Having your own ophthalmology practice can be both exciting and rewarding. During the recent Real World of Ophthalmology 2022 webinar, American specialists shared pearls on how to take your practice from “good” to “great.”
Top Tips for Operating Solo
When flying solo in an ophthalmic practice, any doctor is sure to encounter a new environment, colleagues, patients and responsibilities — which can bring along a whole new level of stress. To make this leap or transition easier, Dr. Lorraine Provencher (Ohio, USA) suggested that doctors make the transition while they’re still in training.
“This means asking for autonomy when the time is right, getting to know the instruments and staff, running the operating room (OR) as if you are in charge, visualizing yourself operating solo, and learning to work without an assistant (while you still have an assistant),” she said.
“Review cases ahead of time, anticipate complications or complexities, have a backup plan and order your cases intentionally, such as scheduling easier cases earlier in the day when you’re still warming up. It’s also nice to have a lifeline on hand. This may be a mentor who is available by phone, or it could be somebody in the room next door,” continued Dr. Provencher.
She also stressed on the importance of giving yourself some grace: “Allow for extra time in the OR, avoid unfair comparisons and don’t let inevitable complications ruin you. If you have the luxury of ramping up your practice, do it at a pace that’s appropriate. Take time to really fine tune things into the pattern that you want.
“Lastly, find your zen. Stick to your routine and don’t be ashamed of it. Focus on the patient in front of you, trust your training, and channel your mentors. Remember that anxiety is normal. Don’t let it control you but use it to become a better surgeon,” said Dr. Provencher.
Network for Success
Meanwhile, Dr. William Trattler from the Center for Excellence in Eye Care in Miami (Florida, USA) stressed the importance of networking at conferences. “Smaller conferences provide tremendous value and a good chance to network and interact with speakers and experts and to learn from them. Reach out to the program committee via email and share your interest in participating. Let them know what you can speak about or share with the audience that will make a difference, help them become better doctors, and take better care of their patients. When you do that, many organizers would love to have you get involved and speak, and maybe even join the panel. Your chance for success increases if you have attended the meeting previously,” he said.
Other opportunities to network include joining events such as YoungMD Connect, and internet discussion groups such as Keranet (which has more than 2,000 participants), Refractive Surgery Alliance (more than 400 participants), EyeConnect International, and many more. “When you start asking questions and answering, you learn so much,” he remarked.
He also encouraged sharing study outcomes. “Reach out to friends/colleagues and evaluate results from multiple centers. Submit your results to upcoming meetings. Stay engaged and help advance the field,” added Dr. Trattler.
Handling High Volume Cataract Surgery
Annual cataract cases are expected to grow at the rate of 3-4% per year due to aging and increased life expectancy. “Plan for double growth in the next 24 years of less, where we will be performing 8 million cataract surgeries a year in the U.S. and 60 million worldwide. I completed over 1,000 cases in my first year, and you probably will too,” said Dr. David Felsted from Barnet Dulaney Perkins Eye Center, Northern Arizona (USA).
“Plan to have a difficult six months filled with complications and a few trips back to the OR. I started with six cases on my first day and never thought I would get to 25 a day. Every case makes you better. So learn to be efficient and look at each step carefully,” he advised.
According to Dr. Felsted, surgeons in their first year of independent practice were over nine times more likely to have high complication rates (≥2 percent) than surgeons in their tenth year. He added that polling at his social network showed that some of the most common complications were run-out rhexis, iris prolapse, bowled out nucleus, anesthesia trouble and posterior capsular (PC) rupture.
“Your most likely initial struggle will be intraoperative floppy iris syndrome (IFIS) and small pupil cases. And you will likely encounter many white cataracts, probably earlier than you think. Focus on decompression and perfect rhexis control,” he noted, adding that recording cases and reviewing them at the end of the day would be helpful.
Editor’s Note: The Real World Ophthalmology conference was held virtually on April 2,2022. Reporting for this story took place during the event.
