THE EFFICIENT OPHTHALMOLOGIST

Make time for mentoring

Why teaching the next generation is still important.

By Steven M. Silverstein MD, FACS

Toward the end of my corneal fellowship, I found myself at a crossroads, as I imagine many of you have. Certainly, my training groomed me for a career in academics. Preparing countless lectures, clinical research, publications and medical student and resident attending responsibilities made institutional service a natural avocation pathway.

Still (and I realize that this is a frighteningly diminishing goal), I dreamed of potential business ownership opportunities: strategic planning, pro-forma creation leading to growth, acquisition and recruitment and, most important, remaining in control of my own destiny, i.e., not working for The Man.

JUMP IN THE TIME MACHINE

The year was 1991. George Herbert Walker Bush was President. We were already drowning in the alphabet soup of medical economics: DRGs, RBRVUs and, ultimately, CPT codes governed how we practiced, coded and were paid. During the next generation, even Health Care Financing Administration (HCFA) had its own identity crisis and, to keep with the times, changed its name to Centers for Medicare and Medicaid Services (CMS). Still, the problems endemic to our system remained, and coding became even more complicated (sound familiar?).

THE BEST OF BOTH WORLDS

So, I carved out a private practice that permitted the opportunities and risks inherent in a private practice setting, while cherry-picking the activities of an academic career I cherished. I developed a research department that today has its own dedicated staff, and we participate in numerous phase 2, 3 and 4 clinical trials for pharma, surgical device, the FDA and NIH.

I have been a faculty member at two Kansas City medical schools, serving as a lecturer, clinical attending and research mentor. I provide some of the ophthalmology lectures in the neurosciences section for second-year medical students and frequently have third- and fourth-year medical students and residents in many different specialties doing a one-month rotation in my practice for which they receive elective credit and a grade.

STUDENT BECOMES THE MASTER

So far, I am humbled to have learned that two of my students, as a result of their rotation, selected ophthalmology as their chosen fields: one became a glaucoma specialist, and the other graduates from medical school this year and will start his residency in Arizona.

Also, I include interested students in clinical research and publishing unusual pathology case reports. Earlier in my career, I served 15 years attending in ophthalmology clinic and surgery and participated in monthly grand rounds, and the boards review section of their residency training.

I learn a tremendous amount from these students, who are certainly more up to date with many of the systemic medications currently on the market than me. Further, the opportunity to explore the pathophysiology and mechanism of action of the ophthalmic conditions we see together provides the motivation to re-learn the etiologies of the more esoteric conditions, and I often gain insight into the latest thinking about various conditions.

It is invigorating when a student lights up after seeing pathology at the slit lamp or learns to use a direct or indirect ophthalmoscope for the first time. And, unexpectedly, teaching makes me a more careful and deliberate clinician, as I portray behaviors that should ideally be emulated in the students’ careers.

In addition to the ophthalmic/medical component, the importance of witnessing the physician/patient interaction cannot be underestimated. We are each the amalgamation of the behaviors and habits of our mentors, and we have a powerful responsibility to demonstrate the compassion, concern and level of fulfillment (and fun) embodied by this privileged and unique relationship.

IF I COULD DO IT ALL OVER AGAIN

When asked, especially in today’s healthcare environment, if I would become a physician if starting out again, I emphatically respond positively and enthusiastically. Regardless of the forces that govern healthcare delivery, nothing is as rewarding as a patient’s trust, and with a strong work ethic, medicine is predicted to remain a growth area with the potential for strong, reliable economic return. OM

Steven M. Silverstein, MD, FACS, is a corneatrained comprehensive ophthalmologist in practice at Silverstein Eye Centers in Kansas City, Mo. He invites comments. His e-mail is ssilverstein@silversteineyecenters.com.