Orthopedic trainees are pushing back against private equity’s pull
Younger orthopedic surgeons are arriving in practice with a different instinct than the one that shaped the last decade of consolidation. In Illinois, surgeons at Kendall Pointe Surgery Center say trainees are increasingly wary of private equity and the loss of control that often follows a transaction.
Xavier Simcock, MD, described a sharp reversal in the career paths once typical for new physicians. He said the old pipeline favored private practice, while employment and academic tracks were smaller slices of the workforce. Those proportions have now flipped. In that environment, private equity is no longer a novelty. It is part of the background noise trainees have watched unfold during residency and fellowship.
The shift is visible well beyond orthopedics. By January 2026, 82% of U.S. physicians were employed by hospitals or corporate entities, up from 52% at the start of 2018, according to a Physicians Advocacy Institute-Avalere Health report. The report combines private equity with other corporate owners and does not separate out specialties, but the overall direction is unmistakable: physician employment has expanded rapidly, and independence has become the exception rather than the norm in many markets.
Orthopedics has resisted that trend better than many other fields.
Autonomy, not just compensation, is shaping the next generation
The 2025 AMA Physician Practice Benchmark Survey found that 54% of orthopedic surgeons remained in private practice, compared with 42.2% of physicians overall. Even there, the gravitational pull of employment has been strong enough to change expectations among trainees. Simcock said five to 10 years of private equity deals and consolidation made employed practice feel “very, very common,” and the next cohort has watched those arrangements play out in real time.
“As trainees, they’re aware of what PE brings to the table and how that influences their careers, and they’re more leery of that,” he said. “They’re more leery of having less control in their day-to-day.”
That concern gets to the center of the debate. Private equity can offer capital, infrastructure, and relief from the administrative strain that drives many physicians away from ownership. For some surgeons, the appeal is simple: no need to manage payroll, lease negotiations, staffing shortages, or the endless business tasks that come with running a practice. But the tradeoff often arrives in the operating room and in the workday around it, where scheduling, staffing, and clinical workflow may be shaped by distant decision-makers instead of the physicians delivering care.
For younger doctors, that loss of discretion appears increasingly costly. The value proposition is no longer judged only by income or short-term stability. It is being measured against the ability to control how patients are seen, how time is spent, and how care is delivered from clinic visit to postoperative follow-up.
Private equity’s scale in orthopedics is real, but so is the backlash
The numbers behind orthopedic consolidation are large enough to alter training culture. Private equity firms acquired 89 U.S. orthopedic practices from 2016 to 2023, and by 2023, 4.8% of the nation’s orthopedic surgeons worked in a private equity-affiliated group, according to an Oct. 15 study published in JBJS Open Access. That does not describe the entire specialty, but it captures a meaningful slice of the market and the direction of travel.
When consolidation advances quickly, it changes what trainees see as normal. Residents and fellows learn from the structures around them. If the dominant model is one in which scheduling, staffing, and business operations are centralized, then independence can start to look antiquated, even if many surgeons still prefer it. The next generation now seems to be asking a different question: not whether employment is available, but whether it is worth the control it demands in return.
Jorge Chahla, MD, vice chair of the Kendall Pointe board, said much of the frustration comes from the inability to make decisions locally. When physicians cannot treat patients the way they want or influence the team and environment around them, the work becomes harder to sustain. His comments reflect a familiar tension in consolidated medicine: efficiency may improve on paper, but bedside and operating-room satisfaction can erode when clinicians lose the ability to adapt care to their own patients and workflows.
Surgeons are tying independence to patient care and daily efficiency
At Kendall Pointe, the argument for ownership is not framed as ideology. It is framed as functionality. Chahla said the group can add staff when everyone is stretched thin and can adjust hours, locations, and surgery center use. Those choices shape access, pace, and surgeon satisfaction, but they also shape the patient experience. In a tightly managed corporate setting, even small changes can require layers of approval. In an independent group, the response can be faster and more local.
Simcock also questioned the growth model that often underpins private equity deals. He said many of those arrangements depend on continued growth to succeed, and growth pursued for its own sake can backfire. The warning matters because physician practices are not traditional high-volume consumer businesses. They are clinical organizations built around trust, continuity, and careful case selection. When the pressure to expand outpaces the capacity to maintain quality, the strain shows up in workflow, revenue, and morale.
Scott Sporer, MD, chair of the Kendall Pointe board, drew a line between ownership and accountability. He said ownership gives surgeons a vested interest in the entire patient experience. In a hospital, surgeons may control the operation itself but little of what happens before or after it. In an owned practice, the continuum is broader: intake, scheduling, surgery, rehab coordination, and follow-up all sit closer to the physician group’s control.
That control can influence clinical behavior in subtle ways. A surgeon who can shape staffing and scheduling is better positioned to protect operating time, reduce bottlenecks, and keep follow-up care aligned with the procedure itself. A surgeon who cannot may still deliver excellent care, but often within a structure that limits flexibility and slows change.
The debate now runs through the training pipeline itself. Younger orthopedic surgeons are not simply inheriting a profession; they are inheriting a set of choices shaped by consolidation, capital, and changing expectations about work. For many of them, private equity no longer looks like a shortcut to stability. It looks like a transfer of authority, and that is the part they are watching most closely.