Valuable Career Advice for Ophthalmologists

Looking for a new job? In this episode, Gary Wörtz, MD, asks David Goldman, MD, to share advice on what to look for, how to negotiate contracts, and more. Cristina Boggiano Lewis, of The Ophthalmic Associates, specializes in matching doctors with the right practices and also shares some advice for physicians who are currently looking for a professional change.

Speaker 4: Ophthalmology off the Grid is supported by Ilevro, from Alcon.

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

Finding your dream job: We all hope to reach that goal, but how do we get there? Which path should we take? Today I'll talk with Dr. David Goldman to see how turning down an initial offer led him down a new path that included working in academia, and eventually starting his own practice.

We'll explore what your priorities should be when looking for a new job, how to negotiate contracts, and the ins and outs of running your own practice.

This is Dr. Gary Wörtz with Ophthalmology off the Grid, and today I have with me Dr. Dave Goldman. Dave, I just wanted to say thank you for taking a little time out of your evening and talking to us about the dream job, or finding your dream job. We met, I guess maybe five years ago, something like that, in a speaker training session down in Fort Worth. Dave is probably one of the funniest guys in ophthalmology, so I've always enjoyed our times and good time just hanging out and also sharing different practice pearls.

Dave, with that being said, tell me a little bit about your experience, maybe after residency and going into practice. Tell us a little bit about your background, in terms of where you found yourself after residency.

Dave Goldman, MD: Sure. I guess everyone has their own story, and for me, even though I ended up at Bascom Palmer on faculty for six years or so, that wasn't really my intention in the beginning. Actually, right before I graduated, I was contracted to join a private practice and as can often happen, in the 11th hour, all the contract negotiations just kind of fell through.

I was in negotiations with a group and one of the critical points of the contract was that I had just gotten engaged, and my now wife Amy was going to be giving up her job in Michigan and moving down, and the noncompete was concerning because it was a whole county. I understood that, and I told them, "Look, if I join you guys and I am doing drugs or I get arrested or whatever may happen, I'm not performing well, you have every right to get rid of me, and I should be out of the county, but if I'm fired without cause, that is to say you just didn't have the volume you thought you were going to have to support me," which was my concern at the time, "you can't force me to leave the county because I'm moving here with this soon-to-be new wife who's giving up everything to move, and it's not really fair."

Initially they agreed to it and then they took it back and decided not to do it, and that was a real dealbreaker for me. I called the whole thing off and then they called me back and offered me that and everything else, and even more things that I'd originally asked for that they said no, and that just kind of bothered me that all of a sudden they were willing to offer me all these different things, just throwing it at me. When before I was just kind of begging for even half of it. At the end of the day I said no, it's not going to work, and here I am, I'm a week away from graduation, I go up for my graduation, I get my diploma, they tell everyone I'm going off to this other practice which I had already known wasn't going to happen.

There were a few offers on the table, but what felt the safest to me at the time was to go into academics and stay at Bascom Palmer. I was familiar with the situation there, and frankly it was a great opportunity for me based on the fact that I'd practiced there already, and the high volume that I was going to take over for some of the other physicians that were leaving.

I actually really enjoyed it, it was sort of a dream job, I really liked it a lot and then a few years later, things started changing a little bit and I decided it wasn't as good as it used to be, and so it was time for me to look into other options.

Gary: I think that's really interesting, if there are residents out there who are looking for jobs, who are listening to this, it is a daunting process. It is really difficult to find a job, and even to know what the right questions are to ask to find a good contract attorney who's going to help you review your contract and really, how do you negotiate with someone who really has all the chips on their side of the equation, or their side of the table?

I guess negotiating from a position of weakness is never a great thing, and the only leverage you really have when you're young is that you have other opportunities. It is really, really tough. When I was a resident, I was really kind of thinking about all sorts of things. I had an opportunity to move down to Tampa and be a surgeon in a high volume practice, and also had an opportunity to start my own practice, and a couple other things were out there. I ended up starting my own practice from scratch in a small community in rural Kentucky, and that was a very interesting time for me.

Like you said, it's ... I guess for me it was the best of times, it was the worst of times. In many ways, I learned so much about what it takes to run a practice, but I also learned about the things that I'm good at, maybe the things I'm not so good at, because there are just so many challenges when you open a practice from scratch. As I understand, and know from knowing you personally and knowing your story, you decided to go from academics into a private practice situation where you were running your own show.

That is not for the faint of heart, but man, you've really seemed to make the transition look easy. From my side of the equation, I know how much hard work goes into that, I know it doesn't happen by accident. Walk me through that process of how you said, "Hey, I want to do something a little different, I want to be my own boss, I want to set the tone and set the culture." How did you go about that? How did you make that leap from academics to not just joining a practice, but starting a practice?

Dave: Sure. You know, in fairness, starting my own practice was actually the last thing I ever wanted to do. It was a long story made short, but I interviewed with just about everybody in the area where I was practicing at Bascom Palmer, before realizing that none of those situations were really going to be ideal for me, and I was basically forced into starting my own practice, because as you mentioned, practices don't necessarily value what ophthalmologists that are coming out are bringing to the table.

I wasn't coming right out of training, I was known in the area and I had several years under my belt where I'd been doing quite a bit, but nevertheless ... This goes out to all the residents, too, don't think just because you're finishing that you don't have an inherent value. You certainly do, and when you're looking for jobs, don't get too caught up with the money. When I counseled a lot of fellows who were graduating and resident, they seemed to get obsessed about the money and the contract, but it really depends on what you're looking for.

Do you want to work a couple days a week? Do you want to work full time? Do you want to become a partner? When you do get that attorney to look over your contract, remember that really, you only want to change about three things. You want to have one or two things that are your hard sticking points that you have to have changed, and then maybe one or maybe two other things that you'd like to get changed, and that's it, because a lawyer will go through a contract and change an "and" to an "and then" or "if" to an "if then" and they'll make a million little marks up most of the contract, then the old practice has to go and send that to an attorney. It runs up a lot of costs, and at the end of the day, really all you're trying to do is have an agreement that you're going to work together and things are going to grow. If you spend too much time going back and forth on the contract, it can really sour the relations. You really want to focus on what's important to you.

That being said, if it's a partnership, no one's going to offer you partnership in the contract, you just have to take it on faith that if things go well, it's going to work out. Again, for that 20/happy, it may not be financial for you, you may want to be in a certain location or in a certain type of practice. There are a lot of different decisions that go into it, and be sure to ask around and get the reputation of the practice. If this is a practice that's churned through a million doctors in the past, you're probably going to be another one of the doctors that gets churned through. That's not necessarily a bad thing, if you decide you want to stay in academics a few years, work for a practice for a few years, and then start your own thing, that's okay, and at the end of the day, that was the best situation for me.

Getting back to your point, Gary, starting your own practice is definitely not easy. I had no clue what I was doing to begin, I remember when I got into my new office, the realtor said, "Okay, now this is where you can put your occupancy license," and I said, "My what?" She kind of looked at me and said, "Your occupancy license, you can't see patients without an occupancy license." This is a week before I'm supposed to start seeing patients, so I had to run to the town hall and have the fire marshal come through and do a check on the unit and everything and all these little things that no one really tells you. Unfortunately there's no book or really great guide that's up to date on how to do it all.

Again, the big advice I would say is go to the internet, go to the cloud for help. I use Modernizing Medicine EMR, I use CareCloud practice management, everything's connected through electronic fund transfer, I use mytimestation.com for team clocking in and out. I use Intuit Quickbooks for payroll, I do Quickbooks for all my accounting, everything's managed in the computer and it's all automated. That definitely makes a lot of things easier in the long term, if you set things up like that.

Gary: Yeah, it's the old rotisserie chicken, set it and forget it. As many things as you can do that you can kind of have a one-time solution and minimal maintenance. I'm all about that.

When I was in private practice for myself, I did a lot of the same things. I really tried to outsource as many things, because you realize overhead just kills you. Every dollar you can save, and overhead is a dollar you can put in your pocket, and so having full-time employees, if they're not working all the time, really can run up your overhead. I used a billing company, I used a credentialing company because staying on all the plans and staying current is a huge thing and you know nothing about that when you're a resident, what it's like to make sure you're on all the panels. There are great consultants out there like John Pinto, he helped me a ton and really thankful to have people like that around.

You're exactly right, there's really no manual for doing this, and especially in this day and age with all the EMRs issues with meaningful use, with PQRS, with quality measures and all the things that are changing. You're always chasing something, you're always looking to hit a moving target, and I think that's one thing that, just like the occupancy license, you didn't even know sometimes what you don't know. That's really what can be so daunting about starting your own practice, I think.

In my situation, I actually migrated from starting my own practice, which was an adventure, actually to being a partner, or soon-to-be partner in a large practice in my area, and actually winding down the practice that I started. That's been a real great thing, but it's interesting just keying in on a couple things that you said. It sounds like one thing that you have really at the top of your priority list, and I compliment you on this because not everyone does, is really finding the right culture.

It sounds like the first practice you interviewed at, they showed their hand, or showed their true colors, but you got a sense that maybe this just isn't the right culture, and you knew where you were in academia, maybe at the time just wasn't the right culture for what you wanted to do. Despite interviewing, I'm sure, with a lot of successful other practices, you realized that in order to have the practice that was yours, you were going to have to really be the one to run it and then you can really drive the culture and drive the practice how you want.

Would you say that that may be the biggest benefit to all the hard work and all the blood sweat and tears that go into starting your own practice? At the end of the day, you get to be the one to drive the culture of how care is being performed.

Dave: Absolutely. I have to credit one of my good friends who's an ophthalmologist in Alpharetta, Georgia, who had started his own practice and raved about how wonderful it was and really put the bug in my ear because exactly as you put it, it's yours. It's your baby, and you watch it grow from nothing into this vibrant practice, and although it's tough at first, once you get it going, it's really not that bad and it's just so rewarding because as you said, you can make it however you want.

Coming out of academics, I was used to all the latest and greatest toys and technology. To go to a practice that had older equipment, that wasn't interested in upgrading, or wasn't interested in taking on EMR, little things like that were frustrating. I'd see these practices where they'd see 80 patients a day, and I didn't want to burn out either. I knew I didn't want these capitated plans, and there were a lot of different things you can manipulate if it's your own practice and you're willing to put the time in.

I remember another tidbit I got from Dave Roman, another great ophthalmologist. He had told me that you know, have the practice that you want to have. For example, if you really don't want to do lid tumors or what have you, then don't ever see lid tumors, always send them out. You want to see the patients for the practice you want to build. If you want to build a cornea practice, do cornea stuff, if you don't want to do retina long-term, then don't start doing retina. Really focus on what it is that you enjoy.

For me, that was mostly surgical anterior segment cornea, cataract, and everything else I pretty much referred out. In that way now, my practice is very big, but it's big with the stuff that I enjoy treating, and that also makes it a lot more enjoyable a day as well. Of course, when you start your own practice, you can hire your own people, so I've got a wonderful, wonderful staff, and that also makes the day just really fly by.

Gary: Well, I think that's so true. There's that whole 80/20 principle, and I've tried to follow those guidelines of figure out the things that are either making the most profit, or you're enjoying the most, and really try to maximize your time doing those activities. For me, that's really cataract surgery and lasik, and doing the surgical side of ophthalmology, anterior segment ophthalmology. I think it's interesting, I've really mirrored what you've done and really set limits on the kind of patients that I want to take care of and what I see.

I realize that I cannot be the best at every single surgical procedure, but I can be pretty good if I limit my practice to a few procedures where you're really getting a lot of volume, where you're getting a lot of exposure, and you really start honing in and refining your technique on those things. You feel really good when you take care of a patient with a complex situation and you realize maybe five years ago or you may not have been able to take care of them so well, and the benefit of really doing a lot of something has allowed you to grow in your breadth and your scope of taking care of complex issues like that.

One other issue that I think everybody has when whether they're either starting their own practice, or whether the managing partner or participating actively in running a practice is finding good help. That's always really a revolving issue, a recurring issue, so where do you go, Dave, when you need to find a new technician, an office manager, administrator, where do you find the best techs or people to help you in your office? Where have you had good success, we'd love to hear about it.

Dave: Yeah, so for me, the very first person I hired, Melissa, was one of the lead techs at Bascom Palmer, who was an all star who was frustrated with the system, as was I, and I got the feeling was interested in coming on board with me when I left. Maybe a month or two before I was out, I just kind of sought out her interest level and sure enough, she wanted to come on board, and that's worked out wonderful.

In the beginning it was literally the two of us, but only for a couple days because obviously you need at least two people when you're starting out besides yourself. I actually just asked a friend. I had a friend that worked int he ophthalmology field, that used to work as a technician, I said, "Hey do you know anyone out there that's looking for a job that does front desk stuff?" She recommended a friend that had some experience. I brought her on board, she recommended another friend that I brought on board about six months later, and she worked out great, I ended up hiring her sister.

Basically, word of mouth was pretty much how I assembled my entire team today, and with everyone the interviews lasted probably about one and a half minutes each, because I really feel like that first impression and that interaction is all you need, because everything else can be taught and trained, but you really need good personalities. The first thing I wonder is "Is this someone that's going to keep the chi with the rest of the practice?"

Gary: Yeah, that is super important. For people out there who might be listening and they're either coming out of residency or fellowship, or maybe they're in a job and they think, "I think I may be not in my right practice." What would you say are the number one things that you would recommend they look for in a new job, or maybe even writing a list of priorities? Where would you put priorities as people might be thinking or looking for a new job? I'd love to just hear your thoughts on where you start when you're thinking about making a change?

Dave: Sure. The reality is, I don't remember the exact specific, but it's way more than 50% of doctors end up leaving their first practice. There's nothing wrong with it if you feel like your practice is not working for you and you want to consider another venue, and I've gotten lots of emails from people who have read my articles about starting your own practice who voiced their frustrations with their current practices. It's not unreasonable, because the reality is a lot of practices that have been around for a long time, on the one hand, it's great because they have a nice infrastructure, people have been there a long time, they're well-known in the community, but on the flipside, it's an older practice and it may not be up to date with the newer technologies.

Again, not just things like EMR, but even a simple thing as a topographer or optical biometry. For someone coming out of training that's used to the latest and greatest, so to speak, they don't want to go to those features. That can be frustrating. A misconception with group practice is that you all work together, kind of simultaneously, it's almost as though you're all working in tandem; but for example, if you have a patient and you want your glaucoma or retina guy to see them, they don't necessarily want to see them the same day because of the billing issues. It's not quite as convenient as one may think.

When you're looking at your practice and the things you don't like about it, and you're thinking about leaving for another practice, remember the grass isn't always greener. If you don't like the practice because you don't like the location, that's easier. If you don't get along with some of your partners, again, that's easy. If there's something fundamental about the way the practice works, you have to really analyze how you can go about making it better, because the reality is, especially for a large practice, there's a lot that goes into it. You may run into those same situations in another large practice.

The majority of people that I know that have left one practice and are happy in their new environment are those that went out on their own, like you did, like I did. Because then you can really craft the practice, as we said before, in the way you want to do it, and you can really, if there's a particular thing you want to excel at or equipment or a culture you want to have, not just for your staff, but for your patients, you can do it all and even though you have 100% of the responsibility. That 100% control can also be a very nice thing when developing a dream practice.

Gary: Well, Dave, thank you so much for all your insights, for your courage, honestly, to take that leap of faith and go out there and show that in this day and age, it still can be done, and even done in a competitive environment, where you are down in south Florida, that's no easy place, perhaps, to start a new practice. I would just encourage people who are thinking about switching to a new practice or starting their own practice.

You have this one life to live, you have two hands, you have work to do, and if you're not happy in a practice, I would just really encourage people to start doing that due diligence of figuring out what it is that is making you unhappy, figuring out if the situation is solvable at your current practice, because as Dave said, the grass isn't always greener, and it's always easier to fix a problem at your current practice than full-sail switching.

Like Dave said also, almost all of us at some point are going to switch practices from the one we started with, and it's nothing to feel ashamed about, it's nothing to feel like you've failed. It's really just figuring out what is making you happy professionally, and pursuing that with laser-like focus.

With that being said, Dave, thank you so much for taking some time tonight and telling us your story and giving us some great pearls of wisdom. Thanks again.

Dave: Oh, my pleasure.

Gary: Dr. Goldman provided some great tips from a physician's perspective, but I thought it would also be beneficial to chat with Cristina Boggiano Lewis about her views on this topic. Cristina specializes in matching doctors with practices, so she is able to provide us with some valuable advice on finding the right job. We discuss vetting a practice, looking for red flags, and the importance of a long-term view on compensation.

Welcome to Ophthalmology off the Grid, this is Dr. Gary Wörtz, and today I have with me Cristina Boggiano Lewis, who is with Ophthalmology Associates, and Cristina has been kind enough to carve out a little time to talk to us about what she does in her world of essentially matchmaking, trying to take doctors and placing them in practices with needs, or trying to take practices that have openings and finding the right physician or actually other technical professionals to really stem the tide or fill those gaps.

Cristina, I just want to say thank you so much for, like I said, carving out time out of your busy schedule to give us a little bit of perspective on what makes a good match between a practice and a physician. With that, just I want to say thank you.

Cristina Boggiano Lewis: Oh, it's my pleasure, Dr. Wörtz, to be able to share any information I can for either side of either a practice that's looking or a physician candidate that is hoping to start or change their position.

Gary: This is usually that time of the year when residents, third-year residents or fellows are starting to look for new opportunities or perhaps even trying to start vetting contracts. It's also that time of the year when you're, in the north or northeast, when it's snowing and you start thinking about maybe moving on to greener pastures. That's not my situation, I'm at my perfect practice, but it's definitely taken me a little bit of time to get here, and I've been through some of those transition points in trying to find the right deal or the right practice to get started in.

The reality is, most ophthalmologists don't end up at their first practice, and I just wanted to get a little bit of your perspective, you've been doing this for gosh, what, almost 18 years now? Maybe you can give me some perspective to share with other folks out there. What's the right way to go about either finding a new associate, if you're in that position, or if you're on the doctor side of things, what's the best way to go after the right job for you?

Cristina: Wow. Well, those two thinks kind of mirror each other in a lot of ways. In regard to practices, yeah, where do they start? Once a practice kind of decides it’s financially viable to bring on a new physician, they've got to be more careful, I think, now than ever to conduct proper recruiting, retention practices. Not only to build that productive and committed staff, but also to avoid big turnover expenses. As you mentioned, it took you a couple of tries to really end up at the right place, and that's very common, as you may know, about 50% of physicians end up leaving their first position within the first two to three years.

Clearly defining that they're looking for a physician who is willing to perform the duties of the position is kind of the first step, but also kind of measuring, a practice needs to measure what they're looking for versus what they have to offer. Does the practice have interesting patients, collegial colleagues, is there a positive culture, are there any internal or external issues that kind of need to be worked on that might affect this new oncoming physician's success? Are there any staffing difficulties, financial challenges, what's the competition in the region? All these things need to be taken into consideration before a practice starts scrutinizing potential candidates, and looking at who their ideal candidate would be.

Gary: I definitely agree with that, it's sort of like making sure the place that you're trying to recruit someone to is a place that someone would want to come and stay. Trying to maybe, any significant hurdles that are there to progress, whether that's getting a new piece of equipment that's going to bring the practice more in line with the 21st century, or already going through EMR transitions before bringing on a new associate.

Really making sure you've got enough space and enough staff and enough cases, either surgical or clinical cases, that's going to keep a new ophthalmologist from twiddling their thumbs or wishing that they had gone to a more busy or productive place. I think those are all really key things that a practice needs to get their house in order before taking that next step of bringing in an associate. Would you agree with that?

Cristina: Absolutely, and just on the flipside, as a physician would start to look at potential opportunity out there, they too must know themselves, and really understand and take into consideration what their priorities are, whether, and the most common are as you may know, location, compensation and practice culture is increasingly important over the years, I've noticed. Really self-knowledge and understanding what your needs are and theirs are. It's hard to predict future circumstances, of course, but really having that introspective moment before you conduct a search to kind of start understanding what the ideal opportunity is for you.

Gary: Right. It's funny, Doug Katsev, who's just a fantastic surgeon out in Santa Barbara, California, he actually talked to me at a meeting when I was still a third-year resident, and I didn't realize how fortunate I was to get to talk to him at that time, but he gave me some great advice. I didn't follow the advice, but nevertheless, it was great advice that I'll pass on.

He said, "You know, Gary, you should find the place you want to live, and go there and build a practice. Either you join someone or you start from scratch, but you're not going to lose momentum from starting and stopping and starting back again from scratch." He said, "Find the place you want to live, and then just go and build a practice." That's easier said than done, especially if you're going to a real competitive market like desirable locations like Boca Raton or Palm Beach, or maybe over on the other side of the southwest coast of Florida, or if you're out in California near Santa Barbara.

Those are pretty competitive markets, but there's a lot of wisdom in what he said, because if you're in the right spot ... There's a lot of things you can change about your practice, but you can't pick it up and actually physically move it. I think location is really key for people to be introspective about and think, "I need to live in a place that I'm comfortable, a place that my family is going to thrive," if that's a priority. There's a lot of wisdom in that, and I thought I'd pass that along.

The other thing that I learned, perhaps the hard way, is it's much more important to look at the structure of the contract and what is promised based on production than what's guaranteed. I was really, at the beginning of my career, when I was a resident, I really wanted to look at what's the guaranteed contract salary, because I really felt like that would be the most important thing and what I realized was it's much more important to find a contract that's going to fairly treat you for your production. The more you produce that you get to participate in the upside of that in terms of bonus and making sure that if there are other things like optical or surgery center or any other perks, real estate, et cetera, that those things are extended to you as an opportunity, and that those things are more or less negotiated up front rather than a “let's wait and see” down the road.

What do you think about that, in terms of looking at the guaranteed money versus looking at a contract that really treats you fairly as you're able to produce?

Cristina: There are two parts to that, and I appreciate you bringing that up, because compensation isn't just what an initial offering is, it is potentially what you can make over the long term, especially if you feel that you've found the practice that you're going to stick with and eventually retire with.

Absolutely it's short-sighted to just solely consider that initial offer and guaranteed salary, so yes, it's important to discuss with the practice up front what the potential is for you. You can either do it with some of the existing docs in the practice that might have the same specialty that you do, or kind of doing a similar caseload to what potentially you could, and that will give you a view of the potential compensation and kind of trajectory of your career within a practice.

If there isn't someone like that to compare to, have that open discussion, see if the practice will be open about discussing not only the kind of formula that they'll be using, but understanding what the practice is doing financially and how and what these projects will be based on. Yes, absolutely, that's important on both sides, not only from a candidate's perspective to inquire about these kinds of things and understand how the practice works, but also for the practice to be open about it and communicate and share.

Also, for the practice to offer a feedback mechanism so that these discussions can be had, but of course numbers change, production changes, there are unperceived circumstances. As long as there's that communication and feedback between the practice and the new physician, I think that that kind ensures an opportunity for long-term commitment and growth for both sides.

Gary: Right. One other thing I want touch on a little bit, and this can be a little awkward sometimes, but for physicians that have been through maybe their fair share of practices or potentially practices that have had a number of associates come and go, how do you message that? What are the red flags that you look for, say you're a physician that's going to a practice that, maybe they have associates that have come and gone every couple of years.

Is that a red flag, potentially? What are the other red flags you might look at if you are maybe a young physician or someone who is trying to figure out, is this ... Am I getting myself into a situation that maybe others have gone before me, and it hasn't worked out? What are those red flags that you look for or you'd advice docs to look for, when they're looking for a new practice?

Cristina: Certainly asking all the questions you can during the interview process is important. Meeting the staff, potentially ... This is spending as much time as you can not only in the region, but meeting the different members of the staff and understanding if the practice culture is either a top-down management or if it's more of teamwork culture, and what of those do you prefer? Matching those two, certainly turnover and those issues will be discussed by the practice, and that's certainly a red flag, but if they're being addressed and normally it boils down sometimes to some administrative issue and practices are good at recognizing and working on those.

To be honest, over the years I've had ophthalmologists that understand that they're ... Even the personality and culture that they've created within their own practice is something that they're working on, and kind of putting ego to the side and explaining that to potential candidates is a conversation that has come up. As long as those things are addressed.

Physicians within, if it's a group practice, are really great recruiting tool, so if during the interview process, they are very involved and you can have one-on-one conversations with other members of the practice, they'll give you great insight to what it'll be like to fill similar shoes. That's important.

Gary: The other thing I'll mention, and this is just sort of an idea, and I'll get your feed back on this as well. You know, ophthalmology is really ... It's such a small world, we're always probably a phone call or two removed from any market that we want to get information on. It's not probably a bad idea to get, if you do have a friend in the region or a sales rep who has a friend, doing a little bit of due diligence on a practice and trying to get a little bit of perhaps an outside perspective on the things that are great about a practice, or maybe the things that haven't worked, or the reputation.

Maybe that would be a way to vet a practice, because we all like to put or paint the best picture of our situation, that's just human nature, but sometimes it's hard to get both sides of that story until you end up moving someplace. Sales reps may have a perspective, other physicians, be they ophthalmologists or perhaps ophthalmologists in a different sector. Maybe if you're a cataract guy, you may call the retina guys in that area to say, "Hey, tell me about this practice," or something along those lines.

Do you feel like that would be a fair way of going about some due diligence?

Cristina: Completely, and as well as developing your network, either whether it's during the conferences or even through social media and not only initiating those contacts, but really developing some relationships with them to access that kind of information is so important. Yes, I would encourage it and you're right. The ophthalmology world is small, and it keeps getting smaller because of these great tools that we have to connect to each other.

Gary: Yeah, absolutely. Well, to that end, why don't you give all of our listeners a way to contact you, maybe point them to your website or what's the best way, if they find themselves in this position where they're looking for a new practice or perhaps a practice is looking for a new physician. What's the best way for them to get ahold of you, Cristina?

Cristina: Certainly, yeah, they can give me a call, my number's 866-488-6363, and my website is theophthalmicassociates.com, so it's just all one word and I'm happy to help, even if someone isn't looking at a specific practice through me, is just looking for some advice or help during some contract negotiations. Whatever it is, I'm happy to assist and provide them benchmarks and ideas on what they can do to move forward, whether it's in their career or in their search.

Gary: Well, Cristina, once again, thank you so much for carving out a little bit of time to record this with us, we appreciate all your perspectives and wish you nothing but the best in this new year. Thank you so much.

Cristina: Thank you so much. I enjoyed listening to your story a little bit as well, and your insight. I appreciate the opportunity and the conversation.

Gary: Wonderful. This has been Ophthalmology off the Grid, with Dr. Gary Wörtz. Thank you.

Speaker 4: Ophthalmology off the Grid is supported by Ilevro, from Alcon.