Here's a number worth sitting with. In 2024, for the first time in the recorded history of American medicine, fewer than half of physicians worked in practices of ten or fewer doctors. The figure was 47.4%, down from 61.4% in 2012, according to the American Medical Association's Physician Practice Benchmark Survey. Go back to the early 1980s and roughly 4 out of 5 physicians worked in small practices like that. So the world most young ophthalmologists were trained inside, the one where the obvious move is to join a large group and collect a salary, is about one decade old. It feels permanent because it's the only arrangement you've ever seen. It isn't permanent. It was built recently, for specific reasons, and what gets built recently can be unbuilt.

That distinction carries more weight than it first appears, because the entire emotional force of the "just take the employed job" advice rests on an unstated premise: that employment is the natural state of medicine and ownership is the exotic, risky exception. The data says the reverse. Ownership was the norm for the better part of a century. The shift toward large-group employment is a recent event with a traceable timeline and clear causes. You weren't born into a world where doctors don't own things. You were moved into one, and the move happened inside your professional lifetime.

What Actually Changed, and What Did Not

The AMA's own analysis ties the shift to a handful of pressures, and it's worth being precise about them because the precision is what dissolves the fear. Reimbursement rates stayed flat or fell in real terms while the cost of running a practice climbed every year. Administrative and regulatory burden grew to the point where a solo physician needed paid staff simply to handle billing and compliance. Electronic health record mandates added fixed cost that a small office absorbs far less efficiently than a bigger one. And large employers, hospitals first and then private equity platforms, arrived with capital and a pitch built around lifting all of that off the physician's shoulders in exchange for the physician's autonomy.

Read that list again and notice what's on it and what's not. Every item is about the difficulty of running a practice the old way, alone, carrying every operational cost personally. Not one item is about ownership being a bad idea. The forces that thinned out independent practice were forces acting on a particular structure for ownership, the solo doctor doing everything themselves, and that structure genuinely did get harder to sustain. But "this specific structure became hard" is a completely different statement from "ownership stopped working," and the conditioning you absorbed quietly swapped the second statement in for the first. The structure broke. Ownership did not. Those aren't the same sentence, and the gap between them is where your options actually live.

Ophthalmology Is the Exception, Not the Rule

There's a second number that should change how you read the first one. Across all of medicine, independent practice has fallen hard. In ophthalmology, it has held. Reporting from Becker's drawing on AMA and specialty data places ophthalmology among the specialties with the highest remaining rates of physician ownership, with roughly 70% of ophthalmologists still owning their practices rather than working as employees of someone else.

Sit with what that means in practical terms. The conditioning that pushed most of American medicine into employment didn't fully land in your specialty. Ophthalmology still runs on owners. The generation that owns those practices is aging, with a large share already over the age of 55 and moving toward retirement, which the rest of this series examines in detail. Somebody is going to own what that generation leaves behind. The realistic choices are narrow: another consolidator absorbs it, or a physician steps into a practice that's already built, already staffed, and already carrying a patient base. In ophthalmology the door to ownership is open in a way it simply isn't in specialties where employment already became the unquestioned default. You happen to practice in one of the corners of medicine where the historical norm never fully died.

Why You Were Taught the Opposite

If ownership was the norm for a century and still dominates your specialty, why did every signal you received in training point toward taking a salary? Because the institutions sending the signal benefit from it. A hospital that employs you captures the margin on everything you produce. A private equity platform that employs you captures the spread between what you generate and what it pays you. Neither has any reason to mention that ownership is available, achievable, and historically ordinary. The silence isn't an oversight and it isn't neutral. It's the predictable output of who was doing the talking and what they had to gain.

This is the part that deserves to be said without softening, because young ophthalmologists so often carry a private sense that not pursuing ownership reflected some personal shortfall, a lack of nerve or a lack of business sense. It did not. You made a reasonable decision inside an information environment that was shaped, deliberately, by parties who profit when you remain an employee. A reasonable decision built on incomplete information isn't a character flaw. It's exactly the outcome the conditioning was designed to produce, and noticing the design is the first step out of it.

A Concrete Picture

Consider a specific case to make this real. A comprehensive ophthalmologist finishes fellowship, joins a large employed group at a salary in the low $400,000s, and spends a decade there. Over that decade the group bills, collects, and retains the surplus that the physician's clinical work produces above their salary. The physician is told, repeatedly and by people they respect, that this is the stable and sensible arrangement. At no point in that decade does anyone whose income depends on the physician staying employed sit them down and explain that the practice down the road, owned by a 63-year-old approaching retirement with no successor, will need a new owner within a few years, and that owning it is achievable without a $1 million loan when someone else carries the operational burden.

That conversation doesn't happen, not because it's untrue, but because nobody in the physician's professional orbit has an incentive to start it. The 47% number is the aggregate of 10,000 versions of that decade, repeated across the profession, until employment came to feel like gravity rather than a choice someone arranged.

What This Changes for You

The practical takeaway isn't that you should've done something differently. It's that the frame you were handed is factually wrong, and once that's visible, the fear attached to it loosens its grip. Employment got sold to you as the safe, natural, only-sensible path. What it actually is, is a recent arrangement that benefits your employer, sitting on top of a profession that owned itself for a hundred years and, in ophthalmology specifically, still mostly does.

Verdira was built to occupy precisely that gap. The model lets a physician own the clinical practice, the professional corporation carrying their name and their license, without taking on the debt or the solo operational weight that drove independent practice down across the rest of medicine. The management company carries billing, hiring, compliance, and the administrative load that made the old path so heavy to walk alone. Ownership stays with the physician. It amounts, in a real sense, to a return to the historical norm with the part that actually broke engineered out. Read the 47% figure as what it is, a measurement of how recently the ground moved. Ground that moved this recently can be walked back, and in your specialty most of it never moved at all.

This article is for general educational purposes and isn't financial advice.

Verdira is a healthcare acquisition platform focused on ophthalmology practices. Physician ownership. Transparent structure. No volume quotas. If you're a physician exploring ownership, we're open to thoughtful conversations. Contact info@verdira.com | 307-381-3734 | verdira.com Images are AI-generated illustrations and do not depict actual Verdira practices, physicians, or patients.