As chief of ophthalmology at a Veterans Affairs (VA) medical center, Ankit Shah, MD, mentors trainees who might be thinking about going into private practice. But he has seen those opportunities dry up — first as private equity (PE) firms began buying ophthalmology practices, and, in the past year, publicly traded corporations have begun buying out the PE ventures.

“I’ve had a lot of colleagues and residents who have either been caught off guard by joining a practice that ultimately got bought out by private equity, or a lot of the places they’re interviewing at are already owned by private equity,” said Shah, who is chief of ophthalmology at the VA in Salem, Virginia, and on faculty at the University of Virginia, in Charlottesville, Virginia.

“Young MDs don’t want to join these groups,” said David Browning, MD, PhD, an associate professor at Wake Forest University School of Medicine in Winston-Salem, North Carolina. Browning was a co-author of a 2025 study that reported about 80% of trainees in ophthalmology would not work at a PE-owned practice.

Will they change their minds as PE sells practice groups to publicly held corporations? At least three such deals occurred in 2025. More may be in the works. “Private-equity firms, by definition, invest with goal of exiting investments or reselling investments in a relatively short time period,” said Yashaswini Singh, PhD, MPH, an assistant professor at the School of Public Health at Brown University in Providence, Rhode Island, and an advisory board member of the Private Equity Stakeholder Project who has studied the effects of PE in ophthalmology.

Deals Heating Up?

PE has made inroads into medical practices well beyond ophthalmology. An analysis by the American Medical Association found that 6.5% of physicians in 2024 said they were working in practices owned by PE, up from 4.5% in 2020 and 2022. In ophthalmology, the percentage is higher: KFF Health News reported in 2022 that 8% of ophthalmologists work in practices owned by PE. In the retina subspecialty, the share is even greater; nearly 30% of retina specialists are affiliated with PE-run practices, according to a 2025 study in Health Affairs.

Shah co-authored a paper in the Harvard Medical Student Review last August that called on medical students and trainees to educate themselves about the influence PE is having on ophthalmology practices and called for more research into the long-term consequences of such investment.

PE acquisitions of private ophthalmology practices peaked in 2019 to 2021, when 245 practices with 614 offices and 948 ophthalmologists were acquired by PE, a 2023 cross-sectional study reported. According to Browning, the peak year was 2021, when 75 PE deals were done, dropping to 39 in 2022. No data are available for 2023 onward. S&P Global Ratings reported that PE investment in healthcare fell by 59% in 2023, mostly thanks to higher interest rates and tighter credit markets.

PE companies “operate in healthcare without any effective oversight” and do not report to antitrust or financial regulatory authorities, according to a report by the American Antitrust Institute.

“Private equity in many ways is exploiting some inherent flaws in the American healthcare system,” Singh said. The primary issue with retina practices, she said, is a “quirk” of Medicare payment policy that ties physician reimbursement to the sale price of the drug administered, which provides an incentive to push patients getting ocular injections into more expensive drugs.

A 2024 study by Singh and her group confirmed this trend. Medicare reimbursements for the three dominant age-related macular degeneration drugs, according to National Opinion Research Center at the University of Chicago, are $90 for bevacizumab (Avastin), a cancer drug use off label; $1186 for ranibizumab (Lucentis); and $1797 for aflibercept (Eylea). The study found the use of higher-priced medications increased by 6.5 injections per quarter, resulting in a 21% increase in Medicare spending on aflibercept.

Effect on Patient Care

A number of studies have found PE ownership increased healthcare expenses and altered the types of services practices provide. Singh led a 2022 study that found such practices had an average increase of $71 charged per claim and $23 in the amount allowed per claim compared with other practices.

Singh also conducted research that found PE-owned practices decreased the number of retinal detachment repairs they do by almost 20% after they were acquired. Retinal detachment repair is not as profitable as other procedures, she said. In fact, Singh said, Medicare reimbursement “doesn’t quite cover the cost of surgery.”

Nonetheless, repairing retinal detachment is a critically important procedure for a retina practice. “If you don’t get retinal detachment repair within days of the diagnosis, you can go blind permanently, so timely care is very critical for patient well-being,” she said.

For PE, “it’s a game of numbers,” Shah said. “They don’t practice medicine through a clinician microscope,” he added. “When you look at it from a numbers standpoint, you lose the beauty of practicing medicine.”

PE Sells Out

Corporate owners are attracted to ophthalmology practices because of an aging population’s growing demand for cataract surgery and retinal injections to treat age-related eye disease, Singh said. “From an investor standpoint you are facing a predictable and sustained if not growing consumer demand,” she said.

These investors are also attracted by the traditional ophthalmology model of a multitude of independent practices in a region, Singh added. “A big part of the private-equity model relies on platform-and-add-on consolidation,” she said. Firms invest in an initial platform practice and then gradually acquire smaller surrounding practices and then roll them up into a larger entity.

The typical play is for PE firms to acquire a large share of a practice, between 60% and 80%, Singh said. This strategy gives the selling physicians some equity and interest in the group’s growth, so they can benefit from a future sale, researchers at Weill Cornell Medicine in New York City reported in Health Affairs.

In 2025, publicly traded corporations started to acquire those organizations that PE had rolled up, Singh said.

In January 2025 Cencora, the pharmaceutical distributor and healthcare support provider formerly known as AmerisourceBergen, paid Webster Equity Partners$4.4 billion for an 85% stake in Retina Consultants of America, a group of 38 retina subspecialty practices with 291 offices in 23 states.

A few months later, McKesson Corporation paid Quad-C Management $850 million for an 80% stake in PRISM Vision Holdings, a group with 96 ophthalmology clinics, eight ambulatory surgery centers and more than 200 physicians. On an international level, EssilorLuxottica , a company that started out making eyeglass lenses and frames before branching into practice ownership, acquired two groups in Europe comprising 85 practices.

Whether this shift in ownership will disrupt physician autonomy and patient care in the way PE has done remains to be seen. A spokesperson for Cencora said Retina Consultants of America’s ownership model aims at “preserving clinical autonomy” and the company does not get involved in clinical decision-making. “Practice physicians and clinicians retain full autonomy and their patient-centric approach,” the spokesperson said.

McKesson itself does not own physician practices and does not influence clinical decisions, according to a statement from the company. “Through PRISM Vision Group, McKesson provides operational support that enables independent ophthalmology practices to remain autonomous,” the statement read.

Whither Physician Opportunities?

Singh led a 2025 Health Affairs study of that found physician turnover quadrupled to 20% a year after practices were acquired by PE. “If a fifth of your practice is turning every year that doesn’t bode well for patient continuity of care,” she said.

Another Health Affairs study Singh participated in found PE-owned practices in dermatology, ophthalmology, and gastroenterology significantly increased the number of nonphysician advanced practice providers.

Today, ophthalmology trainees have limited career options because “it’s almost impossible for someone to graduate and start their own practice,” Shah said. The start-up costs in ophthalmology, which Shah estimated to run between $500,000 and $700,000 — are “astronomical” for young physicians already burdened by education loans.

The jobs that are available are increasingly with PE-backed groups, he said. Their starting salaries may be on par with independent practices, “but there’s no opportunity to buy in, there’s no opportunity to practice ‘independently’ — I say that with quotes because everything is set up for them when it’s owned by private equity,” he said. And young ophthalmologists have little leverage for negotiating these conditions, Shah said.

“There’s loss of MD autonomy,” Browning said. “Younger MDs lose access to equity and become employees.” These tend to shift clinical care to non-MDs “because they cost less,” he added.

The Potential Upside of PE

PE may not be all doom and gloom. About 2 years ago, Jai Parekh, MD, MBA, brought in PE-backed ReFocus Eye Health as a partner in his five-doctor practice in northern and central New Jersey and he has no regrets. He is also the chief innovation officer for ReFocus.

“Not all cars are the same and not all restaurants are the same,” Parekh said. “I would say that not all private-equity arrangements are the same.”

He said he’s been able to preserve the doctor-patient relationship and practice as he did before, without anyone looking over his shoulder to see if he meets numbers. The parent entity handles many business aspects of the practice, namely human resources. “They are a bigger entity that offers better benefits than I ever could have as a small-business owner,” he said.

Parekh said he fought the notion of private equity for years but now called the transition for his practice “seamless.” He is still in charge of many facets of the practice, including the business-side, marketing, clinic schedules, operating room days — and even the holiday parties. “Our culture has not changed, and we actually feel even stronger now,” he said.

With PE, “There have been some good stories and some not-so-good stories,” he said. But physician autonomy and patient care come down to how the owner-physician structures the alliance. “As long as you keep the doctor-patient relationship buoyant and you want to be center stage like you were before the deal, you’re going to be fine,” he said.

The multitude of ophthalmology trainees looking to join practices may be the ultimate judge and jury to determine if PE and the publicly held companies that have bought up ophthalmology practices can deliver that sense of physician autonomy.

Shah and Browning reported no relevant financial relationships. Singh reported receiving research grants from the Commonwealth Fund, the National Institute for Healthcare Management, and Arnold Ventures, and serving on the advisory board of the Private Equity Stakeholder Project. Parekh reported being an officer of ReFocus EyeHealth. 

Richard Mark Kirkner is a medical journalist based in Philadelphia.