Physicians today are caught between growing consolidation of hospitals and large health systems on the one hand and increased financial pressure on ASCs and independent practices on the other.
Hospitals appear to offer a number of important benefits for physicians. They are typically able to pay higher salaries or offer flashy sign-on bonuses that are less feasible in the ASC setting, creating a competitive recruiting environment.
"We get fully staffed, we think everything is good, and then it just falls apart because somebody gets lured away for a $30,000 sign-on bonus at one of these major hospitals that locks them in for two years … you're constantly competing," Curt Collins, COO of Palmetto Surgery Center in Columbia, S.C., told Becker's in July 2023.
While it's challenging for ASCs to keep pace with hospitals' monetary advantage, many physicians find that autonomy offered by ASCs is enough to keep them out of the hospital setting.
"The ability to control their own protocols and office efficiency has driven many of the training physicians I work with to want to have their own practices," Joe Greene, MD, the co-founder of Louisville (Ky.) Hip & Knee Institute, told Becker's in 2022. "Paramount to the success of those private practices is ASC ownership."
ASCs are also getting creative in the non-salary benefits they offer physicians.
"[It] used to be that just the idea of working in an efficient environment like an ASC was enough. So we would contact surgeons and appeal to their nature of efficiency with helpful productive staff (that would often get them interested)," Sandra Berreth, RN, director of the Foothill Surgery Center at Sansum Clinic in Santa Barbara, Calif., told Becker's.
Physicians might also see more opportunities for financial growth in the long run at ASCs and smaller practices.
"The hook was ownership — if ownership was available, that was always a necessary part of the equation," she added. "It is not that easy anymore, with hospitals employing the docs, these physicians are often restricted to work in the [hospital outpatient departments] and main operating rooms of those healthcare organizations."
ASCs are also able to offer more flexible scheduling than hospitals, remote work options and other perks that help physicians achieve a better work-life balance.