Mark Ayzenberg finished his fellowship in 2019 believing the era of owning your own practice was over. He is proof it is not, and the way he tells the story, none of the turning points looked like turning points at the time.

He joined a private group that sold to private equity, which ended the partnership he had been promised and left him a perpetual associate. He moved to a hospital-owned group and hit a different wall: he could not do regenerative medicine at the quality the science calls for. One practice was running a kit that produced platelet poor plasma and calling it platelet rich. When he pushed back at the hospital, the answer was that a fellowship-trained, board-certified surgeon had used the same system before him. Mark is generous about all of it. These were good surgeons doing what they were trained to do. The problem was structural. Hospitals and private equity groups make their money in the operating room, so nothing that keeps a patient out of it ever gets funded.

The part I keep thinking about is that the science was never his bottleneck. He had learned high quality regen from Dr. Don Buford, who he calls his ethical north star, and he still found himself steering seventy-year-olds toward a knee replacement instead of letting them decide whether to pay out of pocket. He was making the choice for them and did not see it. Then he heard a question at a conference about whether you would offer your own mother regen if insurance were not an issue, and what right you have to make that call for a patient who wants to pay. He quotes it back to patients almost daily now. His shorthand for the whole problem is the insurance box versus the science box: what insurance covers is usually reasonable, and the science box is simply bigger.

From there it is an exit story, and a messy, human one. He signed with Mavrix at the Business of Orthobiologics before he had a location or even a finished logo, negotiated one day a week, and ran his first regen day out of a sublet room in a friend’s podiatry practice in May of 2024. By November he had taken over a closed urgent care from a landlord who liked what he was building and priced it like a space a quarter the size for the first year. His old surgical scheduler, who he once joked he would hire someday, showed up and painted the walls before there was work for her to do. She runs the office now. One employee became five in under a year. The non-compete fight was the ugly part, because Pennsylvania’s ban did not reach back to his contract, and his verdict on that is worth the price of admission: you do not have to be right to win, you just have to have clout behind you financially. He paid for the slower, more ethical route and says he is glad he did.

What he built with the freedom is the tell. New patients get forty-five minutes to an hour and he still sometimes feels rushed. There is Fiji and Pellegrino in the waiting room and a coffee menu called Iron Mountain Summit Sips. He asks every patient the same sorting question, is it pain or is it function, because a mechanical problem needs a mechanical solution and he is not interested in operating on someone who does not need it. Ask him what saddens him most about medicine and it is not reimbursement or paperwork. It is that doctors have stopped telling children this is a good path. He knew he wanted this at five years old.

Mark Ayzenberg, MD, FAAOS

The Surgeon Who Left So He Could Stop Operating