On the Cover of Surgery Business Magazine: Stop Asking Permission, Build Anyway

Less than 25% of physicians are still independent. The April 2026 issue of Surgery Business Magazine — featuring me on the cover and three of my articles inside — is about the other 75%, and the path back.

Surgery Business Magazine — tagline Where Money Makes The Cut — released its April 2026 issue this month. The cover line is The Billion-Dollar Specialty: Orthopedic Surgery Reigns Supreme in ASCs, and inside, I authored three feature articles spanning entrepreneurship, patient finance, and technology.

This post is not a recap. The articles are linked below and worth reading in full. What I want to do here is connect them, because they share a single throughline that — months into building Journey Orthopaedic Institute — has become the operating thesis for everything I do.

The Throughline: Stop Asking Permission

Less than a quarter of practicing physicians remain in independent practice in the United States. That is not the result of independence being impossible. It is the result of decades of conditioning — by training programs, hospital systems, payer contracts, and a profession that quietly accepted the idea that someone else should run the business of medicine on our behalf.

The two articles in this issue are different angles on the same problem.

Article 1 — The Surgeon-CEO Mindset (p. 18)

This is the foundation piece. The argument is simple: physicians have allowed other players to enter our game and change the rules — on Capitol Hill, in state legislatures, and in the C-suite — and the only way to take those rules back is to operate as physician-CEOs.

You trained for over a decade. You make life-altering decisions under pressure with a 15-blade in your hand. You are not too fragile to read a P&L statement. The case I make in this piece is that the modern surgeon must remove three suppressing forces — insurance, administrative burden, and political pressure — and then build a practice designed for the patient and the surgeon, not the middleman.

Don't hate the player. Hate the game, which is the corporatization of medicine.

Article 2 — Cash is King (p. 76)

"Cash-pay is only for the rich" is one of the most expensive myths in modern medicine.

Patients are already paying — through rising deductibles, surprise bills, time off work, and weeks lost to referral delays. A bronze-tier marketplace family plan now runs roughly $1,800 per month with deductibles high enough that most insured patients are functionally cash-pay for the first several thousand dollars of care every year. They just don't realize it until the bill arrives.

Direct-pay specialty care is the rational response to that math. Direct primary care is projected to exceed $12 billion in the U.S. by 2030. Direct specialty care is the next logical step — and orthopaedics, with discrete procedural episodes that lend themselves to bundled pricing, is built for it. A bundled surgical episode that cuts total cost 30–50% compared to a hospital-facility case is exactly what self-insured employers — who cover more than half of American workers — are actively asking for.

Patients are not paying for a premium experience. They are paying to avoid a broken one.

Why This Matters Now

Journey Orthopaedic Institute is the practical application of these three articles. Direct surgeon access. Transparent cash pricing. Sports medicine, regenerative procedures, and physical therapy under one coordinated plan. Mobile delivery now, brick-and-mortar expansion next. AI-enabled operations that let a lean clinical team deliver a premium experience at a price patients can quote before they walk in.

TurnKey AI Practice is the infrastructure layer underneath JOI — and increasingly, underneath other independent practices that want to operate the same way.

The future of independent surgical practice is being built right now. The question is whether the physicians who built medicine in the first place will be the ones building what comes next.

Don't let it be built without you.

Build anyway.

Read the Issue

The full April 2026 issue of Surgery Business Magazine is available online.

→ Surgery Business Magazine — April 2026

About Dr. Justin T. Smith

Justin T. Smith, MD, FAAOS, FAANA, ABOSD is a fellowship-trained, double board-certified orthopaedic sports surgeon and the Founder & CEO of Journey Orthopaedic Institute and TurnKey AI Practice Inc. He completed his orthopaedic surgery residency at William Beaumont University Hospital and his sports medicine fellowship at Steadman Hawkins Clinic of the Carolinas.

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