Most employed ophthalmologists think ownership means burning everything down. Quitting your job, taking on massive personal debt, finding a lease, hiring staff from scratch, buying equipment, building a patient base from nothing, and praying it all works out before the savings account hits zero. That version of ownership is terrifying, and it's the reason most employed surgeons never try even though a lot of them think about it constantly.
But that version is also a myth. There's another way to do this that almost nobody talks about, and once you see it, you can't unsee it.
How Ophthalmology Practice Ownership Works While You're Still Employed
In most US states, there's no law that says a physician who owns a professional corporation has to be the one performing every procedure inside it. A surgeon can own a PC, hire a W-2 or 1099 ophthalmologist to cover clinical days they can't be there, set the clinical standards and protocols, and collect revenue from every patient seen under their entity. The owner doesn't have to be physically present every single day. They have to be responsible for the clinical direction, make sure the quality standards are being met, and maintain oversight. That's ownership. And it can happen while you're still employed somewhere else.
What this means practically is that a surgeon currently working four days a week at one practice could own a separate practice that operates on the days they're not there. They come in on their day off, do surgery, go home, and another physician covers the rest of the week. The employed surgeon owns the entity, sets the standards, captures the revenue, and keeps their day job and their income stream until they're ready to transition fully, without any dramatic resignation, any gap in paychecks, or any bridges burned.
In ophthalmology, this works especially well because refractive surgery is cash-pay, appointment-based, and doesn't require the surgeon to be on call for emergencies around the clock. A surgeon could realistically operate one day a week at their own refractive center and generate meaningful revenue without disrupting anything at their primary employer.
The Math on One Day a Week of Ophthalmology Ownership
And the math works at surprisingly low volume. At 20 bilateral LASIK procedures per month, charging the national average of $2,250 per eye, that's $90,000 in monthly revenue and roughly $1.08 million annually. After equipment costs, staff, rent, and supplies, the owner keeps 35 to 40% net margins, which translates to $375,000 to $430,000 in annual profit from a single day of surgery per week.
Think about what that means compared to the standard PE employment model. A surgeon doing cataracts five days a week on a 33% net collections model generating $1.5 million takes home about $500,000. So one day a week of ownership-based refractive surgery produces nearly the same income as four days of employed cataract work. And the ownership asset itself appreciates over time in a way that PE retention equity never does for the physician. An independent ophthalmology practice with $1 million in EBITDA is valued at 5 to 11x under current market benchmarks, meaning the practice the surgeon built could eventually be worth $5 to $11 million. That equity belongs to the surgeon forever. Nobody resets the vesting clock, nobody forces a re-roll into the next buyer's platform, and nobody takes it away if you decide to leave.
How to Navigate Your PE Employment Agreement
The question most employed surgeons ask first is whether their current employment agreement allows it. That's the right question, and the answer depends entirely on how the contract is written. Many PE contracts include exclusivity clauses that prohibit outside professional services, but almost all of them have carve-outs for investments, charitable work, and non-patient-care business activities that only require employer consent. Pure investment in a PC where you don't personally render patient services may not trigger the exclusivity clause at all, depending on the specific language.
The smart move is to have a healthcare attorney review the exact wording in your agreement, identify which carve-outs apply to your situation, and determine what's allowed today versus what requires a conversation with your employer. Some contracts are more restrictive than others. Some PE groups will approve outside activity if it doesn't compete geographically or affect your productivity at their facilities. Some will say no to everything. And knowing which situation you're in before you take any action is the difference between building quietly and blowing up your career prematurely.
The 12-Month Runway That Changes Everything
But even if the answer is no today, vesting schedules eventually end and contracts expire. A surgeon who starts planning ownership 12 months before their agreement allows it can spend that year learning the equipment, meeting the staff, understanding the patient flow, and building relationships with referring doctors in the new market. When the restrictions finally lift, that surgeon walks into their own practice on day one fully prepared instead of starting from scratch with nothing in place.
The employed surgeons we've seen make this transition successfully weren't the ones who woke up one morning and made a dramatic leap. They were the ones who spent months quietly doing the groundwork so that when the window opened, everything was ready and they just stepped through it. Ownership doesn't require a resignation letter to get started. It requires a plan and enough patience to execute it before the window opens.
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
