October 2020

INSIDE THE PRACTICE

YES Connect
Job hunting and contracts amid COVID-19


by Liz Hillman Editorial Co-Director

2020 sure has been interesting. COVID-19 has taken many ophthalmologists back to the drawing board. We obviously aren’t well-equipped at managing pandemic disaster relief efforts in most of our practices. However, many of us are at least in a practice that is sustainable regardless of the COVID-19 pandemic. But what about current residents and recent graduates? Has the time come where jobs are not as plentiful to new hires? Will you need to accept half the money in 2021 than you could have gotten in 2019? Many of this is still unknown.
What we do know is that people, even in the midst of the pandemic, continue to live long lives even with serious medical comorbidities. Patients are also still eager to get their eyes seeing as best they can. My prediction is that while it’s going to take some time for the dust to settle, normal operations will return to pre-pandemic levels sooner rather than later. I think hiring of associates and partners will still have the same formula. I think private practice will thrive in this environment like never before. It could be a lonely road that we have to travel down, but do not get discouraged if you are job seeking, the world is not ending.
–Michael Patterson, DO
YES Connect Co-Editor

How will COVID-19 change the job hunt and contracts for ophthalmologists? While that’s starting to play out, EyeWorld got insights from Matthew Lowrance, DO, Eric Schneider, MD, Blake Williamson, MD, and Zachary Zavodni, MD, on this.
In general, Dr. Lowrance said his practice hasn’t changed in that it’s always looking for good talent to join, however, recruitment is a lower priority for the time being while the focus is more on survivability.
Dr. Schneider said his retina practice is still looking to hire the right candidate. He acknowledged that retina wasn’t hit as hard with the temporary shutdown as other ophthalmology subspecialties.
“We’re still very busy. … In terms of contracts, contracts for us haven’t changed. We’re a traditional private practice—partnership track—and we’re still offering to new providers entering the practice,” he said.
Dr. Williamson said he thinks young eye surgeons just out of residency might have to look a little harder and be willing to accept that rates of pay might be lower as hiring practices look to replace capital they lost in the initial months of the pandemic. Overall, though, he thinks they’ll be able to find jobs at this time, but they might benefit from having some skills that help the bottom line as well, such as “self-scribing.”
“The days of EMR improved usability are upon us. Scribing has never been easier, so that could be something for young eye surgeons to consider when they do cataract, MIGS, or LASIK evals,” Dr. Williamson said.
In general, Dr. Williamson—who credited his brother and practice’s administrator Charles Williamson Jr., with offering insights on many management-related questions for this article—said his practice, which is cooperative with ODs and MDs, is still evaluating and adding providers as they normally would when the opportunity arises.
“Our contracts for new ODs and MDs will stay similar to what they were pre-COVID-19, as the fundamentals are all sound,” Dr. Williamson said. “For example, we’re not going to bring new MDs or ODs into the practice without a non-compete agreement, and in general, the contract will be for about 2 years (with annual auto-renews) at about 30% of collections. I do think contracting will change post-COVID-19, but primarily I think that’s going to be with providers who have contracts coming up that they want to negotiate.”
Dr. Williamson thinks partnership opportunities are still available despite the pandemic- caused conditions.
“I think in the past, partnership has been looked at as a right-of-passage. … In today’s environment, physicians are more in touch with partnership for performance than they ever have been,” he added.
Zachary Zavodni, MD, said his practice, like many private practices at this time, is taking a conservative approach to growth.
“We recently brought on a new surgeon
to replace an outgoing partner and we found ourselves needing to make changes to our standard contract structure,” he said. “Compared to a typical contract for a new associate, we reduced the guaranteed base salary, as a means of the practice protecting itself from a large expenditure in the event of another COVID shutdown. To counterbalance this change, we increased the production-based incentive model such that if the practice is fully operational, the new associate will be able to bring home a more typical compensation.”
While Dr. Lowrance said opportunities still are plentiful, a culture shift not related to COVID is leading many practices away from a partnership model.
“There seems to be a decreased interest in traditional ownership models from newer graduates,” Dr. Lowrance said.
Dr. Lowrance explained that exiting physicians looking to sell their ownership to younger ophthalmologists have different expectations.
“The doctors who are approaching retirement seem to have a different idea of what their practices’ value is relative to a newer graduate’s expectation,” Dr. Lowrance said. “This can create quite a perception gap.”
When there are fewer interested buyers, demand for partnership opportunities is lower, but the partnership supply is high. Dr. Lowrance said healthcare consolidation has been happening for everyone, especially with the move toward value-based care.
“As we move toward a more consolidated healthcare delivery system, I think it’s going to be more difficult, and the competitive opportunities for independent practices are going to be fewer,” he said.
COVID might have accelerated the consolidation process for practices that were already struggling and looking for an exit.
Couple this with reimbursement cuts that continue to happen to cataract surgery, and efficiency becomes paramount for survival. Dr. Lowrance said those coming out of training these days have largely seen what efficiency looks like.
“They are unbelievably well-trained and the skillset the new residents have today is off-the-chart good,” he said. “They are better equipped to take on all of these issues. I’m optimistic and confident in the future of eyecare.”
Dr. Schneider said the uncertainty of consolidation is something new hires should consider when they are joining a private practice. With ophthalmology among the hardest hit medical specialties in the pandemic, it’s important to ask about possible consolidation plans if that’s not something you’re interested in in the future. There is some stability in larger, consolidated practices that offer a salary-based model vs. a volume-based model, Dr. Schneider said. Doctors might consider academia, but he thinks academic medicine has become more clinic based to fund research as outside funding has become scarcer. He also said he has seen a trend toward some doctors pursuing solo practice.
“They have a good network to discuss how to do it, how to support each other,” Dr. Schneider said.
Dr. Zavodni said he thinks practices are teetering on the edge. While the Paycheck Protection Program has helped keep private practices going, there is real concern of what might happen if there is another shutdown.
“That said, the financial crunch of another ‘rainy day’ will fall onto private practices, private equity, and large hospital systems alike,” he said. “I think it is more likely for practices to join together in cases of financial hardship than for PE firms to spend capital when the economy is tanking. Obviously, every community and practice will be slightly different in their approach.”
Dr. Lowrance said he doesn’t think certain conditions will ever be the same “after” COVID. Telemedicine, for example, is here to stay, and technology should continue to be used in its fullest capability to communicate with patients, he said. Working in groups or teams is essential as well.
“Residents should be able to adapt in teams in order to survive. … [The pandemic] forced people to break down walls that were otherwise up. The perception of competition is vanishing; COVID eliminated barriers and forced people to work together,” he said.
As with pre-COVID-19 conditions, Dr. Williamson said younger eye surgeons seeking new positions need to build a permanent character trait within themselves that respects those who came before in a practice.
“The founding providers of the practices in operation today can quickly sniff out any personality who doesn’t show respect for the time it took to build something,” he said. “Vice versa, founding providers need to consider that not all young doctors are out for themselves or to take things away from the founders. It’s fundamental: Communicate well, align your goals, don’t lie to your fellow providers, and work hard. Do those things and it’ll generally work out for you, whether you’re just starting out or have been in the game for decades.”
Dr. Schneider said it’s more important these days for job seekers to focus on things that are knowable. Is it a location you want? Do you like the people? Is it a well-run practice?
“You want to look at reimbursement numbers and contracts, but it’s hard to predict the future. Focus on those things and hopefully the rest will follow,” he said.

About the doctors

Matthew Lowrance, DO
Tennessee Eye Care
Knoxville, Tennessee

Eric Schneider, MD
Tennessee Retina
Nashville, Tennessee

Blake Williamson, MD
Williamson Eye Center
Baton Rouge, Louisiana

Zachary Zavodni, MD
The Eye Institute of Utah
Salt Lake City, Utah

Relevant disclosures

Lowrance
: None
Schneider: None
Williamson: None
Zavodni: None

Contact

Lowrance: mlowrancedo@gmail.com
Schneider: ESchneider@tnretina.com
Williamson: blakewilliamson@weceye.com
Zavdoni: zacharyzavodni@gmail.com

Job hunting and contracts amid COVID-19 Job hunting and contracts amid COVID-19
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