The academic year in the US ends on June 30, which means that every July a new group of about 500 young ophthalmologists enters practice.
One of my mentors used to say, “My worst day of private practice is better than my best day of residency.” And this is from someone who often spoke fondly of the adventures of residency training. This quote gave me hope that the future would be bright. It turns out that the practice of ophthalmology is not quite that simple, but it is true that every year can be better than the previous one.
Yes, there can be challenges along the way, but it is a great time to be an ophthalmologist. Visual results from our treatments, both surgical and medical, are better than ever, and there is an endless pipeline of new technology that will help us deliver even better outcomes to our patients. But the business of medicine is changing, and it could be perceived as less promising as it evolves. The key to the future is not predicting it, but rather being able to adapt to it.
You have spent 4 years in college, 4 more in medical school and at least 4 more in post-graduate training. Add in years for fellowship training, research or other graduate degrees and you can quickly approach 15 or more years of education build-up, culminating in a practice position. In choosing your first job, the key factors are the type of job, location, colleagues and support, and compensation.
Type of job
The main types of jobs include academic positions, multi-specialty groups and private practice jobs. The academic positions may include research components and the ability to work with medical students, residents and fellows. The multi-specialty groups, sometimes in the form of HMOs, tend to offer a good work-life balance and an instant pool of referrals. Private practice jobs can span the spectrum from solo practice to a large group practice, both of which may require skills to run a business. And there are also hybrid positions in which parts of each are meshed together. Less common are non-clinical jobs working for industry or doing full-time basic science research.
The location of a job is critical to happiness. Some people seek to be near family, while others look for great weather year-round or the attractions of a big city, but regardless the reason, if you want to be in a specific location, you should focus your efforts on finding a position locally. The cost of living, job opportunities for a spouse and commuting times also factor into the decision.
Colleagues and support
Having supportive colleagues makes the transition into the job less stressful and provides guidance for future development of your career. This group can help ensure your future success, aid in developing referrals and even assist in challenging surgical cases. One of the biggest surprises in the transition from resident or fellow into the first year of practice is the sparsity of surgery in your new position. In your training, you will do many surgeries every week and as many as a thousand in a single year. But in your first year of practice, this may fall by a factor of 10. Patience is the key, and with time, typically at least a few years, surgical volume will grow.
Surgical volume may be low initially: chief residents do 10 or 20 surgeries per week but this can fall to just 1 or 2 surgeries per week in your first year of private practice
Compensation is often the first concern of job seekers, but it only tells part of the picture. Look at the structure of the payment and determine if it feels reasonably fair. There should be the ability to grow your revenue as your clinical and surgical volume builds up.
A partnership track is important for your long-term happiness in the group, and your buy-in should be reasonable. Mandatory restrictive practice covenants are a warning sign that the group could twist your arm in the future and limit your options. Ownership interest in an outpatient surgery center should be considered as well.
Finally, the most important recommendation is to hire experts to help you. An experienced attorney can assist in reviewing your job contract. A business consultant can do an independent valuation of the practice to determine if your buy-in proposal is reasonable. And even asking the advice of your mentors is quite useful. Most ophthalmologists, me included, have learned from our many mistakes over the years and would be happy to help you avoid these pitfalls.
Understand that while it is possible that your first job will be your only job for the rest of your career, it is perfectly acceptable to switch jobs. And your specific job description and practice focus will evolve over the years. You may limit your practice to a narrower focus, prefer to do more surgery than clinic, or even add other facets such as industry consultant, key opinion leader, or researcher.
Ophthalmology is an amazing field, and we are blessed to have the opportunity to help patients improve their most precious sense, their sight. With an increasingly aging population, we will be busier than ever, and we will have the opportunity to enjoy practicing our profession.