Viewpoint: Challenges greater today

October 15, 2010

A common sentiment from patients, who are often on a quest to regain youthful eyesight, is "I wish I were young again."

But for me, I have no interest in being young again. Oh sure, it would be nice to have less gray hair and fewer wrinkles, but I don't want to be a young ophthalmologist again.

Since my ophthalmology training ended more than a decade ago, I'm not allowed to be part of the "Young Ophthalmologist" programs at our national meetings. I think that means I'm no longer classified as young, which is a good thing, because the challenges young ophthalmologists face today are far greater than in years prior.

Our knowledge base of ophthalmology continues to expand, and entirely new diagnostic and treatment modalities are emerging. For example, anti-vascular endothelial growth factor compounds, optical coherence tomography, and small-gauge vitrectomy have improved the management of retinal disease, but they have added to the mountain of information that our young ophthalmologists must digest.

And since ophthalmology residency is still just 3 years, the new ophthalmologists must learn more material in the same short time frame. Is a 3-year residency enough time to learn the latest surgical procedures and technologies to be comfortable enough to practice the full spectrum of general ophthalmology?

A larger challenge for young physicians may very well be the business of medicine, with the uncertain future of health care, declining fee schedules, and limited practice opportunities. Setting up a solo private practice can be a costly and demanding endeavor, but joining an established practice with an unrealistic partnership track could be even worse.

To young physicians it often seems like the heyday of ophthalmology has passed and that financial security now requires much more work for much less reimbursement. Look at cataract surgery, which is truly life-changing since it permanently improves the way that patients see the world, every waking moment, forever.

It is so important that we carry multi-million dollar malpractice insurance policies in case things go south, but it is also so devalued that people treat it as a simple commodity worth only a few hundred dollars.

The right balance

Luckily, money is not the principal motivating factor for the new generation of physicians, who choose to go to medical school despite the current environment and uncertain future. These physicians are smarter, tougher, and more driven than ever before and they are interested in achieving balance in their lives. I admire these young physicians because they succeed in finding the right mix of work, family, and personal time. Long gone are the 80-hour work weeks from decades ago.

Instead, many young physicians choose to treat ophthalmology as a job instead of a career, passion, or business, while others choose to work only part-time in an effort to devote more time to their children. These young physicians may love ophthalmology, but they love their families and their personal lives even more. Their goal is the pursuit of happiness and fulfillment.

I think that's brilliant and I'm trying to learn from them. I could certainly benefit by reconsidering my priorities, and aiming to achieve a better balance between ophthalmology, family, health, and happiness.

So at the next national ophthalmology meeting, I'll spend some time in the lecture and exhibit halls, but don't expect to find me at the evening presentations. Instead, I'll be enjoying dinner with my family and friends, and contemplating how best to address my own presbyopia.

Uday Devgan, MD, FACS, FRCS(Glasg) is in private practice at Devgan Eye Surgery in Los Angeles, Beverly Hills, and Newport Beach, CA.

Dr. Devgan can be reached at devgan@gmail.com
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