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YOs, What Do You Know? (What We Learned at the Joint Meeting)

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I’m 30,000 feet over Oklahoma, flying back from the Academy’s Joint Meeting, and a gregarious septuagenarian with a three-beer buzz has just informed me that, in five years, I will never believe how dumb I am now. Fortunately, after attending the YO Program at the Joint Meeting, I will not have to wait five years to realize how little I know about preparing for my professional life after residency. And after speaking with residents in the YO Lounge at the meeting, I realized that I was far from the only person lacking such knowledge.

I hope that you were one of the hundreds of young ophthalmologist who had a chance to enjoy the YO Lounge amenities, thanks to Allergan. It was in the lounge that I met Paul Holland, MD, a fellow YO who’s finishing up his residency in Virginia. As we enjoyed lounge amenities — like foot massagers, big screen TV, free WiFi, cushy couches and chairs and beverages and food — Paul told me about his preparations to move back to his home city of San Francisco with his young family. In preparation for this transition, he attended the YO Program at the Joint Meeting. 

For YOs like us who haven’t started our first jobs out of residency yet, the practice profiles panel portion of the program was a great overview of practice options. The panel featured experienced physicians telling us about their work as physicians in small and large-group practices, hospital systems and in academia. Ruth Williams, MD, an Academy board member who is in a large group practice, explained why we should not undersell our value as younger ophthalmologists. When coupled with the business advice we heard later in the program from Wesley Millican, her points could carry significant gravity in contract negotiations.

Marian Macsai-Kaplan, MD, an ophthalmologist in a hospital system, added that you should be prepared to walk into a practice with the mindset of “widening the funnel.” And Mark Packer, MD, a small-practice ophthalmologist, shared his inspirational story on how private-practice physicians can be a part of cutting edge technology and academia.

After the panel, we heard from consultant Wesley Millican, who discussed contracts, buy-ins and negotiations. He especially stressed the importance of setting personal, professional and financial goals — and writing them down. This struck a cord with many YOs, including Paul and his desire to move back near family. Others have different goals — swiftly paying down student loans or paying for private school for our kids. Depending on which goals are most important, certain jobs may have more or less appeal.

Wesley also discussed contract negotiation strategies, restrictive covenants, tail coverage, etc. If you are not familiar with the aforementioned terms before finishing your residency, let me be the first to warn you that you are in trouble. You might consider talking to someone like Wesley at CareerPhysician or using the resources Ann Renucci, MD, highlighted, namely those offered by the American Academy of Ophthalmic Executives (AAOE). You can visit for more information.

The YO Program didn’t just prepare us for finding a job, though. After hearing Sue Vicchrilli’s talk on “Coding it Right,” Paul will be less likely to contribute to the shocking statistic that 40 percent of claims are submitted incorrectly. Paul’s wife and his small child should appreciate this too, since he will be less likely to inadvertently end-up in jail for fraud. To ensure that I avoid the same fate, I asked Sue if she could recommend one book for a person who is trying to learn more about coding. She suggested Ophthalmic Coding Coach, which is the same book the AMA adopted as their ophthalmic coding book. However, even with the most accurate coding, we still face the long-term challenges of declining reimbursement and scope-of-practice battles.

Earlier in the morning, YO Committee member Parag Parekh, MD, walked us through the complexities of the current political climate. He urged younger ophthalmologists to use our medical knowledge to influence policy to better our patients. He also shared with us that the percentage of ophthalmologist under 36 years of age receiving R01 grants from the NEI has shrunk from 24 percent in 1980 to three percent in 2000, and that physicians are headed for a 40 to 50 percent cut in Medicare reimbursements over the next decade due to the sustainable growth rate formula (sometimes referred to as SGR). It was apparent that whether we are in academia or private practice, all ophthalmologists will be significantly affected by politics. For the future of our profession and patients, we should visit to find out more on how we can advocate for ophthalmology.

After the YO Program, Paul and I retired to the YO Lounge, where we took part in an informal round table discussion with one of the most influential ophthalmologist in the world, Bruce Spivey, MD. Dr. Spivey imparted personal advice and provided Paul with ophthalmology contacts in San Francisco that should serve him well. After the roundtable, we met up with 300 other young ophthalmologist at the YO Reception, and the room was buzzing. It was the perfect place for the YOs like Kris Gillian, MD, international subcommittee chair, to network and discuss projects that will undoubtedly positively impact ophthalmology, and to also kickback and relax. 

Let me close by thanking Jennifer Smith, MD, the YO Committee chair from 2006 to 2008, and the rest of the committee for doing such an excellent job with this year’s YO activities. It will be exciting to watch the incoming chair, Andrew Doan, MD, and the YO Committee continue to refine and add to the myriad of educational and fun activities. Undoubtedly, because of the YO activities at the meeting, young YOs like Paul and older YOs already practicing will be better equipped for life as an ophthalmologist and more prepared for the next five years of life. I have a feeling my new friend from the plane ride home would agree. 

Editor’s Note: More resources and information related to the topics discussed at the YO program are available in the back of the YO Program Guide. Also, visit the YO Info Archive to find resources and articles categorized by topic: practice management, advocacy, clinical pearls, etc.

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About the author: Christian Hester, MD, is currently a research fellow at California Pacific Medical Center Department of Ophthalmology in San Francisco, where he will begin his ophthalmology residency in March 2009. After an internship in the Academy's DC office during medical school, Dr. Hester is now interning in the main San Francisco office, where he is working on a social media project.