Dream big. Dream realistically.
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“I dream of painting and then I paint my dream.”
– Vincent van Gogh
“Dreams and deeds are not as different as many think. All the deeds of men are dreams at first, and become dreams at the end.”
– Theodor Herzl
Being an ophthalmologist is a pretty dreamy life. Ophthalmology is a sophisticated specialty with constant improvements, good hours and pretty great pay. And it is being part of an intimate, embracing medical tribe that sticks together and supports its thought leaders.
Although becoming an ophthalmologist takes maximum effort (even for the smartest students), what comes after graduation is an all-but-certain outsized reward. With comparatively little effort, a little wisdom and time, you can help thousands of patients and arrive at financial independence in your 50s. You can contribute to science and education. You can invent new tools and procedures. You can travel the world in luxury. And you can use your wealth to fund much good in the world.
But you can’t have it all.
In the course of a 30-plus-year career, everyone has to decide the wisest dreams to pursue. As rocker Neil Young warns, “If you follow every dream, you might get lost.”
Because so many potential dreams are open to ophthalmologists, choosing between competing dreams can be a challenge. With an abundance of means, your longer-term aims can be blurry.
I have long observed that ophthalmologists, for all their other talents, can be poor at long-range planning or assembling disparate dreams into a coherent life’s work. Perhaps this is because as a medical careerist, so many decisions are made for you. At every educational stage, you study the just-right classes and must excel at them (so you have little time to explore extracurricular interests). Medical school and subspecialty training simply sweep you along, with few choices or much time for dreaming. Finally, at the end of the preparatory gauntlet, with a world of new choices about where and how to practice, many simply settle for a job with the most enthusiastic employer.
At some point, this leads many ophthalmologists, somewhere in the first third of their career, to pause from the daily routine, shake off the dreams that parents and professors imposed on them, and ask their inner selves, “What do I want from this career, anyway?” The big-picture questions fall into just a few categories.
Where to practice?
This is the most important question for young doctors. Job opportunities have never been more abundant, and that will only get better over the next 20 years, as patient demands grow and doctors retire. You can now find a job — or make a job — in any market in America. Choose a place that works best for you and your family.
What to practice?
A couple of generations ago, almost everyone was a comprehensive ophthalmologist. And you can still be one. Or you can narrow the care you provide to your passions or temperament. Decisions in this area are presented throughout your career. Mid-career subspecialists become comprehensivists. Emeritus doctors train to do new procedures.
How hard to practice?
This is a comparatively new question to ask when you are exploring your dreams as an eye care provider. For ophthalmologists over a certain age today, the answer was always to go “flat out,” until the last few years before full retirement. For contemporary surgeons, the options are infinite. “Flat out” is still possible, of course. So is:
- job sharing;
- part-time practice;
- a 50% private practice combined with teaching or research;
- early or late retirement; and
- sabbatical-length breaks from medicine.
Desired enterprise scale?
Every ophthalmologist has a comfort zone. Some are better suited to solo or small group practice. Some are more comfortable being a modest cog in a larger institutional or corporate enterprise. This can be hard to forecast at the start of your career. Some doctors can only imagine running their own practice until the dream of absolute control runs headlong into the nightmare of the super-human demands placed on solo owners. And vice versa. Some doctors find themselves lost or sidelined in a large department or corporate-scaled practice and need to find their way to a smaller organization.
Financial aspirations?
Average ophthalmic incomes are now around $400,000. Tell that to a medical school applicant, and you might hear, “Wow, I can’t imagine needing to earn that or anything close.” But the years pass. School loans mount. Then the house. Then the twins. Then two graduate school tuitions. Before you know it, $400,000 is looking a little thin. Everyone needs to find an approximate fit between their financial needs and their productive capacities. And then one needs to make flexible adjustments along the way. That said, the happiest clients earn significantly more than their living costs.
Scattered in between each of these “mega” dreams and decisions, there are a lot of “micro” decisions. Should we get into dry eye care or next-generation lens technology? Should we develop a full-blown ASC or an office-based cataract operatory?
As important as it is to follow your dreams, it is equally important to decide which dreams to not pursue or to abandon. Abandoning a dream is painful but can be the wisest course. Here are common examples of miscalculation and overreach that we see in eye care.
Satellite offices
Without proper advance planning and ongoing attention, satellite offices commonly fail or, at best, sputter along. Sometimes the failure is absolute, which is the easiest dream to abandon. But sometimes it is appropriate to abandon your dream satellite office even if it is only gently failing or only in relative terms. Examine the net profit per MD-hour in your main office. Then do the same calculation for your satellite office. It is common to find that hourly earnings are much higher in the main office as compared with the satellite. When it is time to pull the plug, pull it. They do not give out any prizes for going broke slowly.
Supplemental patient services
It can be professionally renewing to add a service to your practice, whether it is near the center of eye care (LASIK surgery) or at the far periphery (laser skin resurfacing or hearing aids). Unfortunately, asking your provider team and support staff to take on a new line of business, when they are already working flat out on your core business, commonly results in failure. Do not abandon a vibrant dream you might have to add new services to your practice, but make sure that dream is backed with abundant planning, personal time commitment and capital.
Growing too fast or too large
Doubling the size of your practice can quadruple its complexity and outrun the leadership and operational capacity of your management staff. A rule of thumb we use at the firm is that any practice growing more than 10% a year (which is about twice the pace at which demand for eye care is now growing in America) has to at least temporarily live with errors and imperfections.
Impulsive capital equipment purchases
Unless you are financially independent and simply want to own the latest, coolest device for its own sake, apply this simple two-part screen for any high-ticket items:
- “Does this device now fall within our community’s standard of care?” If the answer is yes, then you are ether obliged to buy the device or stop providing those patient services that reasonably require the device to provide quality care.
- Alternately, if the device is truly vanguard and not obliged by community standards, ask, “Is the net profit per provider hour increased by purchasing this new device?”
Joining the wrong practice
A troublingly high percent of young eye surgeons accept partner-track associate positions without proper contract review or vetting of the employer. What appears on the surface to be a dream job can turn into a nightmare for various reasons: adverse community reputation, poor partner chemistry, unfair buy-in terms (that are often occult until the partnering time comes around), poor financial performance or weak management. Politely listen to your prospective employer, but verify their claims deeply before you invest 2 or 3 years of your career with an employer who is unfair to you or who runs a flawed practice.
Keeping the wrong partner
Ophthalmic practices are remarkably stable. They do not spit out partners at anything like the pace of other professional firms. Maybe that is a problem. Partners can be problematic at lots of levels. Too little production. Too much production (at the cost of overutilization). Staff or patient abuse. Or simply not being a comfortable interpersonal fit with the rest of the partners. Even if it fulfilled a dream to bring in a new subspecialist, and dismissing them will be painful, practice boards need to make decisions based on the long-range interests of the firm, not based on the temporary discomfort or cost of termination.
Summing up
With the familiar line, “a man’s reach should exceed his grasp, or what’s a heaven for?” poet Robert Browning asked that we attempt even those things that may turn out to be impossible. Up to a point, there is a certain nobility in attempting something outlandish and then failing. But beyond that point lies disappointment, frustration and great expense. Pick your dreams carefully. Don’t get lost.
- For more information:
- John B. Pinto is president of J. Pinto & Associates, Inc., an ophthalmic practice management consulting firm established in 1979. He is the country’s most published author on ophthalmology management topics, including John Pinto’s Little Green Book of Ophthalmology: Strategies, Tips, and Pearls to Help You Grow and Manage a Practice of Distinction, UP: Taking Ophthalmic Administrators and Their Management Teams to the Next Level of Skill, Performance, and Career Satisfaction (with Corinne Wohl), Simple: The Inner Game of Ophthalmic Practice Success, and Ophthalmic Leadership: A Practical Guide for Physicians, Administrators, and Teams. Available now for purchase at slackbooks.com. Receive 20% off with promo code PINTO20. He can be reached at 619-223-2233; email: pintoinc@aol.com; website: www.pintoinc.com.
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