For the new MD, a fellowship provides excellent hands-on training.

Thirty years ago, I started my practice, Jacksoneye in Lake Villa, Ill., right out of residency. At the time, there were no fellowships available. Due to my lack of business knowledge, I was forced to learn many lessons the hard way, especially when it came to the business side of starting a practice.

I also didn’t have a lot of money, so I had to take out loans. If I had a fellowship just to learn the business side of running a high-volume, private practice, I probably would not have bought machines that I didn’t need and spent money unnecessarily. Knowing what I know now, I would have done a fellowship in a heartbeat, because it would have saved me 10 years of learning.

Jacksoneye and many other private practices offer private practice refractive cataract fellowships. I’m currently on my sixth fellow, and I recently interviewed 16 new fellowship candidates.

In this article, I will explain why having a fellowship can help you not only be better equipped in your subspecialty but also in your ability to be a better business decision maker — whether you join a private practice or start your own.

THE BUSINESS BENEFITS

With the fellowship program at Jacksoneye, fellows learn everything needed to work in a private practice, including the whole business model.

The fellowship teaches how to incorporate a technology (IOL, LASIK, corneal crosslinking) into the practice, which includes how to establish pricing models, the informed consent process, how to establish preoperative/postoperative orders, and, most importantly, the art of efficiency on surgery days and chair time when speaking to patients. Fellows will learn the art of verbiage and the correct way to say something to a patient in the OR or in the lane. For example, two of my fellows were successfully able to incorporate the Light Adjustable Lens (RxSight) into their own private practice.

Other business-learning advantages in the private sector that are taught include: HR issues, hiring strategies at all levels (doctor, technician, front-desk personnel, phone triage people, billing), EMR intricacies and decision making, coding and billing and modifiers and global period processes, leadership strategies from morning huddles to weekly close-out sessions, clinical study incorporation, income and tax deferment strategies, retirement and other employee benefits processes and lastly — my favorite — how to balance life with work, hobbies and family time.

THE SURGICAL BENEFITS

My fellows also become better surgeons and learn that nothing is ever routine. The moment you think it is, it becomes a disaster. This is important to keep in the back of your mind, especially in the OR. Fellows learn to be like pilots in the OR, to always have a backup plan. They learn how to plan and adapt in case a certain surgical instrument is not available or a new scrub technician is brought in and doesn’t know how to fold an IOL. Fellows learn every aspect of the process of cataract and refractive surgical procedures at any relevant position.

I also advise fellows to learn as much technology as an anterior segment surgeon knows. If they are going to be a cataract specialist, I advise them to learn every phaco maneuver. They don’t know what technique or what technology they will need to use on the fly — such as phaco flip, horizontal and vertical chop techniques. My fellows see that I may use three to four techniques in one case. We review these techniques and why and when they’re important to use.

CLINICAL STUDIES

Fellows also have the opportunity to be involved in clinical studies as sub-investigators, learning the process of incorporating studies into a clinical practice. From the NDA process, feasibility questionnaire process, CTA/budgeting process, protocol evaluation process and adverse event-reporting process, fellows become well prepared to be involved in clinical studies in a private practice setting.

CONCLUSION

A fellowship provides an excellent opportunity to learn everything you need to know about working in a private practice — from the business side to what technology and what techniques to use. It also provides fellows with an opportunity to be involved in clinical studies. Whether you decide to join a practice or start your own, by having done a fellowship, you will be better poised to shine in whatever subspecialty you choose. OM

Mitchell A. Jackson, MD, is the founder/CEO of Jacksoneye in Lake Villa, Ill.