As I See It

Training the Next Generation of Surgeons

Residents need hands-on experience with multiple surgical platforms.

By Paul S. Koch, MD, Editor Emeritus

In previous issues, I have used this space to discuss the conflicts among those who feel companies should sell stuff to us, and those who feel that companies should stay away from us. Put me squarely in the category favoring companies. I believe firmly that companies that innovate, develop, manufacture and deliver products critical to our needs should make a profit off them. I also believe that when a person is hired by a company to sell its products, they should — how shall I say it — sell their products! I do not think a hired salesperson should be providing fair and balanced reviews of all products available to us. They should sell the stuff made by the company that pays them.

We have been assaulted by busy-bodies telling us that a manufacturer's sales force cannot give us things (inexpensive trinkets, mostly) to keep their message in our minds, they cannot take us out to dinner to have us exclusively to themselves for an hour or two, and they cannot put together packages that make their products more attractive to us than others.

We have no such constraints when it comes to attracting or retaining referral sources. The dealer who sold me my car didn't have to tell me about other cars. The grocer who sold me Coke didn't have to offer me Pepsi.

But I am also an aging surgeon who sees the necessity to train the next generation of surgeons to replace us. And here I see a problem that I propose be addressed by the supervisors of the training programs.

No Substitute for Experience

I think that it is a brilliant marketing strategy for a company — any of the big three, really — to offer equipment, such as a phaco machine and lenses, for the residents to use. That gets their products and their message right in front of the young doctors in training and possibly makes them customers for life.

Some lucky programs are able to have equipment from all the manufacturers, and their residents get a very wide exposure to a range of products. Other, usually smaller, programs end up with a sole provider of equipment and lenses. Good for the company, not so good for the program.

The lucky programs are more easily able to turn out what I consider to be real surgeons, individuals who can operate with whatever is at hand. If the other programs are not careful, they can turn out — and I've seen this very often in my travels — ophthalmologists who are less surgeons than they are machine operators. They can use one machine and one only. Their knowledge about fluidics extends to “Use setting A” because they've never had to program or adjust it on their own. If they use silicone lenses, they don't understand how a thick-haptic acrylic lens is different. If they use an acrylic lens, they don't know what “dialing” a lens means.

When they visit a practice looking for a job, they focus less on the opportunity and more on whether the practice uses the only machine they've ever touched. If they eventually have to use a different machine, they don't appreciate the clever features of the new machine, but are afraid of it, and grumpily dwell on how it is different from the only one they know.

Teach Your Children Well

I believe it is the job of the training directors to be sure their residents understand and can use a couple of different machines and lenses. I think the teachers should ask different companies to demo their products for each resident before graduation. Part of the training mission is to open eyes to the wide world that is ophthalmology. Blinding the eyes to only one exclusive provider limits the opportunities for their graduates to become surgeons who can adapt to a rapidly changing field. The residency is only the beginning of an exciting adventure. Give the kids the experience and the confidence to go anywhere and use anything. OM

Paul S. Koch, MD is editor emeritus of Ophthalmology Management and the medical director of Koch Eye Associates in Warwick, RI. His e-mail is: paulkoch@kocheye.com.