How will the impending physician shortage affect ASCs?

The U.S. is expected to reach a shortage of 37,800 to 124,000 physicians by 2034, and while some ASC leaders think this could be an advantage for physicians, many are concerned that it could be detrimental to the provision of outpatient services. 

Fourteen ASC leaders spoke with Becker's ASC Review on how they believe the physician shortage could affect the industry. 

Editor's note: These answers have been edited lightly for clarity and brevity. 

Question: How do you predict the aging physician population and physician shortages will affect the ASC industry in the next three years? 

Christina Holloway, RN. Administrator of Ambulatory Surgery Center of Bala Cynwyd (Pa.): ASCs are likely to be hugely impacted by the physician shortages associated with aging out and recent complications in education for graduating classes. A large percentage of these facilities are physician-owned in some fashion. Our facet of healthcare will not only lose providers for the patient populations served but also supportive funding. When taking these future complications into account, along with the potential upcoming CMS amendments to elective procedures, the next three years will truly navigate how outpatient services will suffer or survive as a viable option for care.

Gregg Florentin. CEO of Michigan Orthopaedic Surgeons (Southfield): The country’s rapidly increasing demand for physicians over the next three years will outpace its supply, leading to a huge shortage. It’s an unbalanced scale — as the population ages, they are living longer and requiring more care later into life, thus driving growth in the demand for surgical services, while the aging physicians squeeze into retirement. Physicians already suffered high levels of job-related burnout and depression before COVID-19 arrived, and the exacerbation of those feelings caused by the pandemic could sway older doctors to accelerate their plans to retire.

Andrew Lovewell. Administrator of Surgical Center at Columbia (Mo.) Orthopedic Group: The U.S. faces a potential shortage of several primary care, surgical and hospital-based physicians in the near future. These shortages are going to cause a ripple effect throughout the healthcare continuum, not just for ASCs. However, the ASC industry is going to have to work hard to assure that the physician base for surgical referrals is solid in the future. Many of the cases that ASCs do come from one surgeon or a handful of surgeons, and if one or more of those surgeons decides to retire at the same time, it can be detrimental to the ASC. If ASCs and outpatient private physician groups do not have a forward-thinking approach to physician recruitment and retention, we will see many ASCs struggle in the future.

Adam Bruggeman, MD. Surgeon at Texas Spine Care Center (San Antonio): The majority of retirements in the next few years will likely have minimal impact on ASCs. Many of the physicians who are performing higher-complexity cases tend to be younger and are not near retirement.

Scott Thellman, MD. Surgeon at Lawrence (Kan.) Plastic Surgery: As the generation of independent surgeons that founded many ASCs 20 to 25 years ago approach retirement, there may be fewer surgeon investors available to replace them. As more surgeons are now employees of health systems, there will be pressure to partner with these systems and develop strategies that allow for employed surgeons to share ownership in ASCs. The health systems can look at the cost efficiencies historically seen in ASCs and recognize that they are attributable to the surgeons having a direct financial stake in a center. Physician ownership preserves efficiency, is a great recruitment tool and keeps costs down for our patients. 

Alfonso del Granado. Administrator of Covenant High Plains Surgery Center (Lubbock, Texas): We have not begun analyzing the physician shortage nor how it is likely to affect ASCs, but I believe our current fee-for-service model will continue to motivate physicians to pursue surgical disciplines, and I do not foresee any impact in the next three years. On the primary care side, mid-level practitioners and other extenders may free up time so that more physicians can enter surgical disciplines. However, on the surgical side, I don’t see the kind of advanced training taking place that could enable surgical assistants to take the place of assisting surgeons or co-surgeons.

Henry Leis, MD. Surgeon at Bienville Orthopaedic Specialists (Gautier, Miss.): With the pending physician shortage expected in multiple specialties by the year 2025, I believe you will begin to see a higher percentage of patients being moved to the outpatient surgical setting. In addition, patients will likely experience longer waiting periods for access to subspecialty appointments and, subsequently, surgical procedures.

Trey Sampson III. Administrator of Newport Beach (Calif.) Surgery Center: It's almost a certainty that every administrator will face this issue at some point. I believe an aging physician population will adversely impact the ASC industry by significantly decreasing the volume of outpatient surgeries after physician retirements. The pace of physician retirements have greatly increased during the COVID-19 pandemic, due in part to physician illness as well as physicians deciding that it's finally time to hang up the stethoscope and spend quality time with family.  

We are also seeing a large number of independent physician practices being sold to hospital systems and redirecting their outpatient procedures to hospital-owned surgery centers. I think the pandemic severely affected the sole-practice physicians, as many of them sold to hospital systems to cut their losses and sustain their careers. 

Christine Blackburn, BSN. Administrator at the South Kansas City SurgiCenter (Overland Park): I think the next three years will be pivotal for ASCs for multiple reasons in regard to aging surgeon owners. These surgeons see inconsistent payer practice from CMS and commercial with restrictive prior authorizations and then the removal of the 258 CPT codes from the ASC. It's so hard to decide where to go with this information. Do we invest in more, or do we retire? Additionally, COVID-19 and all of the variants and the expense and changes that come with this. If they are close to retirement, this might be the tipping point for the physician. Can the new surgeon afford to buy into a center?

Anthony Bevilacqua, MD. Surgeon of Sports Medicine & Orthopedic Center (Suffolk, Va.): I think the physician shortage will result in more physician assistant and nurse practitioner extenders, and the surgeons that do exist will be in surgery more. The way that will most affect the surgery center is likely by having more "flip rooms," where the surgeon can work between two rooms to get a larger case volume completed. I would also expect some centers to work longer hours some days to accommodate this.

David Horace. Administrator and Owner of Bel-Clair Surgical Center (Belleville, Ill.): I do not think the aging physician population will have a significant effect on ASCs in the next three years since we have recently added several physicians at our facilities who, instead of retiring, have decided to transition from private practice to a management services organization environment and continue to practice in the ASC setting to avoid the headache associated with the hospital environment. This increases their satisfaction and that of their patients while earning technical component revenue. 

Timothy Kremchek, MD. Surgeon of Beacon Orthopaedics & Sports Medicine (Cincinnati): I think the physician shortage is going to swing to the advantage of the physician. With higher competition, many physicians are fighting for new business, especially "good business." This will allow better physician reimbursement — hence, higher motivation.

Frank York. CEO of NewSouth NeuroSpine (Flowood, Miss.): With fewer physicians opting to commit the time and resources to specialty surgical training, there will be an increase in the number of patients seen per surgeon. More and more surgeries will take place in the ambulatory setting as minimizing per-patient operative and turnover times will be necessary. 

Glen Silverman. CEO of US Orthopaedic Partners: I think aging physicians are always a concern. These physicians are typically instrumental leaders within many of the groups, they provide leadership and guidance to younger doctors and, in many cases, they have helped pave the way for so many that follow them. I think with effective planning you can take many of the unknowns out of the potential impact they might have in an ASC. Additionally, on a positive note, doctors coming out of fellowship today are being trained in the outpatient space and are probably much more comfortable with it as a primary practice location versus how doctors were trained years ago.  

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