As spine surgeons relocate across the U.S., market dynamics shift for ASCs, hospitals and private practices.
Spine remains one of the most in-demand surgical specialties, and with an orthopedic surgeon shortage of more than 5,000 predicted by the end of 2025, spine specialists are among the most difficult physicians to recruit.
“As the U.S. healthcare landscape continues to evolve, hospital consolidation is emerging as a dominant trend and one with profound implications for spine care delivery. From the perspective of ASCs, this consolidation wave represents both a significant challenge and a unique strategic opportunity,” Ali Ghalayini, administrator at Advanced Spine Center of Wisconsin in Neenah, told Becker’s.
Recruitment timelines are lengthening across the board, with surgical and specialty roles taking the longest to fill.
Recent benchmarks show median physician time-to-fill at 118 days, with oncology searches at 332 days — illustrating how specialty recruitment can stretch for many months, particularly outside major hubs.
More younger surgeons are choosing hospital employment or ASC partnerships over solo practice, though American Medical Association data shows 54% of orthopedic surgeons remain independent.
Sign-on bonuses, loan-repayment programs and infrastructure support make hospital and ASC employment more attractive than solo practice, contributing to consolidation across spine and orthopedic markets.
“In regional markets, as hospitals try to drive out private practice doctors, we will see unusual alliances of otherwise competitive surgeons,” Brian Gantwerker, MD, a spine surgeon at the Craniospinal Center of Los Angeles, told Becker’s.
Reimbursement and site-of-service shifts are another driver. CMS’ 2025 proposals would remove many spine procedures from the inpatient-only list starting in 2026, enabling more to be undertaken in ASCs and intensifying demand where ASC ecosystems are robust.
States with large ASC footprints provide fertile ground for spine migration. Recent analyses of growth rates specifically flag Connecticut, Indiana and North Carolina as the fastest growing for outpatient spinal surgery.
Recent appointment and facility lists also show a concentration of spine activity in ASC-dense states.
These moves highlight how surgeon mobility is reshaping access to spine care: metro markets draw talent as outpatient capacity expands, while underserved regions face tighter pipelines and longer specialty searches — pressures that complicate workforce planning in orthopedics and spine.
