From the ¹Department of Orthopaedic Surgery at Rush University Medical Center in Chicago, Illinois, and 2MedStar Health Orthopedics at MedStar Georgetown University Hospital in Washington, D.C.
PRACTICE MODELS
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Private Equity in Orthopedics and Spine Surgery 10 Years Later
Puranjay Gupta1
Private equity (PE) has become a major force in physician-practice consolidation across the United States. Between 2012 and 2021, annual PE-backed physician practice acquisitions increased dramatically, accompanied by rapid expansion in the number of acquired practice locations and affected metropolitan markets.1,2 Although consolidation has occurred across nearly every specialty, orthopedics and spine surgery remain particularly attractive because of their procedural volume, ancillary revenue opportunities, and continued fragmentation of private practice. Despite ongoing consolidation, orthopedics remains more independent than many other specialties. In 2024, more than half of orthopedic surgeons still reported working within private practice models, even as physician ownership declined nationally.3 This balance between fragmentation and profitability has allowed PE firms to continue targeting musculoskeletal care. The debate surrounding PE in orthopedics has also evolved. While earlier discussions focused on whether PE would meaningfully enter the specialty, current discussions focus on the long-term implications of PE ownership for physician autonomy, costs, access, workforce stability, and the sustainability of care delivery models. Existing evidence suggests outcomes are variable and depend
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heavily on governance structure, debt burden, physician alignment, and integration strategy.
Why Orthopedics and Spine Remain Attractive Musculoskeletal disease affects Aditya Mazmudar2 a substantial proportion of the U.S. population and continues to increase alongside population aging. Lumbar fusion utilization alone has risen markedly over the past 2 decades, particularly among elderly patients, while Kern Singh, MD1 aggregate hospital costs for spine procedures continue to escalate.4 At the same time, orthopedic and spine surgery have increasingly shifted toward ambulatory surgery centers (ASCs). Medicare-certified ASC utilization continues to grow, and outpatient spine surgery volume has expanded rapidly over the past decade.5 Lower facility costs compared with hospital outpatient departments create strong payer incentives for continued outpatient migration while simultaneously increasing the financial value of ASC ownership. Orthopedic groups also support substantial ancillary integration. Imaging, physical therapy, pain management, biologics, urgent care, and durable medical equipment can
Vertebral Columns Summer 2026