ASC ownership tends to move in cycles. Independents sell to hospitals, then a new generation of physicians leaves to build their own, said Adam Schurz, administrator of Riverwoods Surgery Center in Provo, Utah.
“I’ve seen hospital systems, independent, private equity. I’ve kind of seen it all,” Mr. Schurz said Oct. 30 at Becker’s 32nd Annual Business and Operations of ASCs in Chicago.
The industry’s first center shows the cycle. Wallace Reed, MD, and John Ford, MD, opened Surgicenter in Phoenix on Feb. 12, 1970. It is widely considered the nation’s first ASC. Today it operates as Banner Surgery Center-University, run through a joint venture between Banner Health and Atlas Healthcare Partners.
Physicians still hold the most ground. Physicians alone own 52% of ASCs, and hospital-physician joint ventures own 22%, according to August 2025 ASC Data figures cited in an October Medicus Healthcare Solutions white paper. Physicians hold some ownership in about 90% of centers.
Hospitals, however, have been moving in. They hold a stake in 27% of ASCs, according to the same white paper. In 2023, 48% of hospital systems had at least one ASC, up from 41% in 2019, according to an Avanza Healthcare Strategies survey. The share of respondents whose ASCs were owned solely by their hospital or health system rose from 18% in 2021 to 29% in 2023.
For Jeany Dunaway, administrator of Sarah Bush Lincoln Effingham (Ill.) Surgery Center, the stakes were survival. The center’s founding physicians struggled to recruit successors as they aged. Selling to a health system was “the only way for them to replace themselves and for the center to prolong its life,” she said during the panel.
“We had to link ourselves to a bigger fish in the pond or we were going to get eaten alive,” Ms. Dunaway said.
The pool of potential successors is shrinking. The share of physicians in private practice fell from 60.1% in 2012 to 42.2% in 2024, according to the American Medical Association. In a VMG Health survey, 61 responding ASCs named recruiting new surgeons as their biggest physician-related risk for 2026.
Centers that can’t find successors can close. Humboldt Physicians Surgery and Laser Center in California shut down in February because its two ophthalmologists were retiring and the practice could not recruit a replacement after about seven years of trying.
On the panel, Amanda Ryan, DO, an interventional cardiologist and physician owner of Advanced Ambulatory Surgery Center of Carlsbad (N.M.), said some degree of scale is now required. She ran into this issue when her center wanted to add electrophysiology in a rural market.
“How was I going to get top quality electrophysiologists to rural New Mexico?” she said.
The cardiology pipeline is thin. A Journal of the American Heart Association study projects cardiologist supply will grow 2%, from about 37,000 to 37,730, from 2025 to 2037, while demand grows 15.7%.
Partnering means deciding who makes the calls. Dr. Ryan pointed to the choice between pulsed field ablation and less costly radiofrequency ablation. At her center, a combined board that includes the management services organization’s CEO, its medical director and Dr. Ryan decides. Some decisions require a supermajority.
“It’s important to have your contracts pretty spelled out how those decisions really go,” she said.
An orthopedic surgeon in the audience who said he has run ASCs in New York City since 1994 argued consolidation is a step backward.
Mr. Schurz said he would prefer independence, but the numbers don’t always allow it.
“Do I want to stay independent? … Absolutely, 100%, but it’s hard to sit on that other side,” he said.
Geri Eaves, vice president of ambulatory services at MedHQ/Avanza Strategies, said the answer depends on the market.
“There are some places that absolutely could manage independently,” she said, “and then there’s some places that cannot.”
Nationally, independence has eroded slowly. Independent centers made up 68% of ASCs in 2023, down from 70% in 2022, according to VMG Health. That share had dropped only a few percentage points over the previous decade, according to VMG data.
State regulation shapes those odds. In states with certificate-of-need laws, the approval process is long and expensive, which makes it hard for independent physicians and small groups to manage. Developers tend to target states without CON requirements.
“Certificate of need states will see higher consolidation,” Adam Bruggeman, MD, CEO of Texas Spine Care Center in San Antonio, told Becker’s in 2023. Texas let its CON program expire in 1985.
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.
