Manage Your Career Actively
If you don't, you'll miss out on more than financial rewards.
BY JOHN B. PINTO

What do you possess, really, when you leave formal training and enter the world as a newly minted ophthalmologist? Knowledge, to be sure -- in abundance. A few scars. And, if you've been lucky and well-rounded, enough wild-haired stories to fill a small novel. But what you really possess is a brand new, baby career.

Or, if you don't manage your career especially well, if you passively float through your professional life, you'll work less fruitfully, earn substantially less, and retire later and poorer than you might prefer.

The choice between these two divergent outcomes is entirely yours. Here, I'll explain how you can make the choices and decisions that will enable you to have a career that's highly rewarding, both financially and professionally.

Assess Your Opportunities

"Doing" a career is not like "doing" cataract surgery. Unlike the step-by-step plan you've been taught to craft for each of your thousands of surgical cases, you've had no formal training and no logic tree to follow in navigating your career path. And, of course, you only have one, single career to get perfectly right the very first time you try. Thankfully, you have years and years to correct any errors you make along the way, and few mistakes are completely irreversible. Let's first explore the biggest factors that result in success and failure.

There was a time when every new ophthalmic grad had 10 standing offers of employment, from 10 almost-equal contenders. Today, the number of offers has shrunk somewhat, while the diversity of opportunity has exploded. These opportunities include small and large single-specialty group practices, multi-specialty practices, corporate LASIK centers, staff-model HMOs, teaching positions, VA hospitals and related governmental service. Most of the offers out there are solid enough, like the institutions behind them. But today there are also a much higher percentage of career deathtraps than ever before, such as:

• corporate centers too thinly capitalized to make payroll, much less market your services
• institutional positions in highly politicized departments, where you'll spend as much time dodging bullets as doing surgery
• private practice opportunities, where you're promised the moon verbally, but end up with pixie dust, no partnership, and little wage equity -- until you leave only to be replaced by the next naïve short-termer
• well-meaning practices that will hire a partner-track associate before they have enough business to support this next surgeon.

How Solid Is the Offer?

Remember that you're not hiring on as some factory hand, with a union boss to protect you if you're mistreated. As a free-agent ophthalmologist you're a "union of one," and you need to think that way well before you sign off on your employment agreement. At the same time your prospective employer is vetting you, you should be vetting the employer. If you're being considered for a partner-track position, you should have access to at least some of the following due diligence information once you have been accepted as a finalist for the position:

• financial statements for recent years
• production and income statistics for each doctor over the past couple of years
• the provider-to-population statistics in the practice's service area
• a copy of any business or strategic plans
• a copy of a typical partner employment contract and compensation methodology
• a summary of prospective partnership terms
• a written description of efforts that will be undertaken to help you build a practice
• the names and contact information of any partner-track associates who have left the practice in the past 5 years.

Not long ago, doctors signed employment agreements with a blind eye to the details of the contract or the strength of the employer. Increasingly, new grads and mid-career job candidates are spending thousands of dollars for help to comb through this due diligence data -- cheap insurance given what's at stake.

Hard Work Pays Off

Let's now assume you've taken a job, any job. What's the next stage of actively and successfully managing your career? It's simple, really. For real success, you need to work harder than you ever thought possible. You have to work and think like an owner, even if you aren't one yet. Practice owners value hard work.

Your first years as an ophthalmic associate are more profitable and less gruesome than the first years you would have spent as a junior associate in a law or accounting firm. All the same, it really helps to jump-start your practice by adopting a level of workaholism that very few surgeon-bosses would impose on you themselves. By exceeding their expectations, and perhaps your own as well, you'll put yourself on the path to success for the balance of your career. And this work shouldn't be all clinical. In the first 5 years of your career, you should be putting an extra 8+ hours a week into marketing, outreach and learning the business of eye care.

You must actively decide, all along the way, the balance you desire between work and the other aspects of your life. Most young surgeons I know start out their careers affirming: "I'm not going to get into my father's rut. He worked 55 hours a week as a doctor. I'm not working over 40 hours." Check back 10 years later, and this same doctor, rounding the corner to middle age and a maxi-mortgage, is probably treading in his dad's same footsteps. So it goes.

In truth, working smarter will only go so far in today's medical business climate. In a fixed-cost business, it's simply too punishing financially not to work 45+ hours per week. Fortunately, what takes hold of almost every ophthalmologist by this stage in life is a kind of "work hardening" that enables you to see a few more patients every year but not feel any more exhausted, because you're becoming more efficient and toughening up, both physically and mentally.

Plan for the Future

Although at 45 you may have 20 years or more of work to go, decide as early as possible when you want to retire, even if it's only a preliminary goal. Get professional help, in the form of a fee-only financial planner or accountant, to determine the annual savings rate you need to hit this goal.

Along the way, and especially during your high-earning/high-spending years, be sure to manage your living costs. You should be tailoring your lifestyle to live on less than 80% of your net after-tax income, investing the rest for retirement or a rainy day. If your income fluctuates widely, as in the typical LASIK practice, don't delude yourself and craft a lifestyle indexed to your best years -- be extra conservative. In the last 2 years, I've worked with a number of LASIK clients who thought their 1999/2000 high-water-mark incomes were going to last forever. They didn't.

Are you as efficient as you could be? Once you feel you've mastered everything in gross survival terms, and you're making a satisfactory living, it may be time to fine-tune your practice. Regularly examine how you're spending your time, from two perspectives. First, what's your net income per hour? In a typical setting, this figure can be in the range of $150 to $500, once you figure in administrative time. Second, look at things existentially. What's your net pleasure per hour?

Enjoy Your Career

Career management success can be measured by seeing the profit you generate per hour going up, along with the progressive delegation of those tasks you find least pleasant or least suited to your skills and demeanor.

The ophthalmologists I know who are happiest in their careers are those who are flexible. They don't get inappropriately angry with minor staff errors, confused patients, work-ins or cancellations. They exert control where they can, voting on the practice board, going off to get subspecialty training, or learning about the nuances of the business. They don't get bent out of shape by things beyond their control, like the addition of another competing doctor to the community. They enjoy teamwork in all its forms and can shift happily from leadership to "followership." They have a wide range of interests and relate well to people.

Doctors in nominal control of their career write down their goals, and review their lists often. These goals, to be most useful, are measurable and objective. Not: "I will do more surgery." Instead: "By this time next year I will average 25 cataract cases per month."

And, lest you think that success is either an always "on" or "off" switch, some of the doctors I know today who are the most successful in global terms haven't always enjoyed such success. They rose from failure. Like the client who was abused in a group practice setting, but who went on to spectacular success in solo practice. Or the doctor who went down miserably with a failing management company, but rose right back up again from this disaster.

Increase Your Skill Set

We're all paid for value, or at least the perception of value. Most subspecialists are more valuable than most generalists. But if you missed out on subspecialty training, you don't have to forgo subspecialty-level success. Make a list of what you currently do for patients, and a second list of what you refer out. Do you need fellowship training to competently perform your own PRPs or cosmetic lid surgery? Of course not. Increase your skill set, increase your value to the patient, and your career potential will rise.

It vastly helps your career (if not your sense of well-being) for you to fake yourself out a bit and start each day with a healthy dose of fear: "I'd better get going here, or our profits are going to falter . . . our competition is going to climb right up our backs . . . my skills are going to get rusty." This especially helps you fight the complacency that comes with mid-career success. If you haven't yet developed the next big goal to drive to in your career, at least keep the engines roaring to stay ahead of the pack behind you.

Critique Your Own Work

Average ophthalmologists don't think very often or very deeply about their motivation to continue in practice or how well they're progressing in their work. Thoughtful ophthalmologists think often about their progress. They figuratively hover above themselves in the course of a day, saying: "Nice catch, guy," or "I guess you pretty much muffed that one, try harder next time."

I've found that this internal, self-coaching is one of the common signposts of the most successful surgeons I know. They've replaced external drivers -- favorite teachers and loving parents -- with their own internal patter.

Thinking consciously about your career and managing it actively, you'll come to realize that to be happy with your career as an ophthalmologist, you need to love one or more of the four main dimensions of this kind of work:

• the act of serving and helping each patient
• the intellectual and tactile stimulation of the service you provide
• the acclaim and social position medicine brings you
• the financial comforts and security that medicine can generate.

Which of these motivations drives your career?

It's Your Choice

Every medical career has ups and downs. But when you begin to look at your work as a bothersome chore, it's a sure sign that you've lost control of the elements that make work challenging and enjoyable. The danger signs are easy to spot:

• Your sense of career satisfaction rises and falls in lockstep with your monthly income.
• You dread coming into work and find every possible excuse to lighten your schedule.
• You wince when you have to serve a difficult patient.

Physicians who end up hating their work -- and their patients -- almost always wind up that way because they've lost control of their careers somewhere along the way.

It's been said that satisfaction is what's left when you subtract your reality from your expectations. Ophthalmologists who enter medicine with relatively low expectations, and who then gradually perceive that they have gained much, are the happiest and most satisfied in the profession.

John Pinto is president of J. Pinto & Associates, Inc., an ophthalmic practice management consulting firm located at 1576 Willow Street, San Diego, CA 92016. His books include the second edition of John Pinto's Little Green Book of Ophthalmology, Turnaround: 21 Weeks to Practice Survival and Permanent Improvement, and CashFlow: The Practical Art of Earning More From Your Ophthalmology Practice. He can be called at (800) 886-1235, e-mailed at pintoinc@aol.com, or found on the Web at www.pintoinc.com.