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Cover Stories | Feb 2024

Establishing a Glaucoma Practice Fresh Out of Fellowship

Insights and strategies for young ophthalmologists in building a successful, specialized practice.

All comprehensive and fellowship-trained ophthalmologists know that, upon graduating from our respective institutions, we have it all figured out. Ready to tackle any disease dilemma, we are armed with the latest peer-reviewed journal articles to back up our practices. Not just clinically and surgically adept, we also possess the business savvy of a CEO, the marketing genius of a top strategist, and the command of a thriving practice. Our patients view us as trusted, experienced, rock star surgeons. Red tape? We’ve never heard of it. Even insurance companies line up to send us letters of gratitude for joining their networks.

When we wake from this glorious dream, we recognize that graduation is not the finish line but the starting point. I felt exceptionally well prepared when I completed my fellowship 18 months ago. I opted for a small, physician-owned private practice, one without a glaucoma specialist but with a team of fantastic physician colleagues and an outstanding support staff. My journey has been an education, particularly in building a glaucoma surgical practice, and this article shares the valuable insights I gained during my first 1.5 years in practice.

Partnering in Patient Care

We are rigorously trained to diagnose and treat patient conditions and spend years honing our surgical expertise. Equally important, we learn the art of treating patients with kindness and respect and how to communicate complex information in an understandable manner. Many training institutions, however, do not place enough emphasis on the overall patient experience, which begins the moment they walk through the door. Are they greeted with a smile? Are overdue bills addressed efficiently and kindly or in a manner that makes patients feel like a nuisance or delinquent? When they have that one last query about their surgery—the one they have called about twice already—does the surgical coordinator patiently provide an explanation?

As physicians, we have direct control over our actions and interactions. Although I am gratified when patients are satisfied with my care, I recognize that I am not the only one providing their care. Rather, it is a collective effort by my staff and me. My staff is an extension of myself. In building a practice, finding like-minded individuals who embody the same level of respect for patients is a challenging yet critical task. I was lucky to join a practice where the owner not only understood this but also impressed its importance upon me. I believe that much of a physician’s and a practice’s success hinges on the strength and quality of their support staff.

Confronting Age Perceptions

Since day 1 in my practice, I have fielded questions during surgical consultations such as, “How many of these procedures have you done?” I have heard remarks such as, “Wow, you could be in high school!” This often culminates in “How old are you?” This experience is familiar to many young surgeons, particularly female ones. Patients occasionally hesitate to proceed with surgery because of how they perceive the surgeon’s age and level of experience.

Experience is important but is not the sole factor in clinical and surgical success. Excellent training, a willingness to adopt effective new techniques, keen insight, and a strong ethical foundation are also important. I have honed my interpersonal communication skills to guard my personal information (“My age? That’s a state secret”) while maintaining a positive doctor-patient relationship (“Thank you for the compliment! I understand your concerns, but rest assured, I am fully confident in performing this procedure safely and effectively for you.”).

Being a surgeon requires a balance of confidence and humility—the audacity to take a knife to someone’s eye coupled with knowing the right time to do so. It is essential to recognize that we are not the ideal doctor for every patient. Some may prefer a physician with a touch more experience, and that is okay.

Crafting a Specialized Practice

Refining the practice. In the initial phase of my practice, I viewed every patient who came through the door as an opportunity to build my practice. It did not take long for me to realize that not all of them had glaucoma. As a fellowship-trained glaucoma surgeon, I embarked on a journey to refine my practice’s focus.

Building relationships. During training, many of us move from one community to another, only to leave again after acquiring crucial experience. Establishing a practice means becoming a part of a community of other ophthalmologists, optometrists, and primary care physicians who refer patients. A solid training background and good reputation are a great start, but referring doctors might have had negative experiences with other ophthalmologists and practices. How can we prove our reliability in sending reports, returning patients after surgery, and delivering exceptional care? It cannot be done overnight. The key is to build relationships by personally meeting our referral sources, calling them for updates or queries, and doing so consistently. A hands-on approach is the most effective marketing strategy I have found.

Embracing marketing and patience in practice growth. Despite catering to an older demographic, a glaucoma practice without an online presence misses an opportunity. Many of my patients refer themselves. To address this, I developed my own website, YouTube channel, and online advertising campaign. I have even distributed flyers at local coffee shops and give two business cards to each satisfied surgical patient—one for them and another for a friend.

Patience is important to the process. In today’s fast-paced world, establishing strong community ties and a reputable practice takes time—often years. There is no shortcut. It is important to trust the process and avoid comparing our journeys to those of physicians who are 5 to 10 years ahead of us.

Achieving Long-Term Success and Satisfaction

The most valuable advice I can offer is to work in an environment you enjoy. Building a successful practice is unfeasible if it leads to burnout. Creating a workplace that is enjoyable for both you and your staff is crucial for long-term success and personal satisfaction in your practice.

Emily Schehlein, MD
  • Glaucoma specialist, Brighton Vision Center, Brighton, Michigan
  • emschehlein@gmail.com; Instagram and X (formerly Twitter) @EmSchehMD
  • Financial disclosure: Consultant (Allergan, Glaukos, Perceptron Health); Stock options (Perceptron Health)
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