Over the past 13 years or so, consolidation of medical practices has been on the rise. As of 2024, only 42.2% of US physicians across all specialties were working in private practice, a decline from 60% in 2012.¹

Although the ophthalmology sector bucked the trend with 70.4% independence, between 2012 and 2021, 245 ophthalmology practices were acquired by private equity (PE) firms.² Ophthalmology is a particularly attractive area for investors, with the inevitable age-related decline in visual acuity and increased risk of ocular disease, as well as a high demand for elective, cash-pay procedures.²

While private equity offers potential for scale and efficiency, physicians have less authority over their practice. On the other hand, while independent practice provides autonomy, it may come at the cost of profitability and work-life balance. We asked ophthalmologists from both camps to weigh in on the benefits and drawbacks of each practice model.

Administration & Finance

Since private equity firms contract out for the administrative portion of a practice (such as human resources, billing and coding, marketing, etc.), doctors are freed up to focus on medicine.

“No doubt, the administrative burden of running a practice can be mitigated [in a private equity setting] so that physicians have more time to be patient-centric,” says Jai G. Parekh, MD, an ophthalmologist with EyeCare Consultants of New Jersey (ReFocus PE).

Yet Jennifer Loh, MD, founder and medical director of Loh Ophthalmology, an independent practice in Miami, says that while her practice is entirely physician-owned, it does enjoy some of the administrative advantages for which other practices look to private equity firms.

“When I started my practice in 2016, I was the only doctor. I chose a hybrid model in which I am part of a bigger, physician-owned organization,” she says. “[We are] a group of doctors in the South Florida area working together in separate practices. We manage our own practices, but we do share some overhead, like electronic health records, a chief financial officer, and an internet technology expert.”

As business owners, ophthalmologists in both private practice and PE practices must be mindful of their bottom line.

“The drive to make your business successful is as important in private practice as in a private equity group,” says Janelle Adeniran, MD, of Bennett & Bloom Eye Centers (Eyecare Partners PE) in Louisville, Kentucky. “You may even have a little more protection in private equity because it’s a larger entity.”

That said, meeting financial targets is a particularly significant goal for PE investors,³ which potentially can impact patient care and practice culture.

Patient Care & Physician Autonomy

In some cases, physicians in PE practices are expected to support priorities set by nonmedical personnel, even if this means increasing patient load or performing more costly procedures.

Dr. Parekh stresses that this is one of many reasons why it is critical that the physician’s voice be heard when decisions are being made for the practice. He adds that having physicians in management roles, when possible, is vital to the success of the PE structure.

One argument against private equity has been that forced time constraints lead to rushed doctor-patient visits and incomplete information delivery.³

“Balancing efficient patient management with thorough care is a constant challenge,” Dr. Adeniran admits. “It requires effective communication strategies and empathetic consideration of patient needs.”

She adds that it’s particularly crucial to focus on key information to improve understanding and retention with elderly or cognitively impaired patients.

For these reasons and others, some physicians feel that private practice allows them to focus more on individual patient needs, thus building strongerrelationships with patients and the larger community.

“Ties to the community are strong when it’s not a national group that owns you,” says Sylvia L. Groth, MD, who works the department of ophthalmology and visual sciences at Vanderbilt University Medical Center in Nashville. “I think community ties are something that potentially erodes over time, as the culture shifts from the original individual practice to take on more of the culture of the owning entity.”

Dr. Loh believes that being in private practice allows her the autonomy to make decisions more quickly and to work with her staff in the interest of patients. The result, she says, is an all-around positive culture.

“I like not having to deal with a bureaucracy that one might encounter in a large organization,” says Dr. Loh. “As a smaller organization, we can pivot more quickly. We can change protocols and practices quickly for the benefit of our patients. We can control the environment that we work in and connect more with our staff and our patients, make faster decisions, and not have to go through multiple layers of bureaucracy and get permission from someone we’ve never even met.”

Work-Life Balance

Physicians looking to balance their careers with raising a family can benefit from the PE model.

“The operational support [offered by PE] was crucial,” Dr. Adeniran shares. “I have enjoyed being free of operations, management, and billing duties so I can focus on my young children.”

Dr. Groth believes that changing generational goals drive some of the prioritization of work-life balance. She sees an increase in the desire for predictable schedules.

“The generations from Gen X to millennial to Gen Z are far more interested in working a good job with a predictable time frame and a clear clock-in, clock-out setup,” noted Dr. Groth. 

Negotiating Power

Dr. Loh finds that insurance companies often favor large practices, creating challenges for smaller, independent practices to secure contracts and gain patient access.

“It’s not a simple situation where you contract with an insurance company and they pay you. There are so many organized insurance companies that only contract with a certain group,” she says.

Dr. Groth agrees, adding that because negotiating power for contracts tends not to favor private practices, “You might have to ramp up the work to generate a similar revenue [to PE practices].”

“I see a lot of these insurance companies getting very big and powerful. In ophthalmology in South Florida, they’ll pick a few big practices that are willing to work at a very discounted rate,” adds Dr. Loh. “It’s all about cost savings and the bottom line, so it is becoming harder [to get a good rate]. There are so many more expenses, too. We have to buy certain high-tech equipment and follow all these compliance rules.”

Dr. Loh explains that this is why, although she owns her practice, she chose to be part of a larger network that shares resources. “It’s a way to be a bigger player in the market and to not be ignored by the insurance companies or given a poor contract. It’s also a way to have some economy of scale.”

Hiring and Keeping Staff

“[Private practices] won’t be able to start with a ‘wowing’ salary out of the gate, though likely there is the potential for a much higher one once the physician puts the time in to build the practice,” Dr. Groth said.

Dr. Loh agrees that, compared to private equity-backed firms, offering competitive salaries is more challenging for independent practices due to limited financial resources. However, Dr. Groth says private practices can leverage their culture when competing for talent and attracting staff.

Dr. Adeniran also notes that private equity creates opportunities in ophthalmology. “Private equity structures can offer diverse career paths beyond clinical practice, allowing for involvement in operational aspects or broader, system-level roles,” she explains. “Networking opportunities and mentorship programs within private equity settings can provide additional support and career advancement possibilities.”

The Takeaway

All of the ophthalmologists we spoke with expressed a common desire: to chose the practice model that they believe facilitates the best care for their patients.

The decision to join a private equity firm or a private practice ultimately depends on individual priorities, values, and career goals. Private equity offers potentially greater financial rewards, negotiating power, and operational efficiency, but it may come at the cost of physician autonomy. While private practice may offer physicians more control over schedules and patient care, it means longer hours, additional administrative work, and possibly fewer funds for upgrading equipment, securing insurance contracts, and ensuring that all employees are paid a fair wage. OM

References

1. American Medical Association. More physicians move to practices owned by hospitals and private equity groups. News release. May 29, 2025. https://www.ama-assn.org/press-center/ama-press-releases/more-physicians-move-practices-owned-hospitals-private-equity  Accessed June 26, 2025.
2. Patil SA, Vail DG, Cox JT, et al. Private equity in ophthalmology and optometry: a time series analysis from 2012 to 2021. Digit J Ophthalmol. 2023; Mar 31;29(1):1-8. Published 2023 Mar 31. doi:10.5693/djo.01.2022.10.004. https://pmc.ncbi.nlm.nih.gov/articles/PMC10125728/
3. Baker-Schena, L. Private equity and ophthalmology. EyeNet Magazine. https://www.aao.org/eyenet/article/private-equity-and-ophthalmology Published online Nov. 1, 2019. Accessed June 23, 2025.