A look at the different opportunities available to new ophthalmologists.

Oh, what to do with my career … a common question during residency and fellowship that remains somewhat throughout our careers.

For most of us, the decision is between academia and non-academic practices. But there are several other opportunities that you can explore, such as working for industry, Veteran Affairs (VA) and international opportunities. I may be one of the few ophthalmologists who has explored most of these options in my career, which I’ll discuss here.

PONDERING PRIVATE PRACTICE

Owning a practice

In private practice where you have ownership, you have control of your practice’s focus, location, staff, ambiance and time. However, if you don’t know how to run a business, that can create challenges. If you choose to go this route, having good advisors and friends who can help you to avoid pitfalls in business choices can make all the difference. For example, I worked with several business consulting groups but also met with the owners of similarly sized and staffed practices to discuss the good and the bad about running the practice.

Joining an established practice

When joining a practice, you are at the mercy of the leadership of that practice. The culture is also a big consideration. Do the managers/owners seem to get along and support each other? Does it seem like a team spirit exists? If considering this option, the most obvious concern you will have is your employment agreement and possible ownership options to become a stakeholder.

CONSIDERING ACADEMIA

Academic medicine is not as different from private practice as you might think. They both have overhead and see patients. The real opportunity is understanding/funding research — figuring out what scientific questions need to be answered and how to get the funding. Also, grant writing skills are essential for basic science research, whereas clinical research funding might require cross-walking budgets to align with the funding methodologies used when funding was provided by a grant. Additionally, you should also be aware that academic rank and “publish or perish” does play a role in your success.

Knowing your interest/love/toleration for mentoring is key when looking at academic opportunities. For me, mentoring was the highlight of my career. Residents and fellows I have trained went on to great careers (like Rick Hill, MD, who became a co-founder of Glaukos Corp.), and I was able to participate in that.

The other big distinction between private practice and academic settings is your ability to “swim with the school.” Bureaucratic decisions set some people off. Are you able to live with decisions made by others?

WORKING IN INDUSTRY

Industry has a bit of everything except for direct patient care. The things you do affect more lives but without the opportunity to look directly into the patient’s eyes — what I miss the most. In industry, the drive for overhead reduction is mostly gone and the drive for innovation replaces overhead. Also, re-evaluation of the corporate structure, the process by which we do things, methodologies used for research and presenting data, is constantly evolving. Change is daily, but the outcomes from most asset projects are a decade away. Finally, job security and status/rank in industry feels much more linked to direct performance.

OTHER OPPORTUNITIES

In my experience, international opportunities and the VA seem somewhat alike. In these systems, you are first and foremost a provider, and your involvement in running the business is often minimal. Asking for changes is often looked at as disruptive. Research and teaching are possible but can be overshadowed by the need for patient care. Happiness in these systems comes from the consistency of schedules and job security.

CONCLUSION

Whether you focus your career search on the patient, research or specific factors such as where you want to live/work, it comes down to weighing out the pluses and minuses and making your best go of it. For me, the ability to re-invent myself and move on to a new phase throughout my career was energizing and rewarding. Whatever career path you choose, forge ahead. OM

E. Randy Craven, MD, FACS, is the medical director for glaucoma at AbbVie. He is former vice chair of ophthalmology for network locations at Wilmer Eye Institute and former chair of the glaucoma division at the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia.