There are more ophthalmology practices available to buy right now than there are ophthalmologists willing and able to buy them. That sentence seems like it should be wrong, but every broker, recruiter, and practice owner in the industry will tell you the same thing.

The market has a surplus of sellers and a shortage of successors. The reasons for that shortage are structural, and none of them are going away soon.

The Pipeline Produces 525 Ophthalmologists a Year

The 2025 SF Match, the residency matching program for ophthalmology, offered 525 positions across 123 programs. Of 912 applicants, 524 matched. US allopathic medical seniors matched at a 72% rate. Osteopathic seniors matched at 34%. International medical graduates matched at 21%.

Those 524 new ophthalmology residents will finish training in 3 to 4 years. Then the majority will pursue fellowship. Research published in Review of Ophthalmology in December 2025, citing a study by Gedde and colleagues, found that 68% of graduating ophthalmology residents now pursue subspecialty fellowship training, up from 34% in 1996. That means roughly 2 out of every 3 new ophthalmologists specialize in retina, glaucoma, cornea, oculoplastics, or pediatric ophthalmology rather than entering comprehensive practice.

At programs like Harvard, 85 to 90% of residents pursue fellowship training. The pipeline of comprehensive ophthalmologists available to step into a general practice is a fraction of the total graduating class. And that fraction is shrinking every year.

Almost None of Them Want Solo Practice

Among all new physician graduates surveyed by Merritt Hawkins in 2021, only 1% said they would prefer a solo practice setting. None preferred communities of 10,000 or fewer people. The generation entering medicine right now has different priorities than the generation that built the practices currently up for sale.

Practice management consultant Jill Maher, writing in Review of Ophthalmology, observed that most young ophthalmologists prefer medium to large practices with multiple subspecialists and a path to partnership. She noted a small resurgence of interest in ownership among younger physicians, but the dominant preference is for employed positions with institutional support.

The solo practitioner who built a practice from nothing in 1985 and is now ready to retire at 65 is looking for someone to take over. The ophthalmologist finishing fellowship in 2026 is looking for a salary, benefits, malpractice coverage, and a group that handles billing. Those two people are not looking for each other.

The Debt Makes Ownership Impossible Without Help

The average medical school debt for the Class of 2025 is $223,130 according to the AAMC, with 70% of graduates carrying education debt. Public medical school graduates average $210,147 while private school graduates average $244,964. Federal student loan interest rates for 2025 to 2026 hit 7.94% for Direct Unsubsidized loans and 8.94% for PLUS loans.

The median four year cost of attendance for the Class of 2026 is $297,745 at public institutions and $408,150 at private ones. And here's the number that explains the pipeline problem better than anything else: 57.6% of 2025 graduates intend to pursue federal student loan forgiveness. That program typically requires employment at a qualifying nonprofit or government employer for 10 years. It does not cover private practice ownership. The financial incentive structure actively pushes new physicians away from ownership and toward institutional employment.

A newly trained ophthalmologist carrying $250,000 in student debt at 8% interest is not going to sign a lease, buy an OCT machine for $50,000 to $100,000, purchase a slit lamp, fund a pharmaceutical inventory, hire staff, and wait 6 to 12 months for the practice to generate positive cash flow. The startup cost for a non-surgical ophthalmology practice runs $200,000 to $500,000. A full service clinic with surgical capabilities costs $1.5 million to $3.5 million.

The math doesn't work. Not because the economics of owning a practice are bad. They're excellent. The math doesn't work because the physician can't fund the gap between where they are financially at the end of training and where they need to be to acquire or start a practice.

Recruitment Takes Longer Than Anyone Expects

The 2025 AAPPR Benchmarking Report, covering 2024 data from 128 organizations and approximately 15,000 physician searches, found the median time to fill a physician position is 118 days. That's before credentialing, which 70% of organizations say takes 3 to 4 months and another 14% say takes 5 to 6 months. Total time from vacancy to a physician seeing patients is typically 6 months or more.

Physicians accepted only 71% of offers in 2024, down from 83% in 2023. Nearly half of all physician searches remained open at year end. Each month a physician vacancy persists costs $150,000 to $250,000 in lost revenue according to PracticeMatch.

For ophthalmology specifically, the challenge is compounded by the subspecialization trend. If you need a comprehensive ophthalmologist to take over a general practice, you're drawing from a pool that gets smaller every year. If you need a retina specialist or a cornea surgeon, the pool is even smaller and the competition for their time is fierce.

The Chicken and Egg Problem

This is the single biggest deal killer in ophthalmology practice transitions. A seller wants to find a buyer. The buyer says they need a successor physician before they can close. The broker or acquirer goes looking for a successor and the search takes 6 to 12 months. Meanwhile the seller is aging, the practice is losing revenue, and the window is closing.

One broker described the pattern exactly. He finds a buyer for a practice and the buyer says "we need a doctor first." So until they find a doctor, the transaction can't move forward. The practice sits. The seller waits. The patients start leaving for other providers because the physician is semi-retired and not taking new appointments.

The solution is to separate the acquisition from the physician placement. Acquire the non-clinical assets first, install the MSO, stabilize the practice with the existing physician during a transition period, and recruit the successor in parallel. By the time the successor arrives, the practice is already running under new management. The successor walks into an optimized operation with a patient base, staff, equipment, and revenue already in place.

That's the only model that breaks the chicken and egg cycle. It requires a company willing to operate the MSO before the successor is in place and the capital to fund the transition period. It's harder to execute than waiting for a physician to show up, but waiting for a physician to show up is how practices die on the vine.

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 practice owner thinking about succession or a physician exploring ownership, we're open to thoughtful conversations.

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