By Michelle Crouch
Carolina NeuroSurgery & Spine Associates, one of the nation’s largest independent neurosurgery practices, will join Atrium Health on Oct. 1, 2025, the two providers announced last week.
Nearly 300 Carolina NeuroSurgery & Spine staff members across seven Charlotte-area clinics will become part of Atrium, which operates under the corporate banner of Advocate Health, the country’s third-largest public health care system with $34.8 billion in annual revenue.
“By combining our expertise, we will strengthen surgical and nonsurgical care for neurosurgery and spine patients and their families,” Dr. Mark Smith, president of Carolina NeuroSurgery & Spine, said in a news release.
The move reflects a broader trend in health care, as large hospital systems in North Carolina and nationwide grow and consolidate their power.
While headlines often focus on horizontal integration — when hospitals expand their footprints by acquiring or merging with other hospitals — they are also going vertical, bringing independent physician groups into their networks to expand market share, streamline care and funnel patients to their facilities.
To name just a few examples in recent years: UNC Health partnered with Blue Ridge Medical Group in western North Carolina, Duke Health absorbed the Private Diagnostic Clinic in Durham, and Novant Health purchased UCI Medical Affiliates in South Carolina.
Other large practices acquired by Atrium include Pediatric Surgical Associates and Mecklenburg Medical Group in Charlotte and the Harbin Clinic in Georgia.
Independent practices feel the squeeze
The share of physicians nationwide working for hospitals, instead of functioning in a private practice, nearly doubled between 2008 and 2016, according to the nonprofit National Bureau of Economic Research.
Today, only about 42 percent of physicians work for an independent practice, down from 60 percent in 2012, according to the American Medical Association.
“The share of doctors working in practices wholly owned by physicians is unraveling under compounding pressures,” Bruce Scott, the AMA’s immediate past president, said in June when the statistics were released. “The cumulative impact of burdensome regulations, rising financial strain and relentless cuts in payment poses a dire threat to the sustainability of private practices.”
Scott said inflation-adjusted Medicare payments to private physicians have fallen 33 percent over the past 25 years, making it difficult for private practices to stay in business. The Medicare program pays higher rates to physicians employed by hospitals, making independent practices an attractive target for acquisition.
Neurosurgery is one of the most profitable service lines in health systems, said Matthew Hanis, a Charlotte-based health care consultant, in an email.
By aligning with Carolina NeuroSurgery & Spine, Atrium “gets all the downstream referrals: rehab, vascular surgery, oncology, etc.,” Hanis said. “They also get a boatload of really talented surgeons, which is hard to come by.”
Carolina NeuroSurgery & Spine will benefit from having access to Atrium’s billing and scheduling systems, risk management and other infrastructure — along with added financial stability, Hanis said.
What does it mean for patients?
Barak Richman, a health policy expert at George Washington University and a critic of health care consolidation, said mergers and acquisitions between hospitals and physician practices typically drive up health care costs and can hurt the quality of care.
“The growing and overwhelming evidence is that these transactions are bad for patients,” Richman said. “They unambiguously increase prices and, along several important dimensions, can reduce quality.”
He added that the transactions also often result in lower physician job satisfaction, with many physicians who sold their practices “soon regretting it bitterly.”
A paper published by the National Bureau of Economic Research in July 2025 examined what happened when hospitals bought OB-GYN practices. It revealed that two years after an acquisition, prices for labor and delivery jumped an average of $475, and physician prices rose by $502.
The paper’s authors called for more scrutiny of vertical mergers. They also called on policymakers to eliminate the financial incentives that encourage the deals, such as Medicare rules that pay doctors a higher rate if they work for a hospital rather than an independent practice.
Atrium’s deal with Carolina NeuroSurgery & Spine is unusual in that it does not appear to be a straight-up acquisition. While its staff will become part of Atrium, the physicians will not become hospital employees, making it more of a hybrid model, staff members told the Ledger/NC Health News.
Patients at Carolina NeuroSurgery & Spine will be able to see their same doctors in the same locations, the release said. The practice’s clinics in Greensboro and Kernersville are not part of the deal.
This article is part of a partnership between The Charlotte Ledger and North Carolina Health News to produce original health care reporting. You can support this effort with a tax-deductible donation.
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