Adaptability shapes survival of academic health centers

The future of ophthalmology-including academic health centers-will rely much on the ability to adapt to an ever-changing environment, suggests Peter J. McDonnell, MD, of the Wilmer Eye Institute.


Listen to what Peter J. McDonnell, MD, thinks about “town-and-gown competition” and the value of electronic medical records in this audio interview with J.C. Noreika, MD, MBA.




The future of ophthalmology-including academic health centers-will rely much on the ability to adapt to an ever-changing environment, suggests Peter J. McDonnell, MD, of the Wilmer Eye Institute.


Sight Lines By J.C. Noreika, MD, MBA

Editor’s Note: Welcome to “Sight Lines,” a new feature of Ophthalmology Times. In this series, J.C. Noreika, MD, MBA, an ophthalmologist in Medina, OH, will discuss trends in ophthalmology, medicine, and health care with key leaders in their fields.

In this first installment, Dr. Noreika talks with Peter J. McDonnell, MD, chairman of the Wilmer Eye Institute at Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times. In these dual roles, Dr. McDonnell has a unique vantage point to analyze changes occurring in the nation’s academic health centers and medical subspecialty publishing.


Q Dr. McDonnell, how long have you been chief medical editor of Ophthalmology Times?

Ten fun and exciting years. It is a great way to make contact with a lot of practicing ophthalmologists with whom I might not get to interact otherwise.


Q What is your vision for the magazine?

I recently asked my residents how many peer-reviewed publications appeared in the medical literature last year. No one guessed the right answer, about 1.4 million publications.

So, how does a busy physician-who is working on transitioning to electronic medical records, working on maintenance of certification, working to provide the best patient care-find the time to read all the potentially relevant information that would impact his or her practice?

Even a speed-reader cannot do it. Ophthalmology Times aspires to help ophthalmologists learn from physicians who are at the forefront of their fields-our editorial board members-and identify the key new pieces of information they need as practicing ophthalmologists.

Amazing changes are taking place in ophthalmology and it is very important to get that information to the ophthalmologist who is nearing sensory information overload. We have a great editorial team that helps us get out this information quickly through print as well as digital media.



Q At the last editorial advisory board meeting in November, I was impressed to learn that ophthalmologists say they want Ophthalmology Times to provide more information about practice management.

Ophthalmologists who have just finished their residency often say they don’t feel they know enough about practice management. They feel at a real disadvantage when they go into practice. It can take them a few years to get comfortable with how a practice runs.

In this day and age of downward pressure on reimbursement, young physicians don’t have several years to learn by making mistakes in managing their practices. They need to do more with less, and do it more efficiently and more cost effectively, and with higher quality and greater safety. Practice management is part of this equation.


Q Wilmer Eye Institute is one of this nation’s greatest and most storied organizations in ophthalmology. Have long have you been chairman?

Eleven years, but who’s counting? I rush in every morning, because I feel like I have the best job in all of ophthalmology.



Q Some people compare academic health centers with dinosaurs and say they face extinction. How do you respond to that?

I once heard a professor at a business school talk about the velociraptor. Velociraptors were super smart, fast, and could hunt in groups. They were the most lethal machines that ever zoomed around the planet.

This professor said back in that day, velociprators probably stood around the water cooler saying, “We are the baddest dudes on the planet. Obviously, our future is secure. It’s simply a matter of how hungry we are as to how much we’re going to hunt today and how much we’re going to eat.”

Look what happened to them. They were not able to evolve and now there are no velociraptors.

The same is true with academic health centers. They need to adapt or go out of business. That’s actually probably true for many of us in practice as well. Society is asking us to do things differently. Academic health centers are perceived as too expensive and not giving enough quality for the cost.

Large populations of patients no longer can go there, or they have to make a co-payment through a tier system that they find prohibitive. Some academic health centers are no longer filled with patients. There will be no bail out for a preferred payment system to protect the academic health centers. We need to adapt.

Academic health centers are vulnerable because we teach. With young residents and medical students taking (on average) twice as long as faculty to perform certain tasks, such as cataract surgery, we inherently will cost more.

The ophthalmologists we have trained are fantastic. We are the envy of the world in that regard. But trained physicians don’t just emerge fully formed. It takes years.

We need to let them do things-like order more tests or do additional things-that more experienced clinicians and professors might not see as necessary. It is part of the experience and the growth of an ophthalmology resident.

Also, we have standby costs. We have trauma surgeons at all times for those occasional patients with severe medical problems that the community centers cannot handle. A significant part of the time, those teams are not generating revenue.

And, of course, our patients tend to be sicker. Other medical institutions send us patients who need cataract surgery, but who also have other severe health problems that require them to be managed in a special way. That adds to our financial burden. Overall, we are inherently less efficient than community practices and community hospitals.