An Ophthalmology Journey from Beirut to the US

Cynthia Matossian, MD, speaks with Gary Wörtz, MD, about her amazing life story-from her childhood in Beirut to opening her own ophthalmology practice in the United States. Listen as Dr. Matossian explains how her experiences have molded her into the influential surgeon she is today and hear more about her journey to starting her own practice.

Gary Wörtz, MD: Open, outspoken. It's Ophthalmology off the Grid—an honest look at controversial topics in the field. I'm Gary Wörtz.

As I've discovered time and again on Off the Grid, no matter how well we think we know someone, there is always another layer to peel back and more to uncover. Everyone has a story, a narrative of events both big and small, fortunate and unfortunate, that brought them to where they are today. Recently, I heard about the journey of a very influential surgeon in ophthalmology and one who I thought I knew quite well. Her story, however, truly surprised me.

In this episode of Ophthalmology off the Grid, Dr. Cynthia Matossian sits down to tell us about the events that brought her to where she is today. Cynthia details her childhood in Beirut, the unbelievable experience of facing the fear of war as a preteen, and her arrival in the United States knowing very little English. Listen in as Cynthia described how these experiences inspired her to always focus on the positive, and hear how she continued to channel the strength to open her practice and turn it into the incredibly successful business it is today.

Speaker 2: Ophthalmology off the Grid is an independent podcast supported with advertising by Alcon.

Gary: This is Dr. Gary Wörtz with another episode of Ophthalmology off the Grid, and today I have the real pleasure of welcoming my friend Cynthia Matossian to come and talk about all the things that make her so special and so loved by all of us.

Cynthia and I have been friends for quite a while and it's funny when you sit down and have a long dinner with a friend and you start unpacking different layers of the past and stories, and I had such a delightful dinner with Cynthia at OSN New York last year and really got to know kind of the backstory. She was interesting before, and her story as it unfolded, I thought was just fantastic. So, Cynthia, without further ado, thank you for coming on today and being our guest.

Cynthia Matossian, MD: Thank you for inviting me, Gary. It's such an honor to be here. My story, it is circuitous, long, and I will try to explain it.

Gary: Excellent.

Cynthia: I'm Armenian. Most names that end in -IAN are Armenian. Matossian is my name; my husband's name is different. I grew up in Beirut, Lebanon. Most people don't know that because I don't have an accent. I came here when I was just about 12 years old. The reason my story started in Beirut, Lebanon, is that both sets of my grandparents, maternal and paternal, experienced the Armenian genocide in the early 1900s. It was basically ethnic cleansing, although that terminology didn't exist back then. They had to flee because they were Christians and the Ottoman Empire was expanding and they were trying to oust non-Muslims out of that environment.

So, they basically had to flee with the clothes on their back. My maternal grandparents ended up in Jerusalem in the Armenian Quarter, which was welcoming Armenian refugees, and my dad's parents ended up in Aleppo, Syria.

Gary: Wow.

Cynthia: So, what a story. Exactly. Both my mom and my dad grew up in the Middle East as Armenians, as Armenian Christians, and among pretty intense Muslim population at a tense time of the world. Both of them then came to Beirut as young adults and went to the American University of Beirut. That was considered the best educational opportunity in the Middle East. At that time, Beirut was truly considered the pearl of the Mediterranean. It was very cosmopolitan, very Western, and people of all races and religions coexisted very harmoniously. So, that's where I was born, in Beirut, Lebanon, and life was really good for a while.

I went to a German school, Deutsche Schule, in Beirut and that was considered to be among the top schools. So, my first language I learned at home was Armenian. I still speak Armenian with my relatives and my mom. My dad passed away. Then my second language I learned was German, and then French, because Lebanon used to be a French protectorate. That was mandated. And a little bit of English because of course English is ubiquitous.

But then in 1967, the Six Day War started. I have such distinct memories of curfews, and we had to have our blinds down, and we couldn't go out. There was a huge tank, at least to a girl of 12, there was a massive tank right outside of our home that was patrolling the intersection with sandbags. It was a very, very scary time. As soon as the war ended, we were fortunate enough to fly out of Beirut, leave everything behind, all of our belongings, every single thing in our home, and we flew to America.

Gary: Not knowing much English.

Cynthia: Correct. Not knowing much English and arriving at JFK. Everything was so different. Wow. It was an unbelievable experience as a pre-teenager at 12. Then my mom's family had a home in New Jersey, in Bergen County. We stayed with them for a few weeks until we purchased a home in Glen Rock, New Jersey, which is not far from Ridgewood if anybody knows where that is in Bergen County. And that's where I went to high school. That was the beginning. Then I went to college and medical school and did my residency in ophthalmology at GW. And then we've been living in Pennsylvania, in Bucks County, ever since. So, that's kind of my roundabout way of getting from Beirut, Lebanon to New Hope, Pennsylvania.

Gary: So, that story, I'm sure as people are listening to this their mouth is agape, sort of like mine was in New York when you first told me that. You know, Cynthia, I see you as sort of this consummate professional. One of the most well-spoken people inside or outside of ophthalmology, absolutely no accent. As the story was unfolding the first time I heard this, I was just shocked. I was like, "What? No way." It's so interesting.

I'm not alone in my thoughts that our experiences shape us. They shape us into the kind of professionals that we become. The kind of mother, father, spouse, friend, et cetera. I'm sure you've probably had time to reflect on this in your life, in your professional and personal life, how did those experiences, those challenges, those extreme challenges of change of situation at such an impressionable age, sort of instability in a world where you're trying to make order out of chaos as a pre-teen ... How do you feel like that has influenced your life professionally, personally, or otherwise?

Cynthia: Having gone through such a major change, the fear of war, the bombings that we used to hear, the planes flying over our home, and then arriving into this bucolic place with a big grass law and no military around, was such a contrast that of course it impacted me. What that taught me is resiliency, it taught me courage, it taught me that yes you can do it, and it gave me that ability to conquer.

I had really very little fears after that. The biggest fear was already over, so it was easy, it was paradise going forward. When I thought about going into ophthalmology, many people said back in the day that that's only for men, it's very difficult to get into, and I said why not try? I have nothing to lose. I was accepted to a fabulous ophthalmology residency program and then when I wanted to start practice, I wanted to see what it would be like to have my own practice.

There was a group ... actually two brothers from the EENT era. They were practicing eyes, ears, nose, and throat. They had been trained at New York Eye and Ear and they were in their mid to late 70s still practicing both ENT and ophthalmology. I went to them, and I said, "Can I buy the ophthalmology portion of your practice?" Because they were looking to sell, and they said, "Sure." I was so excited. Here I was on the closing day with my attorney and they were there with their attorneys, their respective attorneys, the two brothers, and I signed the document and they looked at me, the two brothers looked at me, and they said they needed a counter signature because I was a woman.

Gary: Oh my gosh.

Cynthia: And that they did not honor my signature.

My jaw dropped. I couldn't believe it. Here I was, an ophthalmologist, an MD licensed to practice, and they did not honor my signature. Fortunately, my husband was there to celebrate the event, and they asked my husband, who has nothing to do with medicine, to counter-sign for me.

Gary: Did that not just light you on fire?

Cynthia: It did. It lit me on fire. I was angry inside, but very composed on the outside, because I knew that I had to do this step and be humble enough to have my husband counter-sign my signature to make the deal happen. It did, he did counter-sign, although he said, "I have nothing to do with medicine, I don't know why my signature guarantees a successful ophthalmology practice." Nonetheless they insisted on it, so we went through with those steps. And 30 years later, here we are at MEA, Matossian Eye Associates with three offices and a large group of physicians and staff.

What's even more interesting, the circle comes around: Their adult children have come to me for cataract surgery.

Gary: Isn't that interesting.

Cynthia: I have done their kids' cataract surgeries.

Gary: Well, I think that speaks to the graciousness and the forgiving spirit that you have. Don't you think those events in life ... I have not experienced anything to that level, so I don't mean to say hey, me too. My first day of residency I showed up and an attending actually said to me on my first day of residency, for some reason he just didn't like me. During my interview process, I did an out rotation, and he said, "Your presence at this program is the culmination of all my professional failures to keep you from being here."

Again, it's one of those situations where it's like, what just happened? I can't believe ... Even if that's the case, why would you say that? I had to sort of just say, well I'm here now, so let's make the best of it and move forward. There are those situations that you say, on one hand let's move on, but the other hand, it's like I'm going to show you that I've earned this. I'm not going to let you be right about me. Do you feel that sense? Did you feel that, like I am not going to let you be right about your misconceptions about me?

Cynthia: Absolutely. Just like your story, which this is the first time I'm hearing it, and coming from a position of authority, telling somebody who's so vulnerable, day one at a residency program where you're just trying to figure out which building is where, to be told something like that for no reason at all, or an impression that he may have had about you when he didn't really know you, is so hurtful. Why make it so personal? I always try to see the positive in people, focus on the positive, and just prove that yes I can and yes I will.

Gary: Right, right, and you know it's like the walk is way better than the talk. My wife says, the best revenge against people who don't like you or have misconceptions about you is just a life well-lived. Let the way you walk around the world be the testimony of how ... of who you are in your character. She's been just a tremendous resource and solace for me.

I have this sort of ... That's not the only thing that's happened in my life, and this is about you, not about me, but I have this kind of working theory that ... Because I've seen a lot of successful people and a lot of times there's something in their backstory that they had to overcome, and when they did that ... Like you said, it gave them the confidence to really get beyond any other challenge because in comparison it's not a challenge relative to what they've been through. I have this sort of working theory that there are these competitive disadvantages that we experience in life sometimes. On the surface, it would look like a disadvantage, but some of those things motivate us to move beyond our natural ceiling. Have you found that in your life?

Cynthia: Absolutely, and I think your theory is correct. I've come across other people who've had to overcome massive hurdles, whether it was a personal illness or a family tragedy, or a life change like in my story. That gave them a different perspective of life and that courage that we talked about and that confidence that they can overcome this hurdle, or at future hurdles that are invariably going to be encountered in life. Life is not just a smooth day at the day or at the beach. There are lots of tsunamis and hail storms and cyclones and all kinds of things. It's the resiliency that you have to reach down inside you and find and have confidence and center and keep going forward.

Gary: I think that is a ... I totally agree with you. When you have the perspective of other things in life that you've gotten over, when you face a setback personally or professionally, you have a difficult patient or a case didn't go the way you wanted it to go. I find that you can sort of call on that fortitude that's been forged in the fire and it helps you move forward and gives you a little broader perspective.

I'd love to hear a little bit more about what's going on in your practice, what's new for you, what is it exciting for you lately, where are your interests? I kind of know, but I would sort of also like to hear you talk about the things that you're most interested right now about in ophthalmology.

Cynthia: Well, we are so fortunate to be practicing ophthalmology in this era. There's so many exciting things happening. Just walking on the convention floor and being in meetings there's a buzz about all the new stuff, whether it is new drug delivery, platforms, new intraocular lens concepts like the ones you've been working on, Gary, new IOLs, new drugs, new diagnostic tools, it's all super exciting. I love this stuff.

My areas that I focus on are ocular surface. I've been baked into this from the get-go when people didn't even want to hear about tear film instability or be even willing to listen to patients who were complaining about their dry eye symptoms. My other area is refractive cataract surgery. Those are the two areas where I spend most of my kind of ophthalmology life in.

What I've been working on lately in terms of the business model that I'm also passionate about, I love running my practice and I'm very engaged with that, is I started a company called PTT for Progressive Tech Training.

Gary: Interesting.

Cynthia: What that is, it's something that I recognize there's a need to train our technicians. More and more of our diagnostic tests, whether covered by insurance or not, are being delegated to our technicians. Technicians often are not very, very well-educated in terms of they don't often have post-graduate degrees or college degrees. Some do and some don't. They come in and it's a great opportunity for them to start a career and grow their career in ophthalmology. There are so many different levels, but they need training. Who has time to train them and to train them to do something consistently, correctly each and every time?

As a result, I noticed a need and we created PTT, which is going to be a digital on-demand video module library that are going to be siloed into different categories, like retina or oculoplastics, or cataract, dry eye, and so forth. Of course, some of the topics will overlap, where it's a how-to like YouTube from a technician to a technician, peer to peer explanation, of how to do a correct tear osmolarity test. How to center the head of a patient so that you can capture a Cassini image as quickly and as accurately as possible, and so forth.

It's going to be short vignettes, maybe 3 to 5 minutes max, if that, and they'll be a maybe two to three question test at the end of the module where the technician has to answer it correctly to "pass," and to demonstrate that they've been paying attention. It is not for credit; it is not going to compete against JCAHPO or anything like that. This is just to help ophthalmologist and optometrists, help with the staff training that they may not have time to do, or it can be done at any time of the day 24/7 regardless of the time zone that you're in.

Gary: Sounds in some ways like the Khan Academy model, where sort of getting best practices, getting video modules, and really pushing education to people to take part in whenever they can. I think that's fantastic, because you're exactly right, we have ... Another theory of mine is the letters that come after your name do not dictate your level of intelligence, they just ... I guess in some way just show what you have done, not what you're capable of.

We have technicians who are incredibly bright, but you're right, they rely on us to teach them and in a busy practice it is very difficult to make the time and have the patience and discipline, I guess, to sit down and really go through all of these things. By being able to put these modules together, it can really solve an unmet need, I think not just for you personally, which is probably where this started, but this is something that can really scale. I think it's fantastic.

Cynthia: Also, one other reason why I did this is often technicians may not be present during an in-service. They may be out on vacation, they may be at a different satellite office, so then once technician is kind of being given the task to train the others. Then it's like that telephone game. By the time the fifth technician learns how to do it, they're doing it incorrectly and not at all according to what the manufacturer or the physician had in mind. This way there will be consistency, because they can go back and watch that video over and over again until they really master whatever step or procedure it is.

Gary: Is this available at this point? Or are you still building this?

Cynthia: It is not available yet. We're building it, we're partnering with industry, so that they can help give us the content that they want our technicians to be the peer leaders to other technicians and be able to explain the process or the procedure correctly. We are right now in the network partnership phase, and once we have enough content in our library, then it'll be open for membership.

Gary: Well make sure you let me know about that because I think that's going to be a fantastic program, not just for my practice, but I'm sure for practices across the country. Make sure that you let us know so we can spread the word when that's ready.

Cynthia: I'd be happy to do that. Thank you, Gary.

Gary: Absolutely. One other thing I want to just dive into a little bit, is you are a practicing ophthalmologist who's also managing a practice. That's a very difficult thing to do, there's not too many people who do it well. I would say you're probably one of the best.

Here's the question: When you're looking to bring on an associate, what do you see are common pitfalls or mistakes that as you're interviewing either a new grad, someone who's just out of residency or optometry school, because I know that you have both in your practice, what do you see as someone who has been through this time and time again, has the longevity of a career to look back on and look forward towards, what do you see are the big mistakes that new grads make when they're looking for a job? I guess the part B of that question is, when they get to the job, what are the things that you've seen that could be potential pitfalls in the early stages of a career?

Cynthia These are such good questions, Gary, and thank you also for all the wonderful compliments you just shared. It is very difficult to find the right match. It is like a marriage. It is like a relationship. Spend time getting to know each other ahead of signing the contract. Make sure you're honest with one another. This is where communication is key. I think on both parties, but of course the new resident or the new fellow coming out may not have the knowledge set to even know what kind of questions to ask. It's incumbent upon the senior partner looking for that junior partner to be able to kind of set out the blueprint.

Things like expectations. How hard are you expected to work? How many patients are you expected to see a day? How much community outreach are you expected to do by going out, meeting and greeting optometrists and internal medicine docs, et cetera? All of those things have to be clearly laid out and talked about so that everybody is very comfortable of what is expected of them and then are they able to deliver that? Then there's no disconnect.

The other thing is the spouse is important or the partner. Just make sure that everybody wants to be living in that geographic area because if one partner doesn't and one does, there's going to be conflict right there and it's not going to be a happy situation.

Gary: That's right.

Cynthia The last thing, which I'm a firm believer of, is transparency. Once a month, we have an MD/OD meeting in our practice where all of management, all of our docs, MDs and ODs comes, sit together and we meet. It starts around 5-5:30 after patient hours, and we go over everybody's numbers, our new patient volume, our surgical volume, and we see exactly how much each doctor is generating so there's no secret. Why should there be? It's all transparent, everybody gets the same handout, and this way there's no negative competition of false assumptions. Transparency, communication, and setting expectations are the three key criteria.

Gary: Those are just absolute pearls. One thing I have seen in a couple of situations play out, is an older doctor who's trying to recruit a junior partner. The junior partner has a different level of expectations about what they want to commit to a practice and the senior partner sort of has to accept that, or at least verbally accept that or communicate that that will be okay, like the 9-to-5 thing will be okay, and fine, okay, we'll ... that's fine. But in their heart, it really isn't fine. So, from the very beginning, the senior partner's wrestling with an internal conflict of perhaps I want this person, but I want them to want to work like I used to work. Have you seen that play out?

Cynthia: Yes, definitely. Because each generation of physician, or really in any field, has different values and different sets of hierarchal importances. Even though in my heart I would say I wish my docs would do X, Y, and Z like I used to, I know it's a different generation and I have to come to terms as the senior partner to know that would be foolish on my part, or unrealistic on my part to anticipate or expect or hope that they would do it. With that, I have learned to alter my set of expectations, and then we're good.

Gary: Right. Well that comes back to something I've said time and again: Frustration is the difference between expectations and reality. So, if you find yourself being frustrated, you either change your expectations or change your reality. It's really the only two variables in the situation.

Cynthia Yes.

Gary: I think there's a lot of wisdom in that that can be applied broadly. Anything else in your practice or things you're looking forward to before we wrap up?

Cynthia: I think this has been an excellent session. I've really enjoyed spending this time with you, Gary. Thank you for the opportunity.

Gary: Cynthia, you are a dear friend, not just to me, and I'm thankful for your friendship. You are a friend to the entire field of ophthalmology, and I'm just so blessed to know you and I'm honored to be able to share this time with you as well. With that being said, thank you for coming in.

Cynthia: Thank you.

Gary: Cynthia is truly a model of strength, resilience, and poise. Clearly, the hurdles she overcame early in life have instilled in her a strong sense of empowerment that has continued to fuel her success in ophthalmology. In the words in Cynthia, when faced with what seems like an insurmountable challenge, keep reminding yourself that yes you can, and yes you will.

This has been Ophthalmology off the Grid with Dr. Gary Wörtz. We really value our listeners' feedback, so please head on over to iTunes and leave us a review. Be sure to catch past episodes at eyetube.net/podcasts. See you next time.

Speaker 2: Ophthalmology off the Grid is an independent podcast supported with advertising by Alcon.