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Top Things I Wish Residency Taught Me

Written by Morpheus

Our guest author, "Morpheus", relays some practical information that he wishes he learned much, much earlier.




Learning (any) Business and/or Practice Management Skills Is Essential (and actually easy)

I think simple business topics is one of the most important things lacking in our Ophthalmology training.  We spend countless hours studying minutiae about the eye, but basically zero time talking about real-life after residency and/or fellowship.  I think the main reasons underlying this business knowledge void is:  (1) our attendings themselves don't know how to run a practice or understand many business concepts; and (2) there is this prevailing sense that "money is evil" and should not spoken about in the hallowed halls of academia.  This is a shame since ignoring financial topics will put you at a huge disadvantage when you arrive in the "real world".  Without some understanding of practice management and financial concepts, you will be more vulnerable to being abused by your employer or swindled by that "trustworthy" financial advisor.  I don't care if your career leads you to Kaiser, academics, or the VA...  you should still improve your financial knowledge base.

I've heard some ridiculous statements like "You need a MBA to run a medical practice" or "You need to hire expensive consultants to be successful".  Guess what?  You are much smarter than any practice consultant or financial advisor out there.  You are an Ophthalmology trainee who has had to study thousands of hours and be in the 99th percentile on basically everything to get to where you are right now.  Do you think that these practice consultants and financial advisors have endured as much as you have?  The answer is a resounding no.  The only thing that those advisors have is experience.  Business is not theoretical physics!  Trust me, you can obtain a solid base of financial knowledge and learn the nuts and bolts of running a small business (e.g. a medical practice) on your own.  The Internet has a plethora of resources to learn basically anything.  All you need to do is have the discipline and hunger to learn these topics.  One of the best resources I've had the privilege of encountering is Ho Sun Choi's blog that has been recently revamped.  Another valuable resource is finding an older mentor who has the type of practice that you envision for yourself.  There is no need to reinvent the wheel and you can significantly speed up your learning by heeding their advice.

Most of Those Salary Surveys Are Inaccurate

Like any other trainee, I wanted to know how much I could expect to earn and what constituted a "fair" job salary.  Unfortunately, the sources of this information fall into these main categories:

  • Physician compensation surveys (e.g. Medscape). 
  • Headhunters.
  • Internet forums (e.g. Student Doctor Network).
  • Ophthalmology colleagues.

The problems with these sources of information is that:  (1) Exact compensation information can never be verified unless everyone submits their tax returns; (2) The people making the real money typically do not respond to surveys or spend time on Internet forums; (3) Headhunters only really know average starting salaries since they typically deal with recruitment for associate positions; and (4) Everyone lies.  Another problem is that everyone's situations are different.  Thus, part-timers that work 3 days a week at the VA are being lumped together with private practice guys/gals doing a gazillion laser-assisted cataract surgeries a week.  There is huge variance in compensation in Ophthalmology.

Let me let you on to a little secret:  there are a LOT of Ophthalmologists making 7 figures!  It is actually quite easy to guess who is making 7 figures in Ophthalmology and how you can obtain that compensation too if you so desire.  Here are the factors (yes, they are no-brainers that you already knew):

  • Equity-partner.
  • High volume of surgery (anterior segment) or clinic patients (retina).
  • Ambulatory surgery center ownership.
  • Has junior associate or optometry employees (the more, the better).
  • Own ancillary income streams (e.g. optical, audiology).
In other words, if you are scoping out a practice and the person interviewing you is a senior partner doing 30 cataracts a week; owns her ASC; has a few optometry employees; and an optical shop.... then there is almost zero chance she isn't pulling in at least 1M.  Of course, it will be rare for anyone (e.g. the senior partner) to tell a stranger (e.g. you) how much money their business pulls in.  I only mention this because you should understand your economic potential and not be mentally trapped by Medscape surveys or what your friend at Kaiser is bragging about his higher-than-average starting salaries.

Heed Your Elder's Advice:  Save Early!

Yes, what you've heard before is true:  During your first job, save as much money as possible.  Most people do not remain at their first jobs.  Whether it be an abusive employer, change of geographic heart, or change in practice preference (e.g. academics to private), chances are you will be moving.  You will have more leverage with your second career move if you have a good amount of savings.  Also guess what?  You are already at least 8 years financially behind your friend from college who went straight into investment banking or working at Google.  Thus, you have a LOT of catchup to do in terms of compounding interest.  Don't make the same mistakes that many newbies make when they land their first job.  Don't buy that fancy car or stay at the Four Seasons on all of your vacations.  You don't have to be a monk early on, but you can't be the Wolf of Wall Street either.  Instead of buying Starbucks every morning, try reading something like this so you can escape the Matrix of consumerism.

Let me know what you think about these ideas in the "Comments" section below.

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