Private Equity: An Insider’s Perspective

This article shares my experience working in an optometry setting owned by a private equity company. The views expressed here are my personal opinions and not a sponsored endorsement for private equity. As an entrepreneur, I believe private equity—with its accessibility, adaptability, and disruptive ingenuity—has been an American dream come true for the eye care industry.

REMAIN OPEN TO NEW IDEAS AND TECHNOLOGIES

During my extern year of optometry school, I practiced optometry at the Veterans Affairs hospital in Norfolk, Virginia; a private practice in Englewood, Ohio; and the OneSight vision center at an Oyler School–based clinic for the city of Cincinnati’s public schools. (The fourth year is called an extern year at The Ohio State University. Sorry, non-Buckeyes, but I have to represent.) All of these practices were up-to-date with technologies and clinical practices. They showcased the value of medical optometry and exemplified how I would practice after graduation. While working alongside doctors of various tenures, I realized that what set them apart from others was their eagerness to learn new techniques in order to better serve and care for their patients. I follow their model to stay current and flexible in my practice by adopting new and improved technologies.

The challenge was that new instruments, which I like to call toys, are shiny and usually expensive. Like many of my peers who attended the private practice club at the College of Optometry, I had a goal to open my own practice. I was not yet ready, however, to buy a practice, let alone to furnish it with new instrumentation.

I assumed that retail optometry was not up to my style, and private practice seemed untouchable, a place for the elites of our field. I began to consider alternatives. Thanks to my student loan obligation and words of wisdom from one of my mentors, Mark Wright, OD, at The Ohio State University, I considered practicing in Cincinnati. Around this time, I came across an advertisement from Thoma & Sutton Eyecare and scheduled an interview at one of their local offices. I met my soon-to-be medical director for the region, who was friendly and shared my passion for medical optometry, specialty contact lenses, and ocular disease management.

Clarkson Eyecare had recently purchased Thoma & Sutton Eyecare. They were changing the mission of this practice, which created an opportunity for me to help them transition to medical optometry while growing the established specialized contact lens and retail portfolio. I would be the primary doctor in my own office. The independence and chance to practice full scope were upsides to this equation. Toys are required for a full scope of practice, and once it was mentioned that technology would be bought by private equity with no investment from the doctor, I was highly interested. The main downside was that I would not be a private practitioner; I would be an employee. Would accepting this job take me away from my goals? Would it satisfy my entrepreneurial spirit?

ADAPT TO NEW SITUATIONS AND OPPORTUNITIES

I think that everyone who attends optometry school chooses to become an entrepreneur by investing in one of their greatest assets—their mind. While training, I was concerned about the field’s longevity and the threats from online companies. They were going after contact lens sales, which have been optometrists’ bread and butter.

Despite this uncertainty and having to repeat my second year of optometry school, I persevered and attained my degree. The experience taught me how to better use resources to succeed. Now, after a couple of years of practice, I realize that working for a private equity company has enabled me to adapt to market forces and demands.

The fluidity of private equity and its openness to input have been empowering. I have had the privilege to learn from board members, medical directors, district managers, operations managers, regional managers, office managers, lab managers, and many other colleagues at Clarkson Eyecare. Open communication has provided support and allowed me to nurture my entrepreneurial spirit.

After discussing my professional goals for treating dry eye disease with my doctor colleagues, my medical director assisted me in developing a business model to get the LipiScan Dynamic Meibomian Imager and LipiFlow Thermal Pulsation System (both from Johnson & Johnson Vision). After delivering a presentation to our corporate team, I received approval to acquire the units and was able to begin offering these technologies to our patients. Later, we used the same method to purchase a topographer for another office to pursue myopia control. The items on our wish list don’t always get approved, but learning how to raise capital and plan the purchase of equipment has been invaluable to me.

CONTINUE GROWING THROUGH DISRUPTIVE INGENUITY

For me, the allure of private equity is growth, and that requires ingenuity. As an example, in my office, we are averaging 80% to 85% prescribed daily replacement contact lenses per quarter—a strong feat, yet I could not shake my patients’ concerns about the environmental cost of this modality. Through my connection with our local Bausch + Lomb rep, with support from her company and my medical director, we have begun to participate in the company’s One by One program to recycle contact lenses. This disruptive model has been a plus for my practice.

Disruption can carry negative connotations, but it was disruption that convened the La Guardia Conference in 1970 to discuss giving optometry the right to start dilating patients’ pupils.¹ Eye care backed by private equity gives optometrists a voice in the growth of our field.

Author's note: These are extraordinary times, and it would be insensitive not to acknowledge the tolls that coronavirus has had on our world. It has been humbling to see patients and staff come together and the elevation of the doctor-patient relationship in patients’ eyes. Thank you to all the medical and nonmedical personnel for the sacrifices you are making to serve on our front lines. I am forever grateful.