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Cataract Surgery: Resident Training | Mar 2011

The Business Course I Wish I’d Had

Ophthalmic training should include education on how to choose and thrive in a medical organization.

Practicing in the real world—whether the setting is private, academic, or corporate—makes ophthalmologists wish they had learned a lot more than how to diagnose and treat eye disease. A 2006 survey of recently graduated ophthalmology residents revealed that the greatest perceived deficiency in their training was in the area of practical business knowledge.1 A full 60% of the respondents reported that they were not well prepared in the areas of business operations and finance, personal financial management, practice management skills, and other areas related to the business side of a practice.

After practicing for 15 years, I enrolled in an executive MBA program. During the next 2 years, I marveled at the practical information that would have helped me so much if only I had learned it earlier. Most of all, I wished I had taken a course on organizational behavior.


All ophthalmologists work in some type of organization. Those who enter solo practice create an organization. Those who join a group or the faculty of an academic medical center enter an existing organization. Outside their families, ophthalmologists’ relationships with their organizations will determine their happiness and productivity. The better one knows how these organizations work, the easier one’s life will be.

Issues include
• motivating, disciplining, managing, hiring, and firing employees
• learning about, adapting to, and changing group culture
• getting along with fellow doctors and recognizing and managing outliers


Given the importance of organizational behavior and the lack of training programs, mistakes are common. For example, many young doctors pick the wrong organization in the first place. They do not know the importance of group culture or how to recognize it, so they join a group with which they do not “click.” They become unhappy and eventually leave, thereby wasting several of the most important years of a practice or academic life.

Alternatively, the physician joins the right group, alienates key employees or colleagues early on, and then spends months or years getting things right. He or she fails to recognize and deal with problematic people, whether doctors or other personnel. The physician does not know how to behave at meetings or how to run an effective meeting. He or she has an opportunity to influence the culture of the organization but does not know how to do so. Several years into practice, the ophthalmologist may assume a leadership role in the organization, but success will be trickier if he or she does not know how to lead, manage, or set the tone.


I wrote What Every Doctor Should Know … but Was Never Taught in Medical School to address the aforementioned issues and to help prevent young doctors from floundering as they enter practice. The American Academy of Ophthalmology offers many business resources. Of particular interest may be The Profession of Ophthalmology: Practice Management, Ethics, and Advocacy, the recently released online publication edited by David Durfee, MD.


It would be helpful if ophthalmic training covered business communications, marketing, economics, accounting, business law, operations management, corporate finance, and strategic planning. Ophthalmologists can learn some of these concepts on the fly once they enter practice, and not all of these areas will prove useful to every practitioner. Organizational behavior is a key subject, however, the minute ophthalmologists complete their training.

Tom Harbin, MD, MBA, is in practice with Eye Consultants of Atlanta. Dr. Harbin may be reached at tomharbin@comcast.net.

  1. McDonnell,PJ,Kirwan,TJ.Perceptions of recent ophthalmology residency graduates regarding preparation for practice.Am J Ophthalmol.2007;114(2):387-391.
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