# Private Practice in the days of big Ophthalmology and PE

Private Equity (PE) is the topic du jour in many specialty medical practices, especially ophthalmology. There are a lot of reasons to sell a practice to PE or join a practice joined by PE, but it hasn’t eliminated small group private practice or even solo private practice.

  • can set your own schedule but you are the only one paying the bills
  • any financial purchases are usually backed by YOU – the risk is not spread out
  • employees full time are more committed – most employees need constant whether full or part-time
  • A benevolent dictator is the most efficient form of government, but an oligarchy brings more ideas and diversity
  • vacation is unpaid
  • no hallway consults in solo private practice
  • a private practice also entails running a business
  • – taxes
  • – rent
    • utiilities, etc.

Most people don’t regret things they’ve done but more the things they haven’t done

Early in your career the recovery is much easier than later in your career although the risk may seem greater with the

Ophthalmology Practices: Solo, Group, and Private Equity Models

Ophthalmology, like many medical specialties, has seen a significant evolution in its practice models over the years. Traditionally, ophthalmologists have operated either as solo practitioners or as part of group practices. However, the rise of private equity in the healthcare sector has introduced a new model, the private equity-backed practice. Each of these models offers different advantages and challenges, and their impact on patient care, practitioner autonomy, and business operations can be substantial. What type of practice you choose depends on a lot of different circumstances.

Solo Private Practice

Solo private practices in ophthalmology represent the classic model of medical practice. A “benevolent dictator” is the most efficient form of government. In this setup, a single ophthalmologist owns and operates their own practice. This model offers maximum autonomy, allowing the physician to make all decisions regarding patient care, staff hiring, clinic hours, and business strategies. For many practitioners, this autonomy is a significant advantage, allowing them to build strong, personal relationships with their patients and tailor their practice to their personal and professional preferences.

However, solo practitioners also face considerable challenges. They bear the full burden of administrative tasks, business risks, and financial responsibilities. Additionally, keeping up with the latest technological advancements in ophthalmology can be financially demanding for a solo practice. The need to manage business operations alongside patient care can be stressful and time-consuming.

Group Private Practices

Group private practices, where multiple ophthalmologists come together to share resources and responsibilities, offer a middle ground between solo practices and large-scale operations. A benevolent dictatorship may be the most efficient form of government, but an oligarchy brings more ideas and diversity. These practices can provide a collaborative environment, enabling physicians to specialize in different areas of ophthalmology, thus offering patients a broader range of services. The shared workload also allows for better work-life balance, and the collective financial resources can make investing in advanced medical technologies and administrative support easier.

However, in a group practice, decisions must be made collectively, which can lead to conflicts or delays. Moreover, the profit-sharing model might not appeal to all, especially if the partners have significant disparities in workload or revenue generation.

Private Equity-Backed Practices

The entry of private equity firms into the ophthalmology sector has created a new practice model. Private equity groups typically acquire multiple ophthalmology practices to form a larger network. The primary advantage of this model is financial: private equity-backed practices have access to significant capital, facilitating advanced technology investments, marketing, and expansion efforts. They also offer practitioners the opportunity to reduce their administrative burdens and focus more on patient care.

However, this model can also lead to a loss of autonomy for physicians. Decisions about the practice are often made by the private equity firm, which may prioritize profitability over other considerations. This can potentially impact the quality of patient care and the work environment. Additionally, the consolidation of practices under private equity can reduce competition in the market, which might have long-term implications for patient choice and cost of care.


Choosing between a solo practice, group practice, or private equity-backed practice depends on a variety of factors, including personal preferences, financial goals, and attitudes towards autonomy and administrative responsibilities. Solo practices offer maximum independence but come with significant financial and administrative burdens. Group practices provide a balance between autonomy and shared responsibilities, while private equity-backed practices offer financial strength and reduced administrative duties at the cost of reduced physician autonomy. As the healthcare landscape continues to evolve, it will be interesting to see how these models adapt and which will become most prevalent in the field of ophthalmology.

Mark Moran