March 2009




The thriving practice: taking a collaborative turn

by Samuel Masket, M.D.


Last month we had a description of how a large, multispecialty practice was developed and how it is anticipated to grow through the next generation of the practice. This month, Dr. Samuel Masket, a clinical professor at the Jules Stein Eye Institute, describes his approach in making a transition away from a solo practice to a collaborative approach with an anticipation of being able to meet the increased needs of the patient population, and the potential for reduced remuneration in the current and foreseeable economic status of the United States. In addition to being a past president of ASCRS and a Binkhorst Lecturer, Dr. Masket has a long history as an international leader in ophthalmology, being a practitioner, a researcher, an author, a lecturer, and an innovator. I am sure there are a large number of solo practitioners who will be especially interested in this month’s column.

I. Howard Fine, MD, Column Editor


Transitioning from solo practice to a more coalescent approach

For any practice to be successful in the long-term it is important to look at demographics. Currently there are approximately 60,000,000 Americans between the ages of 55 and 85. Over the next 15 years or so, that number is going to expand to approximately 90,000,000 people. In short, we are experiencing a graying of our society. With a panoply of conditions that come with age such cataract, glaucoma, macular and corneal disease affecting the eye, we as ophthalmologists need to gear ourselves to handle this increasing patient load. In looking at the socioeconomics, we also understand that medicine in general is already a sizable16.2% of the gross domestic product (GDP) and growing. With ophthalmologic technology also expanding, and the fact that much of the aging population is comprised of “Baby Boomers,” with high utilization and demand patterns, we need to ready ourselves for this new patient load. My sense is that as we see a greater volume of care this will be accompanied by reduced per patient reimbursement. As ophthalmologists we must put ourselves in a position to be able to deliver a greater amount of care, for likely a smaller unit per care of treatment.

Vanishing solo breed

We as ophthalmologists need to be able to prepare our practices for this upcoming increased patient load. The most logical way to be able to do this is to apportion the care to those practitioners who are most efficient in delivering access here.

It is apparent to me that it is the specialists among us who will be able to offer a more efficient degree of care in that area. For years I was a solo-practitioner and enjoyed the autonomy this afforded. As a solo-practitioner, I was able to make all the decisions from which equipment to purchase to the amount of time to spend in the office, to how much office space I actually needed.

The downside of running a solo practice is that it is becoming more and more expensive to practice this way. Costs such as staff salaries and rent continue to rise. There’s also the cost of expanding technology to consider. To run a state-of-the art practice there is more and more equipment needed. This coupled with decreasing reimbursement make the solo-practitioner a vanishing breed.

In my practice, in the past few years I have been moving towards building in more efficiency. About five years ago, I brought in a practitioner to make use of my office space and equipment during times that it otherwise would have lay fallow. While this practitioner was not a partner, this was a very symbiotic move so that the office equipment and staff would be utilized in my absence.

Partnering with specialists

Lately, I’ve also started taking a more collaborative approach. One of the things that I recently did was to bring in a practitioner who was fresh from a corneal fellowship, Dr. Nicole Fram, who is well-schooled in particular in corneal transplantation techniques. Instead of referring such patients elsewhere this now enables me to now keep these patients in-house by offering them another layer of services. Now, in addition I am considering bringing some opticians into the mix. While of course we offer a refractive exam, for a long time I have not dispensed any optical goods such as contact lenses or glasses. I am currently in the process of considering acquiring a practice that does offer those services. My concept here is to integrate with other practitioners and expand the services that my office provides, which I believe will be the way of things to come.

I see this as a long-term approach to deal with the mounting onslaught of demographic factors. Over the next three to five years I hope to ensure that optometric services are integrated in the practice to offer patients these services and to make use of that revenue stream. During that period I will likely also bring another sub-specialist into the mix. I see this kind of coalescence of practice as the way of the future.

Going forward, the fact is in addition to handling the aging population we will likely have mandated health information technology (HIT). Although in the economic recovery plan there is a proposed per physician dollar amount for HIT it probably will not cover the cost for bringing everyone online. So, I think the practitioners will likely also bear some of that burden. Ultimately, for practices to survive as we adopt things such as electronic medical records and electronic prescribing, it will be the economy of scale that will be the rule. In short, with this coupled with everything else before too long the solo-practitioner will truly be a thing of the past. My own practice I hope will be around and thriving for many years to come.

Contact Information

Masket: 310-229-1220,

The thriving practice: taking a collaborative turn The thriving practice: taking a collaborative turn
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