In a peak year, one ophthalmologist was performing more than 2,000 cataract surgeries and several hundred refractive procedures. He wasn't working in an academic medical center with unlimited resources and wasn't part of a multi-specialty group with a built in referral network. He was running his own practice with a team he built, in an ambulatory surgery center he designed.
The System Behind the Numbers
The surgery center had multiple operating lanes. He'd built it over time, adding capacity as the practice grew and configuring the layout around the specific workflows his team had developed through years of iteration. The scheduling logic, equipment placement, patient flow from pre-op to the operating suite to recovery, all of it was calibrated to minimize friction and maximize the number of procedures that could be performed safely in a single day.
His surgical coordinator had worked with him long enough to know what he needed before he said it. The pre-operative technicians could run the full diagnostic workup without a checklist because they'd done it thousands of times. The front desk team could schedule a surgical day that filled every lane without creating bottlenecks because they understood the rhythm of how the physician operated. The team was executing a system built through shared experience over years.
What PE Changed
The practice was acquired by a PE backed group. Within months, the variables changed. Staff were reassigned and long-tenured technicians were moved to other locations or let go because the PE group's centralized staffing model didn't account for institutional knowledge. It accounted for headcount, role classification, and compensation benchmarks.
New hires were brought in from a centralized pool, trained using a standardized onboarding program designed to produce functional staff across all of the group's locations. The program could teach someone how to operate diagnostic equipment. But, it couldn't teach them how this particular physician liked his pre-operative measurements organized, or how to manage the flow of a multi-lane surgery center so the physician never had to wait between cases.
Same Surgeon, Different Output
The physician's surgical volume didn't increase after the acquisition. The PE group paid a premium for a practice that was already operating at peak efficiency, and then systematically removed the conditions that made that efficiency possible.
Research published in NEJM Catalyst found that the most consistent surgical teams achieve approximately 20% shorter procedure times compared to less familiar teams. A separate systematic review of more than 24,000 operations published in the Annals of Surgery confirmed that surgical team familiarity is broadly associated with superior operative efficiency. The data confirms what any surgeon already knows from experience. You operate faster and better when the person next to you knows what you need before you ask for it.
Productivity Is Physician + Environment
Physician productivity in ophthalmology is a function of the physician plus the environment. The surgeon's skill determines the ceiling. The team determines how close to the ceiling the practice operates on a daily basis. Equipment calibration, staff competence, scheduling logic, patient flow design, institutional knowledge, and the trust that develops between a surgeon and a team that's worked together for years. All of it contributes to the output, and all of it is vulnerable to disruption when a new owner decides the environment can be standardized without consequences.
What This Means for Returns
For investors evaluating ophthalmology practice acquisitions, this has direct implications for how returns should be modeled. A proforma that assumes the physician's historical production will continue under new management is only valid if the new management preserves the team, workflows, and operational infrastructure that produced that output. If the acquisition plan includes staff restructuring, scheduling centralization, or any change to the surgical team, the proforma should discount the physician's production accordingly.
For physicians, the lesson is that the operational environment you build around yourself is infrastructure, not overhead. The team you trained, the workflows you designed and the surgical day template you refined over thousands of procedures is a direct contributor to your clinical output. Any acquirer who tells you they'll improve your practice by changing the team around you is telling you they don't understand what made the practice work.
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.
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