At 7:15 a.m. every Monday, first-year ophthalmology residents at the University of Washington meet with uveitis specialist Russell Van Gelder, MD, PhD, to do rounds. They know him as their department chair, but during 2015, he’s also serving as president of the American Academy of Ophthalmology.
Dr. Van Gelder brings a passion for young ophthalmologist education to his year as president. “I love teaching young ophthalmologists,” he said. And he knows firsthand the difference a mentor can make in a young ophthalmologist’s life.
Early in his own career, Dr. Van Gelder was primarily active in his subspecialty association – the American Uveitis Society. But after the society nominated him for the Academy’s Leadership Development Program, Dr. Van Gelder met national leaders like then-future Academy president Michael Brennan, his LDP mentor.
“That was my real introduction to the Academy,” Dr. Van Gelder said. “I had a wonderful time.”
Though Dr. Van Gelder can’t open his Monday morning meetings to every young ophthalmologist, here are three tips to glean from his example and advice to UW residents.
1. Listen to your friends. Dr. Van Gelder didn’t initially plan to become an ophthalmologist. In fact, he was considering neurosurgery when his future wife raised concerns. “‘You can be a fine single neuro-surgeon,’” he joked, recalling the conversation.
Then one day Dr. Van Gelder’s housemate and fellow medical student came home abuzz over his ophthalmology rotation. “Russ, you gotta do this,” he said. As a fourth-year medical student, Dr. Van Gelder’s friend was already committed to internal medicine, but his words would shape the younger man’s career.
|Though Dr. Van Gelder’s Monday morning meetings may be restricted to first-year residents, young ophthalmologists who attend the Mid-Year Forum can meet him and hear him present in Washington, D.C., this April. In January, he made a video pitch to Academy members to attend Mid-Year Forum. He’ll periodically address the Academy membership through aao.org and at AAO 2015 in Las Vegas.
Still in his third year, Dr. Van Gelder quickly got hooked on ophthalmology himself – and unlike his housemate, he went on to specialize in it. “I loved how you could so quickly and directly make patients better,” he said.
During his residency at Washington University in St. Louis, he recalled, he performed his first cataract surgery on a legally blind patient. Though the procedure stretched to typical first-surgery length, “She jumped out of the chair” with a shout the next day when he removed the bandage.
With one procedure, she’d gone from 2/200 in both eyes to driving vision in one. (When offered the same surgery on the second eye, she declined. “‘Oh no, honey. I’m saving that one for when I really need it.’”)
“It’s really like science fiction,” Dr. Van Gelder said of cataract surgery. Early experiences like that convinced him ophthalmology was his destiny.
2. Master your specialty. Despite what he called the “magic” of cataract surgery and recent advances in macular degeneration treatment, Dr. Van Gelder said much work remains for ophthalmologists – especially clinician-scientists like himself.
As department chair, he emphasizes lifelong education, giving ophthalmology residents the book Mastery. “They’re going to impact a lot of lives in their career,” he said. Citing an ophthalmologist who does clinic three days a week, he did the math: 20 new patients a week, about 1,000 patients a year.
“That’s 30,000 lives you’re going to directly touch over an average career. That’s a huge number.”
In most cases, treatment decisions will be fairly clear cut, Dr. Van Gelder said, thanks to the quality of education, evidence-based treatment guidelines and so on. “For the vast majority of those individuals, you’re going to make the quality of their lives much better.”
But the real test of what kind of doctor you are comes down to the challenging cases. They may only account for 5 or 10 percent of the patients you see, but over a career, that could add up to 1,500 to 3,000 people.
In those cases, “the difference between someone who reads deeply and continually engages in education, and someone who doesn’t, is going to come to the fore,” Dr. Van Gelder said. “[Great doctors] never stop learning. They’re always improving their practice, and they can make that extra difference … in the complicated, challenging patients’ lives.”
3. Think big. During their year in the Leadership Development Program, participants develop a project in one of several areas. For his, Dr. Van Gelder decided to address a problem that limited his ability to treat patients.
At that time, rheumatologic drugs were starting to show promise for off-label use with some uveitis patients. But ophthalmologists couldn’t get insurers to reimburse for the drugs.
Deciding they might listen more closely to patients than physicians, Dr. Van Gelder formed a grassroots advocacy group of similarly affected uveitis patients in the St. Louis area. From time to time, they contacted legislators and provided a ready patient voice to insurers as doctors continued to seek coverage for the off-label use.
Though the project never produced direct results with insurers, it did lead to a widely cited white paper published in Ophthalmology and gave Dr. Van Gelder valuable experience in advocacy. It also set him up to become the first Leadership Development Program graduate to assume the Academy presidency – its highest elected post.
“He brings to the Academy something we don’t see very often,” Academy CEO David W. Parke II, MD, said. While active in residency education and advocacy on behalf of the profession, Dr. Van Gelder is also “a fantastically productive investigator,” Dr. Parke said, noting the importance of his research in uveitis.
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About the author: Christi A. Foist is YO Info’s managing editor and a communications manager for the Academy.