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

Speaker 2: Welcome to another episode of Ophthalmology off the Grid’s Survive and Thrive series.

Today, the members of the Survive and Thrive board join Dr. Gary Wörtz for a discussion about one challenge that every young doctor is inevitably faced with: the job hunt.

Drs. Nandini Venkateswaran, Dagny Zhu, Cherie Fathy, and David Felsted talk about finding their first jobs, the ins and outs of contract negotiation, and all of the anxieties that can go along with this complicated process.

Coming up, on Off the Grid.

Speaker 2: Survive & Thrive is an independent program produced by Bryn Mawr Communications and supported by advertising from Johnson & Johnson Vision.

Gary: Welcome to Ophthalmology off the Grid, Survive and Thrive. This is Dr. Gary Wörtz, and I'm really excited about our conversation tonight. It's one that we all think about when we're residents, it can be a little anxiety-promoting in a lot of cases, but the topic tonight is the job hunt. Trying to find your first job, negotiating that first contract, figuring out how to do that, and all the pearls and pitfalls. I have four wonderful guest hosts with me tonight, as always. David Felsted, Nandini Venkateswaran, Dr. Cherie Fathy, and Dr. Dagny Zhu. You all, how's it going tonight? Are we getting ready for Christmas, David?

David Felsted, DO: Yeah.

Gary: You doing good buddy?

David: Kids are getting all geared up and ready.

Gary: Good, good.

David: Got some Legos under the tree for them.

Gary: Excellent, excellent. The job hunt is something that, when we're in residency, and again I'm getting a little beyond that, but the anxiety I remember very clearly. We've got one resident and a couple of young docs here, who are going to share their stories about their job hunt, Cherie is just sort of starting that process. But I'm going to pitch a crazy idea. I think it's almost impossible to know or to even forecast whether your first job is going to be one that is going to check all your boxes and going to be your forever home. We were talking earlier, and I said I think it's almost as likely as your first date becoming your spouse. You're just trying to figure out what things you're looking for, and it's really hard to know if, before you start at a place and you sign a contract, if that place is going to be the right fit.

So, I was saying I think there should almost be like an NBA draft, where residents get drafted, they get a 4-year contract, they sort of figure things out, and after that they become a free agent. I'm really just joking about that, but it's really, really hard I think for ophthalmology residents to determine their value, and to negotiate for that.

We're going to just talk about this from a lot of different angles. I want to start with Nandini. Nandini has recently finished her fellowship at Duke, she's now at Mass Eye and Ear, she stayed at academia. So Nandini, tell us a little bit about your job hunt, when you were a fellow or even as a resident. Just walk us through your process, what you were thinking and how things developed.

Nandini

Venkateswaran, MD: Yeah. I started my job hunt in fellowship. I know some people start towards the end of their third year of residency, but I didn't start thinking about it until probably 2 to 3 months into fellowship. I remember I started talking to my mentors around the end of August, 2 months into fellowship, about okay, what should I do, where should I apply, how does this whole process work? And I was picking the brains of all of my friends who had recently actually started their first 1 to 2 years of practice. For myself, I was pretty okay with either private or academic, I could very well see myself in either arena. So, I pretty much targeted to a few private practices, a few academic centers, and really leveraged the support of senior ophthalmologists that I knew who were looking for a position or were interested in hiring a cornea and refractive surgeon.

I went on a few interviews, got a sense of the different institutions, the different practices, and ultimately when it came down to my decision, that was the most challenging part. Because we're all used to being in a match, we make a list and fate has it as to where we're supposed to end up. And after the first time, we actually have a say in what we want and where we could potentially go.

One of my mentors gave me really good advice, he was like, "Think of three separate categories. One would be location and social life, the other would be professional growth, and the third would be finances and productivity. Make a one to three scale, and rank each of those categories for their number. And whichever places rises to the top is most likely what your gut is going for." I think each of those categories is so critical. When you think about location, once again in training we all go to residence, your fellowship, essentially where we match. That could be where we want to be geographically, or it could be different. So, this is your opportunity to perhaps be closer to family, closer to family and friends, be in a location where you can do more of your extra curriculars with like-minded individuals.

And from a professional growth standpoint, is the practice or the academic institution going to be giving you the opportunity that you're looking for. Your patient mix, your procedures that you want to perform, the new technologies that you could potentially implement. How can you grow, can you grow as a surgeon or clinician, can you expand your skill set? That's important for you to understand. And often financially, productivity becomes a really important question for you. A lot of us have loans, we have families to start bringing up, and can we be productive, can we make money? Are there opportunities for us to start to bring that bank account up? I think that's very important, understanding how that structure works for each of those job offers, and seeing which one aligns with your interests.

So, for me, ultimately Mass Eye and Ear ranked the highest in all of those categories. And I spent a lot of time thinking about it. I don't think there's any perfect answer. People were telling me 75 to 80% of people leave their first job. And we were talking about this before, as ophthalmologists, we're always striving to be the best. We want to make the most perfect decision, and we want to get it right on the first shot. It's like doing phaco and putting in a trifocal, you're not going to get that wrong. But it happens, and so I think it's completely OK to be unsure, even when you sign the contract. But if you in your heart feel like it was the best choice in that moment, and you make the best of it, and you make the best opportunities for yourself, you'll be very successful in any job.

Gary: I think those are really great points. I want to remind those who are tuning in through Facebook Live, if you have questions, please forward those to us. We will try to answer those online as best we can. But you bring up a really good point about those three different categories. If you're not just completely financially strapped, which coming out of residency I was married and I had two kids in private school actually, so I was actually paying private tuition while I was still taking on the debt of being a resident. And David can feel that pain, I'm sure, with four kids. So, everyone's story is a little bit different. But I didn't have the luxury of really thinking about professional development, or I kind of had location because I wanted to be around family, so that was important. But I was really just thinking about, how can I get my debt paid off, and how can I get financially free.

I think if that's not a huge motivating factor, if you're in a little bit different situation, I would actually probably put location number one and professional development opportunity number two. And then finances can be a third. It doesn't have to be like it's a horrible financial thing, but ultimately, when you're young and starting out, what you want most is a really nice guaranteed salary, that's the thing that you're starving for. But in terms of your long-term career prospects, it makes no sense to build a practice in a place that you don't want to be in. Every time you start over, and it'll happen a couple times so don't feel bad if you have to do this, but you're kind of really just starting from scratch. You're meeting the technicians again, you are meeting the practice manager, you're trying to figure out who you can trust, you're trying to figure out how you get on insurance plans. The transition of starting a new job, there's just a lot to that. So, you do want to minimize that if you can.

I think it's very important though that you're in a place that you want to be in, and then whatever you build, you at least are building in a place that you ultimately, it's not a non-starter to be like, "OK, I can live here." And then the money will come, especially if the professional development is there. Because as your skills improve, and broaden, and deepen, you're going to make more money, because you're going to really find a niche for yourself. David, your story is probably kind of similar to mine, and it's playing out in its first year right now, in a year of worldwide pandemic, which is insane, and I'm sorry. You've also had some family challenges that have helped or guided your decisions. I was just wondering if you'd be willing to share your story in terms of your journey, just like what Nandini did?

David: Yeah, absolutely. Thanks for asking. I'm a little bit different from all the panelists. I had my heart set on a refractive fellowship, and I wanted to do just as many procedures as possible and get proficient at a lot of different things. I wanted to work in industry. So, I started applying for all those things and looking at fellowships, and then I realized stacking up the economics, it just wasn't adding up. For four kids, a wife that stayed at home, we just needed to get out and make money. So, I decided well, I looked at other people, including you Gary, who have gone out and learned the refractive with a good mentor. So, I started looking for good mentors, in locations where I knew I could get busy quick. And as the year progressed, I realized that I needed to find someone that's going to really help me. Around November, we found somebody that we just thought this is perfect, it's a great fit, we're going to do well here. So, we signed the contract.

At that same time, my wife's brother developed GBM. They caught it early, they did a subtotal resection, and we thought, "OK, we've got some time on our hands, he's going to be around a little longer." And then December hit, right before Christmas, and he called and said he had a second recurrence, and this time it was rip-roaring. At that point, we really questioned where we were going to stay and live, and proximity to him was across the opposite side of the country. We just had a moment where we just decided you know what, this is not going to work for us. And this is a piece of advice I give to everyone that's going to sign a contract, is number one make sure you're signing it, that you know exactly what you're getting yourself into. And two, if you need to leave your contract, make sure that you have a good exit strategy. Make sure that the cancellation of that contract is going to be fairly easy for you, especially for your first contract.

The person that we signed with was very gracious to let us out, and to this day I still regard him very highly. And then we started looking around. So, January, this is right before COVID, I hasten my search. I looked around at the WHO data coming out and I realized this is something that could really change the world. I call everybody in my network, a lot of people through BMC included. My third-year mentor in medical school really helped me out, and he found somebody for me that was just fantastic. I'm going to name drop here, Dave McGarey in Flagstaff, Arizona is the man. He is my mentor, and I signed a contract with the company that I'm with, with him. I could just go on and on about this guy. Totally amazing, similar personality, interests. He's an excellent surgeon, does the full range of refractive and MIGS, is a family guy with three kids, and he likes to heli-ski. So, I said, "Sign me up, this is it."

On March 8 I signed my contract, and March 11 they executed it, and that was the day that the WHO declared COVID a pandemic, and you guys know the story from there. I think the fall-out after was what was really painful to watch. A lot of my friends and people ahead of me that were even in fellowship were starting to get their contracts pulled. And that was really painful to have people call me and say, "Hey, what are you doing? How do I navigate this, my contract just got ripped from me. I don't have a job anymore, and I'm graduating in a month or two. What do I do?" So, people who are in residency, especially if you have families and you're the single income earner, the one piece of advice I can give you at this point is make sure you have some income diversification to rely on, especially during this time of COVID. I'm not sure how the contracts have been going since this event, but I know it's harder to get a job now.

As Gary and Nandini mentioned, location, location, location. And if you have a significant other, make sure they're going to be happy there, because that is the number one reason why people leave their job in the first 2 years is their SO is unhappy. And lastly, are you going to be happy there too with autonomy, the pay structure, your non-compete, your benefits, auxiliary staff, your patient population. Always have a lawyer ensure that your contract is fair. I paid for a service to look at not only my contract, but my compensation as well. So those are my key points.

Gary: Yeah. The problem I've always had, until my recent contract, which was fantastic, when I was younger there was always something in the contract that I was like, "Well, this isn't great, but I think it's going to work out, so it's probably not a big deal. And I really want this job, and they're not going to budge with it, so I guess I'll just sign it." That is the worst thing you can do. If there's something in the contract that you don't like, you have to really be willing to address it. You have to go into a contract with this feeling or this reality that there's a chance this doesn't work out, and there's a chance you're going to have to get out of this contract one way or another. So, it's really important that there's not something in there that just doesn't sit right with you.

You've got to figure out what your deal breakers are, I'm not saying don't be unreasonable with your requests, but you have to understand that if there's something in that contract that you know you can't live up to, or if it goes sideways, if you can't live with the non-compete, or whatever it is, you just have to understand that that's going to be a negative in the future, or a real possible liability.

Real quick, I want to thank our sponsors, Johnson & Johnson Surgical Vision, they've been a wonderful sponsor of this program and we couldn't do it without them. So, I want to say a special thanks to Johnson and Johnson Surgical Vision. And also, we do have a couple of questions. So, before we get on to Dagny and Cherie's stories, I want to answer a couple of these questions, or we all can together. The first question is coming in anonymously, which is fine, says, "How do you learn about private practice opportunities?" This one, I think a lot of it is really word of mouth. That's a really hard thing to tell people, because it's like, "Well, if you know about it, you know about it, if you don't, you don't."

But for example, Neda Shamie is just a great friend to me in ophthalmology. She's really one of the most fantastic and surgeons and people that I know. She emailed me, along with a group of friends, just a couple days ago and said, "I'm looking for a new partner. They need to be about 1 to 4 years out, they need to be willing to do cornea, refractive, cataract, etc., etc." Now in my mind, I am thinking, OK, if I meet anybody who's in that position, who's looking for possibly the best job on the planet, in my opinion, to go and work with Neda, because she's that great, and Dr. Maloney is just a giant in the field of refractive, I'm going to spread the word. And I guess now, by way of this podcast, I am also now spreading this word. So, it's Maloney-Shamie Vision in L.A., fantastic opportunity.

But it's just really having conversations within your network. So, if you're a resident, usually your program director has contacts with other program directors or other private practice people. Residents who have gone before you are usually out somewhere, and sometimes residents will go join a practice where something is going really well.

And then if you are in a fellowship, I think that's one of the really big benefits of doing a fellowship, although I did not myself do a fellowship, your fellowship director really probably has the ear of a lot of really top-notch surgeons around the country, and they can really place you with a high recommendation in a great situation.

Anyone have any comments on that? Dagny, what about you? Do you have any thoughts on how you find private practice opportunities?

Dagny Zhu, MD: Yeah, so word of mouth definitely, through your network and mentors. Also, reps, I think they know a lot of what's going on in your area. I know a lot of people found jobs through their reps. I actually signed up for a lot of recruiter databases, so I got a lot of emails from recruiters on a daily basis, telling me this job is open in this area that you want. And actually, that's how I found the position that I'm in right now. A lot of other things were just from friends. I had a Kaiser position that was made available to me through a co-resident who was friends with someone who was working there. They had an opening, and they didn't even advertise it to anybody, it was all under the radar. That was the only reason I found out about it, so I went into an interview with very few other people.

And I don't know if you guys know, but in California Kaiser is really hot, it's really hard to find a job with Kaiser, and a lot of people actually really love working for Kaiser. So, I was excited for the opportunity. That was literally just a word of mouth, personal connection kind of thing. A lot of the best jobs are not going to be advertised. By the time it hits a website or a listing where everyone sees it, it's probably already filled.

Gary: That's very true, that's very true.

Nandini: Yeah, I remember I got an email from Dr. Bill Trattler, because my senior colleague Katie Hatch had emailed the Cedars Aspens Group about looking for a faculty member to join her satellite practice at Mass Eye and Ear. That's how it all started. He forwarded me an email, and then I called her, and the rest was history. So, word of mouth I think it huge. Asking your fellowship mentors, your residency director mentor. The American Academy of Ophthalmology job board is also great, just kind of filtering through those different opportunities based on location, sub-specialty. And aside from private practice, for academics the AUPO website also posts a lot of academic job opportunities that are constantly updated, so that's also a fantastic resource if you're looking for academic positions as well.

Gary: I'll also say, and I'm a little biased because I love MillennialEYE, MillennialEYE has been really great to me. But if I were a senior resident, looking to get connected and finding a great job, I think probably the best thing you could do would be go to MillennialEYE. Go there, attend, meet Tammy and Callan and Ranna, and all the ophthalmologists. Present a poster, it's very likely that you'll get a free trip somewhere if you have a nice poster presentation. And get connected, because getting connected is not as hard as you think. But once it happens, so many doors start opening up, and that's probably the best way to find a job is just by the pool, at MillennialEYE, talking to someone, and someone knows someone who needs someone to join their practice. It's a weird networking thing, but I swear that's probably the best advice I can give.

Second question is coming in from Elizabeth…and I'm just going to read this, "How far along in the process do you go with your cohort of job opportunities before you decide between options?" So, this is kind of about keeping irons in the fire. "Do you wait until you get a contract? I'm currently deciding between multiple options, it's hard to know if/when to turn down a possibility given that I know multiple people are also looking at each of these jobs." Gosh, that's a tough question. Dagny, I want your advice on this. I think she brings up a really good point, and it sounds like you were in a similar situation maybe.

Dagny: Yes, yes, yes. That was probably me 3 years ago. I went without a job for 9 months after fellowship because I was still looking for that prize job in Southern California, where my family was, where I wanted to be, and where the market was just really, really tough. Really hard to find a job. So, I was actually at a point where I had potential offers from Kaiser, a private practice group, and the position that I'm in right now. I can't tell you, there's no straightforward answer. There's really no magic crystal ball to know which route you're going to take, and how long each option you have available to you to make that decision. Eventually, at some point, each position will tell you, will give you a deadline where they want to hear a response by. That's what happened with me with Kaiser, they're like, "I want to hear by tomorrow." And I ended up giving them the no. It was really sad, but at that point I weighed all my options and I told them no.

And the private practice job I was going to take, after turning down Kaiser, they ended up ghosting me, which was very unexpected. And that's something that you might come across as you're reviewing job contracts. Some places, they're going to be more flexible to hearing your wishes, and some places won't be. And they won't necessarily be transparent about it, and you may ask for a little bit which you don't think is a big deal, and they may not respond to you and may ghost you altogether. So that did actually happen to me, which is kind of crazy. In retrospect, it all happened, I'm really happy where I am now, and I'm so glad that I had the opportunity, so it all happened for a good reason, but it can be really tough to be in that position. You kind of just have to weigh all your options and just make the best choice at that moment.

Gary: Yeah. I look at this as like The Bachelor. There's so many roses to give out. But I think ultimately, the only way to win The Bachelor, and my wife has made me watch so many seasons of this, I'm just nauseated talking about it, you have to pick the best candidate at the beginning, and just eliminate all other options. Because it's really this paradox of choice. Everything looks attractive, everything looks shiny and good in one way or another. But if you try to split your attention between multiple suitors, you can end up losing out on all of them.

Dagny: Absolutely.

Gary: So, I would say really, really, really try to figure out which job scratches whatever your biggest itch is. Is it location, is it surgical volume, is it practice development, mentorship? And in a weird way, bonus structure. I found that the best thing you negotiate is a good production bonus, rather than a guaranteed salary, because that really aligns your interest with your employer. They're not on the hook for a whole lot to cover your salary, and they know that you're going to be hungry to do a lot of work, and that's a really good way to earn your value. So, I think a really good bonus structure can be a carrot that is something to look at very strongly.

All right. We have come to the point where it is time for Cherie to update us on the job search, to give us a little bit of a peek into what it's like being a senior resident, going through this process in real time. Cherie, lay it on us.

Cherie Fathy, MD: Yeah, it's stressful. Thankfully, hopefully we find out in a few weeks, but hopefully I'll have a year buffer with fellowship. But I am exactly where you were Gary, location is my number one issue. My fiancé’s in D.C., and we're done with long distance. We did it. Been there, done that. It's now time to just be together. So, I have made that very apparent to my attendings at Wills and to anyone who will have my ear. And then I've actually been cold calling practices. So even if they're not advertising a position, I will call them and just say, "Hey, I am a senior resident at Wills, I'm hoping to do fellowship in cornea, and I am interested in joining your practice, or would just love to talk to you more about the practice." Some of them are not looking for positions just yet, some of them are saying, "Yeah, I'm actually thinking of retiring in a year or two so let's keep the conversation line open."

I think it's a little bit early to really seal anything down unless I were to find the perfect program. So, I'm mostly just having conversations at this point, and it's very atypical without these in-person conferences. A lot of what we're doing is virtual, which I think is a little bit of a disadvantage, because you can't have that in-person connection. But I've set up a few phone calls, have made my attendings aware, and then have also just been researching how to set up a good contract. The AAO has actually a contract negotiation class by Jill Maher. They're very short, quick lessons on what to look for, so things that I wouldn't have thought about like what your patient population will be, how much of the payer structure are you set up for, are you going to be seeing primarily Medicaid patients, and how does that impact, like you were saying, your productivity structure. And then how to look at things like buying into a practice, what are these questions that you should be asking.

So, I'm trying to gear myself up with all that knowledge so that when I do have more serious conversations, it's kind of already natural to me, and I know what I'm talking about kind of thing. Because this is my first time applying for a real job, which is really embarrassing.

Gary: Crazy. I think you bring up a really good point though, of if you have a location that you know you want to be in, just cold-calling practices, that is so smart. Because like I said, there's a lot of practices out there that are putting feelers out just through their own network. But if your network doesn't overlap with their network, they're not going to know about you and you're not going to know about them, unless you are proactive. They're not going to call every resident who's a fourth year to see if they're interested. But if you've got that area locked down that you want to be there, just cold call them. Start a database, Excel spread sheet of the phone number, who you talked to, what their time frame is, pros, cons, just start your database and work your contacts. I think that's a fantastic idea.

One thing I was thinking about as we were talking about the job hunt is it's really a match between what you can bring to the table, and how can the practice, what do they bring to the table? How can they forward your career goals and help develop you as an ophthalmologist? So, I think some of the things you should think about in terms of what you bring to the table. I thought about four categories, and you guys are welcome to add to this, or comment. But I think the worst thing is if the practice is just looking for someone to offload the things they don't want to do. You want to do surgery, you want to do advanced things, you want to do refractive. If they are saying, "Hey, we want you to now take all the dry eye patients," which at one point in my life I did a lot of dry eye and ended up loving it as a matter of fact, it's true.

But not everybody is wanting to get on a fellowship, or residency, and then just start dealing with all the low acuity patients. Or just traveling to satellites that the senior partner does not want to travel to. So now you're on the road 4bdays a week. Instead of putting in time in clinic, you're doing a lot of windshield time. Probably the best thing, or one of the best things would be if the practice is so busy that they just cannot accommodate all the patients. And they want to grow, but they cannot grow because they are stretched so thin with what they have. So, bringing in another provider, you're going to lower their overhead, you're going to be productive, you're going to add to the bottom line, you're going to be busy instantly. That is one of the very best things that a practice can offer.

Also, if you're in an area where there's not a glaucoma specialist, or plastics, or cornea and there's a need for that, you can actually bring a new service line to the practice, and that can be a whole new revenue stream that they've never been able to tap into. So that's something you can bring to the table. And then the obvious one that we all think about is there's a senior partner, he or she is wanting to eventually retire, they need to transition their practice to someone, and they need a buy-out strategy, and you become that buy-out strategy. That can be a little tricky, because a lot of times you get there and they say they're leaving, and then they don't leave, they just stay on forever. Which isn't always a bad thing, but it sometimes can be a little frustrating.

And then how can a practice, that's kind of what you're bringing to the table to help the practice, and how can the practice help you? Some of the areas I've thought of are mentorship and skill development, so kind of like having someone in the practice who's willing to show you, sort of peek behind the curtain, all the tricks that they've learned and developed over the years. Whether that's refractive, or MIGS, or cornea stuff, multifocals, talking to patients, handling complications, all the things that we kind of know how to do, but maybe we're not experts at, you have a mentor to help you with that. I think that's super important.

Academic fulfillment and research. Nandini, hopefully you're getting some dedicated research time, or at some point that will be the case, because in academia doing research is super important. And then training resident and fellows, just the fulfillment of being with that next generation and actually teaching. We talked about financial goals, location, and I think, ultimately, it's finding the right match between what you bring to the table, and then what the practice can bring to the table for you. Hopefully that matches. Do you guys have any other categories or thoughts on what you bring to the table, or what a practice can do for you?

Nandini: I think you have to have some time for introspection to know how to advocate for yourself, because everyone who's applying is going to be fantastic, and you really need to know how to articulate your particular strength. Are you going to be that clinician who can see a ton of patients and bring a ton of revenue, or can you obtain grad funding in an academic setting and support yourself in that venture? You have to just be able to show them what you can add to their practice that they don't already have. For me it was that I'm really proficient in DMEK, and I really like endothelial keratoplasty, I like complex anterior segment, but I'm also super excited about refractive cataract surgery and laser vision correction. So, I could offload some of those other patients from other colleagues in my practice, and off that skill set. I think just being able to figure out where you fit in that puzzle is really critical.

And I think having a senior partner, even as David alluded to, is so important. Because even for me, one of my goals is to transition to SMILE. We have the Visimax laser at Mass Eye and Ear, so that's a way for me to expand my skill set, and I have mentors there who can teach me that. So that's a way that I can grow. And institutions are excited about individuals who want to try new things, and who want to continue to bring new perspectives and technologies. That's a way to advocate for yourself.

Just for academic contracts, as you mentioned, asking for that dedicated research time or academic time is really important. I do have that built into my contract, I'm 80% clinical, 20% research, so that's an important thing to ask for. And also, knowing that you have resources. Do you have a set research fund, fund to help you travel to meetings? Do you have a research coordinator, a surgical coordinator, technicians, etc.? All that's going to make your life so much easier in practice, or as you start to build clinical studies, so really considering those in your contract is key.

Dagny: Everything you listed off, I can remember that that happened to me at this job interview or that job interview. For example, finding a practice that'll let you do the cases that you want rather than throwing you their throw-aways. I can think of so many interviews I had where that red flag came up for me, because they would ask me, "What is it that you want to do?" I would say, "Well, I would love to be able to do LASIK, refractive cases, premium lenses," and he literally said to me, "Oh, so you want to do everything that I do." And I was like, "Um, maybe?" So already, in the back of my head I knew that okay, so these were the cases that he was going to do for a long time, and he was going to give me other cases. So that was kind of a red flag where I knew OK, I need to find a place that will allow me to do the types of cases that I wanted to do.

You end up otherwise getting sucked into a lot of places that unfortunately you're never able to grow because your senior partner there doesn't allow you to grow. So, I think it's really important, when you go in these interviews, to listen for things like that. Exactly what you said Gary. A lot of the other things that you'll hear sometimes about whether a place is going to offer you partnership or not is they'll tell you that oh, the last person... You always want to ask, "Why did the last person leave?" That's a great question to ask. And you want to follow up with them to hear about their experience of when they were working there. And a lot of the times they'll tell you, "Well, that person just couldn't step up to the plate, partnership is always available but as long as you hit these milestones, and that person just couldn't live up to those expectations. But you're different, I see that, you'll be able to reach that position soon enough."

Again, those are things that you kind of have to listen for when you're on your interviews. Because ultimately you want to find a place that you can grow long term, and you want to see that it's possible to climb up in that practice that you want to be. So, it just brought back a lot of memories, a lot of things that you mentioned Gary.

Gary: I think we've been down similar roads, it sounds like. The thing I was bad at, I think, early in my career, I was bad at being honest I think, and really listening with honest ears. Or listening for red flags. I was pretty good at convincing myself, "Oh, well it just didn't work out." Like you said, they just couldn't step up to the plate, I'm different, it's going to be different for me. Clearly, I'm amazing, I know I'm amazing, I know I'll be great. Or yeah, he doesn't really want me to do refractive cases, but I'll be able to generate those on my own. You can justify things in your mind, and tell yourself what you want to hear, but your future happiness really depends on how willing you are to be really transparent and honest with the practice that's interviewing you. And also, listening for the cues that they're giving to you about what they're going to be expecting, and what they're not going to do for you.

Dagny: Absolutely.

Gary: I feel like we're really, or at least I was, because of the situation I was in, I really just wanted to see the rosy side of things. I really didn't want to look at the potential pitfalls. And it's only important that you find the pitfalls. The good stuff, if it's good, it'll be fine, no problem. But you really have to be listening for those red flags or yellow flags, and you have to follow up on that. You can't just be like, "Oh, sweep it under the rug, I'm sure it'll be fine, everything's going to be good, it'll all work out." If you go into a job like that, it's very likely that at some point, when you have options, when you have better options, you'll exercise those options. And that's okay. Sometimes you just have to take a job because you've got to put food on the table, and that's all right as well.

David, any thoughts on bringing something to the table, or a practice helping you as well?

David: No, as you were saying that I sort of looked at it as the glass is half full.

Gary: Right, the optimist.

David: And that's not me. I'm actually the opposite usually. In the end, this was a very stressful time for me. But I think people coming out need to realize this is not a forever choice. You've got options in the future, and there's so many great ways to be employed in ophthalmology. And at the end of the day, we're doing all the same thing. We're taking care of people, we're helping them see better, and that's going to be a part of every job. I don't know where my employment's going to take me in the future, I'm happy where I'm at right now, and I'm excited for where my future may be. And I think episodes like this are really paramount to learn from mistakes of others, but I realize I'm going to make mistakes going forward, and it's just a natural part of career progression and development. You just have to tackle those one at a time as they come up.

I think my biggest takeaway from what you guys have said, and from what I've learned, is just find the people that you jive with. You're going to be happy in your job if you're in a great location with great people. And I feel like there's so many ways to make money in ophthalmology, and at the end of the day I think we're all going to get fairly compensated. But yeah, those are my big things.

Dagny: I think there's really no perfect job. There's not going to be something that checks every single one of your boxes. So, you really have to ask yourself what your priorities are, what your walkaways are, and if you can find something that generally matches that. Forget all the little stuff, you don't have to negotiate every single line of a contract. Like I want the best computer, or laptop in my office provided. Just focus on the big picture, and also, I guess just know that whatever job you take, you'll learn something from it. It'll be a good experience, and you can use that for your next position when something better opens up. So it's not the end of the road, this is my only decision I got, it's make or break. Just choose the best that you have based on what it is that you find most important for yourself.

Gary: Yeah. And remember when you're negotiating, that the practice is taking a risk on you also. It's not like the practice is just made of gold and they can afford to take a big flier and guarantee a huge salary, and give you all this time off, and all that stuff. Your first year in practice, it's possible that they lose money on you. It's also possible they make a whole lot of money off you, and it's highly variable. But they are taking a risk, so I think it's important that as new residents coming out, think about that. Just recognize that it might take 2 or 3 years of working in a practice for the practice to break even on you. So, they want to make sure that they're getting someone who is really hard working, trustworthy, knows their limitations, willing to ask for help, kind of all the things that make a good resident make a good private practice doc. So, just be mindful of that.

I'm kind of on the other side of that now as partner, and in the near future looking for another partner. I'm thinking about the last thing I want is for some resident to come in and tell me how much vacation time they want, and they want a company car, and they want a half million dollars. I'm not here for that. Part of me is like, "All right, I want to give you a fair contract, it's got to be fair, but I'm taking a risk on you, you're taking a little risk on me." I think on both sides you've got to just kind of be reasonable. I just have to represent that side that I now am awkwardly finding myself in as the partner.

But I've said this for a long time too, I do feel like there should be like a Geneva Convention for ophthalmology contracts, where it's like, "We hereby agree to pay X, and the non-compete will be this." And you have to have a Geneva Convention contract, or you know it's like across the board there's certain things. You won't torture them, there's a certain amount of vacation. There should be some standard where everyone can say, "OK, yeah we follow the Geneva Convention in ophthalmology."

Nandini: Kaiser worked that way. It's the same for everyone, there's no negotiation.

Gary: Yeah, well…

Nandini: In some ways it makes it easier, right?

Gary: Yeah, I guess take it or leave it. I just want to thank you guys and gals for being a part of this this year. This is our last episode for the year, and it's been so fun for me to get to know you and your personalities. And you've contributed so much to the color and the depth and the perspective has been so broadened from what each of you have brought. It's been a sincere honor to have you guys as my co-hosts on Ophthalmology off the Grid Survive and Thrive. With that, I think we'll just leave it there. Hopefully we'll all have a happy holiday and a wonderful new year.

Maybe 2021 can be the 2020 we all had hoped for. So we can pray for vaccines and meeting each other in person and just never Zooming ever again, the rest of our lives. Does that sound good?

Cherie: Perfect, sign me up.

Nandini: That's a plan.

Gary: OK, sounds good.

Nandini: It's been so fun to be part of this. I really hope that we've shared some pearls, and I've learned so much from each and every one of you listening to everything.

Gary: Absolutely.

Cherie: Thanks, you guys.

Gary: Any final thoughts, Cherie?

Cherie: No, I agree. Thank you so much, I've learned so much just being a part of this, it's been a highlight of my residency experience for sure. I feel like I have three very close new friends, whether you guys consider me my friend or not, you're my friend so I really appreciate it, and mentors in the field, and I really appreciated your perspectives, I feel very fortunate.

Gary: Absolutely. David or Dagny, you guys want to sign us off? Any thoughts?

David: I just hope we can do more of this in the future guys. It's been so fun. Like you guys have said, we've learned so much from each other, and it's going to be exciting to see where we all end up doing things, and what we end up becoming in the future. Thank you for mentoring me in this wonderful journey.

Dagny: Yeah, thank you Gary.

Gary: All right Dagny, take us home.

Dagny: I was just going to say thank you Gary for all your wisdom and insights that you every time. I learn so much just from being on here with you, and I'm so grateful to share it with the whole panel, you guys all provide so much insight. It's just an honor for me, so thank you so much.

Gary: Yeah. We've got a lot to be thankful for. Been a tough year, but next one's coming, so get ready. All right, this has been Ophthalmology off the Grid Survive and Thrive with Dr. Gary Wörtz. Until next time.

Speaker 2: Thank you to our contributors for sharing their personal stories and advice on this episode of the Survive and Thrive series.

This has been Ophthalmology off the Grid. Until next time.

Speaker 2: Survive & Thrive is an independent program produced by Bryn Mawr Communications and supported by advertising from Johnson & Johnson Vision.

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