There's a surgeon in the US right now doing close to a thousand cataract surgeries a year. He'll probably cross 1,200 within the next couple of years as his practice continues to grow. He runs a premium IOL adoption rate north of 35%, meaning more than a third of his patients are paying $3,000 to $7,000 per eye out of pocket on top of Medicare reimbursement. He brings his own OR nurse to every case. His patients send friends without being asked. His referral network runs deep across an entire region. He's in his late thirties.
He doesn't own a single share of the practice he built.
The Math on What PE Takes From a Top Ophthalmology Surgeon
He's employed by a PE group that acquired the practice he joined out of fellowship. They gave him retention equity with a 3-year vesting schedule and put him on a 33% net collections compensation model, paid biweekly as a draw against quarterly reconciliations. If collections come in under the draw, he owes the difference back.
So let's do the math on what this surgeon is actually generating for his PE group.
At roughly a thousand cataracts with standard Medicare reimbursement declining to $463 per case in 2026, the physician fee alone is over $460,000. But that's just the standard cases. With premium adoption north of 35%, more than 350 of those cases include an out-of-pocket IOL upgrade averaging conservatively $2,500 per eye, which adds another $900,000 in premium revenue flowing through the practice. Add in clinic visits, glaucoma management, anterior segment procedures, and diagnostic workups, and this surgeon is conservatively generating $1.5 to $2 million in annual collections.
He takes home 33% of net collections, so roughly $500,000 to $660,000 before taxes. That sounds like a great living until you sit with the other side of the equation. The PE platform is keeping the other 67%, which means they're capturing over a million dollars a year from one surgeon's hands, one surgeon's reputation, and one surgeon's relationships with every referring doctor he's built over the years. The PE firm didn't train him, didn't recruit his patients, and didn't build his referral network. They bought the practice he happened to work at and started collecting their percentage from day one.
Why This Ophthalmologist Is in the Top 5% Nationally
Only 5% of US cataract surgeons perform more than 500 cases per year, and those top-volume surgeons account for 26% of all cataract surgeries performed in the country. This guy isn't an average employed ophthalmologist doing 200 cataracts and coasting through clinic days. He's in the top tier of surgical productivity in the entire United States. And every dollar of equity value his work creates belongs to someone who's never held a phaco handpiece.
The Swedish National Cataract Register data, cited by the AAO, shows that surgeons performing 500 or more cases per year have a complication rate of just 0.59%, compared to 2.15% for those doing fewer than 100. Volume and outcomes are directly linked. This surgeon isn't just productive. He's safer than average because of how much he operates, and PE is capturing the financial benefit of that safety record without giving him any ownership of the practice generating it.
What an Independent Ophthalmology Practice Owner Would Keep
An independent surgeon doing the same volume would keep 50 to 65% of collections depending on overhead, plus they'd own an asset that appreciates over time. An independent ophthalmology practice with $1 million in EBITDA is valued at 5 to 11x under current market benchmarks, meaning the practice could be worth $5 to $11 million within a few years. That equity would belong to the surgeon, accumulating value with every patient served and every premium lens implanted. Instead, this surgeon's value gets captured by a PE holding company that resets his vesting schedule every time the platform gets sold to the next financial buyer.
The Ophthalmology Workforce Crisis Makes This Even Worse
Here's why this matters beyond one surgeon's bank account. The HRSA workforce projection study estimates that ophthalmology will face a 30% workforce inadequacy by 2035, with 150 to 200 fewer ophthalmologists entering practice each year than are retiring. Surgeons doing a thousand cataracts a year are irreplaceable at a national level, and PE knows it. That's exactly why the retention equity exists. They can't afford to lose him, so they give him just enough financial incentive to stay but never enough to feel like he actually owns the value he's creating.
Health Affairs reported in 2025 that physician turnover in PE-acquired practices increased by 265% relative to baseline. The highest-producing surgeons are the ones most likely to leave because they have the most leverage and the most to gain from ownership. PE's own compensation structure creates the exact dissatisfaction that eventually drives their best people to look for something better.
We keep thinking about this surgeon, in his late thirties, doing close to a thousand cataracts a year, generating $2 million in revenue, and taking home 33 cents on every dollar while the platform captures the rest and his equity resets every time the holding company changes hands. At what point does a surgeon that productive stop calling himself an employee and start asking what he could build if the million dollars PE takes from him every year was going into his own practice instead?
This article is for general educational purposes and is not investment advice.
Verdira is a healthcare acquisition platform focused on ophthalmology practices. Physician ownership. Transparent structure. No volume quotas. If you are evaluating private healthcare investments and want to understand the mechanics of this market, we are open to thoughtful conversations.
Contact info@verdira.com | 307-381-3734 | verdira.com
