In 2022, just 44% of physicians owned their practice, compared with 76% in the early 1980s, according to a report from the American Medical Association. Around 61% of employed physicians said they have moderate or no autonomy to make referrals outside of their practice or ownership system, and 47% said they adjust patient treatment options to reduce costs based on practice policies or incentives, according to a survey from NORC at the University of Chicago.
“This one factor makes physicians vulnerable to the whims of large corporations,” Loay Kabbani, MD, a vascular surgery specialist at Detroit-based Henry Ford Health, told Becker’s. “As physicians become more and more employed, we lose control of our practice and our patient-physician relationships.”
Sean Gipson, CEO and ASC division president of Remedy Surgery Center in Houston, has worked as a hospital administrator for a large health system in Texas, giving him firsthand experience with the differences between hospital employment and ASC practice.
“The call responsibilities, the bureaucratic red tape — it’s just a lot harder to get things done in a hospital system compared to an ASC,” Mr. Gipson told Becker’s.
One advantage of ASCs is their ability to move quickly on operational decisions. For instance, when physicians request a piece of capital equipment, hospitals require them to navigate a lengthy approval process, often waiting for the next year’s budget cycle, he said. In contrast, ASCs can pivot much faster.
“In a hospital system, you need to go through a budget committee, get approval and then hope you make the cut for next year’s capital budget,” he said. “By that time, the ASC is already operating on patients.”
ASCs also offer greater flexibility in scheduling and case management. Unlike hospitals, which can have rigid structures and backup teams, ASCs can adapt quickly to maximize efficiency. However, this comes with trade-offs — particularly in attracting top-tier talent.
“In an ASC model, it’s harder to attract renowned physicians because the budget isn’t always there,” Mr. Gipson said. “We have to be savvy in negotiating contracts to even have a chance at bringing those physicians on board, even if it’s just for a couple of days a week or every other month.”
Despite the benefits of ASCs, many physicians still gravitate toward hospitals for one key reason: financial security.
“Doctors often feel safer in a system because hospitals have deeper pockets than an ASC, which operates with limited funds — whether from private equity, physician investment or other sources,” he said.
