Phoenix-based OrthoArizona is adding clinics, imaging, surgery centers and physicians across Arizona.
For CEO Rajan Bhatt, MD, the harder challenge is not finding reasons to grow. It is building an organization large enough to capture that demand without losing the physician control, operational discipline and local access that made growth possible in the first place.
Since Dr. Bhatt took over in late 2024, OrthoArizona has added roughly 77,000 square feet of clinical space, including a new 50,000-square-foot center in Glendale, Ariz. Another 50,000-square-foot center is planned for Chandler, Ariz., in 2027.
But Dr. Bhatt does not describe the expansion as a real estate strategy. He describes it as an infrastructure strategy.
“Data drives decisions,” Dr. Bhatt told Becker’s. “Intuition can’t.”
That philosophy runs through nearly every part of OrthoArizona’s expansion: where it opens, what services belong under one roof, whether a market can support a full orthopedic platform and whether the organization can recruit enough physicians to make the investment work.
The goal is not growth for its own sake. It is to build an orthopedic group capable of scaling without becoming less physician-led as it gets bigger.
Three forces are pushing orthopedic care outward
Dr. Bhatt sees three major forces behind OrthoArizona’s current expansion.
The first is demographic. Arizona’s population is aging, and musculoskeletal demand rises with it. At the same time, the state continues to attract new residents, creating more orthopedic demand across expanding communities.
The second is site-of-service migration. Procedures that required inpatient care five years ago are increasingly moving outpatient, a trend Dr. Bhatt expects CMS policy to accelerate.
“Building our ASC-anchored centers now positions us for where the volume is going,” he said.
The third force is geography. In Glendale and other parts of the region, Dr. Bhatt said population growth has moved faster than healthcare infrastructure. Some patients were traveling across the Phoenix metropolitan area for orthopedic care that could be delivered closer to home.
That gives the expansion a straightforward premise: Follow where the patients are already going. But Dr. Bhatt wants the response to look different from simply planting more clinics on a map.
Why the full-service model matters
The new Glendale center brings clinic visits, imaging, physical therapy and surgery into one location. That model is not new for OrthoArizona, but Dr. Bhatt increasingly sees it as the blueprint for future major centers.
The operational argument begins with handoffs. A patient may start in an orthopedic clinic, leave for an MRI elsewhere, go to another facility for therapy and eventually reach a separate surgery center. Every transition creates another opportunity for delay, fragmentation or loss of continuity.
Dr. Bhatt wants fewer of those transitions.
“Handoffs between clinic, imaging, surgery, therapy, those are where patients just get lost,” he said.
Keeping those services inside one system can also change the economics of physician-led orthopedics. The practice retains more of the care continuum while creating opportunities to coordinate services, reduce duplication and support lower-cost outpatient care.
But Dr. Bhatt is equally clear that not every market warrants that investment. If a market cannot support the clinic, imaging, therapy and ASC model together, it may get a smaller satellite rather than a flagship center.
Scale, in other words, has to follow the economics.
The expansion starts with a heat map
When Dr. Bhatt considers the next market, he does not begin with a hunch. He begins with drive times.
Where are patients already traveling 30 minutes or more to reach OrthoArizona? Where are referrals originating? What does the payer mix look like? Can the market sustain the full-service model? OrthoArizona has built a data warehouse and key performance indicator infrastructure designed to answer those questions before major capital is deployed.
“Referral and drive-time data lead. Intuition doesn’t,” Dr. Bhatt said.
He described four filters. Existing demand comes first. Then comes whether the market can support the full model. Physician recruitment comes next. Finally, leadership evaluates payer demographics and the case mix likely to follow.
The physician piece can be easy to underestimate.
“Building without the right surgeons is a liability,” he said.
A new center can have ideal demographics and attractive economics, but it can still fail if the group cannot recruit and retain the physicians needed to support it.
That is where Dr. Bhatt’s repeated use of the word “discipline” becomes more than rhetoric. The same criteria that justify entering a new market also give leadership reasons to walk away from one.
Growth tests what ‘physician-led’ actually means
As orthopedic groups grow, “physician-led” can become increasingly difficult to define.
Dr. Bhatt has a simple test. Look at who controls the money.
“It really isn’t what we say,” he said. “It’s really who signs off.”
If OrthoArizona is considering a major capital project, the decision ultimately sits within a governance structure led by its physician partnership.
The organization uses finance, operations, executive, and board-level committees to evaluate investments ranging from facilities to technology. For Dr. Bhatt, those structures matter because physician leadership cannot survive on branding alone.
Governance has to preserve it. So does communication.
“If they don’t know what’s going on, and there’s not communication that is collaboratively and continuously given to them, you’re going to lose the battle,” he said.
His priorities are straightforward: governance, physician partnership and “transparency, transparency, transparency.”
That becomes more consequential as an orthopedic organization grows.
A small group can rely on informal conversations and proximity. A group with hundreds of providers and dozens of locations needs systems that preserve physician input without making every decision impossible to execute. The challenge is to institutionalize physician control without institutionalizing bureaucracy.
His first company taught him what not to repeat
Dr. Bhatt has scaled a medical group before. He founded Phoenix-based Spectrum Dermatology and spent nine years growing the practice before its private equity transaction.
But he sees an important distinction between building a company and inheriting stewardship of one.
Spectrum was owned by Dr. Bhatt and his wife. Decision-making was concentrated. OrthoArizona is a decades-old physician organization with more than 300 providers and an existing culture, governance structure and history.
The playbook could not simply be copied. Still, Dr. Bhatt said the “bones” of scaling an organization remain remarkably similar.
Technology. Revenue cycle. Operations. Data infrastructure. Performance metrics. Recruitment. And perhaps most important: learning when something is not working.
“When you build something, you are going to make mistakes,” he said. “A true leader takes those mistakes, and you learn and pivot, and know how to change and adapt.”
He sees stagnation as a greater threat than making the wrong first decision.
Organizations get into trouble, he said, when an approach is clearly failing but remains in place because “this is what we’re doing.”
For Dr. Bhatt, maintaining an edge requires repeatedly asking what has to change, across technology, infrastructure, data and operations, before growth exposes the weakness first.
Before expanding, OrthoArizona spent a year building the engine
That is why Dr. Bhatt views 2025 as especially important. The visible expansion came later. The first job was infrastructure.
He describes the year as one spent “building the engines,” upgrading operational systems, technology, data capabilities and processes so the group could absorb more physicians, facilities and patients without overwhelming itself.
Those changes are not always dramatic. One example is recruitment.
Dr. Bhatt said OrthoArizona has recruited physicians at roughly twice its previous pace during his tenure, with some openings filled within about 60 days after the group redesigned its processes.
To him, those seemingly mundane systems determine whether expansion eventually works. A practice can announce another facility. Scaling the physicians, schedules, technology, revenue infrastructure and operations behind it is harder.
That may ultimately be the more important story behind OrthoArizona’s growth. The new centers are visible. The systems underneath them are not. Dr. Bhatt believes those systems will determine how far the organization can go.
“You have to differentiate at every level of the organization,” he said, “across every metric, from infrastructure and technology to data.”
For physician-led orthopedics, the stakes extend beyond one Arizona group. Practices increasingly face a choice between remaining small enough to preserve autonomy and becoming large enough to compete for physicians, capital, technology and outpatient volume.
OrthoArizona is betting those choices do not have to be mutually exclusive.
Growth alone will not prove it. The real test is whether the organization can get much larger without making its physicians feel much smaller.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
