Young Ophthalmologists Need Business and Management Skills

In professional life, as in business, you seldom get what you deserve—you get what you negotiate. And negotiating success in ophthalmology requires cultivating business and management skills right from the start, particularly if you want your own practice, Daniel Kook MD, PhD said in the ESCRS Leadership and Business Innovation Programme at the 40th Congress of the ESCRS in Milan.

The cost and complexity of running a practice drive a growing share of young ophthalmologists into employment, Dr Kook said. Starting a practice is risky and involves taking on heavy administrative burdens and complex legal and tax obligations. Plus, it can take up to two years of planning and another two years operating before breaking even.

But the rewards are worth it, Dr Kook said. Independence means self-determination that promotes trusting patient relationships and providing the care you think best. It also offers opportunities for balancing work and life needs, financial growth, and skill building. Based on his experience launching a practice in April 2020, he outlined several essential areas requiring skill and knowledge for successful negotiation.

Business and finance

Business planning is one. A clear understanding of the potential market, its competitors, and how to serve and address them creates the foundation for building a practice. Many business planning programs are available online, Dr Kook noted.

Real estate is another. It’s essential to find and choose a location easily reachable for you and future patients, as well as a facility that’s accessible and attractive. Space planning and environmental analysis also are required.

Another requirement is financial planning. Dr Kook’s financial plan, which he developed with help from a colleague’s consulting firm in 2019, assumed realistic sales over a two-year ramp-up starting in 2020. He figured the total cost would be €600,000. That included €100,000 to convert the offices he rented, €110,000 for furnishings, €200,000 for imaging equipment, €30,000 for information technology, and €30,000 annually for marketing.

Ongoing costs included €80,000 annually for staff, €40,000 for rental, his own projected living expenses, and €7,000 annually on a €700,000 loan that delayed repayment for two years.

“In Germany, rates were 1% at the time; now, they are a lot higher,” Dr Kook said.

Don’t forget to save for any future tax, pension, or other delayed payment obligations, he added.

“One of the biggest mistakes you can make is you don’t take this into account, and two years later, when the bill is due [in Germany], you have no money to pay it.”

Certifications and marketing

New practices may also need a range of technical certifications, requiring qualification courses for the surgeon or designated staff. Depending on location and services offered, these may include hygiene, laser protection, data protection, ultrasound, intravitreal injections, and quality management for special contracts.

One last area Dr Kook touched on as needed knowledge was marketing skills. These include setting up and maintaining a practice home page, search engine optimisation, target group identification, print media, online advertorials, social media, brochures, business cards, and information meetings.

That is a lot of complex material, but there is no need to reinvent the wheel, he advised. Networking with like-minded colleagues through professional exchange groups lets you learn from their experience and avoid classic pitfalls.

“Sometimes you stay awake at night wondering what’s going on, what will you do tomorrow,” Dr Kook said. But realise building a practice takes time and patience.

While Dr Kook planned for two years without a revenue gain, he achieved it after about nine months and has since surpassed his five-year goals.

“Questioning yourself doesn’t get you there. Just do it.”

Growing in leadership

Whether in a private, public, or hospital practice, leadership is another essential element for ophthalmology success, said Nic J Reus MD, PhD, adding influencing others to help accomplish a common task is one definition.

Other descriptions range from helping patients make treatment decisions and running operating rooms to running hospitals or research departments to guiding national and international organisations. All require managing the time and resources supplied or controlled by others.

Change management also requires leadership. Adopting a new lens implant or curtailing post-surgery eye shield use requires complex coordination of clinicians, administrators, and outside parties, Dr Reus observed.

Leadership involves setting direction, defining problems, building commitment, and motivating and sustaining efforts. Dr Reus recommended developing these skills early through acting as a trainee representative on committees and progressively taking responsibility for running clinics.

“You grow in your role as an ophthalmologist.”

Formal programmes are available to help residents develop leadership skills. These include training on personal leadership, managing complexity, influencing and conflict management, understanding finances, and quality improvement.

“Everybody is already a leader in one or more aspects of their lives. Effective leadership makes life much easier,” Dr Reus concluded.

Daniel Kook MD, PhD owns Prof Kook & Partner, a private ophthalmology practice in Gräfelfing, near Munich, Germany. daniel.kook@med.uni-muenchen.de, info@profkookundpartner.de

Nic J Reus MD, PhD is an independent ophthalmologist at Amphia Hospital, Breda, the Netherlands. nreus@amphia.nl