The Best of Both Worlds: Private Practice & Academia

Combining patient care and teaching has advantages.

By Salim I. Butrus, MD

When I read the articles written by ophthalmologists in our professional publications, I am happy to see that most of the authors of these articles are identified as having both a private practice and an academic affiliation. I find this a healthy combination for professional growth. It is the model that I have chosen to follow. Here, I will explain how combining private practice and a role in academia has made me a well-rounded ophthalmologist, a more-involved physician and, I believe, a better human being.

First, it is important to remember that both private practice and academia have their advantages and drawbacks. I want to be especially candid in dealing with the drawbacks, as I started out in academic ophthalmology and soon realized that I needed both the challenges and the incentives of private practice to feel fulfilled.

Dr. Butrus enjoys the independence and the rewards of private practice. He is in solo practice in Washington, DC.

The Appeal of Academia

Being solely involved in academic medicine initially appealed to me, as it can be attractive to graduating fellowshiptrained ophthalmologists for a variety of reasons. Let me briefly enumerate these reasons.

1. Gaining an academic title in a medical school or medical center of a community is highly desireable, especially to young physicians who seek to improve their professional status early in their careers.
2. The appeal of teaching residents and medical students is great. What can enhance a physician's self-esteem more than honing the skills and shaping the attitudes of the next generation of ophthalmologists?
3. Speaking at local societies, other institutions and national and international meetings is a way to have a real impact on the profession while also enhancing one's professional reputation.
4. Taking care of a variety of patients who seek help at that particular facility or are referred by other local ophthalmologists in the community helps greatly in developing skills, handling a diverse array of medical issues and ensuring professional growth.
5. In an academic setting, a physician can pursue areas of special interest by having the opportunity to conduct clinical and basic research, and applying for grants and research money. The appeal of making your own personal contribution to the overall profession of ophthalmology is great.
6. In academia, we have the opportunity to collaborate with investigators in other fields of medicine, such as rheumatology, immunology, endocrinology, oncology and others.
7. Finally, and not to be taken lightly, in an academic position we don't have to worry about taking care of the day-to-day issues of running a practice, managing employees, keeping up with the overhead expenses and dealing with different insurance carriers.

But Academia Has its Drawbacks

Despite all the incentives and enjoyments of academic ophthalmology, doctors in academic positions are more underpaid than those in private practice, especially considering the considerable work and time they must devote to their work.

Physicians in academia are at the mercy of the department chair, school dean or hospital administrators who are essentially “running the show.”

In medical school, we are generally not taught the business and management aspects of medicine. Thus, academic ophthalmologists most of the time have no training in dealing with business and management issues and are often stuck with frustrating bureaucracy that they are in no position to leave. They may want to take on the risks and opportunities of private practice, but with student debts that may be over six figures they are reluctant to give up a prestigious but lowpaying position for the many challenges of private practice.

Making the Transition

Still, the many frustrations inherent in academic medicine may push many ophthalmologists towards private practice. That is what happened in my own career.

After finishing two years of corneal fellowship at the Massachusetts Eye and Ear Infirmary, I joined academic medicine. Encountering the frustrations described above, I later started my own private practice in Washington, DC. (The Eye Center on Capitol Hill) and began experiencing the joy of practicing ophthalmology in my own way, with staff that I have hand-picked and patients who often become valued acquaintances and even friends.

My economic situation is now much better. Dealing with red tape and bureaucracy is over. I can deliver the best care to my patients efficiently and directly. They are all highly satisfied and all their expectations are met.

But private practice may not be right for everyone. Much depends on your own temperament and tolerance for aggravation. The challenges of private practice have become enormous, created by the changes in the entire health system in this country in the past 15 years. Office overhead expenses are almost beyond control. Reimbursements by insurance carriers are diminishing and reaching the point of being intolerable if you are not an exceptionally skilled and creative businessperson.

Why I Am in Both Worlds

I am one of those physicians who eventually made what I believe is a wise decision to keep one foot in private practice and one foot in academia. My academic affiliations are clinical professor of ophthalmology, Georgetown University Medical Center and Senior Attending Surgeon, Washington Hospital Center, both in Washington DC. Being a part of these excellent institutions, I enjoy the benefits of teaching residents (and even learning from them at times). I also get to interact and exchange knowledge with other faculty members, plus I have the opportunity to be involved in clinical research and the publishing of professional articles that can constitute a real contribution to our profession.

These are great indispensable, non-economic incentives that help make me a better clinician. A danger of purely private practice is it can throw you into complete isolation and deprive you of the flow of medical knowledge and surgical and non-surgical developments in your profession.

Dr. Butrus finds his role in academia stimulating. Here, (second from right) he exchanges ideas with his residents.

I chose to go into solo private practice because I can control my destiny. My staff is superb and all of them work to their utmost to make the practice as successful as possible, and more importantly, deliver the best care for my patients in the most efficient, direct and dignified way.

Certainly, I enjoy the economic incentives that are not available in academic medicine. Plus, I feel a sense of ownership and believe that I am building future value in the practice that can translate to a comfortable retirement for myself and a better life for my family. Despite this, it is the academic side of ophthalmology that is almost always responsible for developing and testing new drugs, devices and surgical techniques, such as phacoemulsification and now DSAEK, which is replacing penetrating keratoplasty for endothelial disease.

I would advise most young ophthalmologists to set a personal goal of having one foot in private practice and one in academia. I (and my patients) are certainly enjoying the benefits of my being able to combine both worlds to make me a better ophthalmologist, physician and human being. OM

Salim Butrus, MD, is in solo private practice at the Eye Center on Capitol Hill in Washington, DC, and has an affiliation with Georgetown University Hospital, where he teaches, does research and performs corneal transplant and other complex procedures.