This article originally appeared in the Spring 2011 issue of Scope.
In a previous university, I worked under a brilliant academician and scientist. “There are two kinds of senior academicians” he once told me. “One kind says ‘look how great I was - when I retired, everything just kind of fell apart in my department’. The other kind says ‘look at what a great job I did - when I retired, the group of junior people I left in place kept everything working great, if not better’”.
In many ways, we academic ophthalmologists are not so different from our counterparts in the world of business or private medical practice. Some senior partners seem to be constantly adding stellar young people to their groups, mentoring them and having them quickly develop into successful partners who are widely admired in their communities. The senior partner is perceived as a ‘first among equals” and his/her practice acquires the reputation for across-the-board excellence because the group has no “weak links”. Other senior partners in other practices hire a succession of junior people who are not perceived as particularly well-trained. They stay with the practice for a while and then move on, without achieving a great deal of success. Or they stay for quite a while because they have no other options; sometimes people whisper that they were hired to make the senior person “look good by comparison”, the way American presidents often seem to select their vice presidents. When the senior founding partner slows down or stops practicing, the practice fades away, as there was no group of dynamic junior ophthalmologists that had been recruited and mentored to keep the practice strong and growing.
In academics, it seems to me, things are pretty much the same. Some senior faculty in an ophthalmology department delight in the recruitment of talented young assistant professors, who they carefully guide in ways that maximize the odds of success and minimize those of failure. Choosing a young colleague, like selecting a spouse, is risky, and no senior faculty mentor bats a thousand. But clearly there are examples in most, if not all departments of professors who have the ability to consistently identify and nurture talent, resulting in a list of trainees who have gone on to achieve recognition in their field.
But people are people, and there also exist examples of senior professors who never seem to have a younger colleague in their area that might be perceived, in one way or another, as superior or even comparable to the white-haired maven. This is the subset that, rather than delighting in the success of young people, fears junior colleagues who might be so successful as to threaten their self-perception as the ultimate authority. When this category of professor retires, the department typically has to rebuild from scratch by recruiting a successful replacement because there was no one in place and prepared to assume the leadership role.
Needless to say, as is probably the case with most department chairs I prefer the senior academic ophthalmologists who can proactively identify, nurture and retain talent. Those are, by and large, the people who lead large groups, have many exciting things going on in their areas, and attract the brightest residents into their fields of subspecialty. I feel sorry for the other group.
In my opinion, our current crop of senior ophthalmologists in this country (both within academics and in private practice) has a great deal to be proud of in this regard. By any measure, the current readers of Scope, this publication aimed at this cadre of senior ophthalmologists, have been remarkably successful stewards of ophthalmology. The changes that have been ushered in during their watch is impressive: greater efficiency, dramatically safer and better small incision cataract surgery, intraocular lenses, keratorefractive surgery, successful therapies for diabetic retinopathy and other retinal diseases – to name but a few. There is no question but that, by any measure, today’s senior ophthalmologists have enhanced their field. They should feel proud.
The quality of medical students seeking ophthalmology residencies today never ceases to amaze me. It would be the understatement of the century to say that American medical students are not dumb, and their interactions with ophthalmologists, both full-time academics and those in private practice, convince our students that this is a fraternity (or sorority as the case may be) they should join. In short, they are impressed with and choose to emulate their ophthalmology teachers, many of whom are in the senior category.
The knowledge explosion in the last two decades or so has been remarkable. It can be a challenge, no doubt, to keep up with the explosion of knowledge in general, let alone in medicine. The immediate past president of my university, himself a physician, apologized to the graduating university class a few years ago, saying that half of what they had been taught during their four years was wrong. In medicine, I am told that the expansion of knowledge is so great that “facts” become “falsehoods” at an even greater rate. My medical school eschews the use of textbooks as teaching platforms, because so much of the content is demonstrably inaccurate or embarrassingly incomplete within a few short years of publication. When I tell my residents that my early days of training involved my admitting patients to the hospital for a few days so they could have cataract surgery, I am sure they must think dementia is setting in. As a resident, my former chairman declared that it would be “over his dead body” before he would risk a patient’s vision by performing outpatient cataract surgery. Eventually he was willing and able to change when forced to by insurers, and when I finished my residency he was performing only outpatient surgery.
In academics, when we are surrounded by brilliant young medical students, fellows and junior faculty constantly challenging how we do things and adding new knowledge, it is a constant challenge to keep up. Fortunately, ophthalmologists love to learn and innovate. My belief is that this explains why ophthalmology, in general, is one of the specialties that rapidly embraces new technology and new therapeutic approaches. There is no opportunity to relax, as the young will quickly be able to tell when the professor is “blowing smoke”. But my experience has been that senior ophthalmologists are like sponges, seemingly constantly on the prowl for better mousetraps. Many of my faculty tell me that it is the regular interaction with our trainees and their many questions and challenges of convention that makes their work fun and “keeps them young and in the game”.
In academic departments there is clearly a role for faculty who enjoy teaching, even when they no longer have the ability or stamina to see many patients or do a lot surgery. For example, in my department our Grand Rounds is enhanced by the regular presence of a faculty member who has been in the department for over 50 years. When you consider how our approaches to ocular disease have dramatically evolved over the last few decades, you can readily imagine how interesting the insights and historical vignettes shared by this senior colleague must be. He is a treasure trove of information.
We have never in our history had better training in ophthalmology than we do now. Senior academicians find it a joy to work with the young medical students and residents, and have a great deal to offer, even when (or sometimes in part because) they are not seeing as many patients or doing as much surgery.
The presence of senior ophthalmologists enhances the educational environment of academic departments, and senior academic ophthalmologists can probably remain active on average much longer than their private practice colleagues who are expected to remain clinically highly-productive until they retire.