I started collecting refractive surgery data as a medical student in 1985. Then, again, during my residency (from 1987 to 1990), I was fortunate enough to be exposed to refractive surgery. Next, I began my refractive surgery fellowship in 1990 – long before it was thought to be an acceptable branch of ophthalmology.

Now, 9 years later, I’m director of the Southeastern Eye Laser and Refractive Center, a division of Southeastern Eye, which includes 42 offices in two states.

My experiences throughout the years have taught me some valuable lessons that I feel are worth sharing with surgeons who are considering launching into refractive surgery to create a new branch of practice.

Believe it or not, if you have a well-established general ophthalmology practice and want to add refractive surgery to your list of procedures, you don’t begin with a large newspaper, radio or television advertising campaign. You don’t begin with an expensive video for the practice. You don’t have to set up a Web page. And, you don’t have to hire an advertising agency and a refractive surgery coordinator, build a refractive surgery center, or move to a local shopping mall.

Does this surprise you? Realistically, if you’ve been thinking about offering refractive surgery, the safest and wisest place to begin is internally.

But before you jump into refractive surgery, you need to know what you’re getting into and why. If you’re going to offer this procedure, it should be because you like it – because you see it as a new horizon.

Don’t treat this new venture as a way to make up for reduced managed care reimbursements, decreased Medicare reimbursements or loss of income for whatever reason. If you think you’ve made wrong career choices before, you’ll definitely find out that you’re headed down the road to self-destruction with this choice – if you make it for the wrong reasons.

As you’ve most likely heard already, if you don’t like dealing with people on a one-on-one basis, you won’t like refractive surgery.

Refractive surgery patients will tax every ounce of your fortitude. They’ll ask you questions that even you don’t know the answers to. And if you try to give them fairy-tale answers, they’ll stop you dead in your tracks.

Believe me, they evaluate your answers thoroughly. On average, each of these patients has had seven contacts before showing up at your door. They may have asked a friend who has had the procedure. Maybe they researched it on the Internet or attended one of your competitor’s seminars. And they most likely heard about it in an ad, a magazine article, a local billboard or a television spot.

When they ask their questions, you and your staff had better be well versed, or you’ll be left behind.

But if you understand and can accept such characteristics in a sector of your patient population, refractive surgery can be very rewarding. This is true especially if you don’t feel surgically challenged by your present options, or if you’ve made a career choice that hasn’t been very fulfilling and you’re now ready for a change in direction. If this is the case, you can effectively incorporate this procedure into your practice by following these four steps.

Make sure you believe in and appreciate the technology that drives refractive surgery. Get exposure to it by visiting other practices that have programs designed to introduce the physician to the practice model of refractive surgery. For example, you might try the VISX mentor program.

These programs will let you see an active refractive practice function in the real world. The experience will help you decide whether you really like the idea of incorporating this technology into your current practice.

Once you pass this hurdle, you can start investing time and money into training yourself in refractive modalities that you think may be of interest to your patient population. For refractive surgery training, you might attend one of the major meetings, such as the American Academy of Ophthalmology (AAO) or the American Society of Cataract and Refractive Surgery (ASCRS).

Also, subspecialty meetings such as the International Society of Refractive Surgeons will offer specific courses that cover the entire spectrum of refractive surgery.

You may have one of the most efficiently run practices, but all it takes is one or two detractors to run a refractive surgery start-up process into the ground. If your staff doesn’t believe in you, neither will your patients.

Even the most experienced refractive surgeon has had a first case. He may have done 10,000 cases – but he began with one. Never forget this.

Your first refractive case – no matter which type of surgery you perform – needs to be someone who believes in you and your surgical skills. And this individual needs to know that he’s your first refractive surgery patient.

Where can you find this person? Look for someone on your staff who believes in you. Now, before you take this trusting soul and treat him like a cadaver from medical school, you owe it to him to prepare yourself. Practice, practice – and practice some more – until you feel comfortable. Most refractive surgery fellowships require you to participate in many wet labs. Then you watch an experienced surgeon, over and over again.

You should do the same, even if you’re already in private practice. If you can, take your first patient to an experienced surgeon so that you can be proctored under direct supervision.

One other point to consider: Be careful who you choose as your first patient. No matter how much he believes in you, a —12D myope with 4 diopters of astigmatism just won’t do. Start with easy patients, and work up from there.

Once you’ve performed your first surgery, you’ve achieved a significant milestone. Offer the rest of the staff the surgery at no charge or at a reduced rate. You’ll reap benefits when they tell of their experiences.

After your staff is on board with your new venture, you can put them into the public eye. Nothing brings more referrals than a happy staff member at your front door telling other prospective patients about his experience.

Any refractive surgeon will tell you that many of his patients are referred by other patients. Yes, you can get referrals from advertising, other physicians and managed care settings. But still, many come from someone you’ve seen or done surgery on before. Assign a staff member to look within your practice for potential candidates.

Offer surgery to your first candidates at reduced rates or at no charge. Patients who already know you will be more tolerant of minor mistakes, delayed return of phone calls or scheduling difficulties. This will give you an opportunity to work out kinks in your system and give your staff time to get comfortable with new types of questions.

Before you set your sights on a huge marketing campaign, it’s important to spend the time getting ready with respect to your phone lines, your schedule and your office environment.

When you first go public with your new adventure, you don’t have to spend a great deal on a radio, TV or newspaper blitz. You can do simple things like using Microsoft Publisher to make brochures or putting together education tapes that highlight the talent of you and your staff members. Slick presentations don’t always sell to individuals who have done extensive research.

Simple videotaped testimonials of patients’ experiences and your discussions of the procedure are great to show during the 30 to 45 minutes while patients are dilating for a cycloplegic refraction and your examination of the retinal periphery. Plan on spending some time with these patients and modify your schedule to allow time for questions and answers.

Often, patients will come in with questions written down. If your staff is knowledgeable, they can answer many of these questions for you. But make sure you answer the questions these patients want to ask you.

Or, better still, if the patient has watched a tape outlining the procedure, many of his questions will already have been answered. If you do your own informed consents, you need to allow additional time for occasional lengthy discussions. The bottom line is, refractive surgery patients will take more of your time, and you need to be ready for it.

Ultimately, as time progresses, you’ll want to add marketing and other promotions to your practice. But by this point, when patients call, walk-in or visit your Web page, you’ll be prepared to handle the load.

Refractive surgery can be a rewarding addition to your career and your practice, as long as you’re adequately prepared. If you can’t handle the volume, questions or scheduling difficulties, it’ll be your worst nightmare.

By following these basic steps, you can ease into it and find out if you like the adventure before spending a lot of time and money unnecessarily.

First, remember to focus on educating yourself. Second, prep your staff. Third, introduce refractive surgery to your present patient population. Finally, you’ll be ready to venture out into the market and work to attract a new subset of patients to your front door.