Independent practice is struggling to survive in 2026, and the ASC industry is no different.
Between 2019 and 2023, the share of independent physician practices owned by hospitals, health systems or other corporate entities jumped from 39% to 59%. Over the same period, physician employment by these entities rose from 62% to 78%, according to a December 2025 report from the Progressive Policy Institute.
When it comes to ASCs specifically, national chains control about 33.5% of freestanding ASCs, with the remaining 66.5% still held by independents, according to VMG Health. But that number may soon start to slip. While ASC deal volume dropped by 50% in the first half of 2025 compared to the same period in 2023 and 2024, this decline may understate real activity because smaller transactions involving independent ASCs and joint ventures often go unreported.
According to another survey from VMG Health, 59% of independent ASCs would consider a strategic partnership rather than a full sale. Among those open to partnerships, 71% would consider working with a health system, 31% with a management company and 29% with a private equity group.
Here’s what three ASC leaders have recently said about consolidation efforts, partnerships, hybrid ownership and what it takes to stay independent in the industry:
1. Basheer Alismail, president of Capital Surgical Solutions (Germantown, Md.): The most important thing we’ve learned — having come from the ASC side first, then moving into practice management, and now doing both — is alignment. And specifically, transparency about where a physician or physician group falls on the spectrum between quality of life and economic interest.
Some physicians just want a better quality of life. They see the ASC as a way to get out of the hospital, gain some latitude, and if distributions come, great. Others — the ones I call the alphas — are focused on how to optimize the financial returns of an ASC strategy. Those are the partners we work hardest to align with. From a business perspective, they’re the ones who drive success. And that transparency also helps us as an operations team actually define what success looks like. The quality-of-life dynamic is harder to quantify.
Our strategy at CSS is largely built around aligning with those alpha physicians in the MSK and ENT space. We’re very upfront about who we are as an organization and what we’re after operationally. If that doesn’t fit, we need to know early.
2. Travis Doering, MD. Hand and Upper Extremity Surgeon (Austin, Texas): When surgeons lose the autonomy to practice at the top of their training, to offer the right procedure at the right time in the right setting, patients are the ones who pay the price. Independent practice is harder than ever to sustain, but I believe it’s one of the last environments where truly individualized, surgeon-led care can still thrive.
3. Daniel Decker, MD. Urologist and Co-Founder of Vitality Urology Clinic (Mountain Home, Ark.): Having had experience with the various ASC ownership models, there are certainly pros and cons to each. However, there is one that seems to be the most sustainable and promising.
Hospital joint ventures inevitably seem to get bogged down with hospitals exerting control on a desire to maintain site of care leverage as to where procedures/surgeries are performed. This is a well-documented healthcare detriment of increased costs without improvement in (and often decline in) surgical outcomes. Until equitable site neutrality becomes a reality, this model has inherent flaws.
Pure physician/surgeon ownership models generally lack the insight from other specialties and the talent of business and administrators seeing the big picture often missed by busy clinicians. Essentially this model can become somewhat myopic.
Hybrid ownership with PE-backing improves upon that, but it also can become susceptible to variability of long-term sustainability versus short-term profits dependent upon a particular PE agenda.
From a broad perspective, the model that engages physician/surgeon ownership to become good stewards of clinical care and also balances competing business realities makes the most sense. A good example of this is a partnership with a [management services organization] such as [U.S Specialist Management]. This is a physician-owned entity with minority management and equity stakes in ASCs that benefits from multi-specialty surgeon input. Additionally, it employs business and administration experts in ASC management, along with the needed scale to leverage national vendor contracts on a multi-state and site level for variable-sized ASCs.
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.