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Give me that old time religion
Several parallels may be drawn between a religious organization and an ophthalmic practice.
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“All religions must be tolerated ... for every man must get to heaven in his own way.”
– Epictetus
“When I do good, I feel good. When I do bad, I feel bad. That’s my religion.”
– Abraham Lincoln
Every ophthalmic practice is like a really, really, really little religious organization. Here is what I mean.
Accountability: A practice and its surgeons, like a religion and its adherents, have to operate within the larger laws of society or risk destruction. Ophthalmologists have more than the usual obligations to color inside the lines, what with CMS, private payers, licensing boards, national societies and peers on every corner all looking over your shoulder.
Rituals abound: In the same way that many religions congregate on their own weekly schedule to observe their own rites and rituals, so too do ophthalmic congregants gather for board meetings, surgical sessions and even national pilgrimages to reaffirm their beliefs, cast aside old doctrines and win over nonbelievers.
Sacred texts: Every young eye surgeon fewer than 5 years out of training understands John 1:1 to the letter: “In the beginning was the Word ... and the Word was God.” In addition to the sacred texts of one’s residency program, every ophthalmology practice writes its own biblical texts in the form of contracts, employment and operations manuals, physician codes of conduct, care pathways and technician cheat sheets.
A moral code: Every religion has abundant rules, including taboos that sound quaint to the unwashed but are deadly serious to true believers. Very few of you are old enough to remember the transition to IOLs. More of you remember the shift from extracapsular cataract surgery to phacoemulsification. Thundering pronouncements, for and against, attended every shift in beliefs.
Service to the poor: Medicine was kept alive in medieval times largely by an unpaid priestly class, which to this day still saves souls while treating those in need. Thoughtful eye surgeons have kept this tradition alive by flying to distant countries to provide free services. Both priest and surgeon derive the same satisfaction.
Symbology: Jewish Stars of David, Christian crosses and Buddhist lotuses find their counterparts in ophthalmology. Beyond the obvious eye icon, if you watched a surgeon doodling around 1985, when radial keratotomy was still in fashion, you saw eight incisions in circle. A bit later, J-looped lenses came along. And now? The profession still awaits a symbol for femto, but chances are you will see it in these pages first.
Sermons: To some, the only thing more soporific than the second half of Sunday service is the first half of a medical symposium. Of course, both impose the same threat of banishment to boost attendance. Skip church and eventually you do not get to heaven. Skip continuing education and eventually they take away your license.
Attire: Catholic priests and wildly masked African shamans share first place for the elaborations of their religious vestments. Ophthalmologists are pretty tame by comparison, but they still sport the holy robes of their tribe: scrubs and starched lab coats.
Tithing: Like religious groups, no practices can stay in business for very long without a steady infusion of cash. Some electively oriented practices are nearly Mormon in their capital stewardship, demanding a high “tithe” from their “parishioners.” Other practices and practitioners — think pediatrics and neuro — are obliged to take a relative vow of poverty.
Scale: Most new practices, unless their founders are especially vigorous, stop growing with three or fewer physicians. The same goes for most new religions. But some practices, like some especially vivacious religious denominations, crawl across the landscape seeding more coreligionists along the way.
Rejecting the dogma of others: If as a Westerner you think it odd that Sunni and Shia Muslims often oppose each other violently, all it takes is watching a behavioral optometrist and a cataract surgeon discussing vision therapy to appreciate the wide gulf between seemingly close sects of the same religion.
Leader dependence: Practices, like religions, can go astray when an important leader leaves. We often see this in the retirement of a charismatic surgeon-founder — just a year later, the same practice that was so alive under the direction of Dr. Leader crumples when one of his or her junior partners takes the reins.
Modernization and reformation: Every once in a while, along comes a Martin Luther to stick it in the eye of the church elders. It is the same in ophthalmology. At the launch of refractive surgery in America, reformists with diamond blades displaced primitives with broken-off razor blades. In turn, they were cast aside by those with sapphire blades. LASIK reformists battered down the incisionalists, and even they are certain to succumb in our lifetime to the next wave of reform.
The threat of excommunication: Some religions throw you out if you break their rules. It is the same in ophthalmology. And you do not have to overtly break the rules — you just have to go out of fashion. One year you are hot property, invited to international podiums; the next year, you are retired to sit with the general audience for expressing an uncouth clinical opinion or (gasp) mentioning a brand name with insufficient caveats.
Some eschew religion: Although polling tells us that about 90% of Americans believe in some higher power, that still leaves 10% or so who believe in, well, something else, to be polite about it. We see this in a very thin veneer of ophthalmologists who do not belong to professional societies and do not go to their annual meetings.
Some practices are like cults: Some few practices, in the hands of despotically crafty doctors, can devolve into cult-like enterprises with unconventional views. Examples are practices with extremist care pathways (either too aggressive or too clinically meek) and practices with an abusive approach to staff and associate provider management.
Ophthalmologists have yet to crack the market in matrimonial and funerary services, although if the fad of adding hearing aid centers to ophthalmic clinics is any indication, these cannot be far behind.
And unfortunately, under U.S. tax code, ophthalmic practices have missed out on another important parallel with religious organizations: tax-exempt status. Of course, on the present trajectory, American practices may eventually at least achieve something close to nonprofit designation.
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- John B. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979. John is the country’s most-published author on ophthalmology management topics. He is the author of John Pinto’s Little Green Book of Ophthalmology, Turnaround: 21 Weeks to Ophthalmic Practice Survival and Permanent Improvement, Cashflow: The Practical Art of Earning More From Your Ophthalmology Practice, The Efficient Ophthalmologist, The Women of Ophthalmology, Legal Issues in Ophthalmology, Ophthalmic Leadership: A Practical Guide for Physicians, Administrators and Teams and a new book, Simple: The Inner Game of Ophthalmic Practice Success. He can be reached at 619-223-2233; email: pintoinc@aol.com; website: www.pintoinc.com.