We were talking with a physician recently about what it's like practicing medicine in the US versus overseas. She'd spent years working in a country dealing with active conflict, the kind of environment where you lose infrastructure, safety, and sleep all at once but nobody ever stands between you and a patient telling you which drug to prescribe based on what's cheapest for a holding company.
When we explained how private equity treats ophthalmologists in this country, she said something we haven't been able to stop thinking about.
"PE is the American prison for doctors. Because it cuts their freedom."
She wasn't being dramatic. She was being precise. Because even in a conflict zone where the buildings are falling, the physician still has authority over how she treats her patients. PE takes that away. It lets you keep practicing but removes every decision that makes practice meaningful. You can hold the laser and not choose the lens. You can see patients and not set the schedule. You can operate while someone in a boardroom 800 miles away decides whether you're allowed to buy the equipment that would let you do it better.
91% of Ophthalmologists Say Autonomy Is Under Attack
The Physicians Foundation surveyed thousands of doctors in 2025 and the results should alarm anyone who cares about healthcare in this country. 91% said loss of autonomy is a major threat to US medicine. 83% identified third-party practice acquisition as a primary driver. And 64% said it directly affects the quality and timeliness of patient care. These aren't fringe opinions from burned-out residents. This is the overwhelming majority of practicing physicians telling you the system is breaking.
The NORC/Physicians Advocacy Institute survey from 2024 found that 47% of physicians said practice policies led them to adjust treatment plans to reduce costs, and 45% reported policies that influence or limit drug therapy decisions. Only 18% of physicians in corporate-owned practices said corporate ownership improved quality of care. Meanwhile, 68% of self-employed physicians say autonomy is the greatest advantage of independent practice, according to Medscape's 2025 report.
Why Ophthalmologists Can't Just Leave
And the part that turns a bad job into an actual prison is that you genuinely can't leave. PE structures are built with vesting schedules that reset every time the platform sells to another PE firm, non-competes that span 10 miles and 2 years, and bad leaver clauses that force you to forfeit your equity at cost if you resign voluntarily. Some agreements don't even give the physician a legal right to terminate without cause during the contract term. You're locked in until someone else decides you're allowed to go.
A healthcare attorney who works with PE-employed physicians described spending significant time consoling clients who call crying after their PE deals close. Think about that for a second. A licensed professional whose entire job is reviewing contracts, and what he sees happening to physicians after they sign is so bad that the calls turn into therapy sessions. Meanwhile, 78% of ophthalmology trainees say they wouldn't even consider working for a PE-owned practice, which tells you the next generation can already see what's happening before they walk in the door.
The Data Behind the Damage
The data confirms what the physicians already feel. PE-acquired practices see physician turnover increase by 265%, according to a 2025 Health Affairs study. Patient satisfaction drops by 5.2 percentage points within 3 years of acquisition, based on a JAMA study of 73 PE-acquired hospitals versus 293 matched controls. Retinal detachment surgeries, where delays literally cause permanent blindness, decrease by 19.6% per physician after PE takes over.
In ophthalmology specifically, PE-acquired practices showed a 74% increase in expensive ranibizumab injections at roughly $1,186 per injection and a 13% decrease in less costly bevacizumab at roughly $90 per injection. That's PE steering clinical decisions toward higher-revenue drugs, not better patient outcomes. The numbers come from Braun et al. in Ophthalmology, March 2024.
Why Retiring Ophthalmologists Keep Selling to PE
Here's what really gets us though. The doctors who sold to PE often did it because they had no other option. They were 65 or 70, tired, couldn't find a successor, and PE was the only buyer at the door with a check. They didn't sell because PE was good for their patients or their staff or their legacy. They sold because nobody offered them anything better. And that failure belongs to all of us who watched it happen and didn't build an alternative fast enough.
Among the roughly 9,000 solo ophthalmologists identified in CMS data, more than 5,700 are age 55 or older. An estimated 650 to 700 ophthalmologists retire every year while only about 500 complete training and enter practice, creating a net annual loss of 150 to 200 ophthalmologists. Every one of those retiring physicians who can't find a successor becomes a PE target by default, because PE is always at the door and almost nobody else is.
We're trying to change that now, one practice at a time, physician-owned, physician-led, with nobody in a boardroom deciding how you practice medicine. Because if a physician who survived an actual conflict zone looks at PE and calls it a prison, maybe the rest of us should stop pretending it's just a business model.
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
