Eyeworld

14 June 2018 EW NEWS & OPINION by Eric Donnenfeld, MD, EyeWorld chief medical editor also wonder, why would an intelli- gent businessperson buy a practice for millions of dollars just to change it? Perhaps history will repeat itself from the 1990s when private prac- tice management companies tried— and failed—to consolidate ophthal- mology. However, there are major differences today. Consolidation will absolutely occur, and the private equity companies have expertise in running large medical groups. I pre- dict that while private equity is not for everyone, it will be successful for our group and many others. We live in a changing environment, and a quotation that is often attributed to Charles Darwin says it best: "It is not the strongest of the species that sur- vives, nor the most intelligent that survives. It is the one that is most adaptable to change." EW Contact information Donnenfeld: ericdonnenfeld@gmail.com pop hardware stores, food stores, and internal medicine practices had similar plans, but Home Depot, Costco, and hospitals have had alter- native ideas. The forces of insurance companies, hospitals, and the gov- ernment have changed the environ- ment in which we work. Internal medicine has all but abandoned private practice, and many hospi- tals have essentially moved from providing tertiary care to directly competing for primary care patients. With notable exceptions, it appears the era of the small ophthalmology practice is coming to an end and consolidation seems inevitable— certainly not this year but I predict in the next decade or so. I may be wrong, but I want to be proactive. I could work for a hospital, HMO, or insurance company and give up my autonomy and practice ownership, or I could grow large enough to be at the bargaining table myself. The cost of growing large enough is prohib- itive, which is why private equity was the best option for me. Chief medical editor's corner of the world R ecently there has been a great deal of interest in private equity and its involvement in ophthal- mology. So I begin this column with the same mantra I say to myself every morning upon awakening: "I love being an oph- thalmologist." With this as back- ground, some may ask why I would jeopardize the way I have practiced for more than 20 years by agreeing recently to partner with private eq- uity? The answer is: "I love being an ophthalmologist." The future of medicine is in transition and there are forces sur- rounding us that wish to dictate the way we practice. Private practice has always been good for patients and good for ophthalmologists. I enjoy the relationships with my patients, my partners, advanced technology, and the entrepreneurial spirit. All things considered, I would gratefully continue along the same course. I am certain that owners of mom and Thoughts on private equity Private equity brings to mind mercenaries or an exit strategy, neither of which appeal to me. Per- haps there is a loss of control, but that is replaced by sound business principles and a rational approach to growth and purchases. Decisions take more time because data is care- fully analyzed regularly rather than having the potential for spur of the moment individual choices. In our practice, private equity has also removed two major obsta- cles: We no longer have to buy out senior partners, and young ophthal- mologists have dramatically smaller buy-ins to become partners. I am hard pressed to recommend to any young ophthalmologist that invest- ing in a small practice is wise. Now, all of our partners, associates, and future partners will have the ability to own part of Spectrum Vision Partners. There is a misconception that private equity will significantly change the way we practice. This has not occurred to any measure. I

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