Spine surgeon shortage deepens as consolidation, site shifts reshape ASC markets

Editor's Note

Hiring for spinal procedures are tightening and consolidation is accelerating, reshaping where and how ambulatory surgery centers (ASCs) secure talent, Becker’s Spine Review October 3 reports. A mounting orthopedic shortage exceeding 5,000 by year-end is making spine one of the hardest specialties to recruit, with timelines stretching and markets bifurcating between talent-magnet metros and underserved regions.

Per the article, median physician time-to-fill is 118 days, while some specialty searches run far longer, such as 332 days in oncology. More early-career surgeons are choosing hospital employment or ASC partnerships instead of solo practice, though cited American Medical Association data shows 54% of orthopedic surgeons remain independent. Sign-on bonuses, loan-repayment packages, and infrastructure support are making employed and partnered models more attractive, feeding consolidation in spine and orthopedics.

From an ASC vantage, leaders describe consolidation as both a challenge and a strategic opening. Ali Ghalayini, administrator at Advanced Spine Center of Wisconsin, noted that system roll-ups are redefining access and referral patterns. In some regions, competitive surgeons are forming alliances as hospitals pressure private practices, spine surgeon Brian Gantwerker, MD, told Becker’s.

Reimbursement and site-of-service moves are another catalyst. The Centers for Medicare & Medicaid Services 2025 proposals would remove many spine procedures from the inpatient-only list beginning in 2026, enabling more cases in ASCs and intensifying demand where outpatient ecosystems are robust. States with large ASC footprints, including Connecticut, Indiana, and North Carolina, are flagged as fastest growing for outpatient spine. The outlet reports these shifts are pulling surgeons toward ASC-dense metros, while less resourced areas face tighter pipelines, longer searches, and more complex workforce planning for orthopedics and spine.