GUEST EDITORIAL

Reflections on a Unique Group of Physicians

CHARLES C. BARR, MD

As every retina specialist knows, there is never a shortage of bad news. Reimbursement is down, but expenses continue to rise with inflation. The Centers for Medicare and Medicaid Services want to bundle vitrectomy procedures. The reimbursement period for Lucentis is being shortened from 120 days to 80 days. There's even an optometric retina society, whose members want to do everything — laser, injections, surgery — that you do.

In spite of the bad news that seems to bombard us daily, in spite of the patient whose retina will not stay attached, and in spite of working harder and getting paid less, I freely admit that I love being a retina specialist. I enjoy my practice, and each day in clinic is a pleasure, despite the difficulties that we face. But beyond my clinical work, I love being part of the retina community.

The retina community is relatively small — there are fewer than 2000 of us in the United States — and most of us know each other. This, coupled with the fact that we often have opportunities to work together, promotes a collegiality that is found in few other specialties.

Charles C. Barr, MD, is a professor in the Department of Ophthalmology & Visual Sciences and director of the Retina Service at the University of Louisville, KY. Dr. Barr leads a team of specialists in treating retinal disorders, including retinal detachment, retinal degeneration, macular degeneration ocular trauma, and retinopathy of prematurity, either through surgery or medicinal therapy.

CASES IN POINT

About a year ago, the digital camera in our department broke. We had a film camera as a backup, but as everyone knows, once you get used to digital technology, film seems like a horse and buggy. I called Sean Murphy, MD, whose private office in Louisville is a few blocks away from the medical school and asked him whether we could send our patients to his office for photos and angiograms. His response? "Sure! We'll just bill our costs, and you can bill for interpretation if you like. We'll send the patient back to your office with their photos in hand."

This example of generosity is typical in Louisville but also exists throughout the country. Jason Slakter, MD, told me that a retina specialist in New York had access to indocyanine green (ICG) when no one else did. Jason's partner Larry Yannuzzi, MD, called him and asked whether he could send patients to his office for ICG angiograms. His response? "Don't bother to do that — I'll just make you and your group coinvestigators on my study. I'll send the drug to your office at no cost, and you can do your own angiograms."

I hope you have a similar story to tell about colleagues in your community.

CARRY ON THE TRADITION OF COLLEGIALITY

I thoroughly enjoy attending meetings. There is always great information that is shared, and the give and take of audience questions and comments is usually polite, well intentioned, and fun. I often bring photos of tough cases that I can show to other retinologists for informal opinions on diagnosis and management. Advice is always given freely and graciously. I particularly enjoy the coffee breaks, when I can quiz colleagues about new technology and experiences.

In my opinion, the collegiality that exists among retina specialists is a key component to making the practice of medicine a pleasure. It is the way medicine is supposed to be practiced, and I am sorry that it does not exist in all disciplines. Finally, it is incumbent on all of us to make sure that the attitude of cooperation we enjoy continues for younger retinal physicians. RP