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One to One: Cynthia Bradford, MD

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Dr. Cynthia BradfordBecoming a Leader
Some people are born leaders. Me? I’m an accidental leader. After I finished my residency in 1987, I saw a patient who had had laser iridotomy in both eyes and was coming to me for a second opinion. Her main complaint was distortion of vision.

After talking with her, she told me that an optometrist had performed the laser iridotomy. As you can imagine, I thought she was confused. Perhaps the OD did the prep work, then the ophthalmologist stepped in to do the actual procedure … but this was not the case. This immediately set off an alarm for me. Optometrists are clearly not allowed to perform surgery, yet they were blatantly doing it in my state.

I called a colleague of mine at the state medical society and she told me that they were aware of the situation and taking care of it. However, while we ophthalmologists were following the legal and regulatory channels to address the situation, the optometrists were continuing to perform certain surgeries throughout Oklahoma — surgeries they are not licensed to perform.

Even though the medical society triumphed in this case, optometrists argued that regulations and licensing should change. After all, they had been performing the procedures all along, so why should they have to stop?

Throughout this ordeal, I learned a powerful lesson. When you notice that something isn’t right, you need to shout loudly from the rooftops and involve the public, because the legal system is just too long and, very often, too slow to be truly effective.

I also learned that if no one had taken the time or interest to point out what was happening, then it would have continued. Not only is this detrimental to the profession of ophthalmology, but, more importantly, it can be dangerous for the patients we serve.

It was this early exposure to the advocacy side of ophthalmology that led me to my current position as Secretary for State Affairs. I wanted to make sure that I was out there watching and helping others keep watch as well.

Choosing Between Academics and Private Practice
One of the ways I’m able to help others navigate the world of ophthalmology is through my teaching at the University of Oklahoma, focusing primarily on teaching cataract surgery to second year students. In addition to the questions I get regarding the science of ophthalmology, I am also asked how to choose between an academic career and private practice.

During my personal career path, I’ve discovered that you don’t have to choose between academia and practice. You truly can do both. I know, because I am doing it.

However, if you want your primary focus to be academics, then you need to make that decision early. You can always go into private practice after several years in academia, but it can be difficult to do the other way. Also, teaching takes a lot of time and dedication and is very rewarding, but it does not pay as well as private practice. If the financial aspect of your career is a big motivator for you, then this is something you will want to bear in mind.

On this point, I have to caution any young ophthalmologist to not choose your practice (or your career path for that matter) on finances alone. With so many variables at play, one of the biggest mistakes you can make is to choose financial rewards over other factors, such as control over your own practice, flexibility in your schedule and family needs and concerns.

The Future of Ophthalmology
The more I am around young ophthalmologists and those that have enjoyed the profession for many years, the more I am convinced that ophthalmologists truly are the leaders of the eye care community. What I mean by this is that we are the only profession trained for medical and surgical care.

For the young ophthalmologist, this means you have to take an active role in our profession early in your career. Look at the long term and the things that are going on in our profession. Know that one person truly can make a difference.

Also, don’t be afraid to make an independent judgment on surgical patients referred by an optometrist. I’ve seen young (and older) ophthalmologists who feel obligated to perform a surgery if an OD has referred the patient to them, for fear of lost referrals. This needs to change.

Ophthalmologists are the only ones trained to diagnose and determine surgical requirements for patients. Never forget the patient and always give them sound advice when it comes to their surgery.

I’d also like to see ODs working better with ophthalmologists to treat our patients, rather than striving to expand their scope of practice into the surgical realm. Additionally, I’d like to see the role of the optometrist clearly defined to the rest of the house of medicine, as well as in the public domain. There is a difference in training and experience between ophthalmologists and optometrists!

This is an area where young ophthalmologists can play a big role simply by leading rather than being led. Ours is a strong profession and we all have the capability to take solid leadership positions. This allows us to take better care of our patients and communities as a whole.

One great way to do this is to participate in the mentor program established by many state societies. In these programs, a practicing ophthalmologist takes a resident under his or her wing, showing the ins and outs of the practice, answering questions and acting as an overall mentor throughout the young ophthalmologist’s residency.

If your state society does not offer a mentorship program, talk to the Academy’s State Affairs department and ask them to help you establish one. All it takes is one person who is interested, motivated and willing to take the initiative.

Finally, as Secretary for State Affairs, I’ve noticed that while there are regional differences, we have strong national similarities that we can work together to capitalize on. But to achieve our goals, we need strong state societies and strong state society members. If you are not yet a member of your state society, become an active member today.

Active participation in state societies allows us to make enormous contributions, not just to advocacy and regulatory issues, but also to public service, mentoring, advocating for medicine and ensuring the welfare of our patients. In this way, we can all make our states and cities much better places to live.

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About the author: Cynthia Bradford, MD, is the Academy’s current Secretary for State Affairs. She is a professor of ophthalmology at the University of Oklahoma and practices at the Dean McGee Eye Institute.