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Proper balancing act required for a premier surgeon
Different challenges face the leaders of solo practices, large practices and university practices.
The Cambridge Idioms Dictionary defines a proper balancing act as “a difficult situation in which you try to achieve several different things at the same time.” As a premier surgeon, a proper balancing act goes beyond the balance between work and family and extends in detail to the balance of all arms at work. The driving forces behind such balance depend on whether the premium surgeon is in a solo practice, a small private practice with two to three doctors, a large group of 10 or more doctors, a single specialty or multispecialty, or a university-based situation.
Solo practice
I personally face the challenges of being a solo practice surgeon with intermittent part-time coverage with TPA-certified optometrists and/or certain surgical specialists such as oculoplastics. The proper balance for me individually ranges from making business decisions for the practice to making clinical decisions for patients, preparing surgery charts weekly in terms of IOL calculations/femtosecond parameters, doing interviews for PR purposes for the practice, writing papers and chapters for journals, editorials and books, participating in advisory boards both domestically and globally, preparing presentations for ophthalmic meetings and promotional and CME-related programs, rehearsing music as a professional DJ, having family responsibilities as a father and, finally, bringing romance to my spouse. The challenges of a solo premier surgeon will have many faces and change daily, weekly, monthly and annually.
Large practice
Looking at the opposite end of the spectrum, a large group of 10 or more doctors in a practice will bring a set of different challenges, including creating fair equity for each partner, hiring new younger ophthalmologists, sharing the on-call load equally, making sure each surgeon is contributing equally to the pie in terms of upgraded technology (advanced IOLs, femtosecond laser, intraoperative wavefront aberrometry) and making sure not just one doctor is doing all the work with the rest of the partners benefiting. One doctor in a group may travel extensively due to responsibilities as a key opinion leader, which could benefit the practice in terms of reputation but could reduce the bottom line on a daily basis, creating internal conflict. This latter situation is no different in a group of surgeons that owns an ambulatory surgery center.
Now throw in the desire for a practice to participate in U.S. Food and Drug Administration clinical studies, and this adds burden to the overall staffing issue whether in a smaller or larger size practice. In these situations, only one surgeon may be participating, tipping the balance scale again in an uneven position for the remainder of the partners. FDA clinical studies bring revenue for the practice but usually require hiring additional study coordinator(s) to be successful in implementation.
University practice
The university practice faces an entirely different set of balancing acts, from the administrative side in terms of budgeting for the proper education of residents each year to research initiatives on both the clinical and laboratory/scientific side, all while maintaining salaries and motivations of the faculty hired for each ophthalmic specialty. Most university programs also face the added financial burden of overloaded emergency room visits for complex cases without insurance coverage. Clinical studies typically have to be performed with internal institutional review board approval rather than using a central review board set up from a sponsoring organization, tremendously slowing down the enrollment process.
No matter what the situation, from solo practitioner to large private group to university practice, each has its own diplomatic balancing act in terms of doctor satisfaction, patient satisfaction and administrative/financial satisfaction. The smaller-practice doctor has more freedom in terms of decision-making but less so in terms of personal time for him/herself. In the end, most of us have chosen a path to meet our own demands and satisfy our own proper balance.
Stay tuned for next month’s column on why achieving 99% success is considered a failure.