Though the broader healthcare landscape has seen a marked decline in physician independence over the past decade—with only 42.2% of US physicians practicing privately in 2024, down from 60% in 2012—ophthalmology has maintained a stronger foothold in autonomy, with 70.4% of ophthalmologists still in private practice.1,2
Keeping a thriving population of ophthalmologists in private practice is increasingly important when you consider the predicted supply-demand imbalance. According to projections, from 2020 to 2035, the supply of full-time equivalent (FTE) ophthalmologists is expected to decline by 12%, while demand will surge by 24%.3
This over 30% mismatch will disproportionately impact rural communities, where workforce adequacy is projected to fall to a mere 29% compared to 77% in metropolitan areas.3
By 2035, ophthalmology is forecasted to have the second-lowest workforce adequacy of the 38 medical and surgical specialties analyzed, posing both a challenge and a significant opportunity for ophthalmologists considering private practice ownership.3
Barriers to opening a private ophthalmology practice
Undoubtedly, opening an ophthalmology practice in 2025 comes with a unique set of financial and operational hurdles.
Among the overarching challenges are:4,5
- High startup and operating costs
- Declining Medicare and insurance reimbursements
- Regulatory pressure with MIPS reporting and HIPAA compliance
- Prior authorization hurdles
- Inadequate business training
- Competition with private equity (PE) and hospital systems
To the last bullet, the specialty of ophthalmology has become a magnet for PE investment. Between 2012 and 2021, at least 245 ophthalmology practices were acquired by PE firms.2 Factors, such as the inevitable rise in age-related eye diseases and the uptrend of cash-pay procedures, make ophthalmology an attractive sector for investors.
Despite these obstacles and the competitive environment that new practice owners must carefully navigate, there are still a multitude of rewards. Interestingly, in a 2021 survey from the American Academy of Ophthalmology (AAO), ophthalmologists in solo practice reported the lowest incidence of burnout.5
In this article, three leading ophthalmologists share their top tips on opening an ophthalmology practice today.
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Opening an Ophthalmology Practice Checklist
Use this cheat sheet with checklists and itemized budget/equipment lists to facilitate the process of opening your own ophthalmology practice.
David Almeida, MD, MBA, PhD, serves as the president and CEO of Erie Retina Research in Erie, Pennsylvania.
Start with strategic planning.
A well-structured plan not only helps in securing funding but also in staying focused during the initial challenging months. Therefore, begin with a solid business plan that outlines your goals, budget, and timeline.
This will be your roadmap and should include financial projections, funding options, and a clear understanding of your practice type (solo or partnership).
Build the right team.
Remember, your staff will be the backbone of your practice! Therefore, take the time to hire individuals who align with your practice’s values and culture.
Focus on essential roles like a skilled receptionist, an experienced technician, a reliable office manager, etc. A well-chosen team will not only enhance patient experience but also ensure smooth daily operations
Invest in technology.
In today’s healthcare environment, integrating the right electronic health record (EHR) and staying up-to-date with the latest ophthalmic equipment are crucial. These investments, though initially significant, will streamline your practice, improve patient care, and ultimately pay off by reducing inefficiencies and enhancing overall productivity.
Shanika Esparaz, MD, is the founder and owner of Envision Ophthalmology & Wellness in Mayfield, Ohio.
Consider refurbished equipment.
When starting a practice from scratch, your biggest upfront expense will likely be equipment. I highly recommend considering refurbished equipment from reliable redistributors.
This option is often half the cost of new equipment and works just as well. For instance, a used slit lamp might cost between $6,000 and $8,000, compared to over $15,000 for a new one. The savings can be substantial.
Don’t underestimate the power of marketing.
Building your brand and referral base is crucial to the success of your new practice. Learning some basic marketing skills will help you manage costs, as professional marketing services can be expensive. Consider working with a company to develop your brand, logo, colors, business cards, and website.
You might also want help setting up your social media accounts—social media is an excellent, free tool for marketing! Leverage your existing networks and focus on daily posts to showcase your brand and vision. These posts don’t need to be long or complex—just enough to give a glimpse of what your practice.
To learn how to optimize your Instagram account for engagement, check out Instagram for Eyecare: How to Use the Fixed Grid System with Downloadable Guide!
Bennett Walton, MD, MBA, is the founder and owner of Bennett Walton Vision in Bellaire, Texas.
Seek professional guidance.
We've all had very intelligent patients come in with entirely wrong opinions about the eye, since they're not experts specifically in the eye. Often, they are quite confident, despite being wrong. Similarly, make sure to find true expert advice specific to your situation through attorneys, accountants, and other professionals.
A healthcare attorney may be the best person for patient care issues, but you may need a separate attorney to advise you on tax issues alongside your accountant as you form your legal entity, and you may need another attorney still for your employment law concerns.
For example, I was tempted to save a couple of thousand dollars by adopting an employee handbook from a friend's practice, but in doing so, I would have unknowingly weighed down our small practice with unnecessary requirements and liability in two ways:
- First, some issues and requirements are nationwide concerns, while others are state-specific.
- Second, the requirements of a company change very specifically as a business hits a certain number of employees.
Had I simply adopted a handbook, I would have likely accepted unnecessary liability in some aspects and come up short of state-specific compliance in other areas.
In conclusion
Embarking on the journey to open your own ophthalmology practice requires careful planning, strategic investment, intentional staffing, and dedication to delivering the highest level of care while still remaining independent.
Leveraging the resources and insights above can position your practice for long-term success in the evolving eyecare landscape.
