Entering Private Practice

by Michael Haas, MD

Congratulations on the completion of your formal training. Whether it is finishing a fellowship or residency, you’ve worked hard to get to get here. No longer will a faculty member be overseeing your patient care. You will now be staff, and have the privilege to provide the best care possible to the public at large.

Rather than becoming simpler, in many ways your life just got more complicated. You will have a bigger paycheck, but with it comes more responsibilities. First and foremost, you need to find the best place for you and your family. For some people the top priority may be job opportunity, for others job location, and for others it may be about financial prospects. You will certainly find one of these with your job, and if you’re very lucky you may get two of three. Just realize that few opportunities are completely perfect, and it is a matter of finding the best overall match. The majority of ophthalmologists will leave their first job within five years of private practice. Family considerations and spousal considerations should not be underestimated, and are often the make-it or break-it in this whole process.

This is the time to be completely honest with yourself about your future goals. It can be a lengthy process and for the senior-level class of fellows and residents, the time to start looking is now. The Academy’s website has several job listings, as do many of the ophthalmic journal publications. Beyond that, working with recruitment agencies and calling prospective employers are always options. Set up several interviews for the Annual Meeting at the Academy (www.aao.org) to help narrow your list. Ultimately, you will be taking on-site interviews for the most promising leads. Trust your gut instinct during your interviews. If something is causing red flags in your mind, these need to be addressed.

Once you’ve settled on your new position, life gets busy again. You’ll be looking for a new housing situation, along with having stacks of applications for licensure and credentialing to complete. Take advantage of anyone who is willing to assist in your new office.

Efficiency and cost-effectiveness become issues once you enter the real world. Be open-minded to how things are run in your new office as you may not have all the equipment you were used to in residency/fellowship. If this is the case, try to adapt to your best ability and if needed, make some suggestions for items that can help you and your practice improve patient care. Be mindful of your costs (sutures, forceps, blades, cataract accessories, etc.) and try to be as cost-effective as you can in your practice. With lower insurance reimbursements, all ophthalmologic practices should strive to be as efficient and cost-effective as possible.

Before your first time in the O.R., make sure to meet as many of the ancillary staff as possible. Try to remember their names and make a good first impression. You may be working with new equipment, and it will be important for your new scrub techs to know which instruments you’ll be using as well as the individual steps of your surgical procedures. If you have previously typed this out, it can be a big help to the surgical center. By the time you actually start your surgical procedures, it may have been several months since your last surgery. You will also be on your own for the first time. As always, get a good night’s sleep the night before surgery. Expect that it will take awhile to get back into your comfort zone.

On a side note, many practices are now incorporating refractive and accommodative/multi-focal IOL’s as premium services. You should consider allowing your senior partners to handle these, at least at first, until your surgical technique is flawless with very predictable and reproducible results. This can limit the amount of stress you’ll be taking on initially. Today’s ophthalmologic private practice is rapidly changing and you need to be adaptable to achieve success as an ophthalmologist in private practice.

Last but not least, the first couple of years in private practice are difficult because you’ll need to deal with the board examinations. The most crucial thing with your examinations is to give yourself adequate study time. Start a minimum of two to three months in advance, and if possible consider using some of your vacation or CME time just prior to the test to put the final touches on your studying. You can still practice if you don’t pass the boards, but in this day and age it is very important – both for your patient’s comfort in seeing a board certified specialist, and for showing the various insurance companies that you are a physician up to standards. Best wishes on your next journey.