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Am I Still an Ophthalmologist if I Give Up Surgery?
Planning ahead can ensure a fulfilling transition to a non-surgical ophthalmic career.
BY FRANK J. WEINSTOCK, M.D., F.A.C.S.

Eight years ago I made the decision to give up ophthalmic surgery. It was a gradual decision, mainly motivated by my desire to take more time off. I did not feel that it was fair to my patients or my colleagues to perform surgery and then leave town during the postoperative period. Although my surgical skills and results were good, I did not want to spend the necessary time to keep these skills up to date or to learn new surgical techniques. Lastly, I wanted to make this decision before anyone asked me to do so.

I wondered whether I could emotionally handle the change and spoke to a few of my colleagues and friends who had discontinued surgery. When asked how long it took to get over not operating, my friend, Gerald Meltzer, M.D., said: "I think that it was 5 ... no, I am exaggerating; it was 10 seconds." And he was right!

The thought of ceasing to operate may be very frightening, especially if you are forced to do so because of illness or loss of competency. However, as in many other situations, apprehension stems from the lack of preparedness and goal setting; it is important to have an organized plan for the future that is reviewed on a periodic basis, although few people do this. This article will provide tips to help you prepare for a time when surgery is no longer the central focus of your practice.

The Thought Process

First, it is important for the ophthalmologist who is considering giving up surgery to recognize that the rapid pace of ophthalmologic advances makes it difficult to keep up with everything. Don't beat yourself up.

Second, realize that you should decide to give up surgery before you are asked to stop by your associates or the hospital where you practice. A surgeon constantly undergoes assessment by associates and surgical staff, both in the operating room and in the postop period (especially when postop evaluation is performed by someone other than you). Over the years, I have heard many colleagues question why some surgeons continue to operate past their surgical prime. Do not fall victim to this scenario — it is not fair to you or your patients.

Third, decide on how to fill the void before you give up surgery by developing new areas of interest and expertise, and by deciding whether you want to practice full time or part time. Examples of other interests outside of surgery include medical retina, neuro-ophthalmology, low vision, dry eye or contact lenses. If the practice is active enough, you may be able to increase your office time for these non-surgical ophthalmology areas. In larger practices or universities, you might be able to transition to administrative roles.

Adjusting to a New Role

If you continue a full non-surgical office practice, you will not have to concern yourself with filling the void. However, it is only a matter of time until you will have to figure out how to spend the extra free time. This is rarely a problem — if you have had a plan and developed other interests. Young physicians should think about the future when they are beginning their practices and develop interests outside of medicine. During full-time practice, non-medical interests may be indulged on a very limited basis. As practice demands decrease, you should begin to transition to these interests. How often do you hear colleagues say, "I wish I had the time for this or that?" It might be traveling, golf, tennis, taking courses, reading or volunteering. The one thing that should never be put off is spending time with family; that time can never be made up.

When I quit surgery, I worried how my existing patients would react. Would the patients who I had been following for cataracts and other conditions switch to my partners or to other practices? In my case, this has not happened. My patients remain supportive and loyal, and if surgery is necessary, they welcome the opportunity to have it performed by one of the other excellent ophthalmologists in the practice.

Adapting to a non-surgical practice may be different if you are in solo or group practice. I am fortunate to have three very supportive partners who welcomed my decision to stop surgery. One advantage for them was the opportunity to increase their surgical volume with my patients. In addition, they will see my patients with acute problems if I am out of town. When possible, I enjoy maintaining a rapport with patients who have had surgery by performing the postoperative exam and helping them with their refractive needs via glasses.

What is ophthalmology without surgery? For me, it is a lot more fun and definitely more relaxed. I have always considered myself a calm surgeon, but was surprised to notice that my life became even calmer when I gave up surgery. My wife noticed it before I did.

I see patients 2 to 3 days a week when I am in town. Non-surgical ophthalmology continues to call upon my general medical skills and I still see many patients and deal with the full gamut of medical diseases, including diabetes, glaucoma and cataracts.

Contact lenses have long been a part of my life and continue to offer many rewarding challenges and opportunities to make patients happy. In addition to fitting and following patients, I am involved in clinical studies of new lenses. In many practices, contact lens patients do not see the ophthalmologist, so my patients appreciate my ability to be involved with their contact lens care.

Reaping the Benefits

In my "surgical retirement," I have been fortunate to be able to perform medical-legal and other consulting, and have assumed the role of director of risk management for a malpractice company. This has added new dimensions and stimulation to my medical career. In addition, I have more time to spend with my family, travel, play tennis and engage in many other leisure activities.

Stopping surgery has eliminated the time-consuming need to maintain surgical skills or to develop new surgical skills. Attending meetings is more relaxed and fun with time free to spend learning about different areas of ophthalmology. However, it is still necessary to maintain some knowledge in the surgical field because you will undoubtedly find yourself in the role of the advisor for your patients who seek surgery or postop counsel. This information is readily available via meetings, the Internet and the many journals that pass through our offices.

I continue to write for medical journals, as well as regular columns for two newspapers, while serving on the editorial board of several medical journals. The Academy of Ophthalmology continues to be an important part of my life and I still serve on committees and task forces and lecture at the annual meeting. I also continue to lecture annually at the Contact Lens Association of Ophthalmologists meeting.

With my new schedule, I have found time for community activities. For example, I organize programs for chief executive officers for my Chamber of Commerce and run a similar lecture program in Florida, as well as other various community committees.

There may be a fear of economic loss, but several studies have indicated that the refractive portion of ophthalmology may be more rewarding economically than surgical ophthalmology. Dispensing a pair of spectacles produces a greater fee than many surgical fees. Although this concept might not apply to high-volume surgical practices, it will apply to a significant number of practices. In addition, non-surgical fees incur lower write offs and allow for high collection ratios.

A pure "medical" ophthalmologic practice may extend practice enjoyment and gratification; the decrease in pace and pressure enables you to maintain the non-surgical skills required for an active practice. Complications of surgery or answering trauma calls at 2 a.m. are no longer a concern. The outside activities easily fill the time and make you feel as if you are still contributing to the community while indulging your own non-medical interests.

If you are considering stopping surgery, be proactive, prepare carefully and make the change early. This will enable you to enjoy life and practice more fully.

Frank J. Weinstock, M.D., F.A.C.S., is professor of ophthalmology at Northeastern Ohio Universities College of Medicine, and is a non-surgical ophthalmologist at Canton Ophthalmology Associates in Ohio. He can be emailed at FJStock@aol.com.