Ophthalmology Practice Brokers vs. Investment Bankers
The ophthalmology M&A market has matured rapidly over the past eight years. What was once dominated by local buyers and small consolidators is now a core focus area for private equity sponsors, multispecialty platforms, and ASC-driven strategics. According to PitchBook’s Q3 2025 Healthcare Services Report, physician practice management transactions remain a central pillar of healthcare services deal activity, with ophthalmology specifically cited as a specialty attracting sustained sponsor interest despite broader market volatility.
As deal sizes grow and buyer sophistication increases, ophthalmology owners face a consequential choice when preparing for a transaction: working with a traditional practice broker or engaging a healthcare investment banker. While both models can result in a completed sale, they differ meaningfully in process design, buyer access, valuation outcomes, and execution risk.
What you’ll learn in this article:
How ophthalmology has evolved into an institutional M&A specialty attracting private equity and strategic buyers.
The key structural differences between ophthalmology practice brokers and healthcare investment bankers.
Why ophthalmology valuation varies widely by subspecialty, scale, and transaction type.
How representation affects buyers’ access and competitive tension in the sales process.
When a broker-led transaction may still be appropriate versus when banker-led execution is critical.
Market Context: Ophthalmology Is No Longer a “Small Deal” Specialty
Healthcare M&A activity has stabilized following the post-COVID correction. According to PitchBook, U.S. healthcare services deal volume in 2025 is tracking in line with late-2020 levels, with high-quality assets continuing to transact despite tighter capital markets.
Within that environment, ophthalmology stands out. Ophthalmology platforms, particularly those with retina exposure and ASC ownership, continue to command premium interest from institutional buyers. This evolution has raised the bar for how practices are evaluated, marketed, and diligenced.
Structural Differences Between Brokers and Investment Bankers
Practice brokers and investment bankers serve different segments of the transaction market, and their operating models reflect those differences.
Independent evidence reinforces this divide. Sellers rank managing the M&A process and transaction strategy as the single most valuable service provided by investment bankers. In contrast, “identifying and finding the buyer” ranked lowest among perceived value drivers, underscoring that outcomes are driven by how the process is run rather than how broadly an opportunity is listed (McDonald, 2016).
According to PitchBook’s Healthcare EBITDA Multiples: 2025 Dashboard, representation quality has a measurable impact on transaction outcomes, with professionally advised sellers achieving stronger pricing and terms on average.
| Core Differences in Transaction Approach | ||
|---|---|---|
| Dimension | Practice Broker | Investment Banker |
| Typical deal size | Small to lower middle market | Middle market to institutional |
| Buyer outreach | Often utilize public listings with limited buyer outreach | PE sponsors, platforms, strategics |
| Process structure | Unstructured (review offers passively) | Competitive, structured auction |
| Diligence preparation | Buyer-led | Sell-side readiness |
| Valuation framing | Asking price | Institutional benchmarks |
| Closing risk | Higher retrade exposure (often little or no front end preparation and diligence) | Lower retrade risk |
Ophthalmology Valuation Is Highly Segmented
One of the most common pitfalls in broker-led ophthalmology sales is treating the specialty as valuation-homogeneous. In reality, buyer underwriting varies significantly based on subspecialty mix, scale, and ancillary integration. The practice’s location and strategic fit with existing PE-backed groups can also have a major impact on valuation. Often, ophthalmology valuation ranges differ materially between platform and add-on transactions.
This misalignment often originates earlier in the sales process. Sellers consistently report that banker-led transactions produce stronger pricing discipline because valuation expectations are framed within a structured process rather than a static asking price. In fact, 84% of surveyed sellers achieved a final sale price that was equal to or higher than their advisor’s initial valuation estimate, reflecting the impact of disciplined execution and buyer positioning (McDonald, 2016).
| Ophthalmology Valuation Ranges (EV/EBITDA) | ||
|---|---|---|
| Transaction Type | Typical Multiple Range | Primary Value Drivers |
| Platform acquisition | 12–20× | ASC ownership, retina mix, scale |
| Add-on acquisition | 5–11× | Density, physician retention |
| Smaller independent practices | Below platform ranges | Limited buyer competition |
Actual pricing varies with each transaction based on many factors. Intended for educational purposes only and not a guarantee of any outcome.
Brokers often market practices using a simplified asking price that may not reflect these distinctions. Investment bankers instead position the asset relative to its fit within the institutional buyer landscape, ensuring it is evaluated against appropriate comparables.
Buyer Access Has Become Asymmetric
The buyer universe for ophthalmology has expanded, but access to that universe is not evenly distributed. Independent research shows that this asymmetry disproportionately disadvantages first-time sellers. Experienced advisors play a critical role in mitigating information imbalances and ensuring sellers are not negotiating against institutional buyers without adequate preparation or leverage (McDonald, 2016).
According to PitchBook’s Q2 2025 Healthcare Services PE Update, private equity sponsors remain selective, prioritizing assets with operational rigor, compliance infrastructure, and defensible earnings profiles. These buyers typically avoid very small transactions, so they may ignore broker listings; instead, they rely on banker-led processes and proprietary relationships.
| Buyer Universe by Representation Type | ||
|---|---|---|
| Buyer Category | Broker-Led Access | Banker-Led Access |
| Local physician buyers | High | High |
| Regional strategics | Moderate | High |
| PE-backed platforms | Limited | High |
| National PE sponsors | Rare | High |
| ASC-driven strategics | Limited | High |
This difference directly affects competitive tension. A limited buyer pool constrains price discovery, while broader outreach increases the probability of multiple bids and improved terms.
This distinction matters because the middle market remains structurally inefficient. Survey respondents emphasized that investment bankers help level the negotiating field between first-time sellers and highly experienced buyers by managing information flow, sequencing decisions, and controlling buyer leverage throughout the process (McDonald, 2016).
Process Discipline and Diligence Outcomes
Buyer diligence standards have tightened across healthcare services. According to Scope Research’s Healthcare M&A Review 2024, buyers have increased scrutiny around normalized EBITDA, physician compensation methodologies, and regulatory compliance across provider transactions.
Investment bankers typically prepare practices for this scrutiny in advance, coordinating financial normalization, documentation, and management messaging before engaging buyers. Broker-led processes more often shift diligence responsibility entirely to the buyer, increasing retrade risk and execution uncertainty.
Sellers repeatedly cited this preparation as a key reason they were able to remain focused on operating performance during the sale process. Professional management of diligence, buyer communication, and timelines reduced distraction and protected value during what many described as an otherwise disruptive period (McDonald, 2016).
In ophthalmology, where ASC ownership structures and retina concentration materially influence underwriting, inadequate preparation can translate into valuation leakage late in the process.
Representation Correlates With Valuation Outcomes
Our research highlights a consistent pattern: sellers represented by M&A advisors or investment banks achieved meaningfully higher multiples than unrepresented sellers.
This outcome reflects more than just pricing. Represented sellers also tend to achieve:
Higher certainty of close
Better protection against post-LOI retrades
More favorable non-economic terms
In specialties like ophthalmology, where institutional buyers weigh long-term physician alignment and integration risk, these factors can be as important as headline valuation.
When Brokers May Still Be Appropriate
Brokers continue to play a role in the market, particularly for smaller ophthalmology practices that aren’t a fit for private equity buyers. For owners prioritizing speed or simplicity over maximum value, broker-led transactions can still be effective.
However, as deal sizes increase and buyers become more institutional, the structural limitations of broker-only exposure become more pronounced.
The Current Market Rewards Sophisticated Execution
Despite macro uncertainty, premium healthcare assets continue to transact. According to PitchBook, valuation normalization has not diminished buyer appetite for high-quality physician platforms, particularly in specialties with durable demand, such as ophthalmology.
In this environment, the choice of representation is not simply a matter of convenience. It is a strategic decision that can directly influence valuation, buyer access, and execution risk.
For most owners, selling a healthcare practice is a once-in-a-lifetime transaction. Consistent with this reality, surveyed sellers overwhelmingly recommended hiring an investment banker to maximize value, reduce execution risk, and navigate transaction complexity with confidence, particularly in markets characterized by sophisticated buyers and opaque pricing dynamics (McDonald, 2016).
Learn More
FOCUS Investment Banking specializes in maximizing transaction value for healthcare practice owners through our proven quarterback approach to M&A advisory.
If you’d like to learn more about our healthcare investment banking services, you can reach out here.
