Q&A with Laura Periman, MD: Opening an ophthalmic institute amid COVID-19

Laura M. Periman, MD, is a fellowship-trained cornea and refractive surgeon and ocular surface disease expert who is in love with the fast pace of discovery that the ocular surface demands.

With her profound interest in dry eye disease acting as a catalyst, unraveling the complexities of this multifactorial disease, as well as bridging the gap among basic science, clinical practice and patient education, are deep passions.

In March, just as most of Seattle was shuttering its doors because of the COVID-19 pandemic, Periman decided to open new doors in June 2020 as founder and director of dry eye services and clinical research at Periman Eye Institute.

Healio/OSN spoke with Periman about the challenges the pandemic has posed to her new solo venture, as well as her advice for young practitioners and the long-lasting effect COVID-19 will have on ophthalmic practices.

Q: How did the pandemic affect your plans to open Periman Eye Institute?

A: It forced me to reprioritize. I had to completely reshuffle my plans, including the way I structured the ocular surface fellowship and how to configure the small space. Thank goodness current technology has made it possible for me to launch as a solo doctor with only a virtual part-time office manager.

I was already encouraging the adoption of telemedicine because my patients need to travel a long distance, even interstate and internationally to see me. Because of COVID, now it is a necessity. I was able to shift and say, “What do we want this to look like, and how can I leverage this to its maximum potential for each patient?”

Q: What has been your biggest challenge?

A: Having to plunge into it. I do not dive headfirst into anything, and I was forced to. In a good way, it was part of my biggest challenge: knowing how to be a smart businessperson, making sure I can pay the bills, figuring out how and who to hire. I am having to learn all those things about being a practitioner that were always “taken care of” by the bigger organizations. It has been an education.

My main takeaway is that a lot of our colleagues might feel trapped in their work situation. But if you look carefully at each level of how we deliver medical care, it can look like anything you want. Those extra pressures can all be worked around.

Q: What inspired you to open Periman Eye Institute?

A: Between my scientific and research background and my clinical interests, I have zeroed in on ocular surface disease. It is so satisfying to continue to learn at a rapid pace of innovation, and discovery keeps everything fresh and clinically satisfying. Leveraging all these new tools and scientific knowledge to help people, and in the course of trying to figure out how to be the very best doctor I could be, I realized I had to be an independent clinic and structure everything completely differently. When all the focus is truly on the patient, all the noise fades away. It has been an incredibly rewarding experience to be able to structure everything about our clinic to meet the needs of the dry eye patient.

Q: What would you say to someone thinking of starting their own practice?

A: There has been a slow, steady drift toward corporatization of medicine. I think people have had their fill of this model. There is an opportunity, and there is a growing momentum to do the exact opposite by focusing on patient-centered, top-notch care.

When I started, I started small. And that is OK. Do not be afraid of starting as a single shingle because growth is inevitable. People are hungry for alternatives. They want excellent care and connection with their doctor. You can create value for the patient by granting access to quality medical care — that is where you have a huge competitive advantage against the big corporate structures, especially with complicated diseases such as dry eye.

Q: How has COVID-19 changed ophthalmic business?

A: Congress, in its efforts to try to help relieve the impact of the situation, wisely lifted interstate medical license restrictions and telemedicine restrictions. From my perspective, many of my colleagues have tested the waters and feel it is pretty nice. I can finally get paid for my time in talking to a patient, and the patient feels like they have access. Patient satisfaction is high, and doctor satisfaction is high also. There was great concern about loss of that emotional connection, looking at patient perceptions of the telemedicine encounter, but it is actually better than in person.

As we eventually recover from the impacts of COVID, there might be a temptation to pull back those HIPAA and reimbursement constraints and restrictions, but I think patients and doctors are so satisfied with the excellence of telemedicine that nobody is going to be in a big hurry to allow those restrictions to be pulled back. Satisfaction has been excellent across the board.

Q: What words of encouragement do you have for young practitioners entering this field?

A: There are communities of independent doctors out there ready to help and guide and share their experience. Maintain that mindset of believing in yourself and your ability to provide the best possible medical care; there is a whole community of physicians who have that same mindset. There are bumps in the road, but you are not alone.