• 3 Skills Your Training Program Didn’t Teach You

    Your ophthalmology training program has given you the foundation to succeed as an independent physician, but the learning does not stop there. 

    There are many more skills and topics important for a successful career. As you enter the real world of medicine after residency or fellowship, remember that you have tremendous support from your mentors, colleagues and resources through the American Academy of Ophthalmology. Here are a few topics you may not have discussed in depth during your training: 

    Coding and billing. There is often great emphasis on proper, thorough, and accurate documentation for each patient encounter, but it was likely your supervising attending that took care of the coding and billing. These are critical skills not only for maintaining compliance with regulations, but also to ensure you or your practice are fairly compensated for your work. Coding creates a standardized record of patient history and care that insurance companies, governments and health departments can utilize and monitor.

    The main types of codes you will use as an ophthalmologist are:

    • CPT (Current Procedural Terminology). CPT codes document all services you provide to your patient. This includes clinic visits, surgeries, procedures, injections, and imaging such as visual fields or OCTs.
    • ICD-10 (International Classification of Diseases). ICD codes document the diagnoses for your patient.  

    Learning the ins and outs of coding is critical for several reasons. First, it is a medicolegal record for a patient’s health. Second, it is a universal record as it can be compared between different practices and even internationally to help identify health trends. Third, it is critical for billing and reimbursement. Precision and specificity are now more important than ever as insurance companies will look to reject reimbursements for incorrect coding. Finally, reimbursements will eventually transition from fee-for-service to value and outcome-based. Thus, accurately coding patients’ comorbidities and complexities that impact your care and outcomes will one day affect your reimbursements.

    Try to learn proper coding and billing during your final year in training. Once you begin your practice, ask your senior partners, reach out to your former mentors, or connect with your specialty society. You can also turn to the AAOE® (American Academy of Ophthalmic Executives®), which has fantastic coding resources online and offers in-person CodeQuest courses that provide state-specific coding education. If you joined an established practice or an academic center, you may already have coding/billing specialists, but remember that you, as the physician, are ultimately responsible and liable for errors.

    Practice Management. In addition to coding and billing, there are many other aspects of managing your practice that may not have been discussed during your training. Whether you are in private practice or an academic center, you will have some degree of control over your practice. As a new practicing physician, you need to let your community know you are open for business. Marketing yourself is a critical skill to ramp up patient volume and to develop the kind of practice that you envision. Take time early in your career to meet other providers. Reach out to optometrists, ophthalmologists, and primary care physicians to let them know you are available to help whenever they need it.  

    Also consider formulating a marketing strategy that has both digital and traditional approaches. Digital marketing strategies often start with an effective website and can include other approaches with social media (Facebook, Instagram), online reviews (Yelp, RealSelf, Google Business), email lists, and blogging. Traditional marketing may include writing for your local paper, participating in radio or TV interviews, flyers, and speaking engagements. As you enter the real world of medicine, come up with a marketing plan early to establish yourself so that your practice becomes as busy as you would like.

    Another important practice management consideration is clinical flow and efficiency. Think about the clinics and operating rooms during your training and consider what worked well and what didn’t. Now that you are in a position to make changes, implement your preferences in scheduling, clinical flow, efficiency, and personnel as best as you can. AAOE also offers a benchmarking tool, called AcadeMetrics® to help you compare your practice to others around the country. Occasionally checking in to monitor the health and efficiency of your practice is just as important as stepping back and reviewing your surgical outcomes.

    Leadership. Effective leaders have the ability to communicate clearly and motivate those around them. They can solve problems in an ever-changing environment, as well as prioritize and delegate responsibilities. By successfully completing your residency or fellowship, you demonstrated these skills, but likely did not have any formal leadership training. Leadership comes in many forms, so no matter where you practice, you are a leader. In private practice, you will have technicians, employees, and junior associates looking up to you. In academics, you will also have medical students and residents turning to you. 

    Most importantly, you are the leader of your patients’ eye health team. Just as you spent hours in wet labs or on the EyeSi fine-tuning your surgical skills, spend some time learning about leadership skills. Become a better leader to more effectively help those that depend on you. A good place to start is to read about leadership. While there are numerous leadership books, start with these two classics: “The 7 Habits of Highly Effective People” by Stephen Covey, and “True North: Discover Your Authentic Leadership” by Bill George.

    Graduating from ophthalmology residency or fellowship is a huge accomplishment. You have learned so much about managing complex patients, but this is sometimes the easy part in medicine. Spending some time to develop and manage your practice to efficiently jump through all the administrative and bureaucratic hurdles will ensure you have a long and satisfying career!

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    Viraj J. Mehta, MD, MBAAbout the author: Viraj Mehta, MD, MBA, completed his business school at Cornell University and then residency at Vanderbilt University School of Medicine in 2017. He then completed his ASOPRS Oculoplastics fellowship at the Mayo Clinic/University of Minnesota Collaborative Program. He is now in private practice in Washington, D.C.