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Business education in clinical practice
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To the Editor:
Thank you for the focus on business practices and importance of the combination of clinical and business knowledge in the practice of today. Your editorial and the cover story in the March 10 issue of Ocular Surgery News highlighted many important issues.
I share in the interest of this skill set. I have been the managing partner for 23 years of a four-location, 17-doctor practice with an ASC and digital optical surfacing lab. I don’t have a formal MBA, but I had the fortune of accounting and business classes in college. I am sure having the MBA credentials may open some doors, but I have the skills that are needed and have not taken time from being our full-time pediatric ophthalmologist (the only one in our group). I am first to admit, like one of the cover story contributors also said, I have made several less-than-perfect decisions and learned from them.
I really like the encouragement you mentioned about participating in business meetings designed more for administrators at meetings such as the American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery. I have participated for a few years with the American Academy of Ophthalmic Executives and have made some very good contacts with bright people. They are thrilled having physician participation. One troubling finding I have quietly tried to understand and address, for the benefit of our profession, is the frequent intentional or unintentional reporting of inflated or exaggerated practice performance. I know the AAO and subspecialty organizations have offered and continue to offer opportunities to report benchmarking data, but it is often flawed and leads to erroneous conclusions about practice overhead, profitability and success. Sometimes it is only a small exaggeration and sometimes large, but it sounds so good that it is easily spread to others and gives unrealistic expectations. It is also unfair to a candidate if he or she accepts an opportunity that has exaggerated unrealistic potential, and the doctor gets discouraged and leaves after a couple of years, just to start over again.
Have you experienced anything similar in your practice experience? This is a difficult topic to address with the ones doing these practices and giving unrealistic practice performance information. I understand the need to stand out and attract the best talent, and there is a tightrope between truth and exaggeration to be competitive. We are all competitive at heart, and we all have been through a lot of competitive selection processes to be where we are now. But after 31 years in practice, I am seeing a generation gap and the need to be more honest than ever. But if that results in never attracting another recruit, our practice will not be doing 4% or greater growth and will eventually go into decline.
Anthony P. Johnson, MD
OSN Pediatrics/Strabismus Board Member
Jervey Eye Group
Greenville, South Carolina
Dr. Lindstrom responds:
Thank you for your helpful comments and insights. Accurate benchmarking is critical for the leader of any practice. It is rare for any practice to openly share financials with another in detail, but many useful sources are available. First, the books written by John Pinto and available through ASCRS have general benchmarks and guidelines for typical ophthalmology practice performance. And of course, Pinto himself is available for consultation as are others, including Bruce Maller and associates. They both have accurate numbers from decades consulting with many practices and are also a good source for the young ophthalmologist seeking employment or the managing partner trying to give them a dose of reality. Second, many practices join networking groups in which accurate benchmarking of similar practices is a major benefit of membership. Finally, the American Society of Ophthalmic Administrators and AAOE have valuable information available.
In regard to ophthalmologist compensation, I find the Medscape surveys done every year to be very helpful. In 2016, they surveyed 19,180 physicians and stated the conclusions are accurate within 0.68%. According to Medscape, the mean ophthalmologist compensation in 2016 was $309,000 per year, and we were up 6% year over year vs. 2015. Only about one-third of us own equity in our practices, and nearly two-thirds are employees. Men out-earn women by 25%, but this is not adjusted for hours worked. The highest compensation is in North Dakota and the lowest in New Mexico. We ophthalmologists are in the middle of the pack for physician compensation, with orthopedics being No. 1 and several primary care specialties at the bottom. While we ophthalmologists pride ourselves on being a happy lot, according to Medscape many ophthalmologists feel underpaid and underappreciated, and only about 55% would choose medicine and their specialty again.
There is a lot of interesting information in the Medscape annual publications, and I find them a fascinating read. At Minnesota Eye Consultants, we use all these resources for lifetime learning, and incremental improvement is a way of life in our practice.
Richard L. Lindstrom, MD
OSN Chief Medical Editor