The acquisition of ophthalmology practices by private equity is increasingly being seen in the United States. Although this practice is not yet so common in Europe, there are a rising number of corporate ophthalmology practices in several countries, the United Kingdom included. I work in one such corporate practice, Optegra Eye Hospitals.
Most ophthalmologists in the United Kingdom spend a large proportion of their time working in the public sector for the UK National Health Service (NHS). Should they wish to, they also have the opportunity to devote time outside of their NHS hours to seeing private patients, who either are insured or pay out of pocket for treatment.
AT A GLANCE
- Most ophthalmologists in the United Kingdom spend a large proportion of their time working in the public sector, but they also have the opportunity to see private patients.
- For new practitioners, the process of starting and growing their own private practice may seem daunting.
- In the United Kingdom, multispecialty private hospitals are more common than corporate ophthalmology practices; however, the latter is a growing segment.
For new practitioners, after having spent many years training and developing their clinical and surgical skills, the process of starting and growing their own private practice may seem daunting. Most new surgeons will not have been taught the diverse aspects involved in starting a private practice, such as establishing a patient base and managing the potential financial, technical, and administrative challenges that may follow.
It is therefore not surprising that there exists among new practitioners an increasing preference to join an established hospital that provides private health care, whether a corporate practice that focuses solely on the delivery of eye care, such as Optegra, or a multispecialty private (MSP) hospital in which consulting rooms, operating rooms, and administration are shared with other medical and surgical specialties.
IDENTIFYING THE REASONS
In the United Kingdom, it is uncommon for an ophthalmologist to practice solely independently, leasing or purchasing his or her own facilities and equipment. The initial financial investment and ongoing demands on the ophthalmologist’s time are barriers to doing so, and other more easily achieved alternatives are available. Currently, because of the specific way that health care is delivered in the United Kingdom, MSP hospitals are more common than corporate ophthalmology practices. However, the latter represent a growing segment of the health care delivery market here. Herein I present five reasons why a new practitioner might consider partnering with a corporate ophthalmology provider.
Convenience. For many new practitioners, it may be easier to join and begin working within a corporate ophthalmology setting than an MSP hospital. The corporate ophthalmology system and processes are entirely dedicated to the delivery of eye care, and all members of the team are attuned to this. There are multiple examination rooms available at the corporate facility, enabling several ophthalmologists to see patients on any given day.
In an MSP hospital, by contrast, there is often only one room available for the ophthalmologist to see patients at any given time. It is not uncommon, therefore, for ophthalmologists’ work schedules to clash, meaning that one may not be able to see patients when he or she wants. The unlucky ophthalmologist will have to wait for the colleague to finish or try to find another day or time to see patients at the MSP hospital.
Further, the technology of ophthalmology is continually evolving, and a corporate ophthalmology setting may be better positioned to confront changes and invest in new technologies. MSP hospitals may not want to immediately invest in a new technology for ophthalmology due to competing demands from other surgical and medical specialties. Eye-specific diagnostic devices will also be more readily available in a corporate ophthalmology practice, and trained assistants who are familiar with the use of these technologies will be on hand to support the practitioner in delivering high-quality eye care.
Support. Some MSPs provide only room facilities with limited administrative support, whereas others may help practitioners to manage their bookings, billings, and administration. A corporate ophthalmology provider is likely to offer a more comprehensive support setting, assisting with the administrative and nonmedical functions of running a practice. This assistance may include help with billing and collections, managing office space and health records (paper or electronic), and aiding in medical compliance and oversight. This allows the ophthalmologist to use his or her time primarily to focus on providing medical services. The advantages of this type of support will vary depending on how much the practitioner wants the organization to be engaged and involved in his or her own practice.
Marketing. A corporate practice will already have a brand and position in the market that the new practitioner can immediately tie into. This established reputation theoretically provides the practitioner with greater access to more patients than a new surgeon would otherwise have. Patients searching the internet for an ophthalmologist or for advice on an eye issue will often come across the corporate group’s website first and make contact that way, rather than finding the new practitioner directly. This will be the case until the practitioner’s reputation becomes more established, and patients will then hopefully make contact to specifically see him or her.
Being part of a dedicated corporate ophthalmology provider holds potential marketing advantages over working for an MSP hospital. There is no need to share resources with orthopedics, otolaryngology, and general surgery, and there is no competition with those other specialties regarding marketing budgets and time; the corporate practice is positioned to market and promote only the ophthalmologists and their services.
Access. Ophthalmologists working at MSP hospitals compete with other subspecialties for resources such as operating room availability. Until practitioners have been at the MSP practice long enough to be granted regular access to the operating room, they may find themselves having to compete with orthopedic and other surgical colleagues for space and time to operate on their patients. It can be frustrating having to negotiate with the operating room manager for time to book patients for cataract surgery.
There is also the potential risk of less efficient workflow if the surgical team must transition, for example, from orthopedic to ophthalmic surgery. Additionally, in an MSP hospital, the nursing assistants and other operating room personnel may not be familiar with the equipment that the ophthalmic practitioner needs and uses. In a strictly ophthalmic corporate setting, that is rarely the case.
Collegiality and coverage. When you work in a group with other ophthalmologists, it is more likely that a colleague will be able to cover for you if an emergency arises or if an unexpected change in schedule occurs at the last minute. This is less likely when you work in an MSP hospital, as you may be the sole ophthalmologist on duty on a given day. If you have an unavoidable absence, patients may become frustrated if they cannot be seen by an ophthalmologist in a timely manner.
Having colleagues on board can also be advantageous when a same-day opinion from a colleague is needed for a complex cornea, glaucoma, or retinal issue. By the same token, practitioners in a large ophthalmology group may be able to tailor their practice and focus on their subspecialist interests, receiving referrals for retina, cornea, or glaucoma cases, or referring cases outside their area of expertise to other colleagues within the practice.
As the landscape of ophthalmology practice continues to evolve, both new and seasoned ophthalmologists will experience challenges in how they choose to manage their patients and their practices, and these challenges may also change over time. There is no one-size-fits-all practice model. Luckily, numerous options are available, and there are opportunities to find a working environment that best reflects how each ophthalmologist wishes to practice.