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I challenge you to find even one associate at a private equity ophthalmology practice who genuinely says, “I love my job.” Take your time, search thoroughly—use Google, ask around, do whatever it takes. I’ll wait. Did you find anyone?
The reality is, the cons of working as an associate in a private equity (PE) group far outweigh the pros. When I’ve spoken to colleagues about their PE experiences, the most optimistic response I hear is, “My job is fine; it’s not terrible.”
To me, this attitude reflects a troubling mindset. You didn’t spend four years in college, four years in medical school, and another four years in residency, along with countless hours preparing for the MCAT, conducting research, and volunteering, only to settle for a job that’s merely “okay.”
In my opinion, of all the career options available, private equity-owned ophthalmology is the worst choice, and here’s why.
1. In Private Equity, You Will Be Compensated Less In The Long Term
Many new residents are drawn to private equity (PE) ophthalmology positions due to the allure of a relatively high starting salary, often assuming it translates to long-term financial success. While it’s true that these jobs might offer slightly higher earnings during the first 1–2 years, the long-term outlook is far less favorable. Over the span of a 25-year career, physicians in PE-owned practices often find themselves earning significantly less compared to their peers in traditional practice models. This disparity arises from capped compensation structures, lack of equity or profit-sharing, and fewer opportunities to benefit from ancillary revenue streams like real estate or ambulatory surgery centers.
Private equity (PE) firms are focused on maximizing returns for their investors, and they excel at doing so. They aren’t investing in ophthalmology practices without expecting substantial profits. PE firms have aggressively pursued acquisitions in the field, often paying hefty sums based on the practice’s size and financial performance. Smaller practices typically sell for 5–8 times their adjusted EBITDA (Earnings Before Interest, Taxes, Depreciation, and Amortization), while larger “platform” practices—considered pivotal for regional growth strategies—can fetch multiples as high as 11–15 times EBITDA.
Given that these profit-driven entities prioritize financial gains above all else, do you think you’ll earn more or less as an ophthalmologist compared to a traditional practice model? The answer is straightforward. Moreover, PE groups often exploit young ophthalmologists in various specific ways, further tipping the scales against fair compensation and professional fulfillment.
In an ophthalmology practice, both an associate and a partner may have a compensation structure based on a percentage of collections (e.g., 30%), but the partner stands to earn significantly more in the long run due to their stake in the practice and access to profit-sharing from various revenue streams.
Clinic Profit – While both the associate and the partner are paid a percentage of the collections from patient visits, the partner also receives a share of the clinic’s overall profit. The clinic’s operating costs—such as staff salaries, equipment, and rent—are deducted from gross revenue to determine net profit. The partner, as a business owner, receives a portion of this profit, while the associate has no claim to it. The associate’s compensation is fixed at a percentage of their own collections, whereas the partner benefits from the broader financial health of the practice.
For example, if an associate ophthalmologist collects $1 million and their compensation is 30% of collections, they would receive $300,000. However, if the practice has 35% overhead, it would generate $350,000 in profit from the associate’s work. This profit is directed to the partners, not the associate, since the associate is only compensated based on their collections, not the overall practice profits. While the associate earns a fixed percentage, the partners, who own the practice, benefit from the profit generated, including the portion of revenue beyond the associate’s compensation, which often includes revenue from other areas like the ASC, optical, or real estate.
Ambulatory Surgery Centers – ASCs, which are common in ophthalmology, can be extremely lucrative. As a partner, you are likely to share in the profits from the ASC, which can generate significant revenue from surgeries like cataracts. Although an ASC profits can significantly outweigh those of office-based practices, an associate typically doesn’t receive a share of this revenue. Remember, even though the associate may perform surgeries in the ASC, their compensation is tied only to their patient collections, not the overall profitability of the ASC.
Real Estate – Real estate ownership is another major financial benefit for practice owners. In many ophthalmology practices, the building where the clinic operates may be owned by the practice or its partners. This can lead to substantial profits through real estate appreciation and leasing. In fact, many practices engage in sale-leaseback deals, where they sell their property to an outside investor and then lease it back, providing the practice with significant capital. For example, in a sale-leaseback transaction by the Thomas Eye Group, the real estate was valued at $25 million. As a partner may share in these profits from the sale or receive a portion of the lease payments. An associate, on the other hand, would have no access to these financial benefits.
Optical – In addition to clinic and ASC revenues, many practices also generate income from optical sales, including glasses and contact lenses. A partner may have the opportunity to share in this profit, whereas an associate typically does not. Optical sales can contribute a significant portion of a practice’s revenue, which adds to the partner’s overall compensation .
Thus, while both associates and partners may have the same contractual percentage (e.g., 30% of collections), the partner’s access to profit-sharing from clinic revenues, ASC profits, real estate, and optical sales means they have a much higher earning potential over time, while the associate is limited to their patient-related income
2. You Will Lose Autonomy
Private equity (PE) groups often prioritize maximizing revenue, and one of the easiest ways to do this is by exploiting physicians as “forever employees.” Instead of fostering long-term professional growth or partnership opportunities, they focus on maximizing your value as a producer. This often means increasing patient quotas, overbooking schedules, and adding extra responsibilities without input from the physician.
For associates, this could translate into being regularly overburdened with add-ons to your clinic schedule, leaving little room for flexibility. For example, if management decides to add a Saturday clinic or extend clinic hours with additional half-days, there’s often little choice but to comply. These demands reflect the corporate mindset of prioritizing revenue over physician autonomy.
PE-owned practices often exert significant control over clinical decision-making to cut costs, which can create ethical conflicts and compromise patient care. For instance, management may push for more expensive treatment options or procedures, even if they’re not in the best interest of patients. This loss of autonomy, coupled with increased workloads, frequently leads to lower job satisfaction and burnout among physicians
This profit-driven approach not only affects associates but also undermines the overall quality of care, making PE-owned practices less desirable for young physicians seeking fulfilling, patient-centered careers.
3. You Will Likely Be Less Happy
One of the most critical aspects of any career is job satisfaction, though it’s often subjective and challenging to measure. A personal example can help illustrate this.
During residency, one of the most frustrating aspects for me was the lack of control. I often felt confined within a rigid system, with little say over my schedule or workload. The key difference between being a partner or practice owner versus an associate lies in having control. While the types of patients may be the same, the ability to dictate your schedule and priorities brings a profound shift in perspective.
As an associate in a private equity (PE) group, my hours were fairly standard at around 40 per week, but I was frequently scheduled for sporadic Saturday clinics with little input on my schedule. When my son was born, I found that taking time to be with my family was met with disapproval. (Yes, the little man in the title picture). Similarly, if my operating room day finished early, it was frowned upon to leave the clinic early. While I was content working fewer hours and earning a lower income, the company seemed more focused on maximizing my output for their financial gain, pressuring me to see more patients to maintain profitability.
Since going solo, I’ve enjoyed complete control over my clinic. For example, I’ve adjusted my office hours to align with personal priorities—like ensuring I’m home by 2:30 p.m. every day to spend time with my daughter after preschool. This flexibility, paired with lower overhead and the autonomy to make decisions, has improved my work-life balance. I now earn more while working fewer hours than I would in a private equity group, leading to the highest level of career satisfaction I’ve ever experienced.
Final Thoughts
This raises an important question: if you’re likely to earn less in the long run, have less autonomy, and experience poorer work-life balance and job satisfaction, why would you even consider joining a private equity (PE) group? It might be worth exploring other opportunities. If a traditional partnership practice isn’t an option, starting your own practice could be a viable alternative. Creating your own business gives you control over your schedule, financial success, and work-life balance, offering a more fulfilling career path.
