The transition from residency and fellowship to becoming an attending physician can be a daunting process, to say the least. During this time of immense clinical and surgical growth, young attendings must carefully consider what steps to take to begin building their medical and surgical practices, to incorporate work-related travel into their schedules, and to find balance between their clinical and personal obligations.

Here, Jayanth Sridhar, MD, assistant professor of clinical ophthalmology at the Bascom Palmer Eye Institute, shares his advice on how to navigate these challenges and begin a successful academic retina practice.

Q: How many years having you been practicing? What motivated you to start a clinic in an academic setting?

Academic practice was always attractive to me because of the combination of teaching opportunities, including student and fellow mentorship, research, and complex referred pathology. After 2 years as a vitreoretinal fellow and clinical instructor at Wills Eye Hospital and Thomas Jefferson University, I joined the faculty at the Bascom Palmer Eye Institute as a vitreoretinal surgeon and assistant professor.

I have now been on faculty here nearly 3 years — time flies when you’re having fun!

Q: For young attending physicians, what is the best way to build your patient base? Do you partner with optometry? How do you develop referral networks from colleagues within and outside of your institution?

This is highly variable depending on the setting and the needs at your new practice. For example, a busy multispecialty group may have built-in retina referrals from within the group from day one, while other scenarios may require a new associate to aggressively practice build. There are some general rules that apply to any scenario as a new physician.

First, the three As: be available, affable, and able. Distribute your cell phone and direct contact information to potential referring doctors, answer their texts and phone calls, and be responsive. Never criticize a referring doctor directly or indirectly, be nice to all patients and office staff members, and always smile.

Demonstrate clinical and surgical ability by giving local talks and lectures with interesting medical and surgical cases; many practices will arrange this for new associates soon after arrival. Optometrists and comprehensive ophthalmologists are the primary referral source for retinal surgeons, and interfacing with other eyecare providers in a collegial manner results in optimal patient care.

Q: Do you recommend finding a niche early in your career or exploring a wide range of pathology and waiting to see what develops into your area of specialty?

Some retina surgeons leave fellowship with a clear idea of where they would like to go with their career. For most of us, however, it is an organic and evolving process of encountering a need and filling it. For example, an unexpected and unique part of my own clinical practice is operating on retinal detachments and other surgical emergencies referred from underserved areas in the Caribbean that lack surgical retina coverage.

From a research perspective, the best advice I ever received was from one of my mentors, Dr. Allen Ho, who said that being busy and taking care of patients results in stronger, more thoughtful, and more impactful research ideas and projects. Focus on consolidating your general retina practice and clinical skills early, and your labor will bear fruit.

Q: How do you approach challenging cases during the first few months as an attending physician? Do you reach out to mentors at your current and/or prior institutions?

The biggest key with handling difficult cases is a measure of humility. Retina surgery is exciting because of its inherent variability from case to case, but that same variation means that you will certainly encounter situations in the office or operating room that you never came across in fellowship.

Your mentors from residency and fellowship are not simply past acquaintances, but lifelong friends who are there to support you and offer guidance. Cultivate these relationships by sending (privacy-protected) case questions to a brain trust of your choosing. Similarly, every institution operates differently, and senior physicians often have good insight into regional preferences as well as logistical navigation when it comes to complex situations.

Q: How do you balance work-related travel with your clinical duties?

In general, to be academically active, some degree of travel is critical to build relationships and gain exposure on a national and international basis. That being said, early in your career, you will likely be the “low person on the totem pole” and often assigned to cover calls during major meetings.

Accept this fact graciously, but try to attend at least one major meeting a year to stay engaged in the retina community. Later on, you may find yourself traveling more often, and this can cause strain on your clinical practice, given the volume of patients requiring regularly scheduled treatment. Then, the tough decisions start happening.

Some physicians simply limit themselves to a certain number of meetings per year. Others are creative and find ways to jet across the country and back to minimize loss of clinical coverage. As you move through the first few years of practice, do some introspection, and figure out how you aim to balance your clinical duties with travel — and the rest of your life, including family.

PAVE YOUR OWN PATH

In conclusion, there is no one path to take to successfully navigate the transition from training to autonomous practice. Flexibility, enthusiasm, and passion are critical to the process and, with the support and teaching of mentors and colleagues, one can shape his or her journey while building an effective clinical practice and providing excellent patient care. ■