Academia or Private Practice?

Which is right for you?

BY DESIREE IFFT, CONTRIBUTING EDITOR

When you decided to pursue the necessary training to be a vitreoretinal specialist, you made one of the most important choices of your career. Your next big decision will be how you’ll put your training into practice. Nearly all of your job options will be in one of two settings: academia or private practice. To provide you with some real-world insights as you contemplate your next move, we asked doctors in each setting to talk about how they arrived at their decision and why they’re happy with their choice.

Academia:
Lisa C. Olmos de Koo, MD, MBA

Dr. Olmos de Koo is assistant professor of ophthalmology and director of the surgical retina fellowship program at the University of Southern California (USC) Eye Institute. She focuses her clinical practice with Keck Medicine of USC on the medical and surgical management of adult retina disorders. Dr. Olmos de Koo is the primary investigator for the clinical trials of the Argus II retinal prosthetic device and is leading the commercial launch of Argus II at USC.
MD: Baylor College of Medicine
MBA: Rice University
Residency: Bascom Palmer Eye Institute
Fellowship: Bascom Palmer Eye Institute (vitreoretinal surgery, 2009-2010)
Joined USC faculty: 2011

Private Practice:
Ash Pirouz, MD

Dr. Pirouz specializes in the medical and surgical management of vitreoretinal disease with Retina Consultants of Orange County, a three-doctor practice with offices in Fullerton and Los Alamitos, Calif.
MD: Johns Hopkins School of Medicine
Residency: University of California-Irvine, Gaven Herbert Eye Institute
Fellowship: University of California-San Diego, Shiley Eye Center (vitreoretinal, 2011)
Joined Retina Consultants of Orange County: 2011
Became partner: 2013

What led you to your current role? Did you always know which of the two settings (academia or private practice) you wanted to work in?

Dr. Olmos de Koo: I’ve always been very interested in both education and clinical research. After fellowship, I kept an open mind, listened to my mentors, and strongly considered working in an academically oriented large private practice retina group as well as in an academic setting. After all, in retina, so much of the highest quality clinical research is done in the private practice setting. However, there were three reasons I ultimately chose an academic job: 1) the variety of practice settings and patient populations, 2) the ability to teach students at all levels (medical students, residents, fellows, and graduate students), and 3) easy access to ophthalmologists in other subspecialties for both clinical and research collaborations.

It was a difficult choice for me, although I think I would have been happy in either setting. Dr. Carmen Puliafito, who was the chairman during my residency at Bascom Palmer, was a strong influence in leading me to my current role. With his extensive experience in academia, he knew academics would be a great fit for me.

Dr. Pirouz: The majority of retina specialists are trained entirely in academic institutions, so it’s an environment in which we’re comfortable. However, a few of the volunteer faculty members who were part of my residency program were from private practice, which provided an opportunity for me to learn about it. This was also a great opportunity for networking, which came in handy when I was looking for a job. I actually met one of my current partners, Dr. Scott Grant, when he was staffing a residency clinic.

Dr. Lisa C. Olmos de Koo, a professor and surgeon at USC, says if she weren’t a retina specialist, she would be a writer — both fiction and nonfiction. She hopes to be both a physician and a writer at some point.

I was open to either option, but as the time approached to look for a job, I began to realize that although academia and private practice are different, they’re not necessarily mutually exclusive environments when it comes to retina. A spectrum of clinical care, teaching, and research can exist to varying degrees in either setting. What really matters is how much of each you would like to have. Private practice gave me more latitude to tailor that breakdown to fit my objectives. Our practice, despite being very busy clinically, is involved with several major multicenter clinical trials. That said, it’s important to understand that not all private practices have the necessary infrastructure in place to permit clinical research, and certainly not basic scientific research.

Do you have personality traits that make you well-suited for your particular setting?

Dr. Pirouz: I think folks who like having more control over their practice environment are more suited for private practice. But this, like running any business, comes with risks and hassles, so it requires an entrepreneurial personality.

Dr. Olmos de Koo: I collaborate well with others, which is a personality trait that can be helpful in the field of clinical research. I also enjoy obscure diagnoses and challenging surgical cases, which are frequently encountered in the academic setting.

What makes your practice setting similar to and different from other practice settings in areas such as work-life balance and what it takes to be successful?

Dr. Olmos de Koo: Whether you’re in a private practice or an academic setting, it’s always helpful to be efficient when seeing patients and to continue networking with other practitioners to build your practice.

In some ways, my schedule is more flexible because there’s dedicated time for research as well as purely clinical endeavors. Weekly grand rounds and regular academic conferences are a constant source of intellectual stimulation, which keeps me engaged.

Dr. Pirouz: The number of hours worked and lifestyle vary greatly among private practices. It largely depends on the number of associates and clinical volume. I’m fairly comfortable with the work volume and amount of time I have off. I enjoy practicing in a retina group where I can consult with and bounce ideas off my partners, which is one reason I didn’t want to be in a solo practice.

Another practice setting that is becoming more popular, especially in Southern California, is employment by big HMO organizations, such as Kaiser. While it wasn’t attractive to me, it’s chosen by some for a potentially easier balance between work and life. Although it may be bureaucratic, it tends to have a set work schedule and likely doesn’t involve business responsibilities, research, or teaching. This is attractive to some physicians.

In my group, we’re fortunate to have access to the latest diagnostic and therapeutic technologies, and therefore, we can manage many complex cases. However, similar to other private practice retina groups, some cases (e.g., choroidal melanomas or pediatric surgeries) are referred to academic centers where they have the necessary infrastructure in place for management of these cases.

What do you consider the biggest challenges of working in your setting?

Dr. Pirouz: When you join a private practice, it may take longer and require more effort to establish a name for yourself. A potential advantage of being in academics is that patients are at times internally referred to you or come to you because you’re at the university.

Another challenge of private practice is that you definitely feel more of the brunt of the rapidly changing healthcare system. In the era of increasing overhead and shrinking reimbursement, the focus is always on delivering efficient and high-quality care while keeping overhead in check. Academia and large group practices are certainly not immune to this, but I think physicians in those settings have an easier time coping.

Dr. Olmos de Koo: The biggest challenge of working in academia is balancing many different roles — clinician, surgeon, educator, and researcher — and making sure you execute all of them effectively. I’m also a mother, and this balancing act is one that I have become accustomed to at home. The keys are efficiency and time management.

Another aspect of an academic practice setting that can be frustrating or psychologically draining is the larger proportion of patients you see who may not be further helped by medical intervention. In those cases, it may be your role to give them that final word.

What do you consider the biggest rewards of in your practice setting?

Dr. Olmos de Koo: The biggest rewards of working in academia are 1) helping patients with the most challenging cases who may not have been able to get help elsewhere, and 2) helping students learn in the clinic and in the operating room and eventually become full-fledged professionals in their own right. These rewards are analogous to the rewards of parenthood.

Dr. Pirouz: I like having control over my practice environment, with the fewest possible inefficiencies. Most academic practice settings are part of a very large organization, which gives them layers of complexity. This would be the case in any large organization — not just in medicine. One ramification is that decisions may not be made on a “local” level, but higher up a chain of command, where the needs below may not be clearly understood.

In contrast, in private practice, we have authority over our personnel, with respect to setting expectations and hiring and firing. This isn’t the case in a larger setting, where employees may report to a different body other than you. Also, for example, if we want to consider buying new equipment in our private practice, it’s relatively straightforward, and we all provide input. We simply discuss it and make a decision.

What advice would you give to retina specialists coming out of school about choosing a career path?

Dr. Pirouz: Be honest with yourself about your career goals and motivations. Listen to your inner voice. Your happiness matters. If you have a certain geographic preference, take that into account when looking for a job. I realized the importance of having family and friends close when my spouse and I had children. Also, do your due diligence before taking a job. It’s important to pay attention to the track record and reputation of a group. Avoid practices with “revolving doors.” Consider it a red flag if a practice has a history of new doctors coming in and leaving after a year.

Dr. Ash Pirouz, in private practice in Southern California, says if he had chosen a medical field other than ophthalmology and retina, it likely would have been surgical oncology.

In addition, make sure the group practice you’d like to join has a commitment to your success that equals your commitment. That should include a transparent path to becoming a partner so you know what to expect and what is expected of you. Choosing a practice and becoming a partner are a lot like a marriage.

Dr. Olmos de Koo: Think about what type of clinical work is most rewarding to you. To give just one example, if you enjoy spending extra time researching a rare or unusual condition and don’t mind the extra effort it takes to communicate with other specialists to formulate a customized diagnostic and treatment plan, academia could be the right place for you.

Another very important aspect, which applies to positions in both academia and private practice, is making sure your approach to patient care is well aligned with your potential co-workers’. Be sure you can see yourself working well with them. Again, to give just one example, try to get a sense of what type of cases your future colleagues would take to the OR, i.e., their threshold for surgical intervention, and make sure you’re comfortable with this.

Finally, bear in mind your family’s needs because, in order to thrive in your workplace, you must be happy at home. NRP