Christina Weng, MD, MBA, the newest member of Retinal Physician’s editorial board, had a front row seat to a family clinic on how to succeed in medicine and business while she was growing up. In the “typical American town” of Shelby Township, Michigan, she watched as her hardworking parents, both immigrants from Taiwan, gradually developed successful careers as physicians. Her father still works as a general surgeon; her mother, a recently retired general practitioner, once ran a thriving family practice.

“My mom has been my role model and hero since I was a child,” says Dr. Weng. “Not only did I watch her achieve the American dream as an immigrant who started her own business, but she managed to do that while raising a family and providing us with an ideal childhood. The further I move along in my career, the more I look back in awe and wonder how she did it. There is so much risk inherent in starting a business, but she was driven by compassion for her patients — who she unwaveringly put first. Financial success was always secondary to caring about people.”

Long before she began her undergraduate studies at Northwestern University, Dr. Weng felt that she was destined to practice medicine. But after discovering during her freshman year that she found market capitalization as interesting as mitochondria, she went on to double major in biology and economics.

“Economics tickled my brain in a different way than science did, and it was fascinating to me,” says Dr. Weng. “Even though I was pre-med, I ended up spending most of my academic time in the department of economics, and that provided me with a different way of viewing the world of health care.”

After college, she continued to straddle the worlds of medicine and business, completing a combined MD/MBA program at the University of Michigan. The goal was never to end up on Wall Street, she says. Instead, her hope was that business insights might inform her practice of medicine. During early encounters with patients while still in medical school, she began to appreciate the value of her dual degree.

“On the wards, you are really awakened to the harsh reality of socioeconomic factors being intertwined with health care,” she says. “You realize that medicine is business, albeit a very special one. Understanding a health care system from an organizational, financial, and management standpoint can make the difference between impeding and facilitating patient care.”

When it came time to choose a medical specialty, Dr. Weng found herself drawn to a number of different areas, and turned to her mother for advice. Her mother, whose own ophthalmology residency in Taiwan had been curtailed by her immigration to the United States, had been fond of the specialty and suggested it might have just the combination of elements that her daughter was seeking. Ophthalmology turned out to be a good fit, landing Dr. Weng a “dream” residency program at Johns Hopkins University, followed by a surgical retina fellowship at the Bascom Palmer Eye Institute in Miami, Florida. She went on to join the faculty at the Baylor College of Medicine in Houston, Texas, where she is currently an associate professor of ophthalmology, fellowship program director, and staff physician at Ben Taub General Hospital.

“I never had that ‘aha’ moment when it came to choosing ophthalmology as my career path. It seemed to have all the features I was looking for in a specialty, and it was a very rational decision for me at that time. But a funny thing happens as you delve deeper into a field. We tend to love what we are good at, so as you get better at your craft, you begin to experience this positive feedback cycle. I truly cannot imagine loving any specialty more, and I often use my own experience to reassure trainees who are having similar difficulties in deciding what specialty to pursue.”

Applying Business Acumen to Medicine

Shortly after her arrival at Baylor, Dr. Weng discovered another passion: academic research and clinical treatment related to diabetic retinopathy (DR).

“I find diabetic retinopathy intriguing because there is still so much we don’t understand, but I also find it devastating because it is largely preventable with early detection and treatment,” says Dr. Weng. “And yet, DR is the leading cause of blindness among the working-age population in the United States.”

The American Academy of Ophthalmology and the American Diabetes Association recommend annual ophthalmic screening for patients who have diabetes mellitus to prevent complications of both DR and diabetic macular edema. However, compliance rates are poor (35% to 65%), in part because of financial challenges and a lack of patient awareness.¹

“Sadly, even if patients were perfectly compliant with screening guidelines, there would not be enough specialists to examine and treat everyone. Leveraging technology to extend our reach as ophthalmologists is vital,” says Dr. Weng.

As physician champion of the Harris Health System (HHS) teleretinal screening program in Harris County, Texas, she is proud to be part of a program that has conducted more than 160,000 screenings that have led to early disease detection and enabled thousands of people to maintain good vision, including members of socioeconomically disadvantaged and ethnic minority groups who otherwise would not have had access to appropriate ophthalmic care. Dr. Weng also recently performed a retrospective analysis of more than 18,000 patients screened in the HHS program to determine the economic benefits of the program.

“We have evaluated outcomes and accuracy in the detection of disease, but the cost-saving potential of teleretinal screening was really the focus of our 2018 study,” says Dr. Weng. “Telemedicine is an area that is still in its infancy, and its valuation and corresponding reimbursement rates have not quite yet caught up to the technology.”

Dr. Weng and her coauthors demonstrated that teleretinal screening has significantly more direct and indirect economic benefits than conventional screening. They applied activity-based costing to precisely assess screening costs.

“We mapped out the entire process and workflow involved in teleretinal screening and assigned a cost to every step, accounting for all of the resources involved. When comparing the tallied cost estimate with the cost of an in-clinic eye exam, we found that teleretinal screening costs less than conventional screening, but can yield similar benefits.”

Offering Guidance to Others

Early in her career, Dr. Weng began seeking ways to contribute to the career growth of colleagues in her field. Her deep appreciation for the American Society of Retina Specialists (ASRS) and her gratitude to her own mentors inspired a desire to develop a program that might support retina specialists who are relatively new to the field.

“The ASRS does such tremendous things for the entire community,” says Dr. Weng. “In particular, I’ve benefitted greatly from my involvement in the Early Career Section, for members in the first 7 years of their career. I really applaud and appreciate the ASRS for carving out this sector of the membership and supporting programming that helps us navigate the unique circumstances we all face during those early years.”

Together, she and Mitul Mehta, MD, of the Gavin Herbert Eye Institute at the University of California at Irvine developed an ASRS mentoring program that connects early career retina specialists one-on-one with more experienced mentors.

“Your first few years as a retina specialist can be daunting because you’re no longer a trainee, so you don’t have that built-in guidance and yet, you don’t have a lot of experience under your belt, or the confidence that comes with experience. Retina is such a small community and specialists certainly have opportunities to interact at meetings, but we envisioned an organized mentorship program that would provide younger specialists with someone to whom they could turn for questions and advice while their careers are getting off the ground.”

The program, which operates entirely on a voluntary basis and now involves the participation of more than 175 mentees and mentors across the country and around the world, has been extraordinarily successful. Early career specialists are carefully and thoughtfully matched up with more seasoned practitioners based on their background and preferences.

“The exchange that takes place in these relationships can be pretty magical,” she says. “Mentors find the program rewarding because they have an opportunity to improve someone else’s experience by sharing their own successes and obstacles. And mentees are introduced to someone they may not have met otherwise. While the mentorship cycle formally lasts 1 year, we hope and anticipate that some lifelong mentorship relationships and friendships will be fostered as a result of the program. The program is 2 years old now, and we’re committed to cultivating its continued expansion.”

More recently, Dr. Weng has teamed up with Nina Berrocal, MD — a valued mentor and role model she met during her fellowship — to zero in on ways to support fellow women colleagues.

“It’s an interesting time — people are more cognizant of issues regarding diversity and representation,” says Dr. Weng. “So, when I was approached about writing a book on women in ophthalmology, I couldn’t say ‘yes’ fast enough. Although the current gender breakdown in ophthalmology is about 50/50, gender-based disparity is still quite evident when you look at things like leadership positions, academic appointments, and research funding. I think I am even more attuned to these issues now as the number of women choosing to subspecialize in retina is growing. When I was interviewing for fellowship, I was used to seeing only 1 or 2 women in a roomful of applicants. Things are definitely changing.”

Dr. Weng describes herself as fiercely independent and someone who has always had a tendency to figure things out on her own. However, she came to fully understand and embrace the value of mentorship during her education and training.

“I am indebted to so many special people who have helped me along the way by providing opportunities and bits of advice here and there, and who have steered my early career in a positive direction. Sometimes, those coffee-break conversations and 5-minute phone calls end up providing you with invaluable wisdom.”

Dr. Weng and Dr. Berrocal are putting together a collection of narratives that address topics such as how to choose a residency position, how to find a job, how to parent while working full time, and how to conduct clinical trials or start a practice.

“We share advice with one another all the time, but no formal repository for this information exists,” says Dr. Weng. “Since most chapters are being authored by women ophthalmologists, the book will provide a unique perspective on certain issues, but our hope is that all readers — both men and women — will benefit from its contents.”

Women in Ophthalmology: A Comprehensive Guide for Career and Life is scheduled to be published by Springer in the fall of 2020.

Reference

1. Garoon RB, Lin WV, Young AK, Yeh AG, Chu YI, Weng CY. Cost savings analysis for a diabetic retinopathy teleretinal screening program using an activity-based costing approach. Ophthalmol Retina. 2018;2(9):906-913.