Physician ownership has been on the decline in recent years — as of 2024, just 42.4% of physicians work in private practice, down from 60.1% in 2012, according to the American Medical Association’s Physician Practice Benchmark Survey.
Physicians have largely shifted from private practice into employed settings such as hospitals, health systems and other corporate healthcare entities. According to a report published in May in the Journal of the Society of Laparoscopic and Robotic Surgeons, the number of hospital-employed physicians rose by 33% between 2013 and 2022 from around 157,000 to more than 205,000. In contrast, private practices grew by 17%, indicating hospitals are hiring at roughly double the rate.
However, a new wave of physicians are returning to the ownership model, largely driven by concerns over decreased autonomy, compensation and burnout. According to a 2024 survey by Bain & Company, 81% of physicians working in physician-led organizations reported satisfaction with their involvement in strategic decision-making, compared with just 50% in hospital-led practices.
While employed models still dominate the physician workforce, a new era of ownership is being made possible by a wave of management services organizations, joint ventures and hybrid-ownership models are revolutionizing the way that physicians engage with practice ownership.
Becker’s has reported on at least nine new platforms and MSOs in 2025 built around physician-ownership and autonomy. Another group, Franklin, Tenn.-based Regent Surgical Health, founded in 2001, partners with health systems and physician groups to develop, own and manage 26 ASCs across more than 13 states. The company has steadily grown over the last 20 years, steadily growing and adapting to the shifting demands of physicians and of the healthcare industry overall.
“One of the greatest challenges for ASC management companies is that the operating environment has changed,” Regent CEO Travis Messina told Becker’s. “Specifically, physician employment patterns have changed. They were largely independent, now they’re largely employed. Payer mix has shifted. With an aging population, there are more Medicare beneficiaries, and within that, more Medicare Advantage beneficiaries, which brings different operating constraints.”
This evolving ownership model also pivots away from what has been traditionally perceived as competition between independent practices and hospitals and health systems, allowing independent physician owners to reap the benefits and resources of hospital ownership without completely losing physician autonomy.
For example, in August, Norfolk, Va.-based Sentara Health partnered with Manassas, Va.-based Carient Heart & Vascular and Woodbridge, Va.-based Polaris Heart & Vascular Clinic to open the Northern Virginia Heart & Vascular Center — the region’s first outpatient cardiovascular facility.
Mark Langston, chief development officer at Compass Surgical Partners, recently told Becker’s that these hybrid ownership models are a direct response to the “squeeze” on independent physicians, many of whom are struggling in risk-based models with a lack of payer leverage — particularly for those in the ASC industry.
“Independent physicians are really in a squeeze right now,” he said. “If you have an independent surgery center, it’s tough. If you’re in an independent practice, also tough. If you’re doing both—good luck in today’s world.”
