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Underemployment may emerge as economic challenges continue
Years of training and hard work no longer guarantee success. Struggling surgeons must be aware of the trend and respond to secure their future careers.
I can say, with no small measure of guilt, that I don’t personally know a single homeless person. But I do know a number of underperforming eye surgeons who are now approaching the ophthalmic equivalent of homelessness. Maybe “rootlessness” or “failure to thrive” would be the more appropriate term for what happens to a small percentage of eye surgeons in this country, despite what was abundant opportunity, at least until recently.
There was a time when any eye surgeon with a pulse had five easy job offers. No longer. Today’s rootless, underthriving surgeons are the doctors who call me and relate a history of one or more short-term positions, the kind of shifty career history you would expect from a business undergraduate or a PhD in sociology, not a fine-tuned, hugely vetted specialist. When they call me, they are likely as not living on the last weeks of their severance pay or the proceeds of their final home equity loan. Job interviews have not gone at all well lately, and even the recruiting firms no longer return their calls.
Reasons for rootlessness
These rootless, down-on-their-luck surgeons have somehow failed to plant themselves in otherwise fertile soil. There are several causes for not putting down roots and growing as a well-trained ophthalmologist should. I’ve had a chance to see most of the variants of this unfortunate position. Here are some of them.
The Low Boredom Threshold. Physicians who need a lot of excitement and stimulation should work in the emergency room, not in an ophthalmology clinic. A small fraction of physicians who matriculate from an ophthalmology residency are simply not cut out for the numbing sameness of each successive day in this field. They can’t really change the diagnostic mix of their patients, so their need for change and excitement is transferred instead to seeking a series of what-seem-to-be-better associate positions. Of course, each position in each new state is ultimately unsatisfactory. Before long, the physician’s CV becomes suspect. Even if they want to settle down, they have a hard time explaining to their prospective next employer why they move about so much.
The Naïve Contract Signer. There are crafty eye surgeons out there, thankfully rare, who lie in wait for young doctors. Like spiders in the web, they pounce on naïve ophthalmologists who would happily sign any employment agreement put in front of them. Some of these documents are simply tilted to the house’s advantage, while others would make 17th-century indenturing lords blush. After 2 or 3 years of hard work, Dr. Young is told his services will no longer be needed. He is then replaced with the next assembly line worker. Surgeons drawn into these one-sided deals emerge poor, cynical and mistrusting of subsequent, valid offers.
The Malpractice Trap. There has been a fairly large run on this category in the last couple of years, as the growing installed base of LASIK patients had resulted in an inevitable, accelerating cluster of plaintiffs suits. It’s not all that unusual for quality surgeons operating 1,000+ cases a year to have a claim or two a year. Especially in commercial LASIK practices, where surgeons have been hired as “shooters” and patient rapport takes second place, the current downturn has released a number of talented young people with an overhang of liability, who have been typecast as one-trick-cutters.
Keeping Mama (or Papa) Happy. Some physicians, with sincerity or acquiescence, move to markets where their spouses insist they settle down. If things don’t work out just right, Dr. Make Peace has to select a poorer practice choice than they would have if they were otherwise free to find a practice with great chemistry that really needed their service. When I get calls from doctors like this, it’s usually to help back up their argument at home that they really do need to move on down the road.
Doctors, Doctors, Everywhere. In markets with anything less than about 15,000 total population per surgical ophthalmologist, it’s difficult for all but the most talented and ambitious physicians to develop a successful practice. Doctors who want to shoehorn themselves into San Francisco, Denver or Boston are going to wobble, in most cases, despite abundant talent.
Forum needed
In each of these cases, some of which involve a degree of victimization by others as well as innate self-damage, the affected rootless physician must ultimately take responsibility for their situation.
No matter the cause, though, I can’t help thinking I’m seeing the leading edge of a trend. As the reimbursement environment continues to get harsher, the percentage of physicians with the right stuff to practice will diminish.
If my impression is correct, there should be a support group formed for surgeons who are having a hard time finding their way in the increasingly tough world, a world that is stretching the resources of the ablest and is pushing other surgeons at the back of the race completely off the track.
It would be helpful if one of the national societies came forward and developed a Web-based forum for these younger, struggling surgeons to compare notes and support each other’s efforts to reach a measure of the success that was implied by their hard work. It would be helpful if one or more national vendors stepped forward with a series of workshops to help their struggling, nascent customers stay on track.