The case for private practice fellowships

As a graduating ophthalmology resident, I found myself asking a simple question: what kind of fellowship would best equip me for the career I want to build?

Residency provided outstanding surgical and clinical training, but there were still important gaps to fill. I wanted greater exposure to refractive surgery, advanced cataract techniques, premium technology, and exposure to the business side of ophthalmology.

When I began exploring fellowship opportunities, I assumed the traditional academic pathway was the default choice. Like many residents, I spent years training in large academic medical centers and viewed fellowship through that lens. But as I spoke with mentors, visited programs, and reflected on my long-term goals, I realized that the best fellowship depends on the type of ophthalmologist you hope to become.

I wanted to become the best surgeon I could be, but I also want to understand how innovative technologies are adopted, outstanding patient experiences are created, and successful practices are built. During my fellowship search, I found that many private practice fellowships offered a training environment uniquely aligned with those goals.

One of the most valuable parts of the interview process was attending EyePrentice, a conference designed to connect residents with private practice fellowship programs. In a single weekend, I met fellowship directors from across the country and compared programs side-by-side. What stood out was just how different these fellowships were from one another. Some fellowships emphasize high-volume cataract surgery, with fellows performing more than 1,000 cases, while others have built their reputation around an ultra-premium patient experience. Likewise, some provide robust opportunities for research and investigator-initiated trials (IITs), whereas others concentrate almost entirely on clinical training.

Even within the private practice realm, no two fellowships are the same. Seeing these differences firsthand helped me realize that selecting a fellowship is not simply about location or mentor. It is about choosing the culture, philosophy, and training environment that will shape your career.

Early on in fellowship, what has struck me most is the level of mentorship. Working closely with top surgeons has taught me not just how surgery is performed, but how refractive surgeons think. Every day feels like a master class in surgical judgment and patient communication. In refractive surgery, success often depends as much on patient selection and judgment as technical execution. There is tremendous value in learning from surgeons who have spent decades refining their craft.

I have been equally impressed by the breadth of surgical exposure. Many private practices sit at the forefront of the field, often serving as early adopters of new technologies and techniques. Repetition matters. There is a profound difference between performing a procedure once or twice a month and performing it hundreds of times under expert supervision. Surgical confidence is built through experience and repetition.

Private practice fellowships also offer the opportunity to learn aspects of ophthalmology that residency often overlooks. Understanding referral networks, patient acquisition, technology adoption, outcomes tracking, ambulatory surgery centers, and practice management are all important components of modern ophthalmology. Running a successful practice requires much more than surgical skill, and nonacademic fellowships offer a rare opportunity to learn what it takes to build and sustain a thriving practice.

None of this diminishes the value of academic fellowships. Academic medicine remains the ideal environment for many trainees, particularly those pursuing research-intensive careers or highly specialized tertiary care. But my experience taught me that fellowship selection should start by asking, “What kind of ophthalmologist do you want to become?” rather than “What does my program expect me to do?”

As ophthalmology continues to evolve, I believe we should broaden the conversation around fellowship training. For residents interested in cataract and refractive surgery, private practice fellowships deserve serious consideration. They are not a fallback option or an alternative to traditional training. Ultimately, the right fellowship is the one that best prepares you for the career you hope to build.