ASK THE CAREER COACH

You Don't Need a Big City for Big Success

By William B. Rabourn Jr.

Q: Where do you think newly trained ophthalmologists can find the best practice opportunities?

A: Throughout my nearly 20 years of medical practice consulting, I've noticed that many new physicians have a misconception about this. They believe that in order to make the best use of their training and be the most successful, they need to head for a major metropolitan area, such as New York or Los Angeles. In reality, there's as much professional satisfaction to be had and as much money to be made in medium and small markets all across the country.

More specifically, my answer to your question is twofold. First, ask yourself where you want to live, not just where you want to practice. Second, if having a busy surgical practice and earning the associated income is a priority, don't rule out any market from purely a population-size standpoint.

Choosing the Locale

As you pursue your first professional position, consider every aspect of every opportunity. For instance, how comfortable do you feel with the practice's people and protocols? What kind of future would you have there?

Also, make sure the geographic area is somewhere you want to be. Does it match your lifestyle? Does it allow you to pursue your personal interests and hobbies as well as your professional goals? Does your spouse think he or she would be happy living in the area? Many employment deals — and marriages — have been derailed when this consideration is overlooked.

To take a job simply because it's available is definitely a mistake. Most people in your position are about 30 years old when they finish training and plan to retire in their early 60s. So your career most likely will span 30 to 35 years. So, if you choose a place, spend 5 years there, then decide you don't like it, you'll lose about 16% of your career. You earn income during that time, but whatever practice-building you do will be lost. You'll have to start from scratch somewhere else. If you make a second move in another 5 years, you'll have lost nearly a third of your career and everything you worked to build in that location.

Bigger Isn't Always Better

This brings us to market size. If you prefer a big-city lifestyle, you'll surely find plenty of opportunities there. But if living in a major metropolitan area doesn't suit you, you can find plenty of opportunities in medium or small markets, because there are pockets within the country where the population is growing rapidly but is still underserved when it comes to the number of ophthalmologists in the area.

As you decide where you want to be, consider both sides of the coin. While reimbursement might be less in small and medium markets, so are the costs of living and doing business. Controlling practice overhead, which is a constant concern, is easier in a small or medium market, because key items such as rent and staff salaries are lower. In addition, competition is stiffer in large markets. Higher costs and additional competition make things more difficult all around, but even more so if you want to be your own boss in solo practice. In larger markets, that's much harder to accomplish and much more risky.

I have several ophthalmologist clients who work in small markets (loosely defined as a population of 100,000 or less) and medium markets (loosely defined as a population up to 600,000), but they're in the top 5% of the national field in surgical volume and revenue.

Gauging a Market's Potential

No matter what size market you're willing to consider, you can easily find the demographic data you need to help you make an informed decision about where to practice. For example, earlier this year, the U.S. Census Bureau released its latest analysis of population trends. In addition, a variety of business publications routinely research and rate cities, towns and regions on a range of characteristics, including population growth and decline.

You can visit the Web to view the "100 Best Places to Live and Launch," posted by Fortune Small Business magazine. Onboard, a data-collection agency, helped the publication compile information about each area's real estate costs, cost of living, "friendliness" of tax structure to business, level of competition for commercial space, weather, lifestyle offerings, workforce education level, proximity to airports and so on.

Money magazine compiled a similar listing, focusing on places with populations between 7,500 and 50,000. So there are multiple resources to guide your location search.

Consider evaluating the population in the market vs. the number of ophthalmic providers. The phone book is a good starting place. So is the state ophthalmic society's directory. Don't forget to consider the "draw" area. The main city may have a small population, but patients may travel there from miles away.

It's also important to determine who's practicing in an area. One of my clients who's a world-renowned eye surgeon has been highly successful in a medium-sized market. But that situation might not be one that you'd be willing or able to compete in immediately following graduation. Although you could take the "if you can't beat ’em, join ’em" approach and sign on to work for a widely known practice.

Finally, when determining whether a certain market represents a good opportunity, consider the insurance/reimbursement landscape. Which major insurance companies are in the area? How difficult is it to be included on their provider panels? If you call the companies, ask if their panels are open or closed and ask to have their fee schedule and other relevant information sent to you.

Why Limit Yourself?

I sincerely believe that ophthalmology is a great business in which to be. You can argue that reimbursement is less than it was 15 years ago, but population trends support a continuing need for ophthalmologists' services, and you can find more opportunities than ever — especially if you're savvy enough to consider all of them. It's entirely possible to have a successful practice, make a great living and accomplish your life's mission in any size market. nMD