I interviewed three ophthalmologists in their first seven to eight years of practice to understand how each chose their specific practice type. I hope these responses help guide young ophthalmologists to choose the right practice type, whether it be private practice, private equity or academics.
Samantha Williamson, MD, is a cornea specialist at Select Eye Care in Baltimore (a practice owned by Private Equity), though she started at Kaiser Permanente immediately after fellowship. Kevin Mundy, MD, is a comprehensive ophthalmologist at the Kellogg Eye Center at the University of Michigan in Ann Arbor. Christopher Estopinal, MD, is a cornea specialist and partner at Virginia Eye Institute, a large private practice in Richmond, Va. Some didn’t start out in their dream jobs off the bat. They started out in a different practice before transitioning.
What type of practice did you choose immediately after training? Why?
Dr. Williamson: I joined Kaiser Permanente for a number of reasons. I wanted the opportunity to have a busy cornea practice from the get-go and being in a large health care system afforded me the patient volume. I interned at Kaiser Permanente in California and enjoyed the highly integrated system. This job allowed me to focus on clinical skills out of fellowship with strong institutional support, without worrying about building a practice. Also, I knew I wanted to be in Baltimore, and Kaiser did not have a noncompete clause.
Dr. Mundy: I joined an academic center (Casey Eye Institute at Oregon Health and Science University) but practiced at a remote community site two hours from the main academic center campus. One of my responsibilities was education. I commuted to the main campus a few times a month to a staff resident clinic, but residents did not come to the community clinic.
I knew early in training that I enjoyed education and wanted to be connected to an academic center in some way. So I explored several jobs with partnerships involving academic centers. I knew I wasn’t excited to be a business owner (worrying about buying equipment, hiring and firing staff, etc.). I knew I would enjoy coming into work, doing my job, taking part in the educational endeavor and not having to worry about the behind-the-scenes details of a practice when I headed home.
Dr. Estopinal: I joined a large private-practice ophthalmology group with multiple ophthalmic subspecialties on a partnership track. I wanted the main focus of my practice to be patient care, and I wanted to be able to take care of patients with cornea and cataract problems and continue to use the skills I learned during training. I also wanted to be in a practice with like-minded physicians who were seeking to provide excellent patient care in a patient-oriented environment.
What were the best parts of this type of practice? What were the challenges?
Dr. Williamson: The best parts were having institutional support, good equipment (diagnostic in the clinic and state-of-the art cataract and cornea surgical devices in the operating room) and a diverse patient population. I was part of a large integrated healthcare system, which made it very easy to get non-ophthalmology consults and radiologic imaging. Finally, I had a lot of built-in volume from the Kaiser referral system.
However, there were some challenges like inflexibility. Kaiser has a strong uniformity across all regions and locations. This made adjusting my schedule templates difficult. For example, I wanted to have a clinic block where I did all my clinic-based lasers at the same time. Also, they changed the OR days to 10-hour days, which made for very long OR days. In addition, I felt slightly anonymous. I didn’t have interactions with ophthalmologists in the community, and patients didn’t choose to see me — they were assigned to me in the Kaiser system.
Dr. Mundy: I love working with learners of all levels. It’s fun and forces me to stay sharp. Being part of a large academic center, I get to work with a lot of people who know an extraordinary amount about different subspecialties, and I’m lucky to have them at my disposal — both for professional learning and referrals for patient care. I enjoy being with a larger group of people, seeing how different people practice and learning from others’ methods of treatment.
There are also challenges to working in an academic center: Navigating a large institution that has a long history (all of which you may not be fully aware of as a new hire) can present challenges if you have ideas you want to implement, or changes you feel may be beneficial. It can be frustrating to try to exact change in a large, slow-moving vessel.
Also, for the amount of work you do, the compensation is often less in an academic setting than in private practice. It sometimes entails “free work” on committees. I often asked myself, “Does this ‘fill my tank’ to take time away from my family for something I’m not being compensated for?” Ultimately, the answer is often “yes.” However, I’ve learned that it’s important for me to only take on additional uncompensated responsibilities that I find personally enriching and rewarding.
Dr. Estopinal: The best part is caring for patients, both in terms of the care I get to provide and the relationships we develop. I enjoy getting to work in a true partnership with other physicians, actively creating the systems in which we take care of patients and having a measure of control over our day-to-day work. I thoroughly enjoy working with the staff and helping them grow and develop professionally as well.
Challenges include some difficulty coordinating with other specialties, since we’re not part of a group with physicians outside of ophthalmology. Also, there can be a lot of time outside of clinic dedicated to practice administration, including running the business of the practice, hiring and managing a business team, managing [electronic health records, or EHRs], deciding how to invest in new technology and keeping the practice running efficiently.
Did you change your practice type? If so, why?
Dr. Williamson: At year five, I left Kaiser and joined a private equity-owned private practice. Although I enjoyed being part of a large health care system, I was ready for a new practice environment focused on ophthalmology. I also wanted more control over building my practice and schedule. I love being in a group where everyone is working toward a similar goal — providing high-quality, cutting-edge, efficient eyecare. For me, a private equity-owned practice has some of the same advantages as a hospital-based system in that I don’t have big decisions about overhead, EHRs or marketing on my plate. There’s also the purchasing power that comes with being part of a larger group.
Dr. Mundy: I switched academic centers and moved to Michigan to join the Kellogg Eye Center. In my new job, I spend three days a week in Ann Arbor at the main clinic, and my primary role is being part of the education team, staffing resident clinic and surgeries. I do a significant number of in-office comprehensive procedures and lasers with the residents. I also have two days a week at a community site without learners, with my own patients.
I’m not involved in research — instead I focus on clinical care and education, which I set as an expectation with the chair at my original interview. I also wanted to come back home to Michigan, which was the right decision for me and my family.
Dr. Estopinal: I’m now a partner at my private practice and still loving it!
Do you have any advice for residents trying to choose a practice type?
Dr. Williamson: Think about what nonclinical things you’re interested in and not interested in. For me, I gave up some autonomy in exchange for not worrying about practice management and long-term strategic planning. If you enjoy those things, then you’d miss out as a non-owner. Be wary of noncompete agreements as well. You don’t really know a practice until you’ve been there, and it’s hard to know exactly what you yourself like before you start working. It can take three to four years to understand a community and how different practices work.
Dr. Mundy: Be honest with yourself about what you actually want, rather than thinking about what you’re supposed to want. If the answer is “I want to make as much money as possible,” then that’s fine. Seek that! Be honest with yourself and your potential employer about how you see your career unfolding. Some folks will make a spreadsheet with 37 components and crunch the numbers, but much of your job is about the people you work with. Make sure you get a “warm fuzzy feeling” after spending time with your potential team. If you don’t, you might want to look elsewhere, even if it checks all the boxes. Your co-workers are going to be essential for your happiness and success, and this should not be ignored.
Dr. Estopinal: Start with asking what aspects of ophthalmology you find most interesting. Patient care? Research? Training? How entrepreneurial are you and how interested are you in running a practice versus delegating that to someone else? Where do you want to live? Most importantly, are the people you’re going to work with willing and able to encourage you both personally and professionally? Answering those questions will hopefully help you find a practice that fits well for years to come.
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About the author: Evan Silverstein, MD, is a pediatric ophthalmologist, assistant professor of ophthalmology and associate residency program director at Virginia Commonwealth University in Richmond, Va. He is chair of the YO Info editorial board. |