OVERCOMING OBSTACLES
fellow in the University of Louisville Department of Ophthalmology for two years after my intern year , learning the ins-and-outs of grant writing , publications and meeting the various faculty . This was a more circuitous route than originally planned , but patience and hard work led me to residency matriculation at UofL in 1989 .
The Early Years in Practice
1992 saw the completion of residency training . By this time , my wife had changed to pathology , completed her additional four years beyond general surgery internship and was part of a private pathology practice at Jewish Hospital . We had had our first child and thus were committed to remaining in the Louisville area . I was hired by a solo ophthalmologist wishing for an eager , young , potential partner . This senior partner purchased another solo practice a short time later from a retiring physician and I was given the honor and task of taking this on . It became apparent that building a practice meant meeting referral physicians , performing hospital and ED consults and learning the medical community as a whole , much less starting to understand the nuts and bolts of the business . Gone were those halcyon days of attending physician oversight without administrative duties : there was nothing else to do but dive in !
Another couple of years passed and my senior physician was approached by a growing multispecialty ophthalmology group to sell his practice . He kindly gave me a first right of refusal , but my wife and I felt we were not prepared , nor did we have the perceived resources to launch into a solo practice , away from the structure of a more developed practice . So , I joined this larger entity , realizing after some time that this was not a good fit . I made the decision to depart and establish my own practice .
I confess I had categorically no idea of how to start or run a business . The thought of finding office space , hiring employees , completing contracts with insurance carriers , purchasing equipment , acquiring a business accountant , lawyer , banker , manager … the list goes on , was daunting to say the least and certainly financially challenging . I contacted colleagues and mentors , made connections , started reading and attending meetings about the business of medicine , and moved forward slowly but surely .
Making connections within local , state , regional and national medical communities was key to expanding my range of clinical and business acumen , leadership , and communication skills . The GLMS , KMA , AMA and my ophthalmology societies provided excellent resources which gave me support and the confidence to move my practice forward . These entities continue to do this . The stronger I was in communicating , leading , executing and managing my practice , the better care my patients received .
One serious obstruction occurred at the time of establishing my practice . Therein came the lawsuit surrounding my departure from the multispecialty group which hung over my head for four years . This was crushing to say the least , but with perseverance I came out at the end with both pride and practice intact .
From Naïve to More Mature
The work has continued . As a mature , not a novice practice , we needed to grow and adjust to current and future changes to medicine . Frustrations regarding the adoption of electronic medical records both in the office and within the hospitals / surgery centers was a challenge for me and my office team . Yearly changes in reimbursement forced my practice to engage in new approaches , offer new services , and ultimately to become active advocates with a strong voice toward change that reflected our guiding practice principles of bringing patient-centered care while remaining fiscally sound . Every year saw new demands , not the least of which was the all-toorecent resource and care challenges of COVID-19 . Once again , the office had to learn the science quickly , adapt to the forced changes in patient care and be nimble to the ever-changing landscape of the pandemic .
Succession planning likely never comes onto anyone ’ s radar screen until it is upon you . However , this is a necessary part of medical practice , as with any business , as one moves into those potential final years . The time for this is approaching for me which implies serious considerations and plans must be made regarding to whom do I give the reins and how to best transition for this ensures the health of the practice and secures the care continuum for patients . Luckily , I have incorporated a fabulous young partner who embraces our office vision and mission . This necessitated many hours of discussion surrounding our views , philosophies , business considerations and needs .
Closing Comments
As I reflect on my career , the obstacles we overcame , the barriers we pushed through , the trials and the errors , I remain grateful for each and every experience . For all of us in medicine today , roadblocks can and will loom large , but we must continue our pursuit of excellence in patient care , adapting and embracing change even when we might initially fail . The lessons learned are invaluable . It reminds me of the quote by Henry Ford : “ If you always do what you ’ ve always done , you ’ ll always get what you ’ ve always got .” By incorporating business tenets , leadership and communication skills into our own practices while engaging our up-and-coming physicians , we can secure the science and art of medicine to which we all committed in the first place . Our patients deserve nothing less .
I would like to give special thanks to my wife , Carolyn Burns , MD , for her help and assistance in the content and editing of this article .
Dr . Burns is a private practice ophthalmologist . His practice is located in Middletown , KY under the name of Middletown Eye Care .
July 2023 9