Sept. 1, 2026

The Surgeon Who Flies Himself To Every Operation | with Ronen Elefant

There are roughly 9,000 ambulatory surgery centers in the United States, and most of them aren't running at capacity. Ronen Elefant figured out that he didn't need to build another one; he just needed to reach the ones already sitting half empty.

My guest this week is a trauma surgeon in Pennsylvania who has been flying his own plane to work for fourteen years. About a year ago he turned that into a business: rent time at an ASC, fly in, do the cases, fly home. One bundled price covering the facility, the anesthesiologist, and the surgeon. No insurance, no three separate bills arriving weeks apart.

We get into how the economics work at three or four cases per trip, and why patients drive six hours from the Dakotas to get on a cash schedule. Ronen also explains what certificate of need laws actually protect, why he thinks insurance should only exist for catastrophic care, and how an employer could plug fly-in surgery into a self-funded plan without building anything.

If you've been looking at surgical bundles and wondering how the supply side works, this is the episode. Tune in.

"Burnout doesn't come from surgeons standing up all day. It comes from doing all this stuff on behalf of the insurance company." - Dr. Ronen Elefant, ACES

Thank you to our 2026 sponsors!

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Chapters:

(00:00:00) Intro

(00:02:19) Growing Up in the Family Practice

(00:07:33) Why Surgery, and Why Trauma

(00:13:04) Fourteen Years of Flying to Work

(00:18:47) Healthcare Economics

(00:24:37) The $2,500 Colonoscopy Across the Street

(00:30:11) How ACES Was Born

(00:35:56) Renting Time in Half-Empty Surgery Centers

(00:41:38) How the Bundle Prices Work

(00:47:20) Certificate of Need and Who It Protects

(00:52:47) What Insurance Should Actually Be For