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Reaching a half century: What does it mean for the middle-aged premium surgeon?
As ophthalmologists age, it becomes even more important to find balance and reduce stress at work and home.
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I never thought I would write about what reaching a half century means for the middle-aged premium ophthalmologist. What I do know is that it reminds me of one of the greatest quotes from “the greatest,” Muhammad Ali, before his first title fight with Sonny Liston and later repeated ahead of his 1974 fight with George Foreman: “Float like a butterfly, sting like a bee — his hands can’t hit what his eyes can’t see.”
The air of invincibility does not end as one turns 50 years or older as a premium eye surgeon, but rather it takes on the characteristics of either a Doogie Howser, MD, or Marcus Welby, MD, depending on one’s individual aging process. Ultimately, the premium surgeon will have to deal with dry eye, presbyopia, cataracts and maybe even glaucoma and/or macular degeneration as part of the A-G-E syndrome.
Maintaining surgical skills is critical at all times, young or old, but reaction times can change as part of the aging process. Newer technologies such as femtosecond laser technology will assist in terms of more automated flap-making with LASIK, arcuate limbal relaxing incisions and phacofragmentation at the time of cataract surgery, and certain keratoplasty procedures. Other technologies such as the TrueVision 3D suite will improve ergonomics associated with eye surgery, especially for those with neck and/or lower back problems. Due to declining reimbursements and higher overhead stresses associated with private practice, today’s premium surgeons are needing to see more patients and pack more surgeries into a single day to make ends meet and maintain profitability. Such pressures bring additional physical and mental turmoil to the aging ophthalmologist.
Finding balance at home, work
It is important to find a balance with the pressures of work by utilizing the other side of our brain, be it musical, athletic and/or spiritual in nature. Many of our known premium surgeons are musically talented as DJs (Terry Kim, Quentin Allen, Tony Aldave and myself are examples) or musicians (Thomas John, Dan Reinstein, John Sheppard, Paul Singh, Rick Foulkes and Bill Bond, to name a few), which allows for an emotional outlet needed to deal with the daily pressures of “no mistakes allowed.” Adding a good cardiovascular program (swimming, cycling, skiing, running, hiking) is critical to meet endurance demands nowadays. Our free time with family and friends is declining in quantity, but converting this to better quality time is so important. Spiritual ways such as daily meditating, massage therapy and/or yoga can lessen the stresses mentioned above. And this messaging applies not only to the middle-aged surgeon but also to the younger generation of premium eye surgeons if they expect to make it to middle age these days.
Many surgeons are now reducing their surgical loads due to the increased burden of unrealistic expectations by today’s patients and reduced reimbursements. Other ways to generate revenues and keep practicing include bringing in younger eye surgeons, adding nonsurgical revenues to the practice and reducing overhead to manageable levels.
As for other revenues, bringing in programs such as allergy skin testing (Doctor’s Allergy Formula) and dry eye diagnostic products such as MMP-9 testing (RPS), tear osmolarity (TearLab), LipiView and LipiFlow (TearScience) and Sjögren’s finger stick to detect early immune titers of the disease (Nicox) allows a practice to create a center for ocular surface excellence, with excellent value-add to the patient and the practice both clinically and profitably. Adding other diagnostic tests such as VEP/PERG testing (Diopsys) for glaucoma, optic nerve disease and various retinal conditions can add clinical value for the patient’s care and additional revenue for the practice as well. Adding optical services and/or specialized contact lens services (for example, corneal implants, cross-linking or penetrating keratoplasty for keratoconus or ectasia) will yield revenues to a practice that is reducing surgical load and not so worried about optometric referrals anymore. Selling nutraceuticals for dry eye, glaucoma support and/or macular disease (SBH, PRN and Doctor’s Advantage are companies that can provide such products) is also an option for patient convenience and some additional revenue for the practice.
Becoming a patient
And what happens if the premium surgeon becomes a patient in terms of dry eye, cataracts, glaucoma, presbyopia and/or age-related macular degeneration? Not only are our patients looking to the options we choose for therapeutics for our own eye care but so are our colleagues. For example, do not continue to put multifocal IOLs into your patients’ eyes and then decide to put an accommodating IOL into your own eyes due to fear of waxy night vision. Another example is to take generic over-the-counter omega-3 capsules but continue to sell branded dry eye nutraceuticals such as HydroEye (ScienceBased Health) due to high GLA content not found in the diet and clinically proven to be anti-inflammatory in the dry eye cascade.
Unfortunately, our profession has not discovered the cure for the one condition that draws ire from all of us as premium eye surgeons: presbyopia. Stay tuned for next month’s Premium Channel column, Conquering the holy grail: New treatments for presbyopia on the horizon.