ASK THE CAREER COACH

Thinking Ahead to Premium IOLs

By William B. Rabourn Jr.

Q: What advice do you have for new ophthalmologists in search of their first job?

A: We could fill a book on this topic, but here's a timely point to consider. By the time you begin your job search, you'll have a good idea of the kind of practice you want to have. If you choose to focus on the anterior segment, cataract surgery will be a large part of what you do on a daily basis. If you plan to offer your patients premium IOLs, you need to ensure that your practice setting has access to the technologies that will allow you to treat residual refractive error.

Options for Access to Adjunct Technologies

The best results with today's accommodating and multifocal premium IOLs depend on patients being plano after surgery — or slightly myopic or hyperopic depending on lens design and vision goals. It's not uncommon for a small percentage of patients to be slightly off target — objectively and/or subjectively — even if you have performed a technically flawless procedure. To consider their surgery a complete success, these patients may require an additional procedure. Most commonly, the procedure of choice is corneal, such as LASIK or PRK.

Given the importance of patient satisfaction to the foundation of your career, you should not overlook the need to fine-tune results in some of your premium IOL cases. You will need access to an excimer laser and perhaps other technologies as well. If the practice you want to join doesn't have the necessary tools or personnel in-house, you should consider other options.

If you don't plan to personally perform corneal refractive surgery, you could contract with another surgeon. Generally speaking, you would create an arrangement under which a designated surgeon would perform your LASIK or PRK procedures at a predetermined per-procedure cost. You would, of course, need to properly document the arrangement and tailor it to be in compliance with the relevant statutes that govern shared care. On the other hand, contracting with another surgeon may not work for you for competitive reasons or if you have concerns about continuity of care.

If you do plan to perform corneal refractive surgery, there are other options to consider. You could use a roll-on/roll-off laser company or use an open-access laser center or ambulatory surgery center.

As an anterior segment surgeon, it's not a bad idea to provide both cataract and corneal refractive surgery, especially if you're offering premium IOLs. Also, the two can be complementary from a fiscal cycle perspective. In many markets, the busiest times of year for LASIK are the slowest times for cataract surgery and vice versa.

Premium IOLs Are Here to Stay

It's hard to say whether the slumping economy will affect your ability to arrange access to laser vision correction technology, but the possibility is something to keep in mind. According to a recent issue of the ophthalmic business newsletter MarketScope, from Q2 2009 to Q2 2010, the number of corporate, institutional and surgeon-owned laser centers in the United States declined from 290 to 262, 125 to 120 and 735 to 717, respectively.

The outlook for premium IOLs is clearer. All signs are pointing to the introduction of even more effective lens designs and a continued increase in the percentage of patients who choose premium lenses over monofocal lenses. nMD

Mr. Rabourn is founder and managing principal of Medical Consulting Group in Springfield, Mo. The Medical Consulting Group team possesses a wide range of expertise in staff training, development of ambulatory surgery centers, and practice development, management, financial operations, efficiency and marketing/advertising.