By 2035, ophthalmology is projected to have the second-worst workforce adequacy of 38 medical and surgical specialties studied, at roughly 70%. Only thoracic surgery ranks lower, at about 69%. The projection comes from the federal Health Resources and Services Administration workforce model, analyzed by Berkowitz and colleagues in the journal Ophthalmology and summarized by the American Academy of Ophthalmology. The underlying movement is a supply of ophthalmologists projected to fall about 12% while demand rises about 24% between 2020 and 2035. A 70% adequacy figure means the specialty is projected to meet only about 70% of the demand for its services.

That's a shortage, and shortages tend to get discussed as a public health problem, which they genuinely are. But for a physician deciding whether to own, the same number carries a second meaning that's almost never said out loud. In a market where the service is scarce, the person who can provide it holds the leverage. Far from a replaceable input in an oversupplied field competing for scraps, you're projected to be one of the scarcest assets in all of American medicine, and scarcity, in every market that's ever existed, accrues value to whoever holds the scarce thing.

The Fear This Removes

The fear here runs quieter than the others in this series, but it sits deep. It's the worry that there are plenty of ophthalmologists already, that the field is crowded, that an owner could build a practice and then struggle to fill a schedule or compete against the group down the street. Underneath the practical worry sits something more corrosive, a sense of replaceability, the half-conscious belief that an employer is doing the physician a favor by providing a seat, rather than the other way around. That belief shapes how a physician negotiates, how they value their own work, and whether they ever imagine owning rather than being owned.

The workforce data dismantles the belief at its foundation. A specialty heading toward 70% adequacy is short and getting shorter, the opposite of crowded. The demand is present and growing, driven by an aging population that needs more eye care every single year, while the supply of physicians available to meet it shrinks. In that market the doctor is the one holding the scarce thing, and the market is the party that needs them, rather than the reverse. That reversal goes beyond a flattering reframe. It's the literal, mechanical meaning of a supply-and-demand imbalance of the projected size.

Why the Supply Is Falling and Will Keep Falling

The supply side of the projection deserves a close look, because its durability is what makes the leverage real rather than fleeting. The ophthalmology workforce is aging, with a large share of practicing ophthalmologists already over the age of 55 and moving steadily toward retirement. The number of new ophthalmologists trained each year is constrained hard by the number of available residency positions, which hasn't expanded anywhere near fast enough to replace the retiring generation, let alone to meet demand that's climbing at the same time. The decline in supply is baked into the demographics of who's in the field right now and how few are entering relative to how many are walking out, which is what makes it a structural reality rather than a soft forecast a good year might reverse.

That structural quality is the part that matters most for an owner, because it means the scarcity is durable rather than cyclical. A larger residency class two or three years out won't correct it, since the training pipeline physically can't expand quickly and the retirement wave is already underway and accelerating. A physician who establishes ownership in this environment is planting it in a market where their scarcity, and the leverage that flows from it, is projected to persist for the better part of a decade and very likely well beyond. The timing advantage compounds over years rather than expiring next season.

What Leverage Actually Looks Like in a Practice

Leverage is an abstract word, so it's worth grounding it in what a physician would actually experience. In a short market, a physician owner sets terms rather than accepting them. The owner decides the clinical standards, the schedule, the pace of the day, and the strategic direction of the practice, because the scarce resource, the ophthalmologist, is the one input the practice can't function without and can't easily replace. An employed physician in the very same market hands all of that leverage to their employer in exchange for a salary, allowing the employer to capture the value that the physician's scarcity creates and to make the decisions that the physician could be making themselves.

The shortage, in other words, is a windfall, and the only open question is who captures it. If the practice is owned by a private equity platform or a hospital, the value of your scarcity accrues to them, quarter after quarter, while you draw a salary that bears no necessary relationship to the value you generate in a market this starved. If the practice is owned by you, the windfall accrues to you. The 70% figure is, among other things, a measurement of how much value is sitting on the table in this specialty, and a prompt to ask the only question that really matters: who's going to walk away with it.

A Concrete Scenario

Picture two ophthalmologists in the same mid-sized market in 2030, both excellent, both busy. One is employed by a regional group at a salary in the low $400,000s. The other owns an established practice, having stepped into it when the prior owner retired, with the acquisition funded so they took on no debt. The market is short on ophthalmologists, so both have full schedules and waiting lists. The difference is entirely in who captures the value of that full schedule. The employed physician generates a surplus the group keeps. The owner keeps the surplus their own scarcity and skill produce. Same clinical work, same waiting list, same market shortage working in their favor. One of them is monetizing the shortage for themselves. The other is monetizing it for an employer, and was very likely taught to believe that was the safe and sensible arrangement.

The Practical Conclusion

A physician on the fence about ownership usually frames the question as whether it's safe to own, whether the demand will hold, whether they can compete. The workforce projection answers all three at once and in the same direction. The demand is projected to outstrip supply by a wide and durable margin for years. The competition is shrinking rather than growing, as the field fails to replace its retiring members. And the scarcity that results is precisely the condition under which ownership pays the most, because the value of being an indispensable provider in a short market flows, by the basic logic of scarcity, to whoever owns the practice.

Verdira's model is built to put that ownership, and the leverage that comes with it, into the physician's hands, with the practice acquisition funded so there's no debt and the operational burden carried so the physician can focus entirely on the clinical work the market is starved for. The 2035 math will mostly get reported as a reason for the field to despair. For a physician deciding whether to own, it reads as one of the strongest arguments available that the timing is squarely on their side, and that the window to act on it's open now.

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.