The ASC market has become more competitive in recent years as hospitals, health systems and other corporate entities compete for surgical volumes and shift towards value-based care models.
At the same time, independent practices have diminished as hospital employment among physicians rises. Between 2019 and 2023, physician employment by hospitals, health systems or other corporate entities jumped from 62% to 78%, according to a December 2025 report from the Progressive Policy Institute.
By 2024, just 42% of physicians worked in private practice, down from 60% in 2012. Nearly half (47%) were employed by or affiliated with hospitals, according to a Government Accountability Office report.
However, some physicians are observing a shift back to private practice as administrative burdens, stifling bureaucracy and a diminished sense of autonomy begin to sour them on the employment model.
“As hospital systems increasingly move toward physician consolidation, autonomy is on the decline unless those physicians are in a unique system or independent,” Daniel Decker, MD, a urologist in Mountain Home, Ark., told Becker’s. He added that joint ventures or partnerships with management services organizations have been one route physicians have used to reclaim independence, especially in the ASC space.
“The days of the physician [saying,] Listen to me because I know more,” are over,” he said. “That is, autonomy is achievable through MSO arrangements that are much more available in 2026 for independent practices and now like-minded hospital partnerships for the employed offer similar autonomy.”
Joshua Siegel, MD, director of orthopaedic sports medicine at Exeter, N.H.-based Access Sports Medicine and Orthopaedics, said that compensation is also a growing issue among employed physicians, which, when compounded with a heightened sense of dissatisfaction, may push some back into private practice.
“What you’re seeing now is a lot of doctors coming out and getting burned,” he said. “They’re working for two, three years. They have a hard time renegotiating. A lot of what was promised isn’t materializing. Some of their salaries — they have to either make them, or they’re responsible to, in some way, pay them back. So this great deal all of a sudden turns into these handcuffs. And the docs leave.”
Nearly 25% of physicians in health system-led organizations are contemplating a change in employers, compared to just 14% in physician-led practices, according to a survey from Bain & Co. Notably, of those considering a switch, 37% are looking to move to physician-owned settings.
Rural communities could be one space to watch for an increase in physician ownership. Dr. Decker, also the co-founder of Vitality Plus Urology Clinic, said that as site-neutral payment policies gain momentum, value-based care initiatives take center stage and CMS approves more procedures for ASCs—rural physicians may find themselves in a uniquely favorable position.
“CMS wants value-based care, but how are you really going to make that happen?” he said. “I think rural ASCs have an advantage there, because we can keep track of this stuff. We’re smaller, and then you grow from there.”
