Issue link: https://beckershealthcare.uberflip.com/i/1545864
20 TRANSACTIONS — Southeastern Spine Institute's ASC, which has six surgery and procedure rooms, and a gastroenterology-focused facility — as part of its expansion following the acquisition of East Cooper Medical Center and hospitals in Hilton Head and Hardeeville. Novant also broke ground on its first medical campus in the Upstate region of South Carolina in August 2025. e $132 million project will include a medical office building with physician clinics and an ASC. A 20-bed, outpatient-focused hospital with a full operating room suite, specialty care and diagnostic imaging has already received state approval and is expected to open in early 2027. "is is more than breaking ground on a building. is campus represents a significant investment in the Upstate," Jason Bernd, senior vice president and president of Novant Health's South Carolina region, said at the groundbreaking. All of it feeds into an explicit strategic target. Leslie Barrett, BSN, RN, senior vice president of ambulatory surgery strategy and execution at Novant Health, told Becker's in February that the system is building toward a 25-center ASC network. e thesis is site-of-service optimization: moving lower-acuity cases out of hospitals and into ambulatory settings, freeing inpatient capacity for complex patients while offering patients shorter stays, lower costs and locations closer to home. "Novant Health is building a flexible, scalable outpatient surgical network in a way that benefits everyone involved," Ms. Barrett said. "It offers patients affordability and expanded access close to home." Novant has also built governance structures to support the shi — including tools to standardize site-of-service decisions across markets and staffing models designed to scale as outpatient volumes grow. e system has said it is calibrating expansion plans alongside recent changes to North Carolina's certificate-of-need laws, which have begun to open the market for freestanding surgical development. e coastal buildout doesn't stop with outpatient surgery. In February, Novant's board approved a capital plan of more than $1 billion for its Wilmington footprint, which will include a heart and vascular patient tower, a second heart and vascular medical office building and a physical rehabilitation hospital at New Hanover Regional Medical Center. at tower is slated to open in 2031. n Where are physicians moving? By Patsy Newitt The physician workforce is not just shrinking, it is redistributing. The U.S. faces a projected shortage of 86,000 physicians by 2036, according to the Association of American Medical Colleges, but the shortage is not evenly distributed. Florida, Texas and the broader Sun Belt have been the primary beneficiaries of physician migration, mirroring general population movement patterns. Both states rank among the top five for net domestic migration in U.S. Census data, and physician supply data from the AAMC's Physician Workforce Dashboard reflects the same trend. Regulatory environment is a pull factor that operates specifically on physicians beyond general population migration. Texas enacted legislation in June 2025 imposing stricter limitations on physician noncompetes, limiting geographic restrictions to a five-mile radius and duration to one year, making it a more attractive destination for physicians leaving states with broader enforcement. Florida similarly favors enforcement of noncompetes but with statutory guardrails that give physicians more negotiating leverage than many Northeastern states. Several Sun Belt states have also moved aggressively to expand physician supply through alternative licensing pathways. The Federation of State Medical Boards found 18 states have enacted legislation allowing qualified internationally-trained physicians to gain full licensure without accredited postgraduate training as of August 2025, with 16 more states having pending or proposed similar legislation. California, New York and Illinois have each experienced among the largest net domestic out-migration of any states over the past decade, according to Census Bureau data, which is a population trend that the physician workforce data mirrors. California faces the largest projected physician shortage of any state by 2030 at 32,669 physicians, with Illinois projected seventh at 6,203. The residency application data reinforces the pipeline concern: states with strict abortion bans saw a 4.2% drop in U.S. MD senior applicants compared to a 0.6% decrease in states where abortions remain legal, according to AAMC data. The international exit signal is also worth noting. The Medical Council of Canada saw a 750% increase in Americans creating accounts to initiate the Canadian licensure process between November 2024 and May 2025. In addition, recruiting companies reported a 65% increase in the number of American physicians looking for Canadian jobs between January and April of 2025, with many citing the Trump administration as their primary reason, according to a May 29 report from NPR. The U.S. faces a shortage of 64,000 physicians by the end of 2024 and 86,000 by 2036, according to global consulting firm McKinsey. This shortage is disproportionately concentrated in rural and underserved areas where physician density is already lowest. Eighteen states have laws allowing internationally trained physicians to gain full licensure, three states grant limited licensure, three other states have pending bills related to limited licensure and another six state legislatures are considering pathway bills in 2026. n