I’ve written before about developing a niche to help grow your practice in the beginning. Since then, many people have contacted me for ideas about what to do. Below is a list of some of things I find to be in short supply in most, not all, areas (in no specific order):
To begin, you should only try to develop a niche in what you are comfortable performing. However, you can certainly take courses in a particular area to enhance your abilities. While they are typically low on the reimbursement scale, treating these conditions will increase your referral network and help you get off the ground.
Unexplained vision loss.
Whether it’s a malingering patient or some bizarre macular dystrophy, many physicians simply do not have the time to perform the detailed examinations and testing required to elucidate the cause of the vision loss. The scarcity of neuro-ophthalmologists in most areas only increases the demand for this service.
Dry eye.
Every physician for the most part will see and treat dry eye. Most MDs will try artificial tears and Restasis (Allergan), but then they give up. There comes a point where they and the patients simply become frustrated. Becoming versed in all areas of dry eye—lids, conjunctiva, cornea, different layers of the tear film, etc.—will enable you to give more targeted treatment and achieve better outcomes, and your colleagues will thank you for the assistance.
Glaucoma surgery.
Glaucoma surgery doesn’t reimburse well, and the risks can be great with traditional trabeculectomies and tube shunts. While the advent of MIGS will certainly decrease the number of patients requiring these surgeries, there will, nevertheless, still be a large number of patients for whom a trab will be the only effective option.
Complex cataracts.
I am not referring to a white cataract or a patient with pseudoexfoliation; by complex cataract, I mean the patient with a dense lens that is bouncing around the eye due to loose zonules who will require rings, suture fixation, and all other tricks in the bag to succeed. While many ophthalmologists will refer these cases to retina specialists for a pars plana vitrectomy/pars plana lensectomy/anterior chamber IOL, if they’re aware you can do it with a posterior chamber IOL, they will refer to you.
IOL complications.
As patients live longer, the probability increases the bag-lens complex will sublux. Negative dysphotopsias may not resolve, and IOLs can be improperly positioned. Many ophthalmologists are not comfortable entering the eye again after cataract surgery, particularly if there was a complication with the first surgery. This also presents a great opportunity for practice development.
Ocular tumors.
Simply put, this is far outside the comfort zone of most ophthalmologists. Whether conjunctival intraepithelial neoplasia or choroidal melanoma, most MDs want to refer these patients out ASAP.
SUMMARY
There are other areas of ophthalmology in which you can develop a niche, but the most important thing to remember is that whichever you choose will become a part of your practice indefinitely. Once you become “the dry eye expert,” patients will continue to seek you out for these services. In that regard, be sure to pick a niche that you truly enjoy evaluating and treating; in this manner, you will guarantee future success.
