One Born Every Minute

In reference to my Evolution post, I want to comment on my previous job offers.

Looking back at this post, I can’t believe how naive I was back then! Comes to show that I had absolutely no clue how to properly evaluate a potential associate position.  And I thought at the time, that I was rather on the savvy side of this department.  How wrong I was!

I had a job offer in New York, Las Vegas, and Chicago.  Here’s what I originally said about the front runner in Las Vegas:

“It was a fantastic practice with great people, and it was in the best location for my purposes!  My patient volume was going to be immediately strong.  I had the potential to perform 300-400 cataract surgeries a year in no time.  I would have had much support, and the financial potential was very strong.”

The only correct part of this statement was that Las Vegas was indeed the best location for my purpose of grooming a professional poker career.  Other than that, I have a feeling that everything else might have been smoke and mirrors.

Throughout the years,  I visited this practice’s website every now and then to see how much it grew.  Unfortunately, it remained where it was in 2010, but with just different characters.  It burned and churned through four associates in seven years, including the associate that I had met on my interview day.  Had I taken that job, I probably would have ended up being just another passerby too.   I’m not really sure exactly why each associate ended up leaving, but my best guess is that the potentially exorbitant buy-in for a large overhead practice, combined with high volumes in a poorly reimbursed locality might have been a factor.  This practice had multiple large offices, an ASC, and many many employees.

Nevertheless, I remember liking the owner ophthalmologist when I had met him.  We just happened to have different practice philosophies.  That’s all.  Ironically, it was my desire to perform intravitreal injections and need for an OCT that tanked our deal.  Funny how it’s now relatively common for general ophthalmologists to do intravitreal injections, and that an OCT is pretty much an integral part of any ophthalmology practice today.  I would have taken that job in a heartbeat if it weren’t for these two issues.  In retrospect, I should be thankful, because I probably saved 2 to 3 years of my life because of it.

Onto my New York job offer: similar story.  This is the guy that practiced 1986 medicine, and I witnessed questionable clinical judgment multiple times when I shadowed him on my interview day.  Once again, the guy he hired instead of me lasted about three years before he moved on.

I feel like these types of stories are all too common for young ophthalmologists.  It just happens that I was fortunate enough to dodge a few bullets by having the audacity to go directly into solo practice.  I now truly believe the statistic that only one quarter of graduates remain at their first job.   I have spoken to many solo practice ophthalmologists over the years, and their stories are often the same.  They were offered the potential to build a lucrative practice quickly, eventually leading to partnership in two to three years.  Then, somewhere along the line, promises get broken, animosities arise, and the associate eventually gets jaded enough that he or she leaves the position, onto what’s hopefully the real deal.  Some people have gone through this cycle multiple times before realizing that the ideal nurturing practice is hard to come by unless they build it themselves.

Don’t get me wrong.  There are plenty of good practices out there that are truly interested in hiring the right person for the long haul.  However, finding the right job seems awfully similar to dating.  Most people will rarely ever meet their soulmate on the first date.  It’s only after much heartache and turmoil that one might get lucky enough to meet the ONE.  Fortunately for medical practices, you can always create your soulmate out of thin air any time.  You just have to take the plunge.

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