R. Michael Meneghini, MD, once spent years driving three hours a day just to continue practicing orthopedic surgery.
Every morning, he left his home before dawn, drove an hour and a half to work outside the geographic boundaries of a noncompete agreement, operated all day, then made the same trip back home at night.
His nurse, physician assistant and other members of his team did it too.
“Most people would not do that,” he said.
For Dr. Meneghini, founder and CEO of Noblesville-based Indiana Orthopedic Institute and one of the country’s best-known joint replacement surgeons, the experience fundamentally reshaped how he thinks about physician noncompetes and the future of orthopedic recruiting.
“I think they should be outlawed and illegal in the entire United States,” he said. “I don’t think there’s any role for them.”
The business of restricting physicians
Dr. Meneghini has operated under two major noncompete agreements during his career. The first, tied to a private practice position in 2005, barred him from practicing within 100 miles for two years after leaving the group. The restriction ultimately forced him and his family to move out of state.
Years later, while practicing at Indianapolis-based Indiana University Health, he faced another agreement, this time a 50-mile restriction lasting two years. Unlike several colleagues who were released from theirs, Dr. Meneghini said he was not.
“The problem was, I was one of the busiest orthopedic surgeons in all 17 hospitals,” he said. At the time, his practice generated high surgical volume, strong outcomes and significant revenue for the health system, making leadership reluctant to let him leave freely.
The experience left him increasingly skeptical of how noncompetes function inside healthcare systems.
“It interferes with the doctor-patient relationship,” he said.
Unlike traditional corporate industries, he argues, medicine depends heavily on continuity, trust and long-standing physician relationships that cannot easily be transferred to another provider simply because an employment agreement requires it.
“Patients should be able to continue seeing the physician they trust,” he said.
Supporters of physician noncompetes, meanwhile, argue the agreements help protect organizational investments, referral networks and long-term business stability.
The contradiction inside health systems
According to Dr. Meneghini, one of the biggest contradictions in modern healthcare employment is how hospitals simultaneously downplay and depend on physician relationships.
Health systems, he said, often argue that referrals primarily belong to the institution itself rather than to individual surgeons. Yet those same organizations aggressively enforce noncompetes when high-volume specialists attempt to leave.
“They sort of are arguing against one another for their own benefit,” he said. Referral patterns in orthopedic surgery, he argues, are built over years through trust, outcomes and physician reputation.
“We all are going to refer patients to physicians that we know give great care,” he said. That dynamic becomes especially important in orthopedic surgery, where referrals, reputation and long-term physician relationships often drive patient volume more than institutional branding alone.
Why orthopedic surgeons actually leave
While compensation often dominates discussions around physician recruiting, Dr. Meneghini believes surgeons usually leave for a different reason: feeling undervalued.
For him, the issue was rarely about salary itself.
“It wasn’t about the money,” he said. Instead, he pointed to resource allocation, operational support and institutional respect as the factors that most influence physician satisfaction.
If orthopedic surgeons are generating significant clinical revenue, he argues, health systems should reinvest resources back into those programs, whether through staffing support, infrastructure or operational efficiency.
“I always used to say, I’m OK with being taxed,” he said. What became frustrating, he added, was feeling that resources were repeatedly being reduced while expectations remained high.
“When you see a surgeon wanting to leave, they’re feeling devalued,” he said.
The ASC loophole few physicians understand
As hospitals increasingly push orthopedic procedures into ASCs, Dr. Meneghini believes many physicians misunderstand another layer of legal risk tied to noncompetes.
Specifically, he pointed to ASC ownership transactions. When surgeons sell equity stakes in surgery centers to larger corporate entities in exchange for future earnings multiples, he said, their noncompete agreements may no longer function as traditional physician employment restrictions.
Instead, they can become corporate transaction noncompetes, which are often significantly broader and more enforceable.
“Most physicians don’t realize that,” he said. Those agreements, he said, can last five to seven years and may dramatically restrict future mobility.
Very few physicians fully understand that distinction before signing those agreements, according to Dr. Meneghini.
As orthopedic consolidation accelerates, he believes more surgeons may unknowingly enter into restrictive arrangements without fully understanding the long-term implications.
What happens if noncompetes disappear
Dr. Meneghini believes weakening physician noncompetes would initially trigger significant movement across orthopedics, particularly among surgeons practicing in environments they view as unsustainable or unsupportive.
But over time, he believes the market would stabilize naturally.
“The groups that treat physicians well and value productive, high-quality physicians, will retain them,” he said.
In his view, eliminating restrictive noncompetes would force hospitals, private practices and orthopedic groups to compete more directly on culture, resources and physician support rather than contractual limitation.
That, he argues, would ultimately benefit both surgeons and patients.
“If you’re treating physicians well, they’ll stay,” he said.
For Dr. Meneghini, the issue ultimately comes down to a larger philosophical question about medicine itself: whether physicians should be viewed primarily as employees bound to systems, or as professionals whose relationships with patients should remain portable.
“The noncompetes,” he said, “are just a way that hospitals or groups can treat physicians poorly and restrict their ability to move. I think they are just unethical.”
At the Becker's 23rd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference, taking place June 11-13 in Chicago, spine surgeons, orthopedic leaders and ASC executives will come together to explore minimally invasive techniques, ASC growth strategies and innovations shaping the future of outpatient spine care. Apply for complimentary registration now.
