This article is more than 5 years old. Information may no longer be current.
Letter to the Editor
Click Here to Manage Email Alerts
To the Editor:
I appreciate the insights in the cover story that John B. Pinto and Richard L. Lindstrom, MD, co-authored in the April 25, 2019, issue of Ocular Surgery News entitled, “Change is inevitable: Prepare for a challenging future in ophthalmology.” This article outlined many of the challenges and opportunities that are inherent in the changing landscape in the field of ophthalmology. I feel compelled to comment on some of the points within the article.
In our hands, cataract surgery outcomes are better with femtosecond laser-assisted cataract surgery. In my experience, it takes several hundred cases to fully realize the potential of this technology, and I am still learning and adjusting my surgical approach. Declarations that this technology will not have a role in the future are premature. Surgeons who trial one platform and use it for a day or two in the OR are not adequately trialing the technology. I am not suggesting that that was your position in the article, that FLACS does not have a bright future, but it should be recognized that this technology continues to be improved on. It ain’t over till the fat lady sings.
I completely agree that the more services and products we have to offer the patient in one platform, the greater the satisfaction for the patient and consistent clinical outcomes can be achieved (through implementing best practices throughout the organization, measuring outcomes and improving processes throughout the organization).
Unfortunately, some patients are poorly care navigated throughout a disconnected health care system with built-in structural (EMRs from different practices do not talk to one another) and legal (HIPAA requires that information flow slow down pending patient’s explicit permission to share information) barriers, which increase cost, slow down delivery of care and offer no proven gains in quality.
Additionally, there are inherent advantages to the patient to provide them with customized spectacle eyewear to address their specific needs and activities. Patients seek solutions, services and products to help them achieve their goals. Although our practice co-manages with outside optometrists, we also have an active and successful optical shop and excellent in-house optometrists who provide primary eye care. In my experience, it is easier on the patient and more efficient to manage cataract surgical patients within the organization because we can offer patients customized spectacle or contact lens solutions, address their unique concerns and problems, and accomplish all of this with a single medical record that has inherent communication features enabling different departments to easily share information (and also apply analytics to measure outcomes and issue feedback to providers). Most patients need spectacle eyewear for some activity, and no matter how excellent the outcomes are from refractive cataract surgery, there is always an opportunity to improve the patient’s lifestyle by supplementing their vision with spectacles. Some of my happiest patients are retired judges, engineers, doctors, professors and pilots who chose to remain nearsighted after cataract surgery.
Cradle to the grave clinical service is better managed on a single platform, and from a business standpoint, productivity and overhead management can be standardized, measured and managed. Every time the patient drifts outside of our practice, there is an inherent opportunity for miscommunication, lack of propagation of clinical information and inherent challenge in measuring outcomes to improve processes. As an industry, when will we achieve sufficient consolidation in comprehensive eye care as to be able to enter into exclusive, narrow network contracts with health insurance companies? Will PE firms accelerate the M&A activity to a sufficient degree as to enable a carving out of whole states or regions that then could enter into direct, capitated contracting? If you have a large region with many affiliated providers across a broad spectrum of specialties that can offer complete eye care services, medical and surgical, then theoretically that entity could provide sufficient comprehensive care as to assume the totality of eye care for the patient, right?
What really prompted me to contact you was the last section in the article. It was striking to me that the typical surgeon retires at age 67. I am curious. Is this because, typically, ophthalmologists are financially unprepared to retire earlier, or is it that they are otherwise motivated to remain active in their field or simply do not know what else to do with themselves and are afraid to retire? Compared with other fields both inside and outside of medicine, do ophthalmologists have a different consensus on what defines a secure retirement? Did they start their earning years later than most and this results in delayed retirement savings and investment, which translates into insufficient funds for retirement? Or is their lifestyle in retirement more costly than their age-matched controls or is personal perception of financial security defined differently or again is it that they like working in their field? Personally, I struggle with what defines a secure retirement. The retirement financial model can vary tremendously if assumptions such as cost of living, health care expenditures, inflation, family life events and longevity are varied in different ways over decades. One thing is for certain: We have limited time.
Thanks again for the insights in your article. I always learn from you and appreciate your perspectives.
Stephen Orr, MD
Findlay, Ohio
The authors respond:
We want to thank Dr. Orr for his thoughtful comments. The purpose of this cover story was to stimulate thinking, and he is clearly thinking. Every market and every practice are unique and require a specific business plan going forward. We actually said: “The femtosecond laser may have a larger role moving forward ... .” Our concern today is that it adds too much expense to be used on routine cases, and the premium channel in the U.S. is mired at about 15% of volume. A cheaper per case femtosecond laser or another less expensive cash pay channel for the femtosecond laser, such as customized refractive capsulotomy, could accelerate its growth to the next level.
While integrated eye care with ophthalmologists and optometrists working collegially under one room is to us the preferred eye care model, it is the rare consultative practice that can garner significant referrals from the private sector community of optometrists with a large in-house optical presence. We believe Medicare Advantage, now at about 30% in the U.S. and growing rapidly, will be a driver toward narrower provider networks with select health care insurers. The urban markets will lead here, and some poorly positioned ophthalmologists and optometrists could find themselves left out.
Finally, the average American retires at 63 while the average ophthalmologist retires at 67. The reasons for this later date are multifactorial and include career satisfaction along with the desire to grow their retirement fund. As far as a financial goal for a comfortable retirement, talk to your financial planner and wife regarding lifestyle goals, but as a guideline, we suggest once your children are educated, out of the house and employed, you will need 25 times your annual spending plus a debt-free primary and secondary home to retire in style and travel when and where you want. For most successful ophthalmologists, that is a lot of money but doable with good planning. Start to save and invest aggressively now because compounded interest is the eighth wonder of the world, and we do not think it will get easier in the future. Again, thank you for your thoughtful letter.
John B. Pinto and Richard L. Lindstrom, MD