Who Owns Ophthalmology?

It says something of the quality and breadth of the discussions and seminars on offer at September’s ESCRS 2023 in Vienna that my interest was piqued by a session ahead of the main event itself. Alongside the pre-congress Cornea and Glaucoma Days on September 7 was a debate titled “Who Owns Ophthalmology?” – surely a crucial question in any stakeholder’s book.

With a growth in recent years in private equity (PE) firms entering the ophthalmology space, particularly in Europe, there has been a huge increase in cataract surgeries. Victor Chua, Senior Partner at Mansfield Advisors, illustrated that, by 2027, much of western Europe will see a rise of 26–30 percent in cataract surgeries, compared with 2019. In England, chiefly as a result of PE investment, ophthalmology is the only speciality that is back to pre-pandemic levels. In this respect, England is outperforming Europe – and it’s rare, and quite refreshing, Chua noted, to see England or the UK at the top of any European ranking these days… Outsourced providers “have lower complication rates” than the NHS, he added – this is credited to “surgeon selection.”

But here’s the rub. Private providers in England and Wales are not obliged to train surgeons – “they get a bit of a free pass at the moment,” admitted Chua. And the love affair with PE may not be all it is cracked up to be. The Ophthalmologist Power Lister Guy Kezirian – President of SurgeonVision Consultants and, among other roles, President of Physician CEO – was on hand to rain on the PE parade. Based in the US, where the private model is far more advanced, he noted, “Private equity failures in ophthalmology recur about every 10 years – three times in my career!” The current high interest rates are going to see lots of PE companies fail, he added.

Rather than private equity, Kezirian advocates for the concept of physician equity – a private ownership model that is similar to PE but owned by the physicians. In PE, he explained, the doctors are working for the managers; with physician equity, “the managers are working for the doctors.” Of course, success with this model requires business-savvy physicians – perhaps those who have had some formal business training – but the results are “ownership, financial benefits, and control.” And, as much as anything, the physician has a relationship with the patient that “managers” don’t.

Ultimately, of course, ophthalmology couldn’t exist without the physician, said Kezirian – “so the physician should have ownership.”

What do you think? Is physician equity the answer? Or should we rely on improvements to the private model? Drop me a line at [email protected]

Julian Upton
Group Editor