Time is ripe for young ophthalmologists to enter field
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Ophthalmology is an exciting field that is constantly growing and evolving.
Employment opportunities for young ophthalmologists are plentiful across both private equity and larger institutions, and treatment advancements abound.
Source: Leyla Summers
However, early-career ophthalmologists will also be met with an increasing number of patients and will be required to deal with the challenges of practice management, including prior authorizations and decreased physician payments.
“We are expanding our understanding of the etiology of diseases as well as offering new treatment options for many categories of disease from the front to the back of the eye. Over the last 3 years alone, we have seen new treatment modalities offered for macular degeneration, cataracts, thyroid eye disease and dry eye,” Lisa M. Nijm, MD, JD, of Warrenville EyeCare & LASIK, said. “Managing the number of aging patients coming through the system and figuring out how to utilize these new treatments and technologies to offer the highest quality of care, while maintaining efficiency, will be key.”
As a profession, ophthalmology is an exciting, dynamic and innovative field, according to OSN Retina/Vitreous Board Member Judy E. Kim, MD, FARVO, FASRS.
“Ophthalmology is a fast-paced and people-centered field with many opportunities for both medical- and surgical-minded people,” Kim said. “It also provides an opportunity to be in contact with all ages of individuals, and much of our care is somewhat longitudinal, which allows one to form lifelong relationships with patients if practicing in one area for a long time. It is an extremely gratifying and impactful field. There are many different ways to enjoy the ride in the field of ophthalmology.”
‘Golden field’
Individuals starting out in ophthalmology today can expect advancements in treatments and technology on a continual basis.
“During my career, I have seen every new treatment for age-related macular degeneration and diabetic retinopathy. There are more treatment options now than ever before that are effective and safe, both medically and surgically, and many more are currently being developed, continually revolutionizing how our patients are cared for,” Kim said. “Ophthalmology is an innovative specialty. We are able to help more people see for a lifetime now more than ever, and this is true for many of the subspecialties of ophthalmology.”
There are also plenty of career opportunities.
“Another nice thing about ophthalmology is that there are many career opportunities for ophthalmologists to find their niche,” Kim said. “If one desires, they can become consultants, work with the industry, grow expertise in business or administration, or consider positions in C-suites such as a CMO or CEO. There are opportunities in the research and development side of ophthalmology to become a clinical trialist. One of the many things I enjoy about the field is having these potential options throughout the career trajectory.”
Nijm agreed.
“There are many different employment opportunities in the field right now. Ophthalmology is one of the few golden fields left in medicine. We still have the ability to ‘hang a shingle’ and build a viable practice on our own or choose to join a group. Many fields in medicine do not have that freedom and must rely on a larger health care system to survive,” Nijm said. “I’ve had many discussions with colleagues that this is a great time to be practicing as the demand for ophthalmic care is only going to continue to grow as the population ages. Caring for the baby boomer generation and the diseases that are prevalent within this demographic will likely necessitate the adoption of new technologies such as AI and digital solutions and treatments such as enhanced methods of drug delivery and continued improvements in lens technology. One of the things that makes ophthalmology so exciting is the fact that it is such a technologically driven field and as such an innovative mindset to constantly work toward new advancements in patient care.”
Importance of ergonomics
One of the challenges early-career ophthalmologists need to be aware of is the preservation of workplace health and safety.
“Paying close attention to ergonomics early on is key for young ophthalmologists as they embark on their career,” Nijm said. “As physicians, we need to be cognizant of the effects of repetitive motion that place our body at risk of injury. In fact, ophthalmology ranks just behind dentistry in the number of back and neck injuries. An AAO task force was convened in 2013 to address this very topic after the Academy received many anecdotal reports of the same C2 neck injury. It’s something that often gets put aside as there are so many things to learn early on; however, focusing on ergonomics from the start is critical to ensure that ophthalmologists will be able to help patients for the longevity of their career.”
Ophthalmology is constantly changing, and one of those changes is that physicians are becoming more aware of the importance of ergonomics and taking care of their musculoskeletal health, according to Alison D. Early, MD, of Cincinnati Eye Institute.
“We spend a lot of time in somewhat uncomfortable and unnatural positions when examining patients,” Early said. “Throughout the course of many years, doing this day in and day out can take a toll on the spine and neck. Many ophthalmologists suffer from spinal and neck diseases that may require surgery. The younger generation seems to be much more aware of being proactive with our musculoskeletal health to hopefully avoid some of these issues.”
In a 2017 study published in Indian Journal of Ophthalmology, researchers examined the prevalence, severity and associations of back pain among Indian ophthalmologists.
Results showed 70.5% of respondents self-reported the prevalence of back pain, including low back pain (33%) and upper extremity symptoms (16%). Positive associations were found between back pain and age younger than 50 years, female gender, long hours working in an outpatient department, and performing retinal lasers and indirect ophthalmoscopy. Moreover, 74.3% of respondents reported yoga and some form of exercise were practiced to alleviate back pain.
“Prevalence of self-reported musculoskeletal disorders among ophthalmologists in India was quite high and significant enough to cause some degree of productivity loss,” the researchers wrote. “It is imperative to emphasize the implementation of ergonomics in ophthalmology practice with a special focus on younger ophthalmologists. Our study also showed that only a small proportion of participants had attended talks or read literature regarding ergonomics in ophthalmology practice, emphasizing the lack of awareness among ophthalmologists. This calls upon a greater need to educate ophthalmologists regarding the same. Ergonomics is rarely considered during ophthalmology residency training or clinical practice, until one experiences the ill effects of the same.”
Other challenges
Patient volume in ophthalmology will continue to grow in the coming years.
According to David Felsted, DO, a presenter at Real World Ophthalmology, surgeons will perform nearly 6 million cataract procedures in 2030 for an annual volume of more than 600 per year.
“I started with six cases on my first day and never thought I’d get to 25 in a day, and well, here I am,” he said during the presentation. “Every case makes you better.”
As an early-career ophthalmologist, Eileen Hwang, MD, PhD, of Moran Eye Center, said she was concerned with not being busy enough when she first started out, but the opposite has been true.
“I now see people that are junior to me having the same fears and wondering if they will have enough surgeries and whether they will see enough patients in clinic,” Hwang said. “I worried about it a lot when first starting out. My chair would tell me that it would be fine, but I still didn’t believe it until I experienced it myself. I am a clinician-scientist, and I am constantly trying to strike a good balance between clinic and research. Thankfully, leadership has helped me adjust my schedule to get a reasonable balance between those two things, but there’s no threat of the clinic not being busy enough. It’s more that it’s too busy and taking over my research time.”
Kim, who is also president of the American Society of Retina Specialists, said some challenges are experienced by all physicians in general, not just ophthalmologists, but the young ophthalmologists who are new to the practice of medicine may not have been aware.
“There is a lot of red tape and bureaucracy in medicine, including prior authorizations, denial of payments, step therapy, continuing reductions in physician payments despite inflation, rising overhead costs, scope of practice battles, malpractice issues, coding changes and workforce shortages, to name a few,” Kim said. “We are seeing more patients and working longer hours, and some of the issues with electronic health records do not make it any easier. All of these result in physician burnout. The pandemic unfortunately added to our burnout. This is why self-care is so important for young ophthalmologists for a long and fruitful career. Be sure to have a way of releasing stress, and all of us need to work together to change systemic stressors somehow.”
Nijm agreed.
“In most of medicine, there is a well-recognized educational gap between what we learn in training and what we need to know in practice,” Nijm said. “We receive incredible training in the medical and surgical aspects of ophthalmology, but often we find ourselves at a disadvantage when it comes to areas of business, practice management and professional development. As an MD/JD, I’ve given many lectures and workshops to trainees on managing issues that arise when negotiating your first job contract, working with new staff and passing the boards. My advice on this is to be proactive — ask your favorite attendings questions on these topics, pay careful attention to things like billing and coding during your training, and seek opportunities to gain as much insight as you can before you enter practice. Many more training programs are including lectures on these topics — and if yours has not, maybe you can be the first to suggest it.”
Early-career ophthalmologists will also encounter challenges due to inexperience in implanting some lenses, including presbyopia-correcting IOLs, according to Early.
“In general, residency clinics serve patients with less access to premium lens implants, such as community health clinics and the VA health system,” Early said. “As an early-career physician, I have learned most of what I know from on-the-job experiences including conferences, wet labs, webinars, physician forums and real-life trials of various lenses. Since premium lens implants are effectively behind a paywall for patients, residents have relatively low exposure to the population who more often upgrade their IOLs. This is U.S. specific, but I suspect it is generally similar across other health care models, too.”
Mentorship is key
Having a mentor to help navigate through some of the challenging areas of the field can be crucial not only when first starting out in ophthalmology but throughout the trajectory of one’s career.
“Mentorship is important especially for early-career ophthalmologists as it provides an opportunity to have someone who will support their growth, encourage and enable one to develop both professionally and personally, and help provide career insights, which can be so crucial when starting out in the field,” Nijm said. “Serving as a mentor has many benefits for the mentor, too. The adage is true: You learn how well you know something when you have to teach it to someone else. I have been very fortunate to have other people mentor me, and I have been a mentor to others, which helped me gain perspective and provided a sense of fulfillment in having the opportunity to give back to the generation that’s coming after us.”
Mentorship also offers an opportunity for self-reflection.
“It’s an opportunity for the mentor to gain perspective on how far we’ve come in the field, where the gaps are and where we need to be heading, as well as the areas that we can potentially help contribute and improve upon for our patients and colleagues,” Nijm said.
Having a mentor is a way to address and release some of the stressors that occur in the workforce, according to Kim.
“Mentors can provide a sounding board to the mentee and may even serve as a trusted ally or confidante on issues that a mentee may be somewhat reluctant to talk about with others,” Kim said. “An individual can have more than one mentor who can help expedite the growth of the mentee and their profession in different aspects. Having a mentor will make it easier for the mentee to navigate difficult issues and situations and may help them rise in their careers more rapidly rather than having to navigate it all by themselves. With a mentor as a guide, one can go more directly focused on their career route.”
Early said there are many ways mentors help young ophthalmologists.
“The first thing that most of us think about is clinical and patient management and surgical technique as some of the more obvious applications of ophthalmology knowledge, but mentors can also be extremely helpful in navigating other aspects of the field that one may not have exposure to as a trainee,” Early said. “For example, industry and finding one’s way with research opportunities and some of the other things that are a bit more outside of the box than the typical academic mentorship.”
Mentors also benefit from mentees.
“A mentee can help a mentor think about things in a different way,” Early said. “When we do something the same way for a long time, it can be obvious as to why we’re making the decisions that we’re making. However, having a fresh mindset about things from a mentee can be an interesting way to reassess what you’re doing as a practicing physician and mentor and get input from somebody who is looking at it differently than you might be.”
Hwang said it is beneficial to discuss difficult cases with a mentor.
“There are certain patient situations for which the course of action to take is clear, such as when someone has acute rhegmatogenous retinal detachment where it is clear that we need to do some sort of procedure to fix it,” Hwang said. “For other situations where it may not be as clear on whether or not to take action or surgery may not be helpful, that is when I find it helpful to talk to my mentors because they may have experienced similar situations. Many times, certain situations are like a runaway train and may be heading in a bad direction, but you can divert the train and head it in a better direction with a mentor’s help.”
Get involved
Getting involved in organizations such as the American Academy of Ophthalmology and subspecialty societies is important for early-career ophthalmologists.
Nijm, founder and creator of Real World Ophthalmology, said she started the meeting to help young ophthalmologists bridge the transition gap from training to practice.
“Real World Ophthalmology was created to help provide early-career ophthalmologists an opportunity to learn about the latest technologies, engage with seasoned clinicians who want to share their knowledge with the next generation and be a part of a community of young like-minded ophthalmologists who want to help each other and impart their knowledge on the next generations to come,” Nijm said.
Medical students interested in pursuing ophthalmology as a career can also participate in the National Medical Association’s (NMA) annual convention and scientific assembly.
The meeting provides health care professionals across specialties an opportunity to share experiences, explore medical advances and discuss priorities in health care policies, according to a previous report on Healio/OSN.
“Mentorship and giving students the chance to present their research and interact with ophthalmologists are invaluable at the early career stage,” Fasika A. Woreta, MD, MPH, current chair of the NMA ophthalmology section and an associate professor at the Wilmer Eye Institute, said. “They are the future of the field, so it is important for them to be exposed to the National Medical Association at this stage, so they can be active members when they graduate. ... I would like to see ophthalmologists support the NMA because the symposiums and lectures are very high quality, and physicians can obtain their annual CME credit. [This] year’s meeting will be in New Orleans from July 28 to 31, and we would like to see more ophthalmologists from both underrepresented and non-underrepresented medicine backgrounds become members and support the National Medical Association.”
Kim said joining societies and volunteering in committees create opportunities for service and leadership in an organization for those who enjoy working with other like-minded people. She emphasized the importance of advocacy and encouraged young ophthalmologists to get involved as soon as possible.
“As they say, if you’re not sitting at the table, you’re going to be eaten. If we don’t speak up, others will speak up for us, and that may be detrimental to us as ophthalmologists. We want to be proactive rather than reactive,” Kim said. “Voice your needs and concerns and remember why you’re doing it — for patients’ sight and to empower their life. Patients value their sight as much as being cured of cancer. What we do is very impactful for our patients, and we should advocate for our profession, for the sake of our patients. There is power in numbers, so volunteer in organizations and also in your community and around the globe. Continue to have an inquisitive mind. Be curious and creative every day as a physician. That is what will continue to move our field forward, and you will be rewarded with a meaningful career.”
- References:
- Kaup S, et al. Eur J Ophthalmol. 2020;doi:10.1177/1120672118815107.
- Q&A: National Medical Association offers opportunities for students, across specialties. https://www.healio.com/news/ophthalmology/20221019/qa-national-medical-association-offers-opportunities-for-students-across-specialties. Published Oct. 19, 2022. Accessed Jan. 3, 2023.
- Venkatesh R, et al. Indian J Ophthalmol. 2017;doi:10.4103/ijo.IJO_344_17.
- Young cataract surgeons need to prepare for higher case volume. https://www.healio.com/news/ophthalmology/20220418/young-cataract-surgeons-need-to-prepare-for-higher-case-volume. Published April 18, 2022. Accessed Jan. 3, 2023.
- For more information:
- Alison D. Early, MD, of Cincinnati Eye Institute, can be reached at aearly@cvphealth.com.
- Eileen Hwang, MD, PhD, of Moran Eye Center, can be reached at eileenhwang@yahoo.com.
- Judy E. Kim, MD, FARVO, FASRS, of Medical College of Wisconsin, can be reached at jekim@mcw.edu.
- Lisa M. Nijm, MD, JD, of Warrenville EyeCare & LASIK and University of Illinois Eye and Ear Infirmary, can be reached at lnijm@realworldophthalmology.com.
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