June 2018

OPHTHALMOLOGY BUSINESS

YES connect
Experts bestow wisdom on early career ophthalmologists


by Liz Hillman EyeWorld Senior Staff Writer



“Don’t compete. Collaborate. It’s so much easier to collaborate with each other and give each other opportunities.”
—Susan MacDonald, MD

Young eye surgeons have a lot to learn during residency, fellowship, and in the first several years of practice. So much of our time is consumed with patient care, and the remainder is spent studying for in-service exams, preparing for board exams, doing research, preparing presentations, and practicing surgery in the wet lab. We rarely get the opportunity to sit down with our experienced mentors and our best teachers to ask about some of the big picture things: how to be a great teacher, how to stay current in the field, how to interact with industry, how to maintain financial responsibility, and perhaps most importantly, how to achieve a healthy work-life balance.
This month’s “YES connect” column
is my favorite one yet. We asked Lisa
Arbisser, MD, Susan MacDonald, MD,
I. Howard Fine, MD, and Robert Watzke, MD, to share some advice on how to have a successful and fulfilling career. I’m so fortunate to have had the chance to learn from these four remarkable individuals during my training and in my first 5 years of practice. Others who have spent time with them in the operating room, in the clinic, in the wet lab, or at a conference will surely agree. I hope this article reminds you to set aside some time with your own mentors to get some practical life advice. 
This is my final column as “YES connect” co-editor. Zachary Zavodni, MD, and I are passing the torch to the talented Samuel Lee, MD, and David Crandall, MD, who I’m certain will continue to make this column an interesting and relevant resource for young eye surgeons. Many thanks to the EyeWorld editorial staff for a great year!

Naveen Rao, MD,
YES connect co-editor




Those at the top of their field have a wealth of information to offer young ophthalmologists

The phrase “been there, done that” comes to mind when talking with well-established, respected ophthalmologists who have reached the top of their field. There is much that these experts can offer early career ophthalmologists on a variety of topics.
EyeWorld spoke with several leading ophthalmologists to get their top advice on everything from becoming a great teacher to working with industry to achieving work-life balance.

Lisa Arbisser, MD
Adjunct professor, Department of
Ophthalmology/Visual Sciences,
Moran Eye Center, University of Utah
Salt Lake City

EyeWorld: What advice would you give about becoming a great teacher?
Dr. Arbisser: I think a big part of it is the ability to record your surgeries because there is no better way to teach surgery than with video of surgery. One of the things I’ve done in my video editing is to cut out all the dead time and speed up the important parts. That allows people, if they care enough to take the video and slow it down, to see all the details because the devil is in the details. I think the way to be a great teacher is to not gloss over those details. I think some people take the basics and teach them, but it’s the details in between the basics or the nuances of those details that help to make people better master the craft.

EyeWorld: How do you stay up to date?
Dr. Arbisser: I think always putting the patient first, being a patient advocate, has put me in a position to be an early adopter. I have never been on the leading edge, which is sometimes laughingly referred to as the bleeding edge, because of the desire to be the best I can for my patients. The responsibility is to keep up with the literature and become involved with professional organizations so you can pick the brains of other people at the top and those who are on the leading edge. The thing about being an early adopter is to do your best to neither jump on a bandwagon nor eat its dust.
I think one of the most important things is going to meetings and interacting with industry. [Trade magazines] are a harbinger of what is going on; they alert you to what’s new, but then you need to go to the literature or who is using it first to really understand what the risks and benefits are. Once it becomes clear there is a benefit to your patient and your outcomes, I think you’re morally obligated to either go through the learning curve or to refer.

EyeWorld: What are your thoughts on financial responsibility, early-, mid-, and late-career?
Dr. Arbisser: One has to decide how to stay viable and how to still be able to have current technology. One of the ways to do that is to practice where you’re needed and therefore busy; decide how you are going to specialize or where are you going to fill a need. [My husband, Amir Arbisser, MD, and my] goal with the patient first in mind was to create a practice that was both needed and would survive us and continue to serve the community after us.

EyeWorld: What’s the best way to interact with industry?
Dr. Arbisser: I never took any significant money from industry. I had an occasional unrestricted grant to do clinical research or travel, which of course you divulge. Independence allows you to decide what’s best for your patient from the wide world of available options. I’m always doing my best to evaluate information and equipment in order to find what works best in my hands, but the point is you don’t know what’s best without being an insider [who is] able to see it and try things. The problem is cyclical, however, in that the higher volume you are, the more you get industry opportunity and attention, and it’s hard to get that volume at the beginning. In the future, surgeons may be more burdened by the need for their services from an aging population rather than vying for bigger volume.
We take the Hippocratic Oath and we have to believe in that and not be cynical. We must be very clear about this, but we cannot take care of our patients without industry. There is virtually nothing that we do that industry hasn’t created or developed for us. I think healthy relationships between industry and physicians are critical to good patient care.

EyeWorld: How would you suggest maintaining a healthy work-life balance?
Dr. Arbisser: Medicine is one of those fields that cannot be perfectly balanced. Call is, however, one of the most intrusive parts of the profession for balance. My husband and I allowed partners to buy in at a much lower cost than the practice valuation in exchange for taking call. In our later years, with more partners, we decided it was most fair to pay handsomely for call. Deciding one can live happily within their means with less income can help strike the proper balance.
Another way is to value your extenders not only in the office but in the home. There’s no reason for a physician to do laundry, but there is great reason for the physician to be at their child’s baseball games or theater performance. You need to outsource everything that isn’t essential to your life balance and be willing to pay for that. Consistent child care is essential as you can’t call the OR and cancel for a child’s illness and can’t be focused on surgery when you don’t have someone you trust to help and love the child in your absence. I also think couples should schedule at least one vacation a year for just the two of them and one more for the family together. These respites go a long way to helping achieve balance.

EyeWorld: Any final thoughts for early career ophthalmologists?
Dr. Arbisser: Be critical of yourself and be counting your outcomes. There’s a saying that those who don’t count, don’t count. Just assuming your outcomes are up to par isn’t good enough. You’ve got to be collecting and looking at the data.

Susan MacDonald, MD
Associate clinical professor,
Tufts University School of Medicine
Boston

EyeWorld: What would be your advice for success in academic
medicine?
Dr. MacDonald: At all schools of medicine, there is an office of educational affairs and faculty development. I would recommend to anyone who is pursuing an academic position to meet with this office. Some offices have websites with [professional enhancement] opportunities.
I also think it’s important that every time you give a presentation or publish a paper, you cut and paste the essential information from that into your CV. In the future when you need to present it formally, at least you’ll have that information in one place and you can easily edit it.
I think it’s important to ask yourself who your mentors are. Identify someone who you want to model your career after. It’s the mentors who will help introduce you to opportunities and take you onto projects that you might not be able to start on your own.

EyeWorld: What advice would you give about becoming a great teacher?
Dr. MacDonald: When you’re teaching residents, I think it’s important to make a personal connection with them and understand that they need to be encouraged, but they also need honest feedback. I think it’s important to take the time to model for them what you want them doing and also have an opportunity to have a discussion with them. Try to simplify and make sure your points are made in under 5 minutes, break down those steps, and be able to talk with the residents afterward to critique their performance. The best way to do that is by videotaping.

EyeWorld: How do you stay up to date?
Dr. MacDonald: Young ophthalmologists, when you’re choosing a practice, keep these questions in mind: Am I joining a group of early adopters? How are we going to learn from each other? You’re going to spend a lot of time with your partners and your faculty members and you want to encourage each other to adopt new techniques that will benefit your patients. You can also stay current reading journals. ASCRS has EyeConnect, and there are a lot of interesting discussions that take place there. Going to meetings is a great way to stay up to date. Sign up for wet labs.

EyeWorld: What are your thoughts on financial responsibility, early-, mid-, and late-career?
Dr. MacDonald: Think about the life you want to lead, what your values are, how much time you want to spend with family, how much time you want to spend taking care of yourself, doing volunteer work, and just being the person you want to be. You have to track that all back to the financial decisions you’re making.

EyeWorld: What’s the best way to interact with industry?
Dr. MacDonald: I think it’s a complex relationship, but it is critical to have ophthalmologists actively partnering with industry to develop new technologies and pressure test these technologies to make sure they are valid and applied to the care of our patients. Ethically, I think physicians should be compensated for their time when they are involved with contributing to industry knowledge, but I think physicians need to be transparent about it. Your word is pristine; keep your word pristine and be ethical scientists and researchers and an ethical speaker by speaking the truth.

EyeWorld: How would you suggest maintaining a healthy work-life balance?
Dr. MacDonald: Everyone says life is short, I say life is long. There are many choices that you’re going to make, and every time you make a choice for work, that time is going to come out of family time, partner time, exercise time. You need to focus on what your values are and what is important to you. When I had little kids, I worked part time. Now that they’re older, I’m busier than ever. It’s not a mad dash to the top. Just because you say no doesn’t mean another opportunity isn’t going to come up.

EyeWorld: Any final thoughts for young ophthalmologists?
Dr. MacDonald: Don’t compete. Collaborate. It’s so much easier to collaborate with each other and give each other opportunities. Ophthalmology can be full of friendships and relationships.

I. Howard Fine, MD
Clinical professor of ophthalmology,
Oregon Health and Science University
Portland, Oregon

EyeWorld: What advice would you give about becoming a great teacher?
Dr. Fine: You have to have a strong desire to want to help the student. I taught everything from phaco technique and technology to instruments and IOLs, drugs and devices, and I felt I was helping patients. That’s why I got into teaching. I thought if I could impart the knowledge to the surgeon-student, he would be able to apply it and I would be helping patients.

EyeWorld: How do you stay up to date?
Dr. Fine: I think it all starts with wanting to give improved results to your patients. New techniques and technologies are generally devised and innovated in order to make things simpler and safer, and you have to want to bring that to your patient in order to keep up to date. I think one of the most important ways is to stay in touch with the literature, but if you see something that’s interesting and looks intriguing and you want to apply it, get ahold of someone who does it and knows about it and either talk with them or visit them in the OR. I think it’s worth traveling across the country to do that.

EyeWorld: What’s the best way to interact with industry?
Dr. Fine: You have to want to be ethical and let them know that. I let all of the companies I worked with know that I wanted to publish any of my results, regardless of how that made their product look.

EyeWorld: How would you suggest maintaining a healthy work-life balance?
Dr. Fine: Maintaining a healthy work-life balance is impossible. Nobody does it. I think what you have to appreciate is you have choices and options and you pick them, but they don’t always turn out to be healthy. I was able to do what I did because I had such great help from my wife. The one thing I did to maintain a healthy balance is I didn’t start traveling to teach until my youngest child left for college.

EyeWorld: Any final thoughts for young ophthalmologists?
Dr. Fine: I think ophthalmologists should concentrate on doing what they like to do, not what they find easily accessible, because the more you do anything, the more referrals you’re going to get for that thing. If you end up spending a lot of time doing things you don’t like, it’s a mistake. Concentrate on what you like and try to do more of that.

Robert Watzke, MD
Adjunct professor of ophthalmology,
Oregon Health and Science University
Portland, Oregon

EyeWorld: What would be your advice for success in academic
medicine?
Dr. Watzke: First, you have to have a real desire and interest to do this. In other words, your interest in it can’t be simply because you want a title or to be invited to do lectures.
The second is you have to devise a system so that you can keep track of all the interesting cases that you see so that you can find the patient’s records on a particular topic quickly. Otherwise you are cursed with the problem where you remember you had an experience with a topic that reminds you of what you’re looking at but you can’t remember who the patient was or the details of it.
The third thing is to develop a specific interest. Depending on your background or training, you might have a particular subspecialty. You might be interested in technique, complications, helpful aids and devices in surgery.
Finally, if you’re going to go into academic medicine, you need to schedule some time during the week where you can catch up on your reading and leave it for accessing records and bibliographies. Try to stick to it, otherwise you get so behind in reading that it’s difficult to catch up.

EyeWorld: How do you stay up to date?
Dr. Watzke: As far as keeping your skills up to date with surgery and new developments in surgical techniques, that’s a matter of being alert to these new developments when you learn about them or hear about them. Take the time and expense to go to the source and learn it. As far as new techniques in medicine or treatment, it’s a matter of keeping up with reading.

EyeWorld: What’s the best way to interact with industry?
Dr. Watzke: It’s extremely important to keep your relationships with industry at arm’s length. I’m not rigid anymore about it, but I do think that one should not be so interested in it that you lose control of the data, and you’re just a data miner for a company and the company takes the information and uses what they want as they want it.

EyeWorld: How would you suggest maintaining a healthy work-life balance?
Dr. Watzke: If you have family responsibilities that are a huge part of your life, you’ve got to be careful to accept that and not try to do everything in every field. You need to be hard boiled about it and say I might need to forgo an extra amount of income to have more time with my family or to have more time to read and study.

Editors’ note: The physicians have no financial interests related to their comments.

Contact information

Arbisser
: drlisa@arbisser.com
Fine: hfine@finemd.com
MacDonald: susanmacdonaldeyecorps@gmail.com
Watzke: watzker@ohsu.edu

Experts bestow wisdom on early career ophthalmologists Experts bestow wisdom on early career ophthalmologists
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