Top Mistakes and Red Flags When Considering a Job in Ophthalmology

I was finally almost done with all of this Ophthalmology training.  After 4 years of medical school, 4 years of residency, and another year of fellowship, I was ready to start "living".  I was in the middle of my fellowship year, and was now actively hunting for my first job.  The problem was, I had no clue where to start.  I knew I wanted to pursue private practice because I valued efficiency, a higher compensation ceiling, and had minimal interest in an academic career. 

Unfortunately, my academic attendings and mentors were stunningly quiet on job prospects.  For them, the world outside of academia was beneath them or at a minimum, they lacked any concrete experience with that universe.  I loved my attendings for their clinical acumen and ethical treatment of patients.  But their lack of "real-world" knowledge was unsettling.  At that stage of my life, there was zero chance I was going to start a practice on my own especially without a mentor or friend to suggest that was even a realistic possibility.  Basically everyone in my Ophthalmology world told me that starting de novo was impossible in the modern age of Medicine.  Thus, I was relegated to what was posted on various job boards (e.g. AAO Job Center) and what I heard through headhunters.  This brings us to the first mistake when considering an Ophthalmology job.

Avoid Restricting Yourself to Specific Geographic Areas (if possible)

Probably the first criterion that most newbies look for in a job is location, location, location.  And I completely made that mistake by honing into one of the most desirable locations in the United States.  The problems with restricting your job search to very specific areas are obvious:  1) There will be much fewer jobs from which to choose; 2) If that job is located in a traditionally "desirable" area, then you will be at a severe disadvantage in the negotiating process.  Hell, as a newbie grad, you are already at a severe disadvantage in the job negotiating process.  First of all, you probably have very little business or practice management experience or perspective to understand what constitutes a "good" offer.  You also probably do not have much money and thus must be employed by a certain date.  In contrast, a practice has probably been through the contract negotiation process multiple times, has much deeper resources (financially, lawyers, etc), and probably does not have a hard deadline by which to fill the position.  Because of this power imbalance and the law of supply and demand, jobs in these locations will offer much lower financial compensation.  Also, these practices will not be as motivated to let someone buy-in since they can always just "cycle in" another newbie associate without losing any equity and thus control of the practice.

I get it.  You have worked hard to become a full-fledged Ophthalmologist, and you do not want to end up in the boonies for the rest of your life.  Just understand that it is difficult (but not impossible) to have both above-average compensation and live in the heart of paradise.  Reflect deeply on what's most important to you and what you can live with and what you cannot live without.  Also, realize that very few people stay at their first job.  So pay particular attention to the non-compete clause of any employment contract to see if it is onerous or even enforceable. 

Another perspective you may want to consider is that the most important aspect of your first job is getting a good surgical experience and exposure to the business side of Ophthalmology.  Trust me, your 200-300 cataract surgeries during training has not made you into David Chang or Ike Ahmed just yet.  Ideally, your first job should give you a high-volume clinical and surgical experience to better hone your skill set.  I know of too many friends whose first jobs were in highly-desirable locations where they were doing 10 cataracts a month.  Unfortunately, many of them have never become efficient surgeons and their careers have been severely limited by this slow start.  Similarly, gaining a good understanding of how to run a small business will expand your options (e.g. opening own practice) if your first job does not pan out.  Knowing the business side of Ophthalmology also makes you a more attractive job candidate and potential future business partner. 

Network and Be Proactive -- Not All Jobs Are Publicized

One of the most important things to realize is that many job opportunities (especially the most coveted ones) are not even officially advertised.  Ophthalmology is a small world, and many practices will first ask their friends and colleagues to see if they could recommend a candidate, before publishing their job opening.  As a current practice owner, I would place much higher value on the personal recommendation of someone that I trust rather than a random application, even if the latter candidate was stellar.  Thus, as a young Ophthalmologist, do your best to avoid burning any bridges.  Even though you may hate one of your academic attendings or that community Ophthalmologist that is always late to your resident clinic, leave a positive impression on everyone.  Everyone knows somebody and you may hear about an attractive job opening through this loose network.  A famous research paper, "The Strength of Weak Ties", demonstrated that people with more "weak" ties (i.e. friend of a friend) found jobs that people with only "strong" ties (i.e. first-degree friends) could not see.  Also, these jobs from "weak" ties typically carried higher compensation and satisfaction.

Another strategy you can consider if you are committed to a specific geographic location, is to cold call all of the practices in that area to see if they want an energetic, hard-working associate.  A friend of mine had to be in a certain city since his wife matched in a fellowship in that city.  His strategy was straightforward:  he researched all of the top practices in that city and cold-called them to see if they could employ him.  And it worked!  Trust me, most practices will feel honored that you called them.  Even if they cannot accommodate you, they may have some friends who need help (again, the strength of weak ties). 

One last networking resource you shouldn't dismiss are the drug or surgical device reps (e.g. Alcon, Allergan, Bausch and Lomb) in your target area.  These reps visit a plethora of offices and know who are the "shakers and movers" and who just have mediocre practices.  Though reps can sometimes be annoying, they can be a tremendous resource of information, so treat them well because it may well be their words that introduce you to a great job.

(I will cover the additional topics of due diligence and contract review in my next Post :-)