ASC leaders told Becker’s that the next major disruption to the ASC landscape may not be reimbursement reform or a new surgical technology, but accelerating physician consolidation.
As more independent surgeons move into employment models, whether through health systems, large multispecialty groups or private equity-backed platforms, ASC structures are shifting.
Between 2019 and 2023, physician employment by hospitals, health systems or other corporate entities rose from 62% to 78%, according to a December 2025 report from the Progressive Policy Institute.
Tammy Smittle, RN, CEO of Stonegate Surgery Center in Austin, Texas, told Becker’s the migration from independent surgeons to employed models could fundamentally reshape how ASCs operate.
“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,” she said. “This trend fundamentally alters the economic, governance, referral and growth dynamics on which traditional ASCs have historically relied.”
Unlike payment reform or new technologies, which tend to optimize existing care delivery structures, physician employment changes the structure itself, Ms. Smittle said. Traditional ASCs were built on surgeon ownership, aligned incentives and referral autonomy, but the industry is consolidating on the facility side, too.
A national operator partnership now encompasses nearly 2,000 ASCs, up from about 1,300 centers in 2011, reflecting a new consolidation path over the past decade and a half.
As physician employment reshapes those relationships, decision-making authority and strategic direction may increasingly move upstream to corporate or system leadership, Ms. Smittle said.
Other leaders agreed. Travis Messina, CEO of Regent Surgical Health, said the ASC landscape looks nothing like it did decades ago. The employment shift, he told Becker’s, is also changing how ASCs recruit and engage physicians. For younger physicians, the issue is not a lack of interest in ASCs, but limited resources and opportunity to buy in.
“Because of the high costs of everything, there’s usually a very significant buy-in required for younger physicians to become partners in private practice,” Shobhit Minhas, MD, orthopedic surgeon at Fox Valley Orthopedics in Geneva, Ill., told Becker’s. “I would also say it’s hard to find physicians now who are willing to take on the burden of ownership, especially younger ones. A lot of independent ASCs have been operating independently for 15 to 20 years, so they’re essentially governed by the older physicians still in practice. Younger physicians today understand the challenges — getting adequate margins, rising healthcare costs, declining revenue, etc. Do they even want to take on the burden or responsibility of ASC ownership, especially with those tight margins?”
Earl Kilbride, MD, an orthopedic surgeon at Austin (Texas) Orthopedic Institute, framed consolidation as a competitive issue: “The biggest disruptor in my mind to the ASC landscape is the big healthcare system,” he told Becker’s. “Costs are lower when competition exists.”
Partnerships between ASCs and health systems can offer advantages, including stronger payer contracts, administrative infrastructure and labor support, he said. But full ownership can narrow patient choice.
In a 2024 VMG Health survey of 141 health system executives, including CEOs, CFOs and COOs, 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.
“If the ASC and the providers are entirely ‘owned’ by the system, patients may feel the effects as their independence shrinks because they are forced to stay in the system,” Dr. Kilbride said.
In a separate VMG Health survey, 59% of independent ASCs said they would consider a strategic partnership rather than a full sale. Among ASCs open to partnerships, 71% would consider partnering with a health system, 31% with a management company and 29% with a private equity group.
For independent centers, consolidation can create both opportunity and pressure.
Sev Hrywnak, MD, owner and CEO of Advanced Ambulatory Surgical Center in Elmwood Park, Ill., pointed to vertical integration as a defining force. Hospitals, large ASC groups and analytics or technology platforms are increasingly consolidating assets into larger networks that can compete at scale, he said. At the same time, private equity investment and strategic specialty partnerships are accelerating ASC growth in certain markets.“Acquisition and partnerships can rapidly scale an ASC footprint,” Dr. Hrywnak said.
That scale can bring standardized pricing, stronger procurement leverage and operational efficiencies, he said. But it can also intensify price pressures on independent ASCs and shift contract dynamics with payers.
