Image by fernando zhiminaicela from PixabayAmbulatory surgery centers (ASCs) are facing complex challenges as they approach 2026. Costs are increasing, physician recruitment is becoming more competitive, and anesthesiology coverage remains a concern.
This was all revealed in the recently published VMG Health 2026 Leader Expectations Survey.
In September, VMG surveyed 97 leaders from independent and joint-venture ASCs to gain better insight into industry trends and priorities.
While ASC leaders remain optimistic about the upcoming year, with 87% of respondents expecting financial performance to stay the same or improve compared to 2025, two major concerns have arisen.
The main concern for leadership is physician growth. Thirty-seven percent of leaders expect physician recruitment and retention to be a primary operational challenge in the upcoming year. Meanwhile, 61% of respondents said they plan to invest in attracting top talent.
New York-based Mount Sinai has turned the recruitment and retention challenge into a growth strategy by allowing physician ownership in ASCs to attract top talent, shift care to lower-cost settings and expand into new markets.
This strategy is now adopted by more than half of health systems as a physician recruitment and retention tool, according to The Health Management Academy. Beyond financial incentives, equity promotes proactive growth and long-term sustainability. Challenges like compliance regulations remain; however, some believe the benefits outweigh the risks.
Anesthesia pressures continue to challenge the industry. A whopping 67% of respondents told VMG Health that anesthesia coverage was among their top three financial concerns for 2026, as a provider shortage has led to expectations of higher anesthesia stipends.
To address the shortage of anesthesiologists and nurse anesthetists, some ASCs are focused on improving efficiency through optimized scheduling, standardized OR times, and technology to optimize resource allocation and staffing.
A change in the anesthesia model could also ease some tension for leadership, as 80% of respondents favor using independent contractors — either with or without a stipend — to address coverage issues. Only 9% are considering adopting an employment agreement, while 4% are exploring a joint venture partner.
Interestingly, 83% of respondents didn’t see sale activity for independent ASCs in the cards for 2026; even so, most expressed interest in a strategic partnership with a health system.
Respondents, however, also showed interest in expanding surgical specialties in the coming year, with spine surgeries being the most considered.
