Leading with Competency, Not Ownership: A Conversation with SMP’s Greg Thompson
28
Jul
2026
Interview by Michael Winkleman, CMO, Surgical Management Professionals.
I sat down recently with Greg Thompson, SMP’s incoming CEO, to talk about why he took the job, and what actually separates SMP from the crowd of ASC management companies and private-equity-backed groups out there right now. Greg’s spent almost 30 years in physician group and outpatient services, including a long run as a CEO in the space, plus years doing strategic development work for Philips Healthcare across 13 states. He’s seen this industry from a lot of angles.
What came out of the conversation wasn’t a pitch. It was more of an argument, one Greg clearly believes down to his bones.
Why He Took the Job
I asked Greg why SMP, why now. His answer wasn’t complicated.
“SMP was founded by physicians over 30 years ago based upon the vision to create a surgery center management company that respected physicians as the true leaders of healthcare.”
That’s it, really. SMP wasn’t built to own a piece of what physicians build. It was built to help them do it, the same way its own founders once did. For Greg, coming in as CEO wasn’t a career move so much as picking up something he already believed in.
There was a second reason, too, and he didn’t treat it as an afterthought: he already knew a lot of the people at SMP. Talented people he wanted to work alongside, not just manage.
The Equity Question
Here’s where the conversation got sharper. I asked him directly about equity: why SMP doesn’t take a stake in the centers it manages, when so many competitors do.
“Physicians who give up ownership in their ASCs at the very beginning almost always regret doing so two to three years down the road.”
He didn’t hedge on this one. The logic, as he laid it out: giving up ownership early means selling at the lowest point the center will ever be worth. The center matures, the value climbs, and the physicians who kept their stake are the ones who actually benefit. Everyone else is left wondering where the value went.
And it’s not just about the money. It’s about what happens when things go wrong.
“Once you are married to a management company or private equity firm, and there is a concern about managerial performance, there is a very difficult path to separation.”
That word, married, stuck with me. It’s not a throwaway line. Once you’ve handed over equity, you don’t just walk away if the relationship stops working. You’re stuck.
Greg’s read on it: a company that has to earn its keep every year through actual performance is a fundamentally different animal than one that’s locked in through ownership. One has to keep proving itself. The other doesn’t.
He draws a sharp line between the two. A real management company builds its reputation on doing the core competencies of ASC management well. Full stop. An asset company manages in order to pick up more assets, and the distributions that come with them. Same industry, same-sounding services. Different business entirely.
A Resource Physicians Already Have and Don’t Use Enough
This part surprised me a little. I expected Greg to talk about consultants or feasibility firms. Instead:
“Most surgeons spend more time with their implant or device representatives than they do with their own families.”
His point: those reps are already there. Manufacturers run dedicated ASC teams to help physicians work through the early, hard questions (feasibility, pro formas, the groundwork), often before a management company is even in the picture. It’s a resource physicians already have relationships with, and it’s usually free or close to it. The only ask is that physicians use that manufacturer’s equipment and implants at the new ASC, which, as Greg pointed out, most would probably do anyway.
He named names, people he’s seen do this well across the industry: Noah Oviedo at Philips, Jack Zimmerman at Zimmer Biomet, Keith Knag at Stryker, Danielle Armstrong at Medtronic, Jason Weshler at Siemens. Once the feasibility work is done, that’s when a development partner like SMP steps in.
Why Smaller Is Winning Right Now
I asked Greg where he sees things heading. He didn’t talk numbers or trends. He went straight to a metaphor.
“We are like a sturdy old oak that has withstood years of trials and tests, with one root ball of our staff extending out to all our managed ASCs and partner physicians.”
Then, the contrast:
“Large corporations’ organizational charts are often like an aspen grove, with multiple interconnected root systems all feeding every tree in the grove.”
A lot of the bigger management companies are now owned by something bigger still, investors several layers removed from the actual patient care happening in the building. Physicians notice that. Reaching an actual decision-maker can take weeks.
To be fair, Greg wasn’t dismissive of the bigger players. Some groups genuinely need that scale, and there are real reasons those companies keep growing. But he sees a pull, especially among independent physicians, toward partners who are still small enough to know your name.
“We are physician owned, and we are not looking to manage 200-plus ASCs. We are selective, and we look to partner with like-minded physicians.”
The physicians he wants as partners, he said, tend to want an ASC for the same reasons, roughly in this order: better patient access, quality of life, and a new source of revenue that helps them stay independent. Not the reverse.
And the relationship stays personal as SMP grows, or at least that’s the goal.
“We know by name most every physician partner, and they can call us on our cell phones anytime.”
If You’re Weighing Your Options
If you’re a physician thinking about developing or managing an ASC, the ownership question is worth sitting with before you sign anything. It’s easy to underestimate what you’re giving up in year one, and hard to get it back in year three.
Happy to talk through what a no-equity partnership actually looks like day to day. Reach out anytime.
