Independent orthopedic practice may be a “dying breed,” but there are windows of opportunity for those willing to adapt, Kurtis Biggs, DO, said. From surgery center ownership to concierge programs to eventually going fee-for-service, there’s still a path forward for independent practices and physicians.
Dr. Biggs, founder of Naples, Fla.-based Joint Replacement Institute, spoke about the challenges he’s facing in private practice, along with the reasons it can still be a good option in 2026 on “Becker’s Spine and Orthopedic Podcast.”
Note: This is an edited excerpt. The full conversation will be available here.
Question: Independent orthopedic practices and ASCs are under constant pressure from health system consolidation and payer contracting. What’s your playbook for staying independent and financially viable?
Dr. Kurtis Biggs: The biggest change since 2020 is the magnitude of our overhead has gone up so significantly, whether it be what employees are requiring for pay and the overhead of the actual physical purchasing powers of supplies, machines and IT. It’s very challenging, because we’re getting reduced. The number of surgeons is getting reduced every year. Our overhead has gone from 47% to almost 70% in a matter of five years, and they’re not asking your employees to take that hit. It’s always the surgeon.
In private practice, you’re seeing the rise of some concierge services in the orthopedic world — services that are provided outside of what Medicare and commercial insurance cover. That’s another way for the private practice to retain some form of autonomy: try to keep that flow going.
Those have really been a challenge, and when we see the residents, only 29% or so of graduates are going into private practice. It just makes it very challenging long-term for a private practice to survive if we can’t replace physicians that retire, so it’s a dying breed unfortunately.
Q: What’s your pitch for working in an independent group as an early-career surgeon?
KB: The advantage is autonomy where you can choose to do the cases that you like and work in the sub-specialized area that you like. You’re not governed or monitored by a large hospital system that can come in and tell you what you’re going to do, what implants you’re going to use and what days you’re going to work.
In private practice we can’t pay physicians based on RVUs because it doesn’t equate like it does when you’re working for a hospital system that has other income sources. So you have to add the potential for owning surgery centers and the ancillaries … Those are the parts that you have to really emphasize. You’re controlling your own destiny and picking your path, which you can’t necessarily do as an employee.
Q: Despite the challenges, where do you see the biggest opportunities for growth in your practice?
KB: The ASC is the best investment that I think most of us could make. We control the cost of the implants, and we control the costs of the employees, so that’s the best chance for us to have a return on that investment for our work that we do. With the MRI, since we’re not part of a health system, we get paid less for the same procedure … so those traditional ancillaries, such as the MRI and the DME aren’t as great moneymakers as they used to be. But the surgery center is our best opportunity.
You’re going to see a significant rise in the number of concierge programs. It’s becoming much more common. I’m in a very financially strong area, as far as retirees, so there are people here that want to contribute to a concierge program. You’re going to see those come to a head and become more popular. I also think you’re going to see a lot of people dropping out of insurance companies. There’s just going to be a fee-for-service that’s going to come around the corner. I’m probably a couple of years away from doing that because of the frustration of the declining reimbursement. I think those are just options that are out there, and we’re going to see a lot more of that happening.
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.
