We were on a call with a surgeon recently and he mentioned, almost like it wasn't even worth discussing, that he brings his own OR nurse to every surgical site. Wherever the case is, she's there. She's been with him for years and she knows his preferences before he states them and anticipates the next instrument before he reaches for it. She's part of the reason his outcomes are as consistent as they are, and when he told us he'd bring her with him if he joined our platform, that one detail told us more about him than anything on his CV.
Because a surgeon who insists on choosing the person standing next to him in the OR is a surgeon who understands something that PE has never figured out. Surgical outcomes aren't only about the hands holding the instrument. They're about the entire team in the room and how long that team has been working together.
How PE Disrupts Ophthalmology Surgical Teams
PE doesn't see it this way, and honestly, we don't think they're capable of seeing it this way. When a PE firm acquires a practice, they make staffing decisions based on cost optimization models. They decide how many techs you get, they decide whether you can hire an additional scribe or whether you'll share one with two other providers, and they rotate staff between locations based on corporate scheduling algorithms. Your best tech gets moved to a different clinic because the software says volume is higher over there this quarter. The fact that you've worked side by side with that tech for three years and she can read your body language mid-procedure doesn't have a column in the algorithm.
The Physicians Foundation's 2025 survey found that 91% of physicians identify loss of autonomy as a major threat to US medicine. But when most people hear "autonomy," they think about clinical decision-making, prescription authority, and treatment protocols. They don't think about something much more fundamental, which is who's in the room with you when you're operating on someone's eye.
Why the Surgeon-Nurse Relationship Matters More Than PE Realizes
The surgeon-nurse relationship in the OR is one of the most undervalued dynamics in all of medicine. The right nurse catches things before they become problems. She reads the energy of the room and knows when the surgeon needs silence versus when a brief comment helps them stay loose during a difficult case. She protects the patient through hundreds of micro-decisions over the course of a procedure that never show up in any chart note or quality metric. You can't train that in an orientation shift. It develops over years of working together, case after case, building the kind of nonverbal communication that only exists between people who trust each other completely.
PE doesn't measure any of that because it can't be measured. PE measures throughput, collections per visit, and cost per FTE. An experienced surgical nurse who's been with one surgeon for five years costs more per hour than a new graduate, and in the PE cost model that makes her a target for replacement. So PE hires the new grad or uses contract staff from a staffing agency who rotate through different surgeons every week and never build the kind of rapport that prevents errors when things get complicated in the middle of a case.
What the Data Shows When Ophthalmology Teams Get Disrupted
And the data shows exactly what happens when surgical teams get disrupted for cost savings. A JAMA study found that PE-acquired hospitals saw a 25% increase in hospital-acquired adverse events and a 27% increase in patient falls. Those outcomes don't come from the surgeons suddenly losing their skills. They come from teams that haven't worked together long enough to function as a cohesive unit, from rotating support staff who don't know a particular surgeon's rhythm, and from an environment where nobody has been there long enough to develop the pattern recognition that keeps patients safe during the unexpected moments.
In ophthalmology specifically, PE practices saw a 19.6% decrease in retinal detachment surgeries per physician after acquisition. Retinal detachment is a procedure where delays measured in hours can mean permanent vision loss. The surgeons didn't get worse at their jobs overnight. The infrastructure around them got reorganized to prioritize cost efficiency over clinical continuity, and the most complex, least profitable procedures were the first things to suffer.
Why We Let Ophthalmologists Choose Their Own Teams
At our platform, the surgeon who owns the PC decides who works in their operating room. They hire their own team, they keep the people who make them better, and they build relationships with staff who stay because the work environment is good and not because a corporate scheduler put them on the rotation this week.
That OR nurse who travels with the surgeon from site to site would be classified by PE as an unnecessary labor cost that needs to be optimized. She's actually the reason this surgeon's complication rates stay below national averages and his patients feel calm walking into the surgical suite. She's the reason he can give 100% of his focus to the procedure instead of wondering whether the person assisting him has ever worked with the equipment in front of them.
Every surgeon reading this has had a moment where they looked to their left in the OR and the person standing there was someone they'd never worked with before, and every surgeon reading this knows the feeling that comes with that moment. A split second of uncertainty where you realize you need to carry extra cognitive load for the entire case because you can't rely on your assistant the way you could when it was someone who'd been with you for years. The procedure usually goes fine and the patient usually does well, but the margin of safety shrinks and the surgeon feels it even if nobody else in the room does.
Surgeons should choose their own teams. The people standing next to you when you're operating on a patient's vision shouldn't be decided by a staffing algorithm built by someone who's never been inside an OR. That's a simple principle, and it's one that PE will never adopt because it requires valuing people over cost efficiency. In ophthalmology, the people are what make the efficiency possible in the first place.
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
