Over the next decade, the majority of solo ophthalmology practices in the United States will need to transition. The founders are aging out, the patient lists are full, and every one of these practices generates real cash flow that someone built over decades. When you run the math on average practice valuations between $375,000 and $1.3 million across thousands of practices entering the succession window, the total value lands somewhere around $4 billion. And right now, there's almost nobody on the other side of that transaction.
Why PE Stopped Buying Ophthalmology Solo Practices
PE ophthalmology deal volume collapsed from 75 transactions in 2021 to just 18 in 2024, a 76% decline according to PESP and Medscape. PE investment in healthcare overall fell 59% in 2023 as interest rates tightened credit markets and leveraged buyouts became harder to finance. The two biggest ophthalmology deals in 2025 were Cencora acquiring Retina Consultants of America for $4.6 billion and McKesson purchasing 80% of PRISM Vision Holdings for $850 million. Both were massive platform transactions involving hundreds of physicians across multiple states, and neither was a solo practice.
PE firms target practices with $1 million or more in EBITDA because that's where the multiple arbitrage works. A solo ophthalmology practice grossing $800,000 to $1.5 million typically produces $150,000 to $500,000 in EBITDA, which falls below the threshold PE needs to justify the acquisition cost, the legal structuring, and the management overhead. FOCUS Investment Banking confirmed in their April 2026 benchmarks that solo and small practices command only 5 to 6.5 times EBITDA in physician-to-physician transactions, while PE platforms trade at 12 to 20 times. The economics don't work for PE at the solo level, and they've moved on.
Why Hospitals Won't Touch Ophthalmology Solo Practices Either
Only 2% of ophthalmologists expect to sell their practice to a hospital or health system according to the AAO's 2021 Membership Survey. The reasons are structural and they stack up fast. Hospitals typically pay only fair market value of hard assets with no goodwill component to avoid anti-kickback statute violations, which means a practice worth $400,000 on the open market might fetch $100,000 from a hospital. Ophthalmology also generates minimal downstream hospital revenue compared to other surgical specialties, making solo acquisitions unattractive from a system perspective. Only 11% of ophthalmologists are employed by a hospital, HMO, or integrated delivery system, far below the 46.7% average across all physician specialties according to the AMA's 2024 Physician Practice Benchmark Survey.
Why Most Ophthalmology Practice Sales Fail Before They Close
At least half of all medical practices offered for sale never close according to Medical Economics, and that figure is consistent with broader small business data showing 70 to 80% of listed businesses never sell. Strategic Medical Brokers benchmarks the medical practice sale failure rate at 75%. These challenges multiply in ophthalmology specifically. The practices are extremely owner-dependent because one physician equals the entire clinical operation. Young ophthalmologists overwhelmingly prefer employment over ownership, with only 138 solo ophthalmologists in practice for 5 years or less compared to 1,564 in group settings, a ratio of roughly 1 to 11 according to Verdira's Q1 2026 CMS NPPES Registry analysis. The buyer pool for a solo ophthalmology practice keeps getting smaller every year, and the reason has nothing to do with competition. The young ophthalmologists who would traditionally step in simply aren't there.
What Happens to Ophthalmology Patients When a Practice Closes
When practices close without a successor, patients don't just find another doctor. A Journal of Public Economics study found that physician retirement increases total Medicare costs by $572 per beneficiary in the first 18 months and drives a greater than 10% increase in detection of new chronic conditions, reflecting delayed diagnoses that compound over time. A separate Stanford study found that losing a longtime physician increases patient mortality by 4%, emergency department visits by 4%, and hospital admissions by 3%. These costs are disproportionately driven by solo practitioner retirements according to the research, and they're worse in health professional shortage areas where there's no nearby alternative. Average physician appointment wait times hit a record 31 days in 2025 according to AMN Healthcare, up 48% since 2004. In parts of Ohio, patients already wait 6 to 8 months for a cataract consultation.
The $4 billion in ophthalmology practice value sitting in transition isn't an abstraction. It represents revenue that's been flowing for decades, patient relationships that took a career to build, and clinical infrastructure that doesn't get recreated overnight. PE walked away from it because the deal sizes are too small for their model, and hospitals have no economic incentive to step in. The young ophthalmologists who could buy these practices are carrying half a million in training debt and choosing employment over risk. Someone has to be on the other side of this transaction, and the window to build those relationships before the retirement wave peaks is closing faster than most people realize.
This article is for general educational purposes and is not legal or financial advice.
Verdira is a healthcare acquisition platform focused on ophthalmology practices. Physician ownership. Transparent structure. No volume quotas. If you're a practice owner thinking about succession or a physician exploring ownership, we're open to thoughtful conversations.
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