Cover Focus | Jan/Feb '16

The First 5-Year Flash Mob

Ophthalmologists pay it forward with reflections from their early days of practice.

Elizabeth Yeu, MD:

The first 5 years after training are pivotal for young ophthalmologists. It is a period in which you must take on some serious deliberating and decision-making about the direction of your career path. Fortunately, many of us have walked this road before and are here to pay it forward with various insights into how to handle that first 5-year flash mob.

Larissa, can you share something from your first 5 years of practice that you wish you had done differently?

Larissa Camejo, MD:

I felt confident coming out of residency and fellowship. I participated in great programs and was surrounded by amazing people. But somehow, when I emerged from training and was faced with daunting tasks like negotiating a salary, I found it easy to question myself. I started to worry, “Is it appropriate for me to ask about that?” or “Am I going to look lazy?” It is important to realize that you are no longer a student and you should continue to be confident as you work through these sometimes-difficult discussions and decisions.

Dr. Yeu:

What did you do to gain that confidence?

Dr. Camejo:

It was tough in the beginning because nobody talks about or prepares you for things like negotiating your first salary. I read, researched online, and questioned everything I had been told. I started out in academics, which was interesting because I was negotiating with my mentors. But, at least I trusted them. If you are a woman, I would recommend talking to other women in the field. I think as time goes by, you just start to gain confidence and the ability to speak a little more intelligently about these issues and stand your ground.

Dr. Yeu:

Tal, can you tell us what wisdom you gained going from your first to second job?

Tal Raviv, MD:

A couple of years ago, I started my own practice. Before that, I was in a small group practice for a decade. This path isn’t atypical among new trainees. When you are a new doctor, you’re excited to be in practice, you work hard, and it’s amazing. But as strictly an employee, your options are limited. If I could recommend one thing to a new MD, it would be to get involved early with the practice numbers, finances, and overall practice management. That makes you a lot more valuable within your practice and more informed about the job market. Without that business knowledge, a clinician will have some limitations.

Dr. Yeu:

George, you did something unique in going from private practice to academia. Can you share a little bit about that decision?

George O. Waring IV, MD, FACS:

Historically, research and development was done in an academic setting; however, when I was getting out of training, the situation was changing in that it was becoming too difficult to do this efficiently in the universities. More and more clinicians were leaving academics for private practice to pursue research and development, which I was interested in. My thinking was that I would enter private practice and be productive in working with industry and clinical trials.

If you are interested in research and development, you must ensure that the practice you enter is aligned and committed to that type of program. I would venture to say that the practice should already be up and running with a program like that before you join. A lot of practices want to participate in research and development but, when it comes down to it, may not be willing to take the necessary steps to be involved in clinical trials. In my circumstance, I found an academic setting to be a better fit for research, development, and clinical trials.

Dr. Yeu:

I will mention a regret, or something I wish I had done differently in my first 5 years. Within my culture, there is an emphasis on hierarchy. Although I am outspoken, I also believe in rules and in listening to those who are older and wiser than me. However, I wish I had spoken up more. I do wonder if I would be in a different place professionally had I better voiced my opinions or frustrations. I am thrilled with where I am and who I work with today, but in my first 5 years of practice, I recall trying hard not to rock the boat and wanting to please those colleagues who were once my mentors. That is hard because it never feels like you are truly on equal ground. Those are some of the things you have to break through, particularly for those who are going into academics, especially if it is at the place where they trained. You must learn that these individuals are your colleagues and that you are on equal ground with them. You may not have their experience, but you are their equal.

How about you, Jessica? Tell us about a pearl you can pass forward.

Jessica Ciralsky, MD:

Looking back, I wish I had been better about asking for help. In my first 5 years, I often struggled with the management or diagnosis of difficult cases. I would try to figure everything out on my own through books and journal articles. I worried that if I asked for help, I would look weak or uninformed. What I realized is that for many of the situations, there wasn’t a right answer. A couple of years into practice, I realized that asking questions and discussing difficult cases with colleagues was an invaluable part of my ongoing education. I still go to the OR with others to learn new techniques. I try to learn from my colleagues every chance I get. Luckily, ophthalmology is full of supportive people who are always willing to help.

Dr. Camejo:

In thinking about regrets, one suggestion I can offer is to listen to your gut. When reflecting on certain opportunities in my own career, I wish I had listened to my gut more. Logic is important, but so is instinct.

Damien F. Goldberg, MD:

When it comes to negotiation, it is important to have a few trusted colleagues and friends who have gone though it themselves. I am fortunate to have made some strong relationships with peers my age and colleagues a few years ahead of me. We will send around emails with questions like: What is the going rate for this? How do I negotiate this term? What did you guys pay for a buy-in? It is great how honest everyone is in answering those questions. This also applies to getting involved with industry—discuss consulting rates with your peers. We don’t often talk about this stuff, but it is important that you have this information before you start making decisions.

Dr. Yeu:

One thing I think we can all agree on, which is something that I still tell myself over and over again, is that who we were right when we finished training or where we were 2 years out is very different from where we are now. We will all continue to evolve, and what we think we want to do can change quickly. I originally wanted to commit my entire life to training residents, but that changed after 3 years of resident education. Our needs and desires will shift, and it is okay to want to change and to take the necessary steps to do so.

Dr. Goldberg:

Bill, do you have a pearl you can share with us?

William F. Wiley, MD:

One of the things I put off to the side that I wish I had done sooner was putting my ideas out there. Early on, I was just happy working, but I had so many ideas about various techniques or thoughts on papers or research. However, I buried those ideas and did not pursue them. I look back and think, “I wish I would have explored that avenue.” Some of those areas I still want to explore, but now I am busy. It is hard to get that time back.

Dr. Goldberg:

Again, for the younger generation, if you want to get involved, there are plenty of resources all around you. Your peers want to get to know you, and they want to help you get involved.

Dr. Waring:

Also, it is never too early to start helping your friends or someone you might want to mentor. That is a spirit I encourage everyone to take on, as it really can enrich your career. I was fortunate, and I think probably most of the world was somehow, to interface early on with Bill Trattler, MD. Bill embodies this concept of trying to help other people grow, and I have never seen anyone do it better than him. Bill, were you just born that way, or did someone teach that to you?

William B. Trattler, MD:

I was lucky in that I joined a successful group practice, which was my father’s. I decided to attend some of the small regional conferences, but when I first started going, I only knew a few people. I enjoyed the meetings, but I felt I would have a better educational experience, and also enjoy the meeting more, by knowing more of the attendees. Over time, as I became friends with many of the other attendees and faculty at the meetings I was attending, it proved to be true. Getting to know everyone not only was fun but also opened up so many wonderful opportunities, from being invited to write articles to participating in clinical trials. This also makes a major impact on your experience at the major conferences such as AAO and ASCRS. At your first AAO, you may feel like you do not know very many people; however, over a number of years, you will reach a point where you will walk through the convention center and know so many of the other attendees. By networking and getting to know your colleagues, you will experience many benefits to your career, and it also allows you to positively affect the careers of your colleagues.

Dr. Waring:

It is great to collaborate with your colleagues, and it helps you to be more efficient too because you can share resources in terms of publishing or participating in meetings. It is actually a way to offload. One of the keys to efficiency is to collaborate and give people who may be interested in being involved that opportunity as well.
Larissa Camejo, MD
  • Glaucoma specialist, Palm Beach Gardens, Florida
  • Section Editor, MillennialEYE

Jessica Ciralsky, MD

  • Assistant Professor of Ophthalmology, Weill Cornell Medical College, New York
  • Editorial Board Member, MillennialEYE
  •; Twitter @JessicaCiralsky

Damien F. Goldberg, MD

  • Private practice at Wolstan & Goldberg Eye Associates, Torrance, California
  • Editorial Board Member, MillennialEYE
  •; Twitter @damiengoldberg1

Tal Raviv, MD

  • Clinical Associate Professor of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai
  • Founder and Medical Director, Eye Center of New York
  • Editorial Board Member, MillennialEYE
  •; Twitter @TalRavivMD

William B. Trattler, MD

  • Director of Cornea, Center for Excellence in Eye Care, Miami, Florida
  • Founder and Medical Director, Eye Center of New York
  •; Twitter @wtrattlermd

George O. Waring IV, MD, FACS

  • Director of Refractive Surgery and Assistant
  • Professor of Ophthalmology, Storm Eye Institute, Medical University of South Carolina
  • Medical Director, Magill Vision Center, Mt. Pleasant, South Carolina
  • Editorial Board Member, MillennialEYE
  •; Twitter @georgewaring

William F. Wiley, MD

  • Private practice at the Cleveland Eye Clinic, Cleveland, Ohio
  • Editorial Board Member, MillennialEYE
  •; Twitter @Wiley2020

Elizabeth Yeu, MD

  • Assistant Professor of Ophthalmology,Eastern Virginia Medical School, Ghent, Virginia
  • Partner specializing in cornea, cataract, and refractive surgery at Virginia Eye Consultants, Norfolk, Virginia
  • Chief Medical Editor, MillennialEYE
  •; Twitter @LizYeu