Joshua Siegel, MD, has watched the healthcare consolidation pendulum swing hard in both directions. As a Board Certified Orthopedic Surgeon, Sports Medicine Director, and founding member of Access Sports Medicine & Orthopaedics in Exeter, New Hampshire, he has spent more than 25 years building something the consolidation model rarely produces: a physician-led practice that stayed close to its patients, controlled its own decisions, and never mistook growth for drift.
His training shaped that instinct early. After graduating Summa Cum Laude from SUNY Buffalo School of Medicine and completing his orthopedic residency at SUNY Upstate in Syracuse, Dr. Siegel finished his surgical training as a Sports Medicine Fellow under Dr. James Andrews and Dr. William Clancy at the American Sports Medicine Institute in Birmingham, one of the most competitive fellowships in the field. The lesson he carried back to New Hampshire wasn’t just technical. It was about proximity, accountability, and what actually produces good outcomes when a physician stays close to the patient and owns the result.
That perspective has placed him at the center of one of healthcare’s most important conversations. Recently, Dr. Siegel has been featured in Becker’s ASC Review and Becker’s Physician Leadership industry publications, sharing his insights on the issue.
A Pendulum That Has Swung Too Far
For years, the direction of healthcare felt inevitable. Hospital systems expanded. Private practices were absorbed. Physician employment by hospitals, health systems, or corporate entities climbed from 62% to 78% between 2019 and 2023 alone, according to reporting in Becker’s ASC Review. The appeal was real: immediate patient volume, freedom from administrative burden, and a predictable salary for physicians finishing training with significant debt.
Dr. Siegel understood the appeal, but he also saw what came next.
“People didn’t want the headaches of working all the time and building a business and creating a practice when they could just walk into a shift, an hourly-type position, a salary-based position in a hospital and be busy right away,” he told Becker’s ASC Review. “That was the initial move toward hospital-based employment.”
The initial deal, however, often didn’t hold. Dr. Siegel described what happened to many physicians once they were inside large systems:
“What you’re seeing now is a lot of doctors coming out and getting burned. They’re working for two, three years. They have a hard time renegotiating. A lot of what was promised isn’t materializing. Some of their salaries — they have to either make them, or they’re responsible to, in some way, pay them back. So this great deal all of a sudden turns into these handcuffs. And the docs leave.”
The data supports his observation. Survey research from Bain & Co., cited by Becker’s, found that nearly 25% of physicians in health-system-led organizations are considering a change in employers, and of those, 37% are specifically looking to move to physician-owned settings. Average satisfaction in physician-led organizations runs from roughly 70% to 90%, compared to 50% to 75% in health-system-led practices. Those experiences, Dr. Siegel noted, travel fast through professional networks, residency programs, and fellowships — and they’re changing how younger physicians think about employment as a long-term path.
The Cracks in the Model
Becker’s ASC Review published a separate piece in February 2026 examining the structural fractures emerging across the consolidation model. The article documented how, even as hospital and corporate acquisition of physician practices continues, countervailing forces — regulatory scrutiny, shifting workforce expectations, noncompete restrictions, and site-of-service payment reform — are beginning to reshape the landscape.
Dr. Siegel was direct about what those fractures look like from inside the exam room. In Becker’s Physician Leadership, he described the accumulated friction that large-system employment creates for both physicians and patients:
“The hospital-employed physician has a role in medicine and will always exist, yet it is a dinosaur that has created ‘waiting’ rooms and undecipherable billing and collection practices, obscured pricing, crazy ‘pre-approval’ processes, ‘prior authorizations’ and the like.”
The accountability problem, he argued, runs deeper than inefficiency. It shapes clinical judgment itself.
“The accountability in that system, like it or not, is based on the entity paying,” he told Becker’s Physician Leadership, “and when that is the insurance company rather than the patient, the provider ends up consciously or subconsciously working within the framework insurance has provided rather than the best interest of the patient.”
It’s a structural critique, one that goes beyond frustration with bureaucracy and gets at something more fundamental: when the financial relationship between a physician and the system they work inside is misaligned with the patient’s interest, care follows the money, not the need.
What Access Sports Medicine Built Instead
Dr. Siegel’s response to these dynamics wasn’t abstract. When he founded Access Sports Medicine on the Seacoast in 1998, he set out to build a practice where clinical judgment could reach patients without institutional filtering, where the physician closest to the problem was also the one making the decision.
That meant building the infrastructure himself. In his tenure, he was the founding member of two ambulatory surgical centers and a comprehensive physical and occupational therapy program. He also founded an integrated strength and conditioning facility and developed athletic training programs serving numerous local high schools. Today, Access Sports Medicine operates across five locations on the New Hampshire Seacoast.
The clinical reach has matched the organizational one. Dr. Siegel serves as a US Olympic Committee team physician and US Ski Team physician, covers PGA and USGA tour events, and is the team physician for Phillips Exeter Academy, among other local schools. He has been peer-elected as New Hampshire’s top sports medicine physician by Castle Connolly and NH Magazine more than fifteen times over two decades. Those aren’t decorative credentials; they are the accumulated result of a practice that stayed close enough to its community to earn sustained trust.
The Economics Are Shifting, Too
Beyond the clinical and cultural arguments for physician-led independent practice, Dr. Siegel sees the financial architecture of healthcare beginning to move in the same direction.
In Becker’s ASC Review, he pointed to site-of-service payment reform as the most consequential structural force on the horizon. CMS’s 2026 Hospital Outpatient Prospective Payment System rule moves Medicare further toward site-neutral payment, narrowing long-standing reimbursement gaps between hospital outpatient departments and ambulatory surgery centers. If that narrowing continues, the financial advantage that helped large systems consolidate outpatient volume begins to erode.
“You’re starting to see a narrowing of those payment differentials from insurance companies,” Dr. Siegel told Becker’s, “where it doesn’t matter where the treatment was: office-based, surgical center-based, hospital outpatient department-based, or inpatient.”
His read on where that leads is pointed:
“There’s no way hospital rates will go down to what independent rates are, and there’s no way they’re going to jack up independent rates and not try to save money on the hospitals. I have a feeling this big movement to the middle is going to benefit smaller independent practices, because they’re already profitable, making sometimes half of what hospitals are getting for the same services.”
The Real Disruptor
In a third Becker’s piece examining what forces will most significantly reshape the physician landscape, Dr. Siegel looked beyond the structural debate to identify something broader: a fundamental shift in what patients expect and what medicine can offer.
“As insurance companies lag behind the science and speed at which medicine advances,” he told Becker’s ASC Review, “I believe we will see many more options for cash-paying services that are currently not covered under traditional insurance plans.”
He pointed to biologics, whole-body diagnostics, comprehensive biomarkers, and functional medicine as fields already meeting demand that traditional insurance models haven’t caught up to. And he noted that patient empowerment accelerated by AI tools that allow people to research their conditions, understand their options, and find physicians willing to go further is changing the relationship between providers and the people they serve.
“Information in this new world is critical,” he said. “AI such as DoxGPT and others allow patients to be their own advocates, and search for doctors who will provide what they want. The days of only providing a limited scope of services and not informing patients of their many choices are over.”
What Comes Next
Across all three Becker’s pieces, Dr. Siegel’s position is consistent and clear: the pendulum has swung as far as it should, and the conditions are now in place for physicians to reclaim meaningful control over how they practice and how they serve patients.
“I’m hoping the pendulum continues to move back to the realm where physicians have a little more control over their own practices,” he told Becker’s ASC Review, “and we’re no longer just commodities that can be traded out like any other non-professional profession.”
For new physicians entering the field in new delivery environments, he sees the opportunity as concrete. Those who grow up practicing in patient-focused, independent, or semi-independent settings will expect closer relationships, fewer administrative obstacles, more time with patients, and compensation tied more directly to the value they provide. Large employed models will structurally struggle to offer those conditions. Physician-led practices, built the right way, are already positioned to deliver them.
At Access Sports Medicine, that positioning isn’t new. It’s the reason the practice was built the way it was, and why, as the broader industry works through its correction, the fundamentals Dr. Siegel has operated by for more than two decades are proving more relevant than ever.
“I think all the negativity in healthcare we’re seeing is indicative of a lot of change occurring in medicine,” he told Becker’s, “and I’m really hoping it’s for the better. There’s a lot of value in all this stuff that people are very afraid of, and to me, I’m pretty optimistic about where everything’s gone.”
As Dr. Joshua Siegel’s perspective reflects, staying physician-led and patient-focused allows care decisions to remain where they belong, with the people closest to the patient. That approach continues to guide how Access serves its community today. If you’re looking for care built on that foundation, schedule an appointment or learn more about Access Sports Medicine on our website.
