The healthcare industry is recalibrating after President Donald Trump revoked a Biden-era executive order that sought to limit hospital consolidation.
In 2021, then-President Joe Biden directed federal agencies to take a tougher stance on mergers and acquisitions, particularly in healthcare. The order’s repeal may ease regulatory pressure, though antitrust laws remain in place. Some health system leaders see the shift as an opening for growth, while others point to persistent challenges such as payer leverage, uneven oversight and rising costs.
For orthopedics, the key question is whether the move will accelerate consolidation or simply reinforce trends already underway. Becker’s asked orthopedic leaders:
In your view, how will this executive order impact the orthopedic industry? Do you think there will be fewer independent orthopedic groups because of the executive order?
Editor’s note: Responses have been lightly edited for clarity and length.
Pablo Castaneda, MD. Chief of International Surgery at Texas Children’s Hospital (Houston): The revocation signals a looser federal stance on consolidation, which may accelerate hospital-, corporate- and private equity-led deals. By early 2024, nearly 60% of practices were already hospital- or corporate-owned, with private equity accounting for about 6.5% of physician practice ownership.
Evidence shows consolidation often drives prices higher without improving quality. The groups that remain independent will likely be ASC-centric or concierge practices. Site-neutral payments may support physician-owned ASCs, but won’t offset the broader-scale advantages pushing consolidation forward.
Chris Palmer, DO. Orthopedic surgeon at Signature Medical Group (St. Louis): Revoking the order may speed consolidation, but this threatens independent orthopedic practices. Independent groups have long driven innovation, efficiency and patient-centered care. Absorption into larger systems risks losing that diversity and surgeon autonomy, ultimately reducing competition and patient choice.
Robert Peinert, MD. Orthopedic surgeon at Valley Baptist Medical Center (Harlingen, Texas): Hospital acquisition is a major issue for small-market healthcare. Patients often bypass rural hospitals for big-city centers with newer technology, leaving local facilities financially weaker and less able to recruit young physicians. Many rural hospitals risk becoming waystations tied to larger referral centers, with local control fading.
At the same time, medicine has shifted socially. Physicians increasingly seek quality of life, group settings, and reduced call burdens, making solo practice less sustainable. While small groups may survive in select environments — such as concierge models in wealthy urban areas — the solo orthopedic surgeon is largely disappearing, not because of politics, but broader societal and lifestyle changes.
Sylvester Youlo, MD. Orthopedic surgeon at Phelps Health (Rolla, Mo.): This executive order will not dramatically change orthopedics. Executive orders are temporary and easily reversed, making them unreliable for long-term planning. Still, reduced scrutiny could encourage larger systems to pursue acquisitions.
The bigger forces are private equity, payer leverage, workforce shortages and cost pressures. Between 2004 and 2019, 41 orthopedic practices were acquired by 34 investment firms, most in the last three years of that period. That momentum reshaped independence far more than federal policy. Some groups will endure by staying lean and community-based, but overall, independence is eroding because of market forces, not Washington.
Bruce Ziran, MD. Orthopedic surgeon at Atlanta Orthopedic Institute: The ability of hospital systems to merge will significantly impact orthopedics and other specialties. Consolidation turns large systems into corporate entities that commoditize physicians. This shows up in several ways: growth in costly administrative roles, physicians treated as replaceable, restrictive contracts, vendor decisions made without surgeon input, and underpaid but critical surgical support staff. Meanwhile, hospitals prioritize capital purchases like robots over investing in people.
Allowing more consolidation is not a good idea. While some younger surgeons are drawn to steady employment, many eventually leave what they see as exploitative arrangements. The best surgeons seek practices that offer support and autonomy, while corporate entities risk being left with less engaged talent. I see a grassroots movement toward medium-sized groups, though private equity poses its own risks. My hope is that independence will endure, but I fear many will be pulled into corporate or [private equity] models.
