Medical school takes 4 years. Ophthalmology residency takes 3 to 4 more. Fellowship adds another 1 to 2. By the time an ophthalmologist is fully trained, they've spent roughly a decade in education. During that decade, almost none of them received any formal training in how to run a business.
This isn't a criticism of medical education. It's an observation about a gap that affects every physician who practices outside of a hospital or academic system, and a growing number who practice inside them.
90% of Medical Students Have No Business Training
A November 2024 study in the Physician Leadership Journal surveyed U.S. medical students and found that 90% reported having "no," "minimal," or "basic" perceived knowledge of the business of medicine. 55.3% had never taken any business related course at all, not even an introductory economics or finance class, before or during medical school. Yet 73.5% believed they should have at least basic business knowledge before entering residency.
Only 0.55% of MD candidates and 0.61% of DO candidates are simultaneously enrolled in MBA programs. Over 60% of medical schools now offer dual MD-MBA tracks, but only about 150 students enroll annually. That's roughly 0.5% of the approximately 28,000 annual medical school graduates.
A Johns Hopkins study published in Academic Medicine by Myers and Pronovost argued that management skills should be integrated into core medical curriculum rather than siloed in optional dual degree programs. Their reasoning was simple. Every physician, regardless of specialty or practice setting, will make financial, operational, and personnel decisions that affect patient care. Pretending otherwise leaves the majority of graduates unprepared.
Financial Literacy Is Low Across the Entire Training Pipeline
A February 2025 study published in Medicine tested healthcare financial literacy across different training stages and found that medical students scored an average of 36.36% on a standardized questionnaire. Residents scored 34.63%. Junior hospitalists scored 34.78%. There was no statistically significant improvement from student to resident to early career attending. A decade of medical training didn't move the needle on financial understanding.
A systematic review published in January 2023 found that 42 to 79% of residents report "below average" financial understanding, while 79 to 95% agreed personal finance should be taught during residency. A Yale pilot study published in Cureus in 2023 found that over 70% of physician respondents said their graduate education did not provide the tools needed for personal financial success.
An OB/GYN residency program that implemented a financial literacy curriculum found that it significantly improved physician well being scores. Financial competence didn't just help physicians manage money. It reduced burnout. The study was published in AJP Reports in February 2022 by Cawyer and colleagues. The connection between financial understanding and professional satisfaction is measurable.
The Administrative Burden Fills the Knowledge Gap
When a physician doesn't understand the business side of practice, the business side doesn't disappear. It just becomes a source of chronic stress instead of a manageable function.
Shanafelt and colleagues at Stanford Medicine published the most authoritative 2025 burnout data in Mayo Clinic Proceedings in April 2025. They found 45.2% of physicians report at least one burnout symptom, with physicians 82.3% more likely to experience burnout than workers in other occupations. Medscape's 2025 report of over 5,700 physicians found 47% burned out, with 55% citing "too many bureaucratic tasks" as the number one cause.
Ophthalmology's burnout rate sits at 30 to 39%, which is among the lowest across specialties. But that lower rate doesn't mean ophthalmologists are immune to administrative burden. The ASCRS surveyed ophthalmologists specifically and found that nearly 90% have delayed or avoided prescribing treatment due to prior authorization requirements. 95% reported that prior authorization has influenced their ability to practice medicine. And nearly two thirds have staff working exclusively on prior authorizations, with half estimating those staff spend 10 to 20 hours per week on the process.
The AAO estimates that ophthalmology physicians or staff typically must spend the equivalent of 2 or more full days each week negotiating insurance approvals. That's 2 days per week spent on administrative processes that a physician was never trained to manage, performing work that has nothing to do with patient care.
The Documentation Time Sink
An AMA funded time and motion study by Sinsky and colleagues, published in Annals of Internal Medicine, observed 57 physicians for 430 hours and found they spend 27% of their office day on direct patient care and 49.2% on EHR and desk work. For every hour of clinical face time, physicians spend nearly 2 additional hours on documentation and administrative tasks. A 2022 study using Epic Systems data from over 200,000 physicians confirmed those findings and added that primary care physicians spend 2.7 hours of personal time outside of scheduled hours on EHR work.
An AMIA Pulse Survey of 452 physicians in September 2024 found that 75% had not seen a recent decrease in documentation burden, 83% said documentation time was not appropriate for the work being done, 84% finish work later or do additional work at home because of excessive documentation, and 81% said documentation impedes patient care.
These are the tasks that consume physician time and energy. Billing, coding, compliance, credentialing, payer negotiations, documentation, prior authorization, HR, scheduling, marketing, lease management, equipment procurement. None of it was covered in medical school. All of it lands on the physician's desk when they own or operate a practice.
There's Another Way to Learn
The gap between medical training and practice management isn't going to close in the curriculum any time soon. Medical schools have more clinical content to cover than they can fit into 4 years already. Adding a full business education on top of that isn't realistic.
But the gap doesn't have to be a barrier to ownership. The reason PE has been successful in recruiting ophthalmologists isn't that physicians want to give up autonomy. It's that PE offered to take the business side off their plate. The problem was what came with it: non-competes, volume quotas, equity rollovers, and fund timelines that prioritize investor returns over clinical stability.
A management services organization offers the same operational relief without the same structural tradeoffs. The physician owns the clinical entity. The MSO handles everything the physician was never trained to do. The separation is legal, contractual, and enforceable under state corporate practice of medicine laws.
Medical school didn't teach business. That's fine. The physician doesn't have to learn it. They have to find someone who already knows it and whose incentives are aligned with theirs. That's not PE. That's a partner.
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 physician who wants to own a practice but doesn't want to run the business side, we built this for you.
Contact info@verdira.com | 307-381-3734 | verdira.com
