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One to One: H. Dunbar Hoskins Jr.

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Hoskins_smlWhen I look back on my first few years in ophthalmology, I realize how many different opportunities there were, and how challenging it could be to navigate one's way through the options. As you embark on this amazing journey, I'd like provide a few beacons to help light your way. I'll share a few of my experiences, offer some insights and then challenge you to live up to the integrity and responsibility of the degree you hold.

After I completed my residency at the Medical College of Virginia, I served in the U.S. Navy for two years before beginning my fellowship with Dr. Robert Shaffer here in California. After my fellowship, I moved back to Virginia and started a solo practice, specializing in glaucoma. As you may imagine, solo practice can be difficult, but I was fortunate that another glaucoma specialist in the area was retiring, and he sent many patients my way.

Within a year, Dr. Shaffer invited me back to California to join his practice. With the exception of accepting Dr. Shaffer's invitation to do my fellowship with him, joining him in practice may have been the single best professional decision I ever made. Not only was Bob Shaffer a well-respected physician, but he was also an internationally recognized lecturer and speaker. More importantly, he was — and continues to be — a world-class mentor.

During this time, I was offered an opportunity to teach at UCSF. I struggled with the decision of full-time practice versus heavy involvement in academics. Fortunately, I didn't have to make an all-or-nothing decision. I chose to devote much of my time to academics, while still seeing patients with Dr. Shaffer's group (which I still do to this day). For me, the decision was actually quite easy. I admired my teachers and wanted to emulate them. I wanted to share my love and knowledge of ophthalmology with future generations.

It's amazing that 30 years later, young ophthalmologists are still struggling with the same questions — solo practice, group practice or academics. As I can attest, you can choose academics and still practice. Therefore, the real question becomes solo or group. Having done both, I would say that it depends, in large part, on your personality and preferences.

If you like to make the majority of decisions, relish being in charge and like to manage details, then solo practice may be for you. My best advice, however, would be to pay close attention to where you will live. If you live in a medium to large city with a high concentration of ophthalmologists, it may be difficult to carve out a space for yourself among the already-established physicians. But, if you are in a more rural location, it could be easier to go on your own.

As a member of a group practice, I can tell you that the benefits are numerous. You have better coverage on the weekends and in the ER, so you are not on call all the time. You can divide the administrative costs among the doctors, so the expenses are less per physician. You also have the benefit of being able to confer on a regular basis with your colleagues.

If you do choose the group route, I would suggest that you first make sure you have a good cultural fit. Is there good chemistry between you and the other doctors, as well as the office staff? Do you have similar morals and values? Is the overall attitude toward work and patients in keeping with your own? If you can answer yes to these questions, then group practice may be the right decision for you.

Of course, I'd be remiss in not mentioning the role you can play within the Academy. I joined the AAO as soon as I completed my boards in 1970 and became active in a variety of committees within three years. Today, there are more opportunities than ever to get involved. Whether you join the Congressional advocates, work with the clinical education team, volunteer with EyeCare America or offer to be a media spokesperson, I urge you to jump in and make a difference.

Through all of the experiences and opportunities I've had during 37 years in ophthalmology, I have come away with three valuable lessons that I'd like to share with you. I've found them to be helpful in life as well as in practice.

  1. There is such a thing as 110 percent. Success comes from hard work, pure and simple. Find out what you are passionate about and give it everything you have.
  2. You can always learn something from everyone you meet. If you are willing to be a student, the teachers will surround you. Take it all in, every day, especially from your patients. If nothing else, they will teach you humility.
  3. You are treating a patient, not an eyeball. Your patients are coming to you for guidance. They need to see that you are confident, not cocky, and that you can give them the care they need.

I cannot imagine a career more rewarding than the one we share. It is a big, broad profession filled with opportunity and promise. I hope you enjoy the journey as much as I have.

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About the author: H. Dunbar Hoskins Jr., M.D., is the executive vice president of the American Academy of Ophthalmology. He practices in San Francisco.