ASCs have long used physician ownership as a key differentiator from hospital-employed models, but industry leaders say many centers are failing to fully leverage ownership structures to recruit the next generation of surgeons and protect long-term volume.
As high-volume, senior surgeons retire or reduce their caseloads, ASCs that don’t have a pipeline of younger physician-owners risk watching their volume walk out the door.
The physician workforce has faced an aging problem for decades. In 2005, more than 11% of physicians were 65 or older. That number rose to 22.4% in 2025, according to the Association of American Medical Colleges.
Ray Brown, CEO of Maitland, Fla.-based Lucien ASC, said the issue starts with how ASCs structure buy-in opportunities for newer surgeons.
“Some players in the industry have to look at their ownership model and how they allow new surgeons to buy in at a price that is not a barrier to entry, or allow younger surgeons the ability to buy in,” he said. “To get to a good bottom line, we need to be mindful of our top-line revenue.”
The concern is that prohibitive buy-in costs effectively shut out the emerging surgeons ASCs need most. When ownership isn’t accessible, younger physicians may gravitate toward hospital employment — taking their volume with them.
Shobhit Minhas, MD, orthopedic surgeon at Fox Valley Orthopedics in Geneva, Ill., told Becker’s that younger physicians are deterred by the significant buy-in required to become partners in private practice.
“Sometimes the buy-in can range from half a million to almost a million and a half dollars, depending on how big the practice is. That’s an initial barrier, because very few younger physicians have that kind of money right out of medical school — especially with the amount of debt. So I think the financial restraints are probably the No. 1 factor for physicians, unless they get lucky or the buy-in is relatively small,” he said. “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, Dr. Minhas said, so many times they don’t want to take on the burden or responsibility of ASC ownership, especially with the tight margins.
Jack Dillon, CEO of Grand Rapids, Mich.-based Anesthesia Practice Consultants, told Becker’s the solution lies in deploying structured, performance-tied equity pathways, and doing so intentionally.
“One of the most underused strategies in the ASC industry is using equity-driven models to intentionally recruit, retain and reload surgical volume through the next generation of independent physicians,” he said. “As senior, high-volume surgeons slow down, reduce FTEs or approach retirement, many ASCs accept volume attrition rather than actively recruiting emerging surgeons who are seeking autonomy, efficiency and ownership.”
Mr. Dillon said those equity pathways should be tied to measurable performance metrics — case volume growth, block utilization and contribution margin — while aligning anesthesia, staffing and OR access to help younger surgeons ramp up quickly.
“By offering younger surgeons a clear path to ownership and operational influence, ASCs can capture loyalty early, stabilize long-term volume and avoid the costly gap created by retiring partners,” he said.
Sixty-five percent of self-employed physicians said autonomy was very important to them in Medscape’s Self-Employed Physicians Report 2025. In Medscape’s Employed Physicians Report 2025, 48% of physicians said that diminished autonomy was the worst part of their job, demonstrating the value of autonomy for both independent and employed physicians.
The opportunity, Mr. Dillon argued, is particularly acute given the current market dynamics. Hospital employment models frequently limit physicians’ equity and control, giving independent ASCs a meaningful competitive advantage if they use it.
“Independent ASCs that use ownership as a recruitment and retention tool can preserve independence and build a durable, multigenerational surgical platform with aligned incentives and sustained growth,” he said.
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.