17 July 2010
Posted in Pearls in Ophthalmology
By Michael G. Haas, MD
After four years of college, four years of medical school, a one-year internship and three years in residency (and possibly a fellowship), you have finally made it. Congratulations! Life just became easier and more enjoyable, but it became harder as well…
At some point during your PGY-4 you should have been in contact with potential employers. You may choose to start your own practice, join a solo practitioner or even join a large group. Either way, you will have some work to do. The first step, once you know where you will be working, is to start the process of obtaining a full license to practice medicine in your new state. Once you have obtained your license, you then need malpractice insurance and hospital credentialing (for hospitals your TB testing and CPR will likely need to be up to date). These are often required before the next phase of applying for and joining insurance panels (many insurers will require you to be credentialed with a hospital prior to getting on their panel). In addition to all this, you need to be credentialed with the ambulatory surgical center (ASC) where you’ll be performing surgery as well. The mountains of paperwork have begun, and if you are lucky someone in your new practice may help with this. This whole process can take anywhere from 4-6 months or more to complete. Full credentialing may take a few additional months as well. The best advice I can give is to start early, as soon as you have your job lined up.
Day 1. You are finally here. As the new associate, you should be respectful and courteous to your new staff. They can help to make or break you in your new position. Quickly learn the names of everyone in the office. Be friendly to your staff, and let them see you lead by example. Do not be late for work. Work hard, and always treat your patients with respect. Oftentimes, your reputation starts before you walk through the door, and word-of-mouth patient referrals will provide you with much of your long-term patient base. It will be very important to have formal (and informal) review sessions with your employer, especially in the beginning. It is important for you to know what is expected of you, and there should be no ambiguity as to whether you are achieving your benchmark goals. Monthly or quarterly meetings with your employer to review your production and bedside manner will help to assure that down the road, there are no surprises when it comes time to buy into the practice.
I would discourage everyone from having a narrow scope of practice, at least initially. You may or may not be fellowship trained, but now is the time to see as many patients and perform as many different types of procedures as you can. Over the years you will quickly learn what you enjoy and can adjust your patients accordingly.
Working in your new surgery center will also be an important time to be at your best. Again, you should know the names of the staff quickly, and do not hesitate to spend some extra time there initially to familiarize yourself with the equipment and/or personnel. You may or may not be familiar with the surgery center’s equipment and instruments. Halfway through your first surgical case is not the time to find out that you do not have something you need.
For those of you who will be performing cataract surgery, it is a very exciting time right now. If you have not yet read Phacodynamics by Barry S. Seibel, M.D., now is the time to do so. It is important to know the fundamentals of phaco, and there is a very real chance you will work on a phaco machine you have never used before. The knowledge from this book will ease the transition for you. It should be in every cataract surgeon’s library. The equipment has never been better, and you now have the option of premium, presbyopia-correcting IOLs to choose from too. In today’s market, your patients will expect perfection. It is important for you to have impeccable skills before offering these services. There is an art to guiding your patients to appropriate expectations, and in determining what is best for the individual patient. Before venturing into the premium IOL market, consider adding Mastering Refractive IOLs: The Art & Science by David F. Chang, M.D. to your collection.
It will be more important than ever to stay current in your education. You are not simply finishing your training. Rather, you are just starting your chosen career. You will finally start to enjoy the fruits of your labor. Read your journals, attend the meetings, and do not forget your CME credits. You will soon be taking your written and oral boards. Make sure you plan for your studying time. Too much time, effort and money is involved to not take these seriously. Checkhttp://www.abop.org/ for more information.
On a last note, consider purchasing the new Ophthalmic Coding Series from the AAO as well. If you are the typical resident or fellow, you have had little exposure to coding in the real world. You have worked hard for your career, and this series can help to assure you are paid for your work, and it will lessen your chance of committing accidental billing fraud.
Above all, simply be yourself. Treat your patients as you would want yourself or a family member to be treated. We are privileged to provide eye care to the public, and it is our duty to always strive for excellence. By putting your patients’ best interest first, you have already started down the right path. There truly is no better time than now to be starting a career in ophthalmology!