Ophthalmology Business

MAR 2014

Ophthalmology Business is focused on business topics relevant to the entrepreneurial ophthalmologist. It offers editorial, opinion, and practical tips for physicians running an ophthalmic practice. It is a companion publication of EyeWorld.

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mologists with an interest in refrac- t ive surgery were unable to pursue those interests in institutional set- tings. "Our business model is based on a private pay, lifestyle medicine practice. That's a difficult model to emulate in an academic setting," Dr. Durrie said. Those differences aside, all three physicians agreed there are more similarities than differences between the two types of fellowships and that high quality fellowships exist throughout private and academic settings. But choosing a fellowship program goes beyond just opting to learn surgical techniques, Dr. Lindstrom said. "When you choose a fellowship, you're choosing lifelong mentors. They'll continue to mentor you and represent your interests over the life of your career," he said, advocating that people considering fellowships visit the facilities to ensure personali- ties will mesh. "I've been taught by some of the best doctors in the world," Dr. Donnenfeld said. "They made my career. My responsibility is to give back to the next generation and help someone else's career." With the increased interest in lifestyle healthcare, Dr. Durrie said his fellows are having no problems finding jobs, as many practices are looking to add highly trained lifestyle surgeons, a trend he predicts will continue well into the next decade. For the most part, Dr. Lindstrom said the lines are blurring and eradi- cating differences between academic and private settings. "Academic practices need to be much busier than before; they need to contribute to the setting's bottom line, which wasn't always the case," he said. "It's becoming easier and less expensive to do clinical research in private practice. There is a strong opportunity to participate in the c linical studies at both types of prac- tices, if that's someone's interest." For those interested in true basic research, however, private practice fellowships may not present much opportunity, Dr. Lindstrom said. "Very few practices have cell biology labs, for instance." Pros and cons Years ago, if a physician was strongly motivated toward an academic and research-oriented career, it was con- sidered a significant benefit to have undergone a fellowship at a teaching facility. "Basic science was pursued in institutional centers, and private practice was more translational science," Dr. Lindstrom said. These days, that differentiation is not as distinct. Most academic centers don't have their own ambulatory surgical centers, however, which may be a downside. "Our fellows are exposed to how to run a business in refractive sur- gery—they see firsthand what the overall experience is for patients as they go through exams and how that affects the practice once the surgery and follow-up are finished through word-of-mouth referrals. The business side of things is not a general focus at an institutional setting," Dr. Durrie said. Dr. Donnenfeld said because his fellowships are in private practice, there are fewer restrictions than a university might have in the OR. "We teach all aspects of anterior segment surgery, and our fellows are not only shown the techniques, but perform them as soon as we feel they're ready. They've not only seen the patient, but done the surgery and are now conducting the follow- up. That's not necessarily how an academic setting would work." That's not to say surgeons trained in private practice are obligated to that career choice— Dr. Lindstrom noted his last three f ellows went into full-time academic careers. As far as Dr. Donnenfeld is concerned, the only disadvantage to a private fellowship is the lack of grand rounds. "I miss that ability to go to grand rounds with other subspecial- ists. We don't have academic talks where we go over the cases like you would in an academic setting," he said, but private practice fellows do gain a considerable amount of busi- ness expertise that is not available in an academic setting. There are fewer integrated opportunities in a private practice setting, Dr. Lindstrom agreed. Conversely, those who want to use the latest technology will generally be able to so in a private setting long before an academic one has pur- chased the device. "Companies tend to find the indirect costs of the university set- ting are much more restrictive," Dr. Lindstrom said. Dr. Durrie agreed: "Femtosecond LASIK surgery didn't start in an aca- demic setting. Femtosecond cataract surgery also started in the private sector, although Bascom Palmer (in Miami) was an early adopter. In the excimer laser field, the early adopters have always been in private practice, and the opportunity to conduct ground-breaking research has been in private practice as well." For these leading surgeons, fel- lowships are an integral part of any ophthalmologist's training. But for those seeking fellowships, the lines have blurred a bit regarding advan- tages of one type over another. OB Contact information Donnenfeld: ericdonnenfeld@gmail.com Durrie: ddurrie@durrievision.com Lindstrom: rllindstrom@mneye.com March 2014 • Ophthalmology Business 15 02-19_OB March 2104_Layout 1 2/19/14 11:07 AM Page 15

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