ASK THE CAREER COACH

When Making Career Choices, Don't Ignore Your Personality

By William B. Rabourn Jr.

Q: Which is a better career focus, cataract surgery or refractive surgery?

A: Whether you choose to focus on cataract surgery or refractive surgery, you can be successful. However, many young surgeons fail to realize they should base this decision in large part on their personality. One question you need to ask yourself is, "Am I able to tolerate bad times along with the good?"

You need to have this insight into yourself because the demand for cash-pay elective procedures like LASIK is closely tied to the health of the economy and the Consumer Confidence Index (CCI) in particular.

When people believe the economy and their own financial wellbeing is in jeopardy, they don't spend money on items or services they don't believe are absolutely necessary. Therefore, surgical volume and revenue in practices focused on LASIK and clear lens exchange (CLE) and other cash-pay elective procedures can fluctuate from time to time — sometimes significantly.

On the other hand, while cataract surgery is technically an elective procedure (no one must have a cataract removed), it's partially paid for by Medicare and other third-party insurers. Therefore, even when times are tough, people continue to have cataract surgery. As a result, volume and revenue in cataract-focused practices tend to be more stable over time.

How Would You Have Fared This Year?

This year has been a prime example of how refractive surgery volume fluctuates with the economy. A slew of factors, including the mortgage crisis, a record number of bank failures, turmoil in the stock market, the federal government's struggle to pass a financial bailout package, job losses and the uncertainties of an election year, have combined to knock consumer confidence on its heels. Although the CCI posted a slight gain in September, in releasing the numbers, the director of The Conference Board Consumer Research Center stated, "Just as noteworthy, consumers' assessment of current conditions continues to indicate that the current economic environment remains quite weak."

Throughout the year, refractive surgery volume followed suit. According to the ophthalmic industry research firm Market-Scope, demand for refractive surgery during the first quarter of 2008 was down 11.6% compared with the same quarter last year. For the second quarter, the firm reported a 24.5% decline compared with the second quarter last year, and that "The softening of demand is expected to accelerate through the rest of 2008." Similarly, the CEO of LCA Vision, one of the nation's leading corporate LASIK providers, said of the company's second quarter, "We continue to feel the impact of eroding consumer confidence on consumer discretionary spending. As anticipated, our year-over-year procedure volume was down 38%."

In stark contrast, Market-Scope reported the number of cataract surgeries performed in the first quarter increased 3.1% compared with the first quarter last year.

Can You Tolerate Market Volatility?

As you might imagine, downturns in refractive surgery volume such as these can be jarring for a practice and its owner's wallet. However, those who are mentally prepared from the outset — socking away funds when volume is high and sticking to a sensible financial plan — have little trouble weathering these market swings. For them, 2008 was a year to make minor adjustments, perhaps putting off the purchase of an interesting, but not necessary, new piece of diagnostic equipment. They feel OK about 2008 because they know they did well in previous years and their financial situation eventually will improve. Their personalities enable them to handle fluctuations in the market and make adjustments when necessary. In other words, they can tighten their fiscal belts or loosen them, and it doesn't affect the amount of air they can take in. They can still breathe freely and feel optimistic.

Does that sound like you? If not, you may be better off building a relatively conservative ophthalmic practice, where most procedures are reimbursed by third-party payers. Your financial situation will still have ups and downs, but nowhere near the extent of an exclusively cash-pay elective procedure practice. And, in the long run, you can be just as successful.

In my years of providing consulting services for physicians, I've met quite a few who thought they could tolerate the ups and downs of the cash-pay elective market. But many discovered they were wrong. If you judge your natural tendencies accurately from the start, you can avoid a bundle of stress once your career really gets under way.

So give this a great deal of thought before you begin charting your course. In addition, you can consider providing patients both reimbursable and cash-pay procedures. There's definitely something to be said about not putting all of your eggs into one basket. Right now, many ophthalmologists are glad they offer a reimbursable procedure such as cataract surgery in addition to LASIK, CLE and the like because in 2008, cataract surgery is what's paying the bills, and it will continue to do so.

Find the Right Fit for a Rewarding Career

No matter what type of practice focus you choose, sometimes you'll have to make some difficult financial decisions along the way. But ophthalmology, because it's a medical profession, is more insulated from a sputtering economy than most other industries. As long as you know who you are and what you can tolerate, you should be able to make plans to have a satisfying and successful career and a comfortable retirement. nMD