Ambulatory surgery centers, both single- and multispecialty, have flourished in a decade that has witnessed a phenomenal shift of medical services from the inpatient to the outpatient setting. The survival of single-specialty endoscopic ambulatory surgery centers (EASCs) will depend on their ability to meet the demands of a rapidly changing healthcare marketplace. EASCs are particularly well adapted to thrive under the dominant forces and trends that will drive the foreseeable future of healthcare: consumer expectations, cost containment, consistency of care (quality), and consolidation. Those EASCs that anticipate and adapt to the conditions of the healthcare market environment will thrive as vital components of the new millennium's healthcare industry.