Becker’s Healthcare | Written for Becker’s ASC Review
Many ASC real estate owners are likely approaching retirement in the next 10 years—which explains why the sale-leaseback market for ASC real estate is accelerating right now.
We can estimate this fairly well by combining ASC ownership counts, physician age demographics, and retirement trends.
Estimated ASC Real Estate Owners Approaching Retirement (Next 10 Years)
1. Total physicians who own ASC equity
- ~65,000–80,000 U.S. physicians hold equity in an ASC.
- Roughly 25–40% of those physicians also own the ASC real estate (usually through a separate LLC).
➡ Estimated ASC real estate physician owners: ~16,000–28,000 physicians
Ownership within the three ASC-dominant specialties
| Specialty | Physicians | Est. % with ASC ownership | Est. physician ASC owners |
|---|---|---|---|
| Ophthalmology | ~19,000 | ~35–45% | ~7,000–8,500 |
| Orthopedic surgery | ~18,500 | ~30–40% | ~5,500–7,500 |
| Gastroenterology | ~15,700 | ~25–35% | ~4,000–5,500 |
Estimated total in these three specialties: ➡ ~16,500–21,500 physicians who own ASC equity
These three specialties account for a large share of ASC procedures (GI ~32%, ophthalmology ~26%, orthopedics ~21%), which explains their high ownership rates.
Why Physician-Owners Choose to Sell-Leaseback Their ASC/MOB Real Estate
The data shows a wave coming — but what does the actual decision look like from the physician’s perspective? Read this next.
2. Age distribution of physicians (key driver)
- 23% of all U.S. physicians are already age 65+.
- Surgical specialties (including orthopedics and ophthalmology) have even higher percentages over 65.
Industry studies also warn that many ASCs were founded 20–25 years ago, meaning the founding surgeon-investors are now reaching retirement age.
3. Estimated retirement cohort among ASC real estate owners
| Category | Estimated physicians |
|---|---|
| Total physician ASC real estate owners | ~16,000–28,000 |
| Age 60+ today (likely to retire in ~10 yrs) | ~45–55% |
| Likely retiring within 10 years | ~7,000–15,000 physicians |
What this means for ASC real estate
Over the next decade, 7,000–15,000 physician real estate owners will likely exit ownership. These physicians collectively control thousands of surgery center buildings and medical office buildings tied to ASCs. Because many younger physicians are hospital-employed, carry student debt, and are less likely to buy real estate, the traditional physician-to-physician ownership transition is weakening.
Why this accelerates sale-leasebacks
1. Aging physician investors
Many founders of ASCs built in the 1995–2005 era are now in their late 50s–70s.
2. Younger physicians rarely buy buildings
Most younger surgeons prefer equity in the ASC operating entity — not illiquid real estate.
3. Strategic operators prefer asset-light models
ASC management companies prefer to operate centers but not own the real estate. So sale-leasebacks solve several problems simultaneously: monetize physician equity, reduce succession problems, maintain long-term physician control of the ASC, and allow physicians to diversify wealth before retirement.
Big-picture takeaway
In the next decade, ~7,000–15,000 ASC real estate owners will likely retire. That represents one of the largest generational ownership transitions in healthcare real estate, which is why private equity, REITs, and infrastructure funds are aggressively targeting ASC real estate sale-leasebacks right now.
What Is Your ASC Building Actually Worth?
Most physician-owners are sitting on more real estate equity than they realize — and many have no idea a sale-leaseback is even an option. Start with a free, no-obligation valuation.
For physician-owners evaluating the next phase of their ASC business strategy, proactive analysis — rather than reactive timing — is critical to preserving value. The right guidance can help you unlock capital while ensuring your control of your ASC business and property.
Physicians can obtain more information about how to choose the right strategic partner, ASC business valuation, and sale-leasebacks of real estate by contacting Jon Vick ([email protected]) at 760-291-7745 or Jason Winokur ([email protected]) at 914-216-3574.
See Jon & Jason at Becker’s Spine, Orthopedic and Pain Management ASC Conference
ASC Realty Advisors is a Gold Sponsor at Becker’s 2026 in Chicago. If you’re attending, stop by the booth — or schedule time with Jon and Jason before the event.
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