Pros and Cons

Recent graduates and even experienced ophthalmologists searching for their next career move will be asking themselves, “Do I target a small or a large practice?” Spoiler alert: There’s no right or wrong answer.

As you might have guessed, there are pros and cons to consider when determining which career path is best for you. Large, multispecialty practices may provide opportunities and resources a smaller group practice simply cannot. But those small practices could provide autonomy and leadership opportunities at a faster pace than a larger practice. What practice size is right for you depends on your own career goals, skill set and personality.

Weighing your options carefully by building a pros and cons list is suggested. Below is a list that our experts began to help get you started.

Small Group Practice


  • If you enjoy more autonomy and are a self-starter, a small group practice could be a setting where you will excel. Typically, small practices will provide a new associate the opportunity to have more of a voice in business operations and patient development right from the outset of the relationship. This is a pro IF you have the ambition and drive to leverage the opportunity.
  • Another benefit is a more traditional path to partnership. Small practices mean limited partnership restrictions and red tape. The process for becoming a partner should be obvious and tangible. The opportunity to have more one-on-one discussions with leadership will also benefit your progression towards partnership.
  • Small group practices should also have a lower overhead. What does that mean for you? If well managed, the lower overhead of a smaller-sized practice should provide opportunity for a more lucrative bonus structure.
  • A new associate who is fellowship trained in a smaller practice and is the only person in his or her specialty will almost certainly benefit from internal referrals.


  • New associates may have to work harder on building their own referral networks at a small practice. You shouldn’t expect to walk in on day one and have a huge referral network built into the position. Small practice, small network.
  • A second downside to joining a small group practice is that the overall surgical volume will be lower to begin with. That means you’ll need to work harder to market yourself and the practice to build a more robust surgical volume during your initial development period.

Large and Multispecialty Group Practice


  • New associates will likely start out with more built-in patient volume in a larger practice. You will likely be stepping into a previous position that is now open rather than into a brand-new position created just for you. The tradeoff with this pro, however is that you will likely be busier quicker, so as a new associate, you should be ready to hit the ground running!
  • Unlike a small practice, large offices will have a more robust referral network already in place, and new associates will also benefit from a solid internal referral network. With multiple specialties all housed within a single practice, first preference for any referral will certainly be to keep the patient in-house.
  • Large and multispecialty group practices are also more likely than small group practices to be targets for private equity purchase. If you manage to make partner in a larger practice before such a purchase happens, the sale could be extremely lucrative for you.
  • Large and multispecialty group practices also provide more opportunity for professional development. New associates in large practices will have more colleagues to bounce ideas off of and to interact with when odd cases present themselves. The skill and knowledge growth opportunities should be increased simply due to the larger pool of experts you’ll be surrounded by every day.


  • Although large and multispecialty practices may still offer traditional paths to partnership, dependent on location, they’re more likely to have nontraditional partnership structures or equity buy-ins. This varies from practice to practice, but is something all new associates should be clear about before making any decisions.
  • Larger practices equal increased overhead. Operating costs will tend to run a little higher with these practices, which means production bonuses may not be as lucrative. This is another tradeoff scenario, as you will likely be busier quicker and benefit from a solid internal referral network.

The moral of the story is to evaluate the pros and cons of each type of practice, and determine which is best for you personally. What’s ideal for you may not be the best choice for another practitioner. There is no “one size fits all” when it comes to choosing the right environment for you — and that is one of the advantages of the career path you have chosen!

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