American Academy of Ophthalmology Web Site:
Original URL:

June 2006


On the Professional Road, Are You a Hitchhiker?
By Richard P. Mills, MD, MPH
Chief Medical Editor, EyeNet

In my youth, hitchhiking was an honorable, if slightly unsafe, means of getting where you wanted to go for nothing. The driver who picked you up (assuming you didn’t look too unsavory) would assume the expenses of the auto depreciation, gas, tolls and maintenance in exchange for a little conversation and gratitude. The driver implicitly understood that you had insufficient funds to buy a bus ticket, and would have taken offense if you were discovered to be the heir of the Smucker’s jelly empire.

Fast forward to the present. A lot of ophthalmologists are still hitchhikers, but now in a professional sense. They are nonmembers of their state ophthalmology societies, even though they may be loyal, dues-paying, meeting-attending or even meeting-presenting Academy members. Their colleagues who are members of the state society are the drivers, paying the freight for all that state societies do for the profession. You know what? The drivers should feel plenty mad that there are professional hitchhikers in their midst, and the hitchhikers should feel plenty guilty.

Over the years, I’ve tried to have a dialogue with individual hitchhikers, and they are a hardened bunch. Some don’t perceive adequate value for the cost of the dues. Others have “relationships” with optometrists that make their philosophic views on scope of practice different from the public position of the state society. Still others complain that their employer (often medical school departments, HMOs or multispecialty clinics) pays only for one professional organization’s dues, and they get the greatest benefit educationally from the Academy.

I point out the value that state societies bring to the profession, like public education, relationships with local payers fighting for reimbursement, advocacy with state regulatory agencies, and political leverage locally where all politics is grounded. I point out that scope of practice battles are only a small part of what a state society does. I point out that state societies serve as the major conduit for most ophthalmologists’ communication with the Academy through its Council. Did I forget to mention that facilitating technician training and job placement is a major state society function? Or that they mentor ophthalmology residents in preparing for the realities of practice? I finish with the observation that, unlike those patients who have to choose between food and their medicines, the hitchhiker can certainly afford the annual dues.

The economists have a category for the state societies. They are a public good, at least for the profession. That is, no matter whether individuals contribute to a public good or not, they still are beneficiaries of the public good. So why bother to contribute, since you benefit either way? In my opinion (and that is the title of this column), it’s as much a professional responsibility as behaving ethically and showing respect for your colleagues (yes, even the hitchhikers). While I’m on the subject, hitchhiking applies to noncontributors to the PAC (both Ophth- and state) and noncontributors to the Surgical Scope Fund.

Add up your dues and donations, and divide by your annual income, and tell me your contribution is larger than what the trial attorneys and the optometrists chalk up to a cost of doing business. So, if you are a professional hitchhiker, please consider buying a car and driving. And for those behind the wheel, in the spirit of collegiality, I hope you don’t try to run the hitchhikers off the road.