Off the Grid LIVE

Host Gary Wörtz, MD, sits down with Blake Williamson, MD, MPH, at MillennialEYE Live for another live Ophthalmology off the Grid interview. Dr. Williamson, a legacy ophthalmologist in practice with his father, talks about the challenges he faced early on as a student, what it means to be a millennial in the field, and the pros and cons of working with family.

Gary Wörtz: 00:00 Open, outspoken, it's Ophthalmology off the Grid, an honest look at controversial topics in the field. I'm Gary Wörtz.

This year at MillennialEYE Live, I took the opportunity to conduct another live Ophthalmology off the Grid interview. In thinking of guests to sit down with at this progressive venue, I thought about who embodies that millennial spirit, who embraces new technology, rolls with the changing landscape of medical practice, and approaches ophthalmology with passion and enthusiasm through and through. My mind went instantly to Dr. Blake Williamson. For those who don't have the privilege of knowing Blake, he's a legacy ophthalmologist in practice in Louisiana with his father, Dr. Charles Williamson. But Blake has truly carved out his own path in this field. An expert cataract and refractive surgeon, a dedicated young father of two, a skilled water skier and radio DJ, and an all-around great guy, Blake is really a true trailblazer. So, with that, let's hear from Blake.

Speaker 2: 01:13 Ophthalmology off the Grid is an independent podcast supported with advertising by Alcon.

Gary: 01:20 I think we all know that music, if you don't, it is the signal that we are here for the second live Ophthalmology off the Grid. And I am so excited to have this guy sitting next to me today. Last year we had Ike Ahmed, and we had a fantastic time talking. And basically, the whole genesis of Ophthalmology off the Grid, for those you who are not familiar with it, is a lot of the best content, a lot of the best pearls that I've ever come up with, unfortunately haven't happened in a setting like this. We do get good ideas with lecture, but a lot of times, the best conversations happen, actually, out there. They happen, you know, basically around the coffee pot, they happen around, you know, just having, a sit-down conversation in the halls of the conference hall.

So, the whole idea of Ophthalmology off the Grid is basically having real conversations between friends and colleagues that mimic those things, but actually getting a chance to share that with folks who are interested in ophthalmology. So that aside, I'm so excited Blake for you to be the second guest on Ophthalmology off the Grid live. This will actually be going live as a podcast very shortly after this. So, we can listen to it again if we want to. Blake and I met, I think, at ACES. Is this right? I think it was ACES a couple of years ago in Cancun. That's a fantastic meeting, if you haven't had a chance, the Caribbean Eye Meeting. I was so impressed with Blake's energy, enthusiasm, and willingness to actually just put himself out there right from the beginning, right when we first met.

And I knew from the start that there was something really special out Blake, and I knew that I needed to get to know him. So, over the past couple of years we've really gotten to know each other well. We've actually gone to the racetrack together at Keeneland in Lexington, we've shared some pretty fun experiences. So, Blake, thank you for being willing to open up and be our second Ophthalmology off the Grid live member today.

Blake Williamson: 03:28 Thank you very much Gary, and I remember clearly at that ACES meeting Caribbean Eye, like, stalking you. The reason why is because you and your partner made this amazing cataract video that was basically educating your patients about the benefits of femtosecond laser and about your practice and how you like to serve your patients there, and I thought it was absolutely amazing. I was like, would you mind if I just, like, copied that exactly? And in fact, we did, and you were so kind to share that with me.

Gary: 03:57 So, I think that's actually a great place to start. I joined my practice that I'm in currently about 4.5 years ago, and I joined an ophthalmologist who is—he is evergreen. He's in his 60s, but is always coming up with new ideas, new innovations. So, he is both old school and new school, I feel like, kind of a renaissance man. You had a similar experience. You went into a family practice with family members. But, the question I have for you that I really want to get your take on is, MillennialEYE is all about, what are the needs of millennial ophthalmologists and how do we incorporate new technology, and I think that's sort of the impetus for why a lot of us are here.

But, I think we have to start with, what did the old guys get right? The old guys and gals, the real pillars of our profession, what have they gotten right over the years? You know, we can't shift all the way to the new paradigm without giving a little bit of credit for what they did well. And I want to get your take on that because you've seen it for a while.

Blake: 05:00 Yeah, I've seen both sides. And the truth is, they got and still get a lot right. You know, there's a lot of differences between boomers and millennials. When I think about communication, when I think about willingness to adopt new technology, when I think about creativity, especially in the OR, you know, there's all kinds of different things, and work life balance, too. You know, take the first thing. If you're thinking about communication, I think millennials are really, really good at communicating, you know, we like to over communicate, right?

And that's in all facets. It's not just to each other, but it's to our patients, too. For instance, on the day of surgery, I call every single one of my patients. The old generation probably weren't going to do that. When it comes to staff, when I hear a problem, I want to fix it right away. Whereas, sort of the old thinking was, well, you reported to this person, and it goes up this tree—

Gary: 05:59 The chain of command.

Blake: 06:00 Yeah. I want to solve it right then, so that's different. But then you have other things, like creativity. So, boomers, there were no fellowships back then, right? Or if there were, there were very few, right? Now, there's fellowships for like, refractive cataract surgery, like just that procedure. So, that's both good and bad. But, I find that one thing that, for instance, someone like my dad has is that they had to solve problems. They had to think on their feet, because technology didn't always work. So, they kind of have that notch in the belt for us.

Then I'd also say, the work life balance thing, they were trailblazers, they had to make things work. They had to think on their feet, do all these things, and it kind of took away from their family and from their other pursuits. And I think that millennials are a little better at that than they are. We understand that it's important to have other interests, because when you're doing other things that are not ophthalmology, that's when ideas happen, right? When you're doing other things.

Gary: 07:05 Absolutely. And I also have to say, the previous generation of ophthalmologists had to go through an incredible transition between extracap to phaco. And a lot of us, we hear these stories about going from extra cap to phaco, and it seems like everyone who went through that transition, it was really impactful. They want to tell that story, and I feel like I've heard it so many times. I'll be like, "Yeah, okay, you went from extracap to phaco. I get it. I mean, we all make changes." But, I think it was like a real paradigm shift, and it really calibrated their mind toward, we can do things better, there is a possibility that technology, if we just, if we invest in it and we try it, we can actually make a difference in our patients. So, we go from extracap to phaco, we go from RK to PRK to LASIK.

We have all these advances in technology and imaging, all the way through pharmaceuticals—I think we have to give them a lot of credit for giving us an environment where new technology in our field is generally embraced. Not all the time, and things find their place, but I feel like they created a culture that is very special, and we need to be very thankful that they've given us a profession in which innovation and new technology is something that is really looked at with a lot of favor.

Blake: 08:31 My biggest thing is respect. Right? People who are a generation above, or two generations above, they may treat you like a pal and a friend, but it's still like, I'll still say doc, you know what I mean? Like, I don't even call them by their first name. You know? It's things like that.

Their experiences kind of affect the willingness to adopt new technology. People say, “Oh, well, you know, the millennials are much more willing to adopt it early,” but that's because, if you think about how we think, so I’m a millennial, I think about right now, right? Whereas Gen Xers, they kind of think about the future, and baby boomers think about the past, because they have the past to think on. So, they use those experiences to sort of—they're more educated about it, right? They're a little bit more, they have had more pause. It's a little bit more thought out, which could be a good thing in certain respects.

Gary: 09:20 Yeah. And I'll say this, this probably ages me a little bit, but, when I came out of residency I was really confident that everything I was doing and every thought I had was really correct. I was very confident in my ability to always make the right decision. The further I get away from that, the older I get, the less confident I become, because I've made mistakes, and I recognize that I have the ability to delude myself into thinking that this technology or this procedure is right.

And having a senior partner who is just fantastic and really wise, you know, we can use that wisdom, it's available to us. If you have a senior partner or colleague that's a little bit older, don't just disregard the wisdom that is gained by the years of experience. So, I think with the energy of youth, and the wisdom of experience, I think that's like the perfect combination.

Blake: 10:17 Agree.

Gary: 10:17 I want to talk a little bit about your road to becoming an ophthalmologist. My road was not smooth at all. It almost died a quick death before it even started, and I won't necessarily get into that unless you want me to, but I want to know about what was your road like to becoming an ophthalmologist?

Blake: 10:37 So, I grew up, you know, it was a little bit of a peculiar situation, not so much within ophthalmology, but my grandfather started our practice 70 years ago. He had four sons. All of them went into ophthalmology.

Gary: 10:53 So, no pressure, right?

Blake: 10:54 Yeah. So, we're very non-creative people, we just keep doing the same thing over and over. So, from the get go it was always there. But, I never felt real pressure, to be honest. It was just a lot of education. You know, mine was like yours, man, it was pretty rocky, you know.

Ever since I was a kiddo, I was always mischievous, always had an issue with authority. Had a couple bumps in the road during high school and things like that, and you kind of get labeled, you know, the bad boy or something like that by your teacher. And next thing you know, you have your teachers telling you, "Oh, you know, you're never going to amount to anything. You're never going to get into medical school or anything like that." That kind of takes its toll.

For me, I kind of turned inward halfway through high school, started reading a lot, started writing a lot. I really fell in love with music and developed a great group of friends that, we used to drive down to New Orleans and see live shows all the time. We used to follow bands around the United States. I would even, I've even got into to like field recording and things like that, kind of found those hobbies. I think by the time I got to college, I had really chilled out. I'd experienced it all, I was a very experienced kid, grew up fast, and by the time I got to college I was like, "Man, I'm ready to study now." I always had my head in the books. Um, I think that's one thing that was a turning point is, after a couple of issues in high school, I had to sit down with my dad and he was like, "Man, you know, you’ve got to fix this. You can have a path forward right now." So, when I was 16, I decided to be an ophthalmologist, and I've never looked back since.

Gary: 12:28 I think that's really crucial, to have those moments in time where you say, my future is about to be limited if I don't make some choices, some very strategic choices. When I got to college, and it's weird, at every stage of my track, I've had somebody tell me “You'll never make it, you'll never going to be a doctor.” My first day of college, I actually had my advisor tell me to change from premed to go into business because “You're just going to waste four years and not get into med school.” I actually took his advice for a year, and decided after a year that I wasn't going to let somebody tell me what I couldn't do, and that maybe I wasn't smart enough, but, the only variable I could control was how hard I worked.

And, that was a real blessing because, I think a lot of times if we try to rely on our innate abilities, we can sometimes get over our skis a little bit. And so, by getting humbled, it can really be impactful in terms of how much work we put in. I've told this story a couple of times too, but, on one residency interview at a very prestigious institution, one of my interviewers said, "Uh, you know, you should pick a different specialty, because you're never going to match in ophthalmology, not here, not anywhere."

Blake: 13:44 Yeah.

Gary: 13:45 And if you do match, if you're so unfortunate to match, you'll never pass your boards. So, after I passed my boards, this is the first go around, I wanted to send him a message, but I didn't. But, it's funny how people tell you what you can't do, or they want to tell you what you can't do. You can go one of two ways. You can either just be labeled that, okay, you're not that bright, or people don't see in you what you see in yourself, or they want to limit your future. Or, you can take that as fuel in the fire. You can take that and say, "Okay, someday you'll see, I'm going to make something of myself." And it sounds like we kind of had a similar track there.

Blake: 14:23 It was the same. I mean, I remember being crushed when I didn't get into medical school the first go around, so I had to reapply. I hear nowadays it's relatively common, it's gotten so crazy. But, I was just absolutely crushed, you know, once I got there I was like, "Oh my gosh, I'm never going to be able to, you know, join my family's practice." Thank God I got in, and I did pretty well in medical school, enough to secure an ophthalmology residency. But then, you get to ophthalmology residency, and like everybody's a rocket scientist, right?

So, immediately I recognize this like, okay, pretty much everyone here is sharper than I am. So, I got to figure out a way.

Gary: 14:58 Same feeling.

Blake: 14:59 So I was like, what can I do? You know, I always felt like I had good hands. I had a good grasp on what I wanted to be, and, I could always work well with others. I could play well in the sandbox with other people. So, that's sort of like an emotional intelligence type of thing. And so, I just keyed in on that and focused on my goal, which was to become an ophthalmologist. I'd gotten involved in research and studied as hard as I could. And, somehow, some way, I made it onto this couch sitting next to you.

Gary: 15:28 Two guys who were both told they'd never make it anywhere are actually here, so it's pretty funny. I want to switch gears just a little bit. I want to talk about starting practice after residency. I think we have a lot of either new grads, or residents, or med students. So, a lot of these questions will be really pertinent to them. But, when you get out of residency, or when you're going through training, you kind of have this idea of what it's going to be like. You think all of your problems are going to be solved the day that you finish residency, and you're going to be ushered into this utopia, and it's just going to be rainbows and unicorns. What were your assumptions that we're right about what it's like after residency, and what was maybe a shocker to you?

Blake: 16:19 Imma tell y'all right now, the biggest shocker: taxes. Have you guys heard about this, like, the more you make, the more they take, have you heard about this?

Gary: 16:26 It’s uh…yes. Every April, I'm reminded.

Blake: 16:31 It's just, it's really brutal. There's a lot of things. I think that what I've learned most about the real world is, the real world is a grind, right? If you want to push it, and if you want to do things like we do things, and like I know you do things, and you want to be the best, there aren't any sick days. You don't show up late, and you don't call in sick, you know.

I've had zero sick days, and I've only missed one surgery day in 3 years. And the reason for that is because, at a practice like ours, we have 120 employees, people are depending on you not only to show up, but to show up ready to rock. I mean, they want you to perform, not just be there, but perform, right?

Gary: 17:17 Yes.

Blake: 17:17 So, to a large extent, that's kind of the problem with what we do, we have all these people that depend on what we can do with our hands in order to pay the bills, pay their health insurance, keep the lights on, etc. I think that's really what caught me by surprise.

Gary: 17:38 The pressure, the pressure to perform a little bit in some ways.

Blake: 17:40 That's it. Yeah, I mean, it's like there are no off days, right? So, you need to come here and be ready to go. It's game time, right? Every single day, because the second they see you, and you're not on, then they're not on. And, I don't think that's fair to your team. I think if you're going to be a leader, you need to be ready to roll.

But, I will say, having said that, that the grass is greener. It's great.

Gary: 18:05 Grass is definitely greener.

Blake: 18:06 There's fewer people telling you what to do, which works great for me and my personality. I get to do exactly what I want to do and nothing else. In terms of assumptions that were right, it's that ophthalmologists, and particularly cataract refractive surgeons, are just awesome, happy people. They're fulfilled with what they do. I remember being a resident, and at my program I had a couple of the faculty that were like, you don't want to just be a cataract LASIK guy do you, like, that's not all you want to do? And I was like, actually—

Gary: 18:36 Like, what else is there.

Blake: 18:37 I was like yes, that's exactly what I want to do. And in fact, my assumption has been right. Getting the chance to meet people like you and so many people in this room that have helped me tremendously. You know, you gave me one of my very first opportunities I remember early on. That part of my assumptions was correct.

Gary: 18:55 Yeah. And for those of you who are in the audience thinking about either a subspecialty, or comprehensive, or whatever, find people who are happy doing what they're doing, and copy them. If you find a group of people who are happy in general, if you follow that track, most likely you're going to be happy also. And I think it's no surprise that we find ourselves amongst a group of people that we really enjoy hanging out with.

I mean, I really enjoy these meetings because there's just a few people in the world that understand the pressure of what you just said, of I have to go to bed at 10:30 at night because I wake up at 6:30, and I have to give myself eight full hours of sleep, because there are not only so many patients relying on me, my staff is relying on me, and I can't afford to be tired at 4 o'clock. I have to still be ready to perform my absolute best, whether it's the first case of the day or it's the last case of the day.

Patients, they deserve our absolute best. That means being hydrated, that means being well rested, it means sometimes just having to make some sacrifices personally because what we do—and I've said this before, and you may agree or disagree, I'd like to hear your take on this—but, I think what we do is as close to a performance sport as anything else in medicine, especially as cataract refractive guys who are doing the high volume, because it is taxing on our bodies in terms of our ergonomics, it is mentally straining, and the task has to be performed with perfection.

So, whether that's like a NASCAR driver, or someone who's like a concert pianist, there's a real aspect of performance that is both mental and physical and requires a lot of stamina. What are your thoughts on that?

Blake: 20:45 My thoughts on that are, number one, I agree with you completely. But number two, unfortunately for guys like you and us, that's just the ante-up-ship, right?

Gary: 20:45 Exactly.

Blake: 20:57 That's just the ante-up-ship. And what I mean by that is, just because you can show up, and do 35 cataracts in a morning, and do them all beautifully, and blah blah blah, that's great. But, like a lot of people can do that, right? Many people can do that, right? The point is, is, like, that's just where you start, right?

So, everything else that you do around that in your OR, that's what separates you. And to be honest, I'll add that to that last comment, that “what surprised you?” What surprised me was, when I got to the OR in the real world is, it's not about me. It has nothing to do with me, right? It has everything to do with, besides the patient, it has everything to do with the staff around you, because those gals work their tails off in our surgery center doing all those cases, and so you got to make it about them.

So, not only do you have to perform all those cases, and do them beautifully, and serve your patients, but you also—you know, I remember that when I came in, I had my music, I listen to, like, old country music and blues, and they're like, “Uh-uh.” And I told my dad, “Wait, this kind of relaxes me, and dah, dah, dah.” Because, that's what I did in residency. And my dad was like, “But it's not about you anymore. If you have to have a certain type of music, you're missing the point. So, play the music that your team wants to hear. Do nice things for your team. If you've got a bunch of cases on, buy them lunch. If you have a tough case, don't start getting grouchy and throwing stuff. I don't care if a 757 crash lands in your OR, finish the case, and tell everybody thank you, and be nice.”

Gary: 22:22 Well, and that gets into leadership. Leadership requires trust. You cannot lead a team of people who don't trust you, and you can never lead beyond the level to which they trust you. And how do you build trust with the team? You're kind to them. You have their back. If they make a mistake, you don't immediately call them out on that. You give grace. You tell someone, thank you. I've said this before, but appreciation is the most underutilized resource that we all have access to, and it's the only thing that multiplies itself other than, by the same token, negativity will multiply itself.

Blake: 22:58 And it's free.

Gary: 22:59 It's free, it's absolutely free. And you won't believe what a difference it makes just walking up to your staff at the end of the day and thanking them personally for their contribution to the case, because, you're exactly right, it's really not about you, but you are a servant leader. You are serving them and you're leading at the same time.

So, one of the things I want to talk to you about a little bit is just your family. You talked about this at the beginning and I wanted to just kind of circle back on this. Family can be tricky. I think in the best of circumstances, family can be complicated. Dealing with my dad about what my mom wants for Christmas is complicated, I can't imagine dealing with family with regard to not only just like boss, employee, or partnership things, but you throw in all those other dynamics and you have, I believe your uncle works with you as well, and your sisters in the practice also. Talk to us a little bit about how do you manage those dynamics?

Blake: 23:57 Yeah. So, it's kind of a circus. It's a lot of fun. We should have like a reality show or something like that.

Gary: 24:04 Yes. That I would tune into. The Williamson—can we pitch that right now? I hope someone's listening.

Blake: 24:10 It would have to be on HBO though. It'd have to be R-rated.

Gary: 24:12 Yeah, it's okay. It's okay.

Blake: 24:14 But, people who have visited our practice, and our industry partners, it's a lot of fun. We're real people, we're honest people, but we have opinions, and every one of us has one. We have uncles in the practice. We have a cosmetic center that my sister runs, she's a very busy PA, etc.

I'd say that there are pros and cons. Certainly, I think the biggest pro for me is that I've been given the playbook, right? So, being able to walk into a generational practice, it's just, here's how we did it, and here's how I think that you could make it better. Now, all you have to do is really go execute, right?

To a large extent, that takes a lot off of my plate. I was able to walk into a busy practice doing a high-volume of cataract surgery from the jump, so that's a tremendous, tremendous advantage. The other pro for me personally would have to be probably the relationship that I've formed with my dad. He was very busy when I was younger, and he was traveling around the world giving these talks, introducing clear cornea cataract surgery. He's one of the first guys to ever do that, with Howard Fine.

Doing RK in Russia, doing ICLs in Argentina with Dr Saldivar, you know. So, we went around a whole lot, I'd had a great childhood, but he's busy. So now, my dad and I have the opportunity, on our LASIK days, we operate together, and it's a lot of fun. We’re just back and forth, joking and stuff like that, and we've been able to connect in a very special way that perhaps we didn't do when I was younger and, kind of, getting in trouble in school and stuff like that.

As for cons, it's hard to leave work at work. We're constantly talking about ophthalmology. I dream about ophthalmology, which is sad, but true. The last thing I'd say about a con is that, sometimes it's hard to be professional at work, right? So, if you have a disagreement, sometimes you say exactly what you think, whereas in other places you might sort of—

Gary: 26:14 Might filter that a little bit.

Blake: 26:15 You'd filter it a little bit. And so, being professional, maintaining that when you're at work, and you're onstage, as Vance Thompson teaches us, in front of your staff, I think that can sometimes be difficult. But overall, it's a real blessing, man. And it's been a lot of fun.

Gary: 26:36 Blake, I can't thank you enough for taking the time today to share a little bit about your story. You're someone that I am just so excited to be sharing this profession with. I can't tell you how much I'm looking forward to the next 30-year run that we're going to have, getting a chance to make each other better, make the profession better.

I want to thank BMC for allowing us to do Ophthalmology off the Grid live for the second time here.

I hope this has been enjoyable, and, as I've said before, anytime you want to come on the program, you're always welcome to come back.

Blake: 27:12 All right. Thanks so much, Gary.

Gary: 27:21 Once again, thanks to Blake for taking the time to share more about his background and his passions with us at ME live, and thanks to our listeners for checking out another episode of Off the grid. For more interviews like this, plus our first live Off the Grid interview with Dr. Ike Ahmed, visit eyetube.net/podcasts. Catch you next time.

Speaker 2: 27:48 Ophthalmology off the Grid is an independent podcast supported with advertising by Alcon.