July 2009




A Fine time in ophthalmology

by Maxine Lipner, Senior EyeWorld Contributing Editor


At the party celebrating my retirement, which was held in conjunction with the recent ASCRS meeting in San Francisco, many friends and colleagues from all over the world proclaimed that they did not really believe I was retiring. Not only did they not think I would ever retire, but they also didn’t believe I would be able to retire. Well, in fact the truth is in some ways a mixture of all of those thoughts. However, one of my favorite journalists, Maxine Lipner, called me recently to interview me about my retirement which has become the subject of this month’s column. Senior ophthalmologists may find a part of their own situation in this article, and junior ophthalmologists may learn a little bit about how, with enough fore thought and planning, it can become a relatively non traumatic event.

I. Howard Fine, MD, Column Editor


I. Howard Fine, M.D., on the brink of change

Surgeons from all around the world come to Eugene to observe Dr. Fine perform surgery Source: I. Howard Fine, M.D.

You’re too old. We don’t have good luck with people your age—they don’t finish.” That’s what several medical school administrators told the then 26-year-old, I. Howard Fine, M.D., a Massachusetts Institute of Technology, Cambridge, Mass., graduate who was at the time attempting to make a career change from polymer engineering. Today, with an almost 40-year, storied career behind him, Dr. Fine, renowned ophthalmic physician, lecturer, and investigator is poised to make another big change—partial retirement. Casting his mind back to his early days in the medical school at Boston University, Boston, Dr. Fine, who is now clinical professor, Casey Eye Institute, Oregon Health & Science University, Portland, Ore., and in private practice, Fine, Hoffman & Packer LLC, Eugene, Ore, recalls what first drew him to ophthalmology. “I became aware of physicians making rounds at 10 to 11 o’clock at night and I can remember some of them saying, ‘This is no way to live,’” Dr. Fine said. To get a better feel for what the various specialties had to offer the industrious medical student began inviting clinical faculty from each department to lunch. “I interviewed them about what they liked about their work,” he said. “Really just to be complete the last person who I took out was an ophthalmologist.”

This last lunch with the acting chairman of the ophthalmology department had a profound effect. “He said that every year when Medical Economics interviews specialists from every specialty about professional satisfaction, the group that is on top every time is ophthalmology,” Dr. Fine recalls. “That made me really look into what it was and what ophthalmology was like.”

Training for success

As only a junior, he found that he was fortunate to land a residency right at Boston University. Dr. Fine credits the extraordinary faculty which at the time included Ephraim Friedman, M.D., a retinal surgeon, and Howard Leibowitz, M.D., a corneal practitioner, among others as inspiring and molding his career in unexpected ways.

Dr. Fine, who was older than most of his fellow residents, was determined to take full advantage of his training opportunities. “I worked very hard to learn how to use an indirect ophthalmoscope and I drew retinas as much as I could,” he said. Dr. Friedman was impressed by Fine’s industriousness and rewarded him accordingly. “He let me do multiple retinas while I was a second year resident,” Dr. Fine said. “Then when he left on vacation during my third year, he let me take over his practice.”

Likewise, the then resident worked as diligently during his corneal rotation. “During my senior year Howie Leibowitz who as the chief of cornea said to us, ‘Anyone who wants to learn corneal transplant, come to my lab at 6 o’clock,’” Dr. Fine recalls. “I hurried to finish my work and I got there at 6 o’clock and I was alone.” Dr. Friedman helped him to perform a corneal transplant on two cadaver eyes. “From that time on in my residency program whenever he had a corneal transplant wherever I was he had me assist him,” Dr. Fine said.

Beginning practice

While Dr. Fine and his wife, Vicky, who had graduated from Wellesley College, Wellesley, Mass., were firmly entrenched in the Boston community, they began to think about living elsewhere. This was spurred by concerns for their three children. Dr. Fine had always assumed that they would attend public school just as he had. “The Boston public schools at the time were rife with problems. “Some of the schools had police in them to keep ruffians out and to keep peace,” he said. “I was very frightened about having my children have to live with intimidation in the schools.”

Instead the Fines headed out to the West coast looking for a new home. Ultimately they ended up in Eugene. “It was April and it had rained, the sun was out so it had this washed appearance—we literally fell in love with it,” Dr. Fine said.

He also found the community itself to be very welcoming. Practitioners in Eugene were eager to send the talented young doctor their overflow patients. “They were happy to have somebody who could take their cases that they would normally have sent to the medical school,” Dr. Fine said. “So, I ended up doing all of the scleral buckles on the retinal detachments and all of the corneal transplant surgery for southwest Oregon.”

A controversial time

In building his career, Dr. Fine found that his engineering background served him well in adapting to emerging technology, which didn’t intimidate him. “The use of microscopes was just beginning and the development of 10-0 nylon suture was very new,” Dr. Fine said. He had actually been using 10-0 nylon sutures in corneal grafting as a resident, and now began to apply this as a cataract surgeon.

During the early 1970s, spurred by a backlog of hospital patients during flu season, he became a local pioneer in the outpatient cataract surgery movement. This was enabled in part by the forgiving nature of the 10-0 nylon sutures he was now using. While he was having success with the outpatient approach, which cost about $1000 less than the traditional approach, he found great resistance in the community. “Some of the senior ophthalmologists felt threatened because maybe their patients would want to be operated on, on an outpatient basis,” he said. Things did not ease until four or five years later when approach became popular in nearby Portland.

Contact information

Fine: 541-687-2110, hfine@finemd.com

For additional insight on Dr. Fine’s esteemed career as well as partial retirement pearls, be sure to read the second part of this article in the August issue of EyeWorld.

A Fine time in ophthalmology A Fine time in ophthalmology
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