For Hector Mejia, MD, managing physician partner of Tallahassee (Fla.) Orthopedic Clinic, partnering with a managed services organization wasn’t driven by financial distress. It was driven by a structural problem that hits physician partnerships once they reach a certain size. TOC, which delivers orthopedic care and sports medicine across North Florida and Georgia, partnered with Orthopaedic Solutions Management, the largest orthopedic services provider in Florida.
Dr. Mejia spoke with Becker’s about what pushed TOC toward the partnership and why he believes physician control — not the mere existence of an MSO — is what actually protects autonomy, a distinction he raised as lawmakers introduced the Stop Corporate Takeovers of Physicians Act targeting corporate influence over physician practices.
A voting problem, not a cash problem
Dr. Mejia said as a group grows, the pressure to consider outside partnership comes from simple math. In a typical physician-owned partnership, votes are roughly equal regardless of tenure — meaning a senior partner nearing retirement may see a major capital project’s five- to 10-year payback very differently than a newer partner would. That generational split makes consensus on big projects harder to reach as groups scale.
He described roughly seven or eight partners as an especially difficult threshold — too big to operate informally, not yet big enough to have built the infrastructure larger groups have.
“As you get bigger, you have more opportunities,” he said. “With more opportunities come bigger projects, and when bigger projects come, you need more capital.” At that point, a group has to decide whether to stay the same size or grow — and if it grows, whether to do it alone or de-risk by partnering with an outside entity.
He was direct that no orthopedic surgeon would choose outside partnership as a first preference. “If you ask all orthopedic surgeons across the country, would you like to own your own place and just be your own place — yes, the answer is unanimously, yes,” he said. But he pointed to external pressures — declining reimbursement, rising overhead and staffing costs, and competition from both hospital systems and private equity firms with far larger budgets — as real headwinds that force the analysis.
Why physician control changed the outcome
Dr. Mejia argued that an MSO’s governance structure, specifically, whether physicians sit on the board, determines whether it preserves or erodes autonomy. He pointed to OSM’s board, where local market knowledge from physicians like himself can outweigh a purely data-driven read. Comparing Tallahassee to Tampa, he said a decision rooted in a specific hospital relationship might not be obvious from spreadsheets alone.
“Only if you’re the physician practicing there do you know those things,” he said.
Growth benefits beyond risk-sharing
Beyond governance, Dr. Mejia pointed to two concrete advantages the partnership has delivered. First, it spread financial risk across a larger base — TOC’s Tampa-based partners now share investment in growth happening in Panama City, Fla., and vice versa, rather than each local market bearing its own capital risk alone. Second, scale itself became a negotiating asset. TOC is now, by Dr. Mejia’s account, the third-largest orthopedic group in the state and one of the largest in the country — a position he said has made conversations with insurers and hospitals easier. “The more physicians and providers are together, the more the insurance companies, the hospitals listen,” he said.
He also noted a structural disadvantage independent practices face that rarely gets discussed: unlike hospitals, physician groups don’t have access to state or federal funding, and they lack certain malpractice protections hospitals carry. That imbalance, he said, is part of what pushed TOC toward a partnership model rather than continuing to grow entirely independently. “The playing field is so uneven and unfair in that regard,” he said.
His advice to other practices: skepticism first
Asked what he’d tell another thriving practice considering an MSO, Dr. Mejia’s answer centered on skepticism, not enthusiasm.
“Be very skeptical, for sure,” he said. “Not all of them are created equal.” He recommended a slow, deliberate process: determine whether a partnership is actually necessary before deciding when or how to pursue one, and build out a clear list of specific goals before signing anything.
“If there’s a way you don’t have to do it, I would tell you don’t do it,” he said. “But if you do have to do it, or you feel there’s advantages to do it for a specific reason — I would definitely recommend doing a physician-owned MSO.”
He was careful not to oversell the experience. “We all went into this with a lot of fear and skepticism, and not everything has been roses,” he said. “But for sure, at least from our experience and the way we’ve structured this, it’s been a very positive experience — not in all ways, but in most ways, and definitely in the ways we targeted.” For physicians weighing the same decision, he said a physician-owned structure specifically — not corporate or private-equity ownership broadly — is “what I think most doctors went into medicine for.”
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.
