Webinar Examines Impact of Investors on Ophthalmology

Young ophthalmologists in Europe can look forward to a busy career, thanks in large part to an ageing populace. According to Eurostat, cataract surgery was performed 4.32 million times in the European Union in 2021, making it the most common surgical procedure in the consortium’s 27 countries.¹

The growth in cataract surgery and other procedures has been accompanied by a rising desire among private investors to include ophthalmology in their healthcare portfolios. To address some of the questions surrounding investor interest in ophthalmology, ESCRS hosted a webinar on 21 November titled “Who Owns Ophthalmology?” Moderated by Sheraz Daya and Artemis Matsou, the webinar explored how ophthalmologists can retain their independence while engaging with industry in a constructive and positive manner.

Daya, founder and medical director of the Centre for Sight in the UK, laid the groundwork for the webinar by positioning ophthalmology within the overall healthcare business environment. “The business of ophthalmology is ever changing,” he said. “What we want to discuss today are the options that are evolving. And that discussion principally starts with what do we, as ophthalmologists, want?”

Vincent Qin, a consulting surgeon in Belgium, followed with an overview of private investment and its impact on the work and careers of ophthalmologists. He cautioned that the interests of private investors and those of ophthalmologists are not always aligned.

“For private equity groups, profit is paramount,” he said. “They’re looking for a return on their investment, and their ultimate goal usually is to flip the practice within five years. So they’re not necessarily making business decisions with the same motivations as the physicians who are working in these practices.”

The motivations of ophthalmologists, Qin explained, can vary greatly, especially by age and career stage.

“The older ophthalmologists usually are pleased with the arrangements because they’re close to retirement and want an exit strategy,” he said. “But there is significant concern among younger ophthalmologists because they have 30 or 40 years to go, and now they find they might have less of a say in the control of their practice.”

A sense of control

Because of the profit-seeking nature of private investors, doctors in investor- owned ophthalmology practices can expect to perform more surgeries than their counterparts in public settings. In the UK, for example, the number of private clinic groups backed by private equity has grown exponentially. As a result, the number of cataract cases outsourced to the private sector has skyrocketed—as has the workload for surgeons.

“In the UK, the private sector has embraced a very high-efficiency, high-throughput model in their clinics where they only operate on outpatients,” said Victor Chua, an ophthalmologist and senior partner at Mansfield Advisors, a healthcare consulting firm. “They select surgeons who can perform 25 cataracts per day. You have to ask yourself, is that the kind of job I would like to have?”

Increasingly, young surgeons entering the workplace may answer that question in the negative.

“I think young people today have a healthier attitude towards life in general,” said Arthur Cummings, consultant eye surgeon at the Wellington Eye Clinic and consultant ophthalmologist at the Beacon Hospital in Dublin, Ireland.

“They want to be good family members and involved fathers and mothers. I think what may happen is they’ll say, ‘I’ll work in a public setting now or work for a big company as an employee, get some experience and develop my own my skill set, and when my kids don’t need all my time anymore, then maybe I’ll go out and do my own thing.’”

Ultimately, the deciding factor in whether ophthalmologists opt for private practice and seek investors is whether they can retain a sense of control and/or ownership over their work arrangements.

“We don’t want to lose our sense of control,” said Artemis Matsou, a consultant ophthalmic surgeon at Queen Victoria Hospital in East Grinstead, UK. “We’ve been training for many years, and we’ve reached the stage as young ophthalmologists where we are ready to go out there in the market, but we don’t want to lose our sense of autonomy, decision making, and choice. I think that scares a lot of young people.”

“To get new doctors you have to offer life-work balance,” said Joern Joergensen, chief executive of Denmark-based EuroEyes. “I think making them a partner is very crucial. You should not have employees; you should really try to make them partners.

“I think we have a model in EuroEyes where we can do that. When we are going to take over a practice, I don’t wish to intervene there. They have full autonomy. That way, we can talk doctor to doctor. It’s much, much easier than talking to a banker.”

1. “Cataract surgeries down 4% in 2021.” Eurostat, 12 September 2023.