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"Knowledge Is Power": Sir Francis Bacon... Or Schoolhouse Rock?
Exploring academic and private practice.
My program director Frank LaPiana, MD, who is now retired, used to say that ophthalmology is the “Queen” of specialties, and I cannot see any of us disagreeing with him. Even in today’s current health care environment, it’s not too often that you learn about someone who has left ophthalmology for a different field. In fact, frequently, I hear the opposite. From time to time you’ll find a few of our medical brothers and sisters leaving their specialty of medicine to join our merry band in eyes. Ophthalmology offers so many great directions.
I do not believe that one path is more prestigious or rewarding than the other, and therefore making the decision of what type of practice one desires is a very personal choice. Academic medicine takes place in an environment of constant clinical education. Handling complex challenging cases as well as educating residents and fellows on the details of our field keeps your clinical skills sharp. Plus, if you subspecialize, you are more likely to see patients in your specific field and be able to spend more time with them. Academic programs offer morning rounds where there is a greater chance to interact with multiple colleagues and subspecialists to discuss challenging cases that continually refresh your knowledge base. Another clear advantage for academics is that joining a teaching center is like being an athlete and joining a successful team franchise. Depending on your program, your patients will think you’re a star from the start. You also do not need to make any financial investment to join the program, and there is a high probability that your teaching programs will have already made the investment in technologically advanced diagnostic and surgical devices. Like in teams or large businesses, however, strategic decisions are not always made quickly, and there is clearly more bureaucracy.
Private practice, on the other hand, allows you the freedom to focus your practice on any or all of your interests. Now, though, you have a new responsibility: the bottom line. With reductions in reimbursement and a need for significant capital to start a practice, it can be tricky to navigate starting this successfully. Additionally, if you are new to an area, you may be amazing at what you do, but you have to go out and introduce yourself to the other care providers in your community. You must market yourself, find your niche, and work hard every day to fill your schedule. There will be times when things will be feast or famine. The true advantage here, though, is that in the private practice you have greater control. You make the call, you are your own boss, and you can choose what insurance you want to accept and what procedures you want to perform.
Both academic and private practice offer so much opportunity and the potential for extremely satisfying careers. I hope you enjoy your pursuits.