Brush up your business skills

Peter J. McDonnell, MD

He is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times.

Young ophthalmologists consider themselves well-prepared in terms of the medical and surgical knowledge but unprepared for non-clinical aspects of ophthalmology, such as leading employees and managing a successful practice.

Key Points

"The business of America is business."-President Calvin Coolidge

"You can't overestimate the need to plan and prepare. In most of the mistakes I've made, there has been this common theme of inadequate planning beforehand. You really can't over-prepare in business!"-Chris Corrigan

"Dealing with people is probably the biggest problem you face, especially if you are in business. Yes, and that is also true if you are a housewife, architect, or engineer."-Dale Carnegie

Although it is nice to remember that people sign up for medical school out of a desire to help others, and that medicine is a profession and "higher calling," the reality remains that the laws of economics do not cease to operate once they approach the thresholds of physicians' offices. Like it or not, physicians are small-business owners, and our employees depend on us the way the employees of "normal" businesses depend on their chief executive officers. The details of billing, collecting, scheduling, negotiating contracts with third-party payers, employment law, equipment leasing versus outright purchase, efficiency, etc.-all of these are important, if not crucial, to the success of a physician's practice. And, according to the survey, these skills are not taught, or not taught adequately, to U.S. ophthalmology residents.

To address this issue, the AAO has prepared a publication titled The Profession of Ophthalmology: Practice Management, Ethics and Advocacy (Executive Editor David W. Parke II, MD). I had the opportunity to read the practice management section of this book during my recent flight home from the AAO annual meeting in New Orleans. It's excellent, and in my view it should be mandatory reading and the basis for further study for every resident, fellow, and young (and maybe not so young) ophthalmologist in the United States.

In addition to detailed tables listing the various components of contracts, setting up practices, etc., the book has nice pearls and tidbits about addressing common problems in managing a practice. One of my favorites is a vignette about a practice that had recurrent vacancies in the schedule due to no shows, last-minute cancellations, or other reasons. The physician in charge established a policy of rewarding all the staff with a bonus of $5 every day every single appointment slot was filled. The result was that all patients received reminder phone calls, last-minute cancellations were filled in by calling patients scheduled in the future and offering them immediate appointments, and empty slots quickly and entirely disappeared in that practice.

To quote the introduction of this text: "An ophthalmologist completing residency or fellowship training may be extraordinarily well-prepared to care for individual patients, but may fail to master the business of delivering that care and ultimately not serve his or her career or patients as well as possible."

Let's face it: some aspects of employment law are like something right out of a Kafka novel, and dealing with managed care entities and denials of payment can be nothing short of surreal. Many aspects of running a practice are not intuitive, and medical school and residency do not prepare us for these challenges.

If you are in practice or planning to start in practice anytime in the next couple of years, I urge you to obtain a copy of The Profession of Ophthalmology and begin mastering this material well in advance of opening your practice.

By Peter J. McDonnell, MD director of the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times.

He can be reached at 727 Maumenee Building, 600 N. Wolfe St., Baltimore, MD 21287-9278 Phone: 443/287-1511 Fax: 443/287-1514 E-mail: pmcdonn1@jhmi.edu

References Parke DW, ed. The profession of ophthalmology: Practice management, ethics and advocacy. San Francisco: American Academy of Ophthalmology; 2005.

McDonnell PJ, Kirwan TJ, Brinton GS, Golnik KC, Melendez RF, Parke DW 2nd, et al. Perceptions of recent ophthalmology residency graduates regarding preparation for practice. Ophthalmology. 2007;114:387-391.