Any ophthalmologist starting or growing a practice has to make a conscious choice whether to focus on tertiary care, including surgery, or to provide more comprehensive care within the practice. This decision affects many aspects of the practice, including whether local optometrists are likely to view it as a comanagement ally—or as the competition.
When I took over the Sinskey Eye Institute, I chose to focus on maximizing my surgical offerings. To better position the practice as a tertiary referral center, I eliminated the practice’s somewhat lucrative optical shop and contact lens dispensary, which meant letting go of some staff, relinquishing retail revenue opportunities, and to some extent, even giving up the opportunity to develop long-term, primary-care relationships with patients.
Figure 1 | Dr. Assil with Kambiz Silani, OD, a local Beverly Hills optometrist, and Mona Bagga, MD, a glaucoma specialist at Assil Eye, during a continuing education event.
On the other hand, the move was an important step in building trust with referring optometrists and nonsurgical ophthalmologists in my community. Today, I count many of those doctors in my referral network as valued colleagues and friends. We have developed successful comanagement relationships in which both parties are confident that each of us is providing services that complement one another.
Getting to that level of comfort and trust takes time. How one deals with initial bumps in the road is crucial. My staff knows that I actually consider it a good sign when a new referring doctor calls to complain about something. It means that the doctor believes in the relationship enough to want to fix whatever is not working smoothly.
MULTIPLE CHANNELS OF ENGAGEMENT
Our comanagement model encompasses a large network of ophthalmologists and optometrists who refer to us for corneal and lens-based refractive surgery. We maintain this network through at least three types of engagement with referring doctors: educational, personal, and patient-centered.
1. Educational: We host three to four formal continuing education events per year, with space for about 60 people at each (Figure 1). These events feature live surgery, didactic lectures, and panel discussions and include plenty of time for questions. We also hold smaller roundtable dinners about six times per year. These are typically focused on a topic of interest, such as corneal crosslinking or the latest premium IOLs, and are more informal, free-flowing discussions. We also send mailers or emails about clinical studies and other practice news.
2. Personal: It is important to get to know the doctors in your network personally and be directly accessible to answer questions and respond to concerns. Surgeons may also want to consider hiring an optometric liaison to drop in on referring doctors regularly, but not at the expense of direct contact with the surgeon, especially as the relationship is developing.
3. Patient-centered: Comanagement ultimately should benefit the patient, so it is crucial to hone the ways in which surgeons engage with referring doctors about their patients. This requires setting up systems internally to facilitate seamless communication at every step of the process. For example, comanaging doctors typically alert us to a referral prior to the patient making an appointment so that we already have a file with pertinent information. In return, we notify the referring doctor of the patient’s surgical decision, our surgical plan, and the date of surgery.
After surgery, I email or text our comanaging doctors, in addition to faxing clinical notes. Whenever there is a situation in which I need to better understand the subtleties of the patient’s history or follow-up exam or if there is a complication or tough clinical decision to make, there is no substitute for picking up the phone and making a call to that doctor to discuss the case.
CUSTOMIZE THE RELATIONSHIP
Comanaging doctors help me to achieve better outcomes by providing important information about patients’ history, lifestyle, and personality. However, not every referring practice is alike, so it is important to customize the sequence of postoperative care according to the preferences and skill set of the referring doctor. Some wish to see patients back as soon as possible after surgery, while others prefer for us to handle the full global surgical period. Regardless, when you work together to best serve the patient, everyone benefits.
