Private practice: No more a one-man job

In the early days of my career as a private practitioner in the field if ophthalmology, armed with just a slit lamp and a trial frame, the challenge was only the appropriate care of the patient. Improving your skills as an ophthalmologist implied being updated with medical protocols and improving your skills as a surgeon. If you were successful in your career, you could even hire an assistant in order to streamline your numerous patients.

If you had glaucoma patients, an automated visual field analyser was a must, and for a cataract surgeon, a good biometry device was a unavoidable need. In addition, an argon laser would be invaluable in retina cases. For high-volume practitioners, the costs incurred from such expensive machinery were easily absorbed by one’s practice.

With time, though, more and more sophisticated pieces of diagnostic machines became available and as such, became necessary to obtain for those who wished to keep up with advancements in their field. These days, my old diagnostics friends are armed with a topographer, a tomographer, an endothelial microscope, miRNA mimics and inhibitors, a third-generation optical coherence tomography (OCT) instrument, a non-contact tonometer and an optical biometer. Not forgetting the assistant who has been hired with the sole task of running all of these tests.

Better patient care

Nowdays, the eye can be analysed with pinprick accuracy, thus allowing the surgeon to deliver more appropriate, personalised care to the patient. My collection of ophthalmic ‘toys’ seems to be in a state of perpetual growth: a tonometer, a fundus camera and an OCT angiography instrument are just some of the items I will be talked into adding to my wish list at the next Congress.

In parallel, the surgical theatre has changed just as much. For example, in the past, extracapsular extraction would require the surgeon to have a steady pair of hands and only a handful of surgical instruments; the process evolved and surgeons now conduct phacoemulsification which requires, obviously, a phaco machine.

This was a relatively easy succession, but some changes are less appealing. As everybody knows, but few acknowledge, most surgeons are terrified by the next wave in cataract surgery: the femtosecond-assisted procedure. Their fear stems from the fact it is a very expensive tool, and at this stage of development capable of only minimal improvements in clinical outcomes. Nevertheless, it is, most probably, the future of cataract surgery.

The business module of ‘one man, job, physician’ no longer holds. The amount of investment needed in order to run a complete and updated diagnostic and surgical office is very difficult to maintain with a solo practice.

Either you are a very successful surgeon in a low competition setting or you have two survival strategies: teaming up with other surgeons or offering your services as a consulting surgeon for a big company with deep pockets. And these strategies, nowadays, are required from the beginning.

Ophthalmic surgeons starting out in their careers now have to develop not only surgical skills, but business acumen as they seek to partner with colleagues in a world full of private clinics and where the surgeon is the less expensive and more easily replaceable part of the surgical process.

E-mail: pa.fazio@gmail.com

Dr Fazio is in private practice and is the head of the refractive surgery service of the Cantanese Centre of Medicine, Italy.