Help!!!

[DOCTORSAIB]

Let's say hyopthetically that a two doctor general ophthalmolgoy practice and was are in need of an associate. They have enough overflow to fill your schedule 2-3 days a week. One of the doctors is in his late 50s and thinks about retiring over the next 10 years. The other one is in his mid 40s and doesn't antipate retirement for 20-25 years.

How would you handle a situation like that? What would you do for this practice?

I'm still not sure why everyone is talking about retina surgeons doing Botox, etc. I'm perfectly aware of the idiocy of such a move.

However, KHE's hypothetical scenario is asking about a GENERAL ophthalmology practice. And that's what I was referring to in my examples. Sheesh people.

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[KHE]

I'm still not sure why everyone is talking about retina surgeons doing Botox, etc. I'm perfectly aware of the idiocy of such a move.

However, KHE's hypothetical scenario is asking about a GENERAL ophthalmology practice. And that's what I was referring to in my examples. Sheesh people.

Clearly a sub-specialist ophthalmologist who wants to build a practice on referrals from other ophthalmologists and a smattering of ODs is going to have to take on a different tactic than a generalist who is highly UNlikely to get referalls from other opthalmologists but who would like to get referrals from primary care doctors or optometrists.

Building a referal network can be time consuming and tedious and not very lucrative at the start. But in the end, it's the best way. What other options are there really? You can essentially advertise, market directly to patients, utilize insurance plans and basically compete with everyone else. That's what many ODs do and some are very successful at it but most aren't. They don't crash and burn but they aren't very effective and they sort of limp along making a decent living but never really growing a practice to anything more than a small time one doctor outfit and they rarely get into the upper echelon of making money.

I'm going to be a bit profrane for a second, and I apologize to the moderators and other viewers in advance. If we're really honest with ourselves, we'll all kind of admit that most ophthalmologists are arrogant jackasses. You sort of understand where that comes from. Most of them are overachievers. Most of them are at or near the top of their med school classes, which is pretty much a requirement for admission to an opthalmology residency. The nature of the work that you do, "healing the blind" can also make for a somewhat inflated ego as well.

There's a difference between confidence and arrogance and I think this is where too many young opthalmologists stumble, particularly when dealing with other providers.

If you want ODs to refer to you, this is what I recommend.

First and foremost....SEND THE PATIENT BACK. Far too often, this doesn't happen. I know...I know...sometimes patients do want to stay with the ophthalmologist. That does happen, and that's fine. But at least make an honest effort to encourage the patient to return to the OD for ongoing care, and please for the love of God, don't try any crap like "hmmm....little Timmy seems to have some unusual astigmatism here. We really should see his brothers and sisters as well." (This, on a kid who's refractive error was
+0.75-0.75x10) ODs are a fairly close knit group and word spreads real fast who the docs to avoid are and who the ones to send to are.

Secondly, when you see the patient...please call. Even if you just leave a message or talk to us for 10 seconds, just call and say "Mrs. Jones is fine, we gave her this treatment. Or yes, Mrs. Jones does have a cataract and we will schedule her for surgery." This makes a huge difference because often times patients will phone us the next day asking "what did he say?" and if we have to wait 3 weeks for a dictated letter to cross our desks, it's a pain. If you get referred anything acute, call. Even if it's for 10 seconds.

When dealing with PCP types, try to network with young doctors who are also trying to build their practices. Send the letter quickly so they can get their little PQRI bonus. (if they care.) And also, don't be affraid to send patients to them. Eye care is a very strange business. There are patients who get their eyes examined once every 20 years and we never see them. There are other people who are "anti-doctor" but they wear glasses or contacts so their eye doctor might be the ONLY doctor they see on a regular basis. If you think people need it, have your staff make an appointment with someone. Don't just say "you should really get your cholesterol or your blood pressure checked." Say "Look, you're 40 years old and you have some early signs of cholesterol (or whatever) in your eye. You should see Dr. Orbitsburg and have him/her check that out and just make sure you aren't clogging up your arteries. He/she is a really great guy/woman. They won't hurt you and will take great care of you."

Even the most recalcitrant patients deep deep down know that they should be doing these things. If you say "get your cholesterol checked" they'll say to themselves "yeah....I should" but really, they aren't going to do it. If you say "we'll make you the appointment" they may not show up but the chances are MUCH HIGHER.

Also, the reason that I advocate trying to seek out younger PCPs is that they are much more likely to be greatful and refer YOU patients than a thriving IM practice where the last thing they really need or care about is yet another in a long list of 40 year olds with slightly elevated cholesterol. They won't give a crap about you or your referrals in most cases. So try to work with people who are in a similar boat.

 

[eyehope]

Thanks for your insight KHE. I have heard that another way to attract referrals is to hold a CME conference/lecture. In your opinion, what topics would be helpful for optometrists?

 

[KHE]

Thanks for your insight KHE. I have heard that another way to attract referrals is to hold a CME conference/lecture. In your opinion, what topics would be helpful for optometrists?

I can't speak for every OD on this, but for me personally, I always like to hear about the difference between cases you can sit on for a few days and which are truly ocular emergencies, or at the very least need to be seen within a day or two by an ophthalmologist.

ODs by their nature tend to get easily bent out of shape for minor things. For example, a patient who is 20/30 in an ophthalmologist office is usually considered a fantastic result, or has "nothing" really wrong with them. However, a 20/30 patient in an ODs office is a catastrophe requiring a stat referral. Obviously I'm exagerating a bit but you see where I'm going on. ODs look in someone's eye and see an ischemic CRVO and go nuts. Stat referal to retinologist when in actual fact, an ischemic CRVO doesn't require that. No one is going to do an FA until some of that blood clears out of there.

Even a detached retina can sit for a day or two. No need to run to the ER in most cases.

So I guess I prefer things like that.

 

[DOCTORSAIB]

KHE, you mentioned somewhere that you have a successful practice? How long did it take you to get to that point? And what's your 5-yr? 10-yr plan?

I'm interested in knowing how a successful OD/OMD takes their practice to the next level? Do you just keep on hiring new docs as your practice grows?

Do you open multiple practices?

Do you transition from taking care of patients to managing docs/operations at some point?

 

[andwhat]

KHE, you mentioned somewhere that you have a successful practice? How long did it take you to get to that point? And what's your 5-yr? 10-yr plan?

I'm interested in knowing how a successful OD/OMD takes their practice to the next level? Do you just keep on hiring new docs as your practice grows?

Do you open multiple practices?

Do you transition from taking care of patients to managing docs/operations at some point?

I would strongly advise you to concentrate on residency first. Don't worry so much about the money, wow! It is scary sometimes, the mentality.

 

[Tippmann]

I would strongly advise you to concentrate on residency first. Don't worry so much about the money, wow! It is scary sometimes, the mentality.

funny you can harp on and on about lifestyle/salary and when others do it, it's taboo

 

[WhatNEyeTem]

Beginning the job search... my first impressions:

1) Ophthalmology seems to have fewer job openings compared to other medical specialties.

2) #1 is even more true in places where I would consider living (in other words, not in middle-of-nowhere America).

3) I should have done dermatology or GI! My Medicine friends are laughing at me now...

Guess I'll be making half as much as my friends

-J

 

[orbitsurgMD]

Beginning the job search... my first impressions:

1) Ophthalmology seems to have fewer job openings compared to other medical specialties.

2) #1 is even more true in places where I would consider living (in other words, not in middle-of-nowhere America).

3) I should have done dermatology or GI! My Medicine friends are laughing at me now...

Guess I'll be making half as much as my friends

-J

Maybe not. Both GI and derm are overdue for a trip to the barber. Their haircuts are coming, and probably pretty soon.

Derm has kept a firm grip on its numbers of slots. That works up to a point, but it can also be an invitation to something that could be outside their control, like fellowships of medicine or pathology in the same discipline but outside the control of the American Board of Dermatology.

 

[Eyefixer]

Hits you like a ton of bricks, doesn't it? You would never expect this considering how competitive and how cool ophtho is. With refractive being down 50-80% in most major cities people now are falling back on general ophtho/postponing expansion plans/getting out of town, etc. Expect the job market to get even worse. Good luck.

Beginning the job search... my first impressions:

1) Ophthalmology seems to have fewer job openings compared to other medical specialties.

2) #1 is even more true in places where I would consider living (in other words, not in middle-of-nowhere America).

3) I should have done dermatology or GI! My Medicine friends are laughing at me now...

Guess I'll be making half as much as my friends

-J

 

[Eyefixer]

Demand for GI is tremendous. You can pretty much get a job anywhere. Away from major markets- start at $400K. My good friend is a 3rd year GI fellow going through job search now.

Maybe not. Both GI and derm are overdue for a trip to the barber. Their haircuts are coming, and probably pretty soon.

Derm has kept a firm grip on its numbers of slots. That works up to a point, but it can also be an invitation to something that could be outside their control, like fellowships of medicine or pathology in the same discipline but outside the control of the American Board of Dermatology.

 

[Bagster]

Hits you like a ton of bricks, doesn't it? You would never expect this considering how competitive and how cool ophtho is. With refractive being down 50-80% in most major cities people now are falling back on general ophtho/postponing expansion plans/getting out of town, etc. Expect the job market to get even worse. Good luck.

depressing...considering that I finally felt sure about ophtho...in fact I will do it regardless of compensation at this point...but still depressing

 

[KHE]

Beginning the job search... my first impressions:

1) Ophthalmology seems to have fewer job openings compared to other medical specialties.

2) #1 is even more true in places where I would consider living (in other words, not in middle-of-nowhere America).

3) I should have done dermatology or GI! My Medicine friends are laughing at me now...

Guess I'll be making half as much as my friends

-J

You guys are still going about it the wrong way. Don't think in terms of someone "giving you a job." Think in terms of how are you going to create a job for yourself.

 

[orbitsurgMD]

You guys are still going about it the wrong way. Don't think in terms of someone "giving you a job." Think in terms of how are you going to create a job for yourself.

KHE

Here is the reality: most fresh residency graduates have negative net equity, often significantly net negative. Going into a "market" cold with no prior presence and reputation, with no referral base established and with the need to establish many things at once: household, repayment of school loans and then the establishment of a practice, the choice of getting a job is often the only viable one. In the last several years and in the last year particularly, the opportunities for professional lending have dried up in many places. A bank won't just give you a six figure loan to launch unless it has pretty strong reassurance that it will see its money back. That means collateral in most cases.

Most new graduates haven't got enough assets to secure the lines of credit and capital equipment lending they need to launch. If you are lucky, a local hospital will act as a guarantor, but even those opportunities are rare compared to the sponsored startup terms offered to GS, GI and cards.

Showing a bank you have a patient base in an area certainly helps, but getting that is difficult. If a practice hires you but reneges on promises at equity ownership of your own practice, you may be locked out by a non-compete if you leave, and are not bankable.

I can't blame these doctors for being concerned. It is not an easy market to break into--in fact it is difficult when you consider how expensive the typical outpatient eye office is to equip and the minimum requirements for equipment needed to sustain a competitive presence in a community and offer services at the standards presently expected, especially compared to a GI or Cardiology practice, which have relatively lesser demands for technical equipment while receiving much more support from typical hospitals.(OK, if you want a cath or endoscopy suite, you can compare that cost to a 1-room surgery center for an ophthalmologist).

 

[KHE]

KHE

Here is the reality: most fresh residency graduates have negative net equity, often significantly net negative. Going into a "market" cold with no prior presence and reputation, with no referral base established and with the need to establish many things at once: household, repayment of school loans and then the establishment of a practice, the choice of getting a job is often the only viable one. In the last several years and in the last year particularly, the opportunities for professional lending have dried up in many places. A bank won't just give you a six figure loan to launch unless it has pretty strong reassurance that it will see its money back. That means collateral in most cases.
).

Again, the issue isn't "start up a practice" although I do believe that even in today's climate, that is a still a viable and often overlooked option.

But assuming for a second that that's not the route you want to take, too many people seem to be approaching this as "someone please give me a job."

When I say think about how to create a job for yourself, I'm saying think about what you can do or how you can market yourself to potential employers (or potential seller, some of whom may not be actively looking to employ or sell)

Because on some level, you're right....in today's climate there probably aren't a lot of practices looking to bring on people to do more of the same thing they are already doing.

So what are you going to do? (Besides bitch and moan I mean. )

 

[orbitsurgMD]

Again, the issue isn't "start up a practice" although I do believe that even in today's climate, that is a still a viable and often overlooked option.

But assuming for a second that that's not the route you want to take, too many people seem to be approaching this as "someone please give me a job."

When I say think about how to create a job for yourself, I'm saying think about what you can do or how you can market yourself to potential employers (or potential seller, some of whom may not be actively looking to employ or sell)

Because on some level, you're right....in today's climate there probably aren't a lot of practices looking to bring on people to do more of the same thing they are already doing.

So what are you going to do? (Besides bitch and moan I mean. )

You're right, you need a plan in any case.

If you have your heart set on a competitive area, you need to start early and find out who is practicing there, who is growing, who is retiring, or wanting to retire and where the pockets of small-scale growth are (even areas that are static in a regional sense will have some pockets of relative growth.)

Contact practices you think you would like to work for well before you will be starting work. There is no harm in calling someone and asking whether they have considered expanding services with another doctor. Be creative. Explore whether a part-time arrangement would meet a need. Practices that might be intimidated by the cost of starting a new doctor full-time might not be so intimidated by a part-time arrangement (and with that should go corollaries, like no non-compete).

You might as well call the hospitals too. Speak to the medical staff recruiter. Find out whether they would be willing to sponsor you as a startup. Sometimes the idea has never been considered and may be left that way because of more pressing recruitment needs. But it can't hurt to ask.

Be discreet. Many hospitals want to be protective of their staff doctors and might not like to solicit new practitioners for fear of alienating the staff, but a doctor approaching retirement age without a successor aboard could leave the hospital suddenly without coverage in the event of illness or other sudden event. They need to look out for their own interests. There are ways to propose a recruitment sponsorship without making yourself look like a buccaneer.

Giving the impression that you are interested in the area, that you are committed to staying and that you consider the welfare of the overall practice community will lend credence that you can play well with others, something that will make you more welcome than if not.

 

[KHE]

You're right, you need a plan in any case.

If you have your heart set on a competitive area, you need to start early and find out who is practicing there, who is growing, who is retiring, or wanting to retire and where the pockets of small-scale growth are (even areas that are static in a regional sense will have some pockets of relative growth.)

Contact practices you think you would like to work for well before you will be starting work. There is no harm in calling someone and asking whether they have considered expanding services with another doctor. Be creative. Explore whether a part-time arrangement would meet a need. Practices that might be intimidated by the cost of starting a new doctor full-time might not be so intimidated by a part-time arrangement (and with that should go corollaries, like no non-compete).

You might as well call the hospitals too. Speak to the medical staff recruiter. Find out whether they would be willing to sponsor you as a startup. Sometimes the idea has never been considered and may be left that way because of more pressing recruitment needs. But it can't hurt to ask.

Be discreet. Many hospitals want to be protective of their staff doctors and might not like to solicit new practitioners for fear of alienating the staff, but a doctor approaching retirement age without a successor aboard could leave the hospital suddenly without coverage in the event of illness or other sudden event. They need to look out for their own interests. There are ways to propose a recruitment sponsorship without making yourself look like a buccaneer.

Giving the impression that you are interested in the area, that you are committed to staying and that you consider the welfare of the overall practice community will lend credence that you can play well with others, something that will make you more welcome than if not.

All excellent advice!

I would encouarage people to not fall into the trap that many young doctors do...which is to graduate from residency and say "Ok world! Here I am! Pay me!!"

That's not going to fly in most cases, particularly in eye care. Start thinking about how you are going to market and promote yourself so that you can create a job rather than "looking for a job."

 

[thackl]

Some upper levels at my program have been complaining about this as well.... one even considered just doing the 2 additional yr of IM. I see my brother (a new interventional pain attending) doing so well already and it really makes me wonder. Gas/Pain was the other thing I applied to along with Ophtho, but felt like ophtho suited me better. I really cringe to think of how hard it will be to find/create a job in a major metro area

 

[TicToc22]

Are all of the issues discussed in this thread also present when starting a practice in pediatric ophthalmology? Or does the need for more pediatric specialists generally make this an easier practice to find a job in?