The first people to feel a private equity acquisition are never the physicians. The physicians are the revenue and you don't touch the revenue in the first year. You touch the people around it.

An ophthalmologist who'd built his practice over more than two decades had staff members who'd been with him for decades. They weren't employees in the way a PE platform uses the word. They were the practice, knew every patient, knew which referring optometrists expected a same day callback and which ones were fine with a message. They knew the physician's surgical rhythm, diagnostic preferences, and flow of a day that produced thousands of procedures per year.

When the PE group acquired the practice, the staff restructuring started within months.

Fired, Then Asked to Come Back

Long-tenured employees were let go because the PE group's regional model didn't have a line item for a technician who'd been there for 20 or 30 years and was being paid accordingly. The centralized staffing model required standardized roles at standardized compensation levels. An employee earning what decades of loyalty and institutional knowledge justified was, to the spreadsheet, overpaid.

Some of the staff who were fired were later approached by the same group about coming back. The regional team had discovered something that anyone who'd spent 10 minutes in the practice could have told them. The people they removed couldn't be replaced by a two week onboarding program and a training manual. The diagnostic workflows that had been built over years didn't transfer to new hires. The patient relationships that drove the practice's reputation and referral volume didn't survive the transition to unfamiliar faces at the front desk and unfamiliar hands in the exam lane.

The physician described what happened bluntly. The group took a practice that was running at peak efficiency and ran it into the ground.

Zero Wait to One Hour

Patients who'd never waited more than 15 minutes were now sitting for over an hour. The scheduling template that the PE group implemented was designed for throughput, not for the kind of practice this physician had built. His model was high volume achieved through efficiency, not through cramming. The difference is that efficiency requires a team that operates without friction, where every person knows their role and every handoff is seamless. When you remove that team and replace it with people learning the job in real time, the throughput drops and the wait times explode.

The PE group's response to declining patient satisfaction was to increase the scheduling pressure. If each visit generates less revenue because patients are leaving and reviews are dropping, the answer within a PE return model is to add more visits to compensate. The physician absorbs the difference by working faster, apologizing more, and watching the practice he built turn into something he doesn't recognize.

A 2025 JAMA study of PE acquired hospitals found that patient satisfaction scores declined progressively after acquisition, dropping by 5.2 percentage points by year 3, a decline larger than the national drop during COVID-19. Staff responsiveness specifically deteriorated. While the study focused on hospitals rather than physician practices, the mechanism is the same. PE cost cutting drives staff instability, which degrades the patient experience.

Where the Damage Shows Up

The reviews are where the damage shows up publicly. A practice that maintained a 4.8 star average for years starts accumulating one and two star reviews within months of the acquisition. The complaints follow a pattern. Long wait times, unfamiliar staff, feeling rushed, and difficulty reaching someone by phone. The physician is still performing at the same level and the results are still excellent, but the staff who built everything around that clinical work is gone.

The referring network feels it too. Optometrists who sent patients to the practice because they trusted the team, start routing patients elsewhere. They don't make an announcement about it, they just stop calling. The referral volume drops quietly, and by the time the PE group's analytics team notices the trend, the OD relationships that took years to build have already shifted to a competitor.

Irreversible on a PE Timeline

What makes this pattern particularly destructive is that it's irreversible within the PE ownership timeline. Rebuilding a clinical team with the kind of institutional knowledge that a decades old practice accumulates takes years. PE doesn't operate on a timeline measured in years. It operates on a timeline measured in quarters and by the time the staff destruction has fully worked its way through the practice's performance, the PE group is already preparing for its next transaction, and the physician is left managing a practice that produces less than it did before the acquisition, with a team that's less experienced than the one it replaced.

A management model that treats staff retention as a core operational metric rather than a cost to be optimized produces a fundamentally different outcome. When the management entity's incentive is long term practice performance rather than short term margin improvement, then keeping experienced staff isn't an expense. It's the single most efficient investment in patient satisfaction, referral volume, and clinical output. The staff stays because the structure values what they do, and the practice performs because the staff stays.

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 are evaluating the ophthalmology market and want to understand how different practice models affect transition planning, we are open to thoughtful conversations.

Contact info@verdira.com | 307-381-3734 | verdira.com