OF WHAT ARE YOU PROUDEST?
Gary Foster, MD
My greatest accomplishment was convincing my wife,
Lonnie, to marry me. She was the central office human
resources director for a large health care conglomerate
and was dating investment bankers, while I was a punk
medical student driving a car she had to help me push
to start. Every other good thing in my life since then has
flowed from my marriage.
Kathryn M. Hatch, MD
I feel proudest when hearing stories from my patients
about how they are achieving their goals after having eye
surgery.
Robert K. Maloney, MD
I am most proud of 2 weeks I spent in the Marshall
Islands in the middle of the Pacific Ocean after my fellowship.
I arrived at a hospital where the hallways were
lined with people blind from cataracts. My colleague,
Tony Capone, and I performed a “boatload” of cases but
barely made a dent in the line of patients. Fortunately,
we also spent part of our time training an ear nose
throat surgeon there how to remove cataracts. Three
years later, there were no cataracts left in the Marshall
Islands, because that surgeon had operated on all of
them. I feel like we were personally responsible for eliminating
cataract blindness for an entire nation in that
brief trip.
Cathleen M. McCabe, MD
I feel fortunate to be practicing ophthalmology at a
time when we have the ability to routinely perform surgeries
that improve patients' vision, frequently allowing
them to see better than they ever have without glasses.
The best part of my day is celebrating with a patient who
is amazed at the improvement in his or her vision.
Jonathan Solomon, MD
I am most proud of my decision to follow in my
father's footsteps, the joy that comes from contributing
to the care of my patients, and the opportunity to collaborate
with colleagues and friends.
Kerry D. Solomon, MD
I am proudest when I am able to hit the refractive
result that the patient wants and I am able to meet or
exceed his or her expectations. When patients are happy
with the care and outcomes I provide, that really gives
me a great deal of satisfaction.
Robert J. Weinstock, MD
I am most pleased with the quality of care and the
outcomes we deliver to our patients at the Eye Institute
of West Florida. I am so proud of my father's 4-decade
dedication to the profession of ophthalmology and of his
instilling in me the drive and commitment to raise the
bar and put the patient first in all decisions that I make.
WHAT KEEPS YOU AWAKE AT NIGHT?
Gary Foster, MD
My three teenagers can keep me awake at night. I
want them to find faith, confidence, and passion for
their lives that best the amazing love I have for ophthalmology.
Most of their days are spent building that
dream, but sometimes, when they face big decisions, I
lose sleep.
Kathryn M. Hatch, MD
My 4.5-month-old keeps me up the most! Aside from
her, I worry about how my husband and I will afford two
college educations in the next 18 years.
Robert K. Maloney, MD
What keep me up at night are complications. I hate
them, they happen, and that is life. The other thing that
keeps me up at night is drinking red wine with dinner.
Cathleen M. McCabe, MD
I am always concerned about patients' care and outcomes.
I also spend time trying to plan for the future
success and longevity of my practice. It is a challenge to
determine how to grow the practice while improving
patients' care, overcome the challenges of decreasing
reimbursement and increasing regulation, and meet
patients' rising expectations while having less time to
spend with them in general.
Jonathan Solomon, MD
Everything keeps me awake: my 3-year-old daughter,
the geopolitical effect of closing Gitmo, drone strikes,
the looming debt crisis, whether my horse came in, and
wondering if I locked the front door. I suppose my professional
concerns regard the trajectory of the profession
of ophthalmology in the face of decreasing cooperation
with third-party partners and the potential obligation to
retain legal counsel to assist with every major decision
given the complexity of health care reform.
Kerry D. Solomon, MD
When I have a patient who is disappointed with
an outcome, justifiably or not, I tread over that a lot.
Patients have increasingly high expectations, and as
much as I try to meet or exceed them, and as much as
I try to ground them in advance, there is an occasional
person who still feels that I have not done my part and
did not properly educate him or her upfront.
Robert J. Weinstock, MD
I am a great sleeper, but occasionally, I will lie awake
thinking about a patient who is not doing well, how to
improve what I do and make the practice run better, my
kids, and fishing plans.
WHERE ARE OPHTHALMOLOGY AND MEDICINE HEADED?
Gary Foster, MD
The amazing technology that we already have and that
will soon become available allows me to get up every day
and assume that I will be better at restoring my patients'
sight than I was the day before. How many people could
dream of saying something like that? I believe these advances
will be realized first in the elective channels but will work
their way through the insurance bureaucracies in time. For
this reason, I have emphasized the elective options available
to my patients in cataract and refractive surgery. That is
where I consistently have the biggest impact on their vision.
Kathryn M. Hatch, MD
I believe all practices will become a part of accountable
care organizations as well as single-payer systems. I expect
ophthalmologists will have to carry an even larger surgical
load as the baby boomers require cataract surgery.
Robert K. Maloney, MD
Medicine will become more and more like a (coeducational)
priesthood. Reimbursements will continue to
be squeezed. Physicians' incomes will continue dropping.
The major compensation for surgeons will be the pleasure
of the work. This happened in Europe 20 years ago.
There, anyone who is not the professor of the university
department generally has a very modest life. In the
future, unfortunately, many brilliant people simply will
not find the remuneration of medicine to be worth their
time. They will go into other fields, and medical advancement
will be the worse for it.
Cathleen M. McCabe, MD
The future will most certainly necessitate a much
greater focus on efficiency and fiscal responsibility in all
areas of medicine but particularly in ophthalmology. As
the population ages and the volume of patients rises,
without a concomitant increase in providers, the need to maximize efficiency and minimize unnecessary expenses
will grow. I anticipate that we will be able to provide our
patients with a wide range of elective options that will
improve their outcomes while allowing us to continue to
provide a high level of covered services despite decreasing
reimbursement for those services.
Jonathan Solomon, MD
I anticipate a great schism in the delivery of medical
care due to changes in insurance coverage. As more and
more services come to be considered premium products,
a parallel health system will generate a multitiered divide.
Kerry D. Solomon, MD
I have concerns about the direction in which medicine
is headed. I think that the system is getting more and
more squeezed. Physicians will continue to be pressured
by insurers, hospitals, and patients' expectations. We will
have to deal with those challenges. The good news is that
ophthalmologists provide refractive services in addition to
what insurance traditionally covers, and as a result, we have
an opportunity to improve patients' quality of life. Because
refractive services are not covered by insurance, we can continue
to achieve great satisfaction from the work that we are
doing despite the changes in health care that are coming.
Robert J. Weinstock, MD
The prevalence of disease will rise, owing to a national
epidemic of obesity and the aging of the US population.
Ongoing regulation will distract us from caring for patients.
Reimbursement will decrease further, and the government
will continue to interfere in our decisions about what is best
for our patients. I anticipate eventual governmental control
of medicine with a small, second-tier, private-pay system.
WHAT CHANGES ARE YOU MAKING IN YOUR PRACTICE?
Gary Foster, MD
I love restoring patients' vision, so I have always invested
time, money, and training into areas that will improve
their outcomes and safety. Most recently, my practice has
invested in laser cataract surgery and intraoperative aberrometry.
Change and continuous quality improvement are
the norm in my practice. This approach flies in the face of
most who feel it is time to hunker down and lower costs. I
believe that elective medicine will expand in ophthalmology
and that best-in-class outcomes and customer service will
be rewarded. In addition, I expect that insurers will increasingly
reward providers who can demonstrate better quality
and safety. Even if they do not, I did not enter medicine to
have the highest profit margin. For me, it has always been
about the quality of the outcomes I achieve for my patients.
Kathryn M. Hatch, MD
We are increasing our marketing and changing strategies
in an attempt to reach Generation Y for laser vision correction
and the baby boomers for laser cataract surgery.
Robert K. Maloney, MD
Five years ago, I mostly performed LASIK. Five years
from now, I will mostly perform cataract surgery.
Premium IOLs and laser cataract procedures make up
a major part of my cataract activity, and that will not
change. My team's comfort with customer service and
our expertise at talking about excellent uncorrected
visual acuity have not and will not change.
Cathleen M. McCabe, MD
My practice is becoming more integrated and
diverse, with optometrists, ophthalmologists (including
oculoplastic surgeons), opticians, dermatologists, and
auditory specialists working as a team to provide a full
range of services to patients. We are investing in new
technologies that will allow us to provide the highest
level of care.
Jonathan Solomon, MD
Positive and negative incentives have propelled my
practice into the arena of electronic health records. Most
of the changes we have made, however, are driven by
our desire to adhere to the tenants of The Experience
Economy by Joseph Pine II and James H. Gilmore. We use
multimedia educational tools to assist with knowledge
transfer, and we stock creature comforts in the office to
foster a more relaxing environment.
Kerry D. Solomon, MD
In this day and age, people have choices about where
they can go for eye care. At my practice, we are therefore
focusing on providing customized outcomes to
meet patients' expectations. We are also working to
deliver great customer service. These efforts should
generate a high level of satisfaction among our patients.
Everyone can talk about customer service, but you
actually have to act on it. Changes that we have made
include redesigning how we see patients. Our average
waiting times are 15 minutes or less, and the total
length of visits to our practice has decreased. We are
being respectful of our patients' time, and that has
made a big difference in terms of our customer service.
Robert J. Weinstock, MD
We are diversifying the services we offer. We have
added cosmetic self-pay procedures and products. Our
focus is on customer service and patients' education.
WHAT ADVICE DO YO U HAVE FOR THOSE JUST GETTING STARTED IN OPHTHALMOLOGY?
Gary Foster, MD
Find the part of ophthalmology that you really love
and become an expert at it. Emphasize that aspect of
your profession and build it at the sacrifice of other parts
of ophthalmology. Become involved in research, and
start helping with that area on the committees of your
professional organizations. Make time to build strong
friendships with other like-minded ophthalmologists.
Each of these areas brings joy and builds on the others.
Kathryn M. Hatch, MD
Be patient with your current job. Do not make rash
decisions or let your ego get the best of you. Try to
love what you do each day for your patients as well as
the people with whom you work. Treat patients and
coworkers how you would like to be treated. Understand
and study the business of medicine.
Robert K. Maloney, MD
You will not be as well compensated as your forebears,
but you will have more interesting work. You will have
great tools and fascinating problems to solve throughout
your career. Join a four-person group in a rural or suburban
area where you want to raise a family. Forsake the
false allure of the big city.
Cathleen M. McCabe, MD
Learn about the business of medicine; it will be even more
important to be a savvy businessperson in the future. Find a
group of like-minded partners with whom you enjoy interacting,
because you will spend most of your time working
together to face future challenges. Do what you love, and
remember that it is a privilege to provide the gift of sight.
Jonathan Solomon, MD
Learn as much as you can about the business and
management of medicine, but do your best to lead with
your heart. Allow your passion to drive your decisions
for your carrier. Change is a guarantee, but if you remain
vigilant about fueling your fire, then even the unforeseen
obstacle should not deter you.
Kerry D. Solomon, MD
Be progressive in your thinking. Be open-minded and
flexible about new technology. Look beyond standard
outcomes in cataract surgery. We have options for making
patients less dependent on glasses for distance vision.
Deliver on refractive outcomes, and be realistic about them.
Offer LASIK and PRK enhancements as part of the overall
package of solutions for patients, because the predictability
and accuracy with cataract surgery are not where
they are with LASIK. Deliver good customer service. If
you can do these things, cataract and refractive surgery
is a rewarding and growing field. The baby boomers are
just reaching Medicare age, they have disposable income,
and they are very interested in solutions that improve
their quality of life.
Robert J. Weinstock, MD
Slow and steady wins the race. Bond with your
patients, and treat them like family. By making their care
your number one priority, you will almost always make
good decisions.
Gary Foster, MD, is the medical director for The Eye Laser Center of Northern Colorado in Fort Collins, Colorado. Dr. Foster may be reached at (970) 221-2222; website: garyfostermd.com.
Kathryn M. Hatch, MD, practices corneal, cataract, and refractive surgery at Talamo Hatch Laser Eye Consultants in Waltham, Massachusetts, and is a clinical faculty member at the Alpert Warren Medical School of Brown University in Providence, Rhode Island. Dr. Hatch may be reached at (781) 890-1023; kmasselam@gmail.com.
Robert K. Maloney, MD, is the director of the
Maloney Vision Institute in Los Angeles.
Dr. Maloney may be reached at (310) 208-
3937; info@maloneyvision.com.
Cathleen M. McCabe, MD, is a cataract
and refractive specialist practicing at The Eye
Associates in Bradenton and Sarasota, Florida.
Dr. McCabe may be reached at (941) 792-2020;
cmccabe13@hotmail.com. Jonathan Solomon, MD, is surgical/refractive
director of Solomon Eye Physicians and
Surgeons in Greenbelt and Bowie, Maryland,
and McLean, Virginia. Dr. Solomon may be
reached at jdsolomon@hotmail.com. Kerry D. Solomon, MD, is a partner at
Carolina Eyecare Physicians, the director of the
Carolina Eyecare Research Institute, and an
adjunct clinical professor of ophthalmology at
the Medical University of South Carolina, all
located in Charleston. Dr. Solomon may be reached at
(843) 881-3937; kerry.solomon@carolinaeyecare.com. Robert J. Weinstock, MD, is a cataract
and refractive surgeon in practice at The Eye
Institute of West Florida in Largo, Florida.
Dr. Weinstock may be reached at (727) 585-
6644; rjweinstock@yahoo.com.