham cut roughly 1,500 positions that same year — together accounting for about a third of the first half of 2025’s total reductions.
3. The cuts have also moved from the bedside to the back office. Where 2025’s reductions were largely tied to facility closures that touched every level of staff, 2026’s rounds have concentrated in revenue cycle, IT and corporate consolidation roles rather than clinical positions. Winston-Salem, N.C.-based Novant Health, for example, eliminated 31 revenue cycle positions in July as part of an effort to “prevent redundancy,” while Marietta, Ga.-based Wellstar Health System cut 761 positions the same month in a restructuring meant to reduce “administrative layers.”
4. Activity was quiet early in the year, then picked up through the summer. Beyond Wellstar, July brought a 200-position reduction at Fayetteville, N.C.-based Cape Fear Valley Health, an 83-position cut at Portland-based MaineHealth and a 103-position reduction tied to a hospital closure at Memphis, Tenn.-based Regional One Health. Becker’s running tally now counts cuts at 48 hospitals and health systems so far in 2026. Systems in both years have cited rising care-delivery costs, pharmaceutical expenses and federal reimbursement cuts as primary drivers; 2026 filings have added a new one, with several systems citing exits from Medicare Advantage and Medicaid markets altogether.
5. The more consequential trend for outpatient providers may be happening below the corporate layoffs: hospitals are closing entire service lines. Becker’s has tracked 47 hospital department or service-line closures since Jan. 1, most concentrated in labor and delivery, behavioral health and primary care rather than surgery. Some have hit ASCs directly. Ogdensburg, N.Y.-based North Star Health Alliance closed North Country Orthopaedic ASC and Group in Watertown, N.Y., within a 90-day window, eliminating more than 100 positions. Baltimore-based LifeBridge Health shuttered its Ellicott City, Md., ASC over low procedure volumes, and Lancaster, Ohio-based Fairfield Medical Center closed its River View Surgery Center ahead of its acquisition by Columbus-based OhioHealth.
5. Rural hospitals are where the pressure is most acute. About 720 rural hospitals — nearly a third of all rural facilities — are considered at risk of closure, with 294 facing closure within two to three years, and more than 40% now operate at a loss on patient care. The federal Rural Health Transformation Program is distributing $10 billion annually over five years to help offset the strain, but a Commonwealth Fund analysis projects that Medicaid, Affordable Care Act marketplace and Supplemental Nutrition Assistance Program cuts under H.R. 1 will total $160 billion combined by 2029 — and that 1.65 million jobs will disappear nationally that year, with nearly half of them in healthcare.
6. CMS, meanwhile, is clearing regulatory room for ASCs to pick up more of that volume. A three-year phaseout of the Medicare inpatient-only list is removing 285 procedures, mostly musculoskeletal, with 266 coming off the list in 2026 alone; the agency has also added 573 new codes to the ASC Covered Procedures List.
7. But ASC capacity doesn’t line up with where hospitals are shrinking, and several structural hurdles could slow how fast the industry closes that gap. As of 2024, 94% of ASCs were located in urban areas and just 6% in rural ones, and the states carrying the highest hospital closure risk — including Texas, Kansas, Oklahoma, Arkansas and Mississippi — show some of the widest ASC density gaps in the country. Certificate-of-need laws still restrict new facility openings in rural states such as Wyoming and Idaho; Montana, which repealed its CON law in 2021, saw a 12.5% increase in ASCs, home health agencies and addiction treatment centers afterward.
8. Staffing is its own constraint: 83% of orthopedic and spine ASC leaders cite credentialing and verification delays as their top staffing challenge, and 67% still track it manually. The orthopedic surgeon workforce is projected to shrink 4.3% from 2025 to 2037 even as demand for those surgeons rises 6.4% over the same period, leaving hospitals and ASCs competing for the same limited pool of scrub techs, circulating nurses and fluoroscopy technicians. Nationally, ASCs are growing at only about 1.6% annually — a pace that lags how quickly hospitals are shedding service lines in 2026.
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.
