We need to tell you something…
We’ve watched many cataract and refractive surgeons fail to reach their potential.
After being in the business of laser eye surgery marketing for over 20 years, we’ve witnessed many practices led by talented surgeons who have trained and worked tirelessly “vanish”…seemingly overnight. The sad part is that they physically couldn’t carry on…
They had the skills, the experience, the passion that got them to where they thought they wanted to be.
Everything was in place. And yet, NOTHING was ready to face today’s reality.
And so, what do many people do in the face of uncertainty and hardship…
…they keep their problems to themselves and carry on.
And that’s when they make what is probably the worst decision of their entire career…
“My marriage broke down along with my practice”
When Michael decided to start his private practice, he was fresh-faced and full of energy. He knew exactly where he wanted his practice to be, so he worked long hours while getting little sleep to try and get there.
For a while, the hard work was paying off. He had achieved a level of surgical expertise that other surgeons could only dream of.
But he wanted more.
Michael wasn’t feeling challenged enough. He still hadn’t distinguished himself from his colleagues, and not enough people were benefiting from his work.
He would get up super early. He’d read his emails before breakfast and recheck his emails before his first patient. Then, he’d read his emails in between patients too, often making the entire clinic late when he’d get caught up in a call or an email. The team supporting him were frustrated with him.
He’d urge everyone around him at the clinic to change something. Anything! He was desperate for his practice to improve, but he couldn’t get it to function at the same high level as his medical standard of care.
Sure, other surgeons were jealous of his surgical skills and intellect, but they were secretly glad that he wasn’t a commercial success.
Eventually, he hit a wall. Nothing was working anymore.
He became riddled with worry that he didn’t have the expertise to run a successful business and plagued with guilt that he never had time to spend with his family and friends.
Within a year, it was clear that things weren’t going to get better.
By the next year, he had completely burnt out.
It wasn’t until his wife came to him and said she wanted a divorce that he decided it was time to make a real change.
Michael was desperate. He was still just as clueless about marketing and business management as the day he had decided to open his own private practice.
Worst of all, he was too proud to ask for help…
Hitting rock-bottom and a cry for help
Realising that your career is stagnating and that your marriage is failing is painful.
Sure, taking a step back from work to try and patch things up at home provided Michael with some temporary relief. But, he still felt exhausted.
So, during this period of slow-motion collapse, Michael largely kept to himself. He stopped talking to friends. He stopped returning calls and texts from peers. And he stopped attending events and conferences.
He had failed. He was embarrassed. The last thing he wanted to do was talk about it.
And now, things were even worse…
Not only had he failed at running his own private practice, but he had also failed at his marriage.
His survival instincts eventually kicked in. He considered taking a break. But, he knew the team wasn’t equipped or capable of handling the clinic in his absence. So he couldn’t just let it all fall apart.
So, for the first time in 24 months, he asked for help.
“You can’t even run your own practice? Wow, you are one pathetic LOSER…”
Sadly…. That’s literally what Michael thought his friends and family would say when he shared his story and confessed why he had been “off the grid” for the last 2 years.
Fortunately, the reality was very different.
When Michael began talking to his peers, he discovered that they were ALL struggling with the same issues and were ALL too afraid to talk about it because they were ALL operating under the illusion that EVERYONE else “had it together”.
Michael was gobsmacked – “Thank God…I’M NOT ALONE!”
In fact, when asked, just about every surgeon who had established their own private practice shared a similar experience that went something like this…
The stories were so similar it was shocking…
For literally ALL of them, the burnout and ensuing feelings of failure came immediately after they had made that first leap towards independence. They were all so keen to stop their dependency on corporate healthcare, private medical insurance providers and national health service work and go at it alone, that they rushed in without a plan.
More surprisingly, it wasn’t the growth of their private practice that did them in. Instead, the decision to single-handedly scale their practice to the “next level” was what sealed their fate.
Let me say that again, because it’s so, so important…
Growth didn’t hurt them. Instead, the decision to scale their practice without the necessary support and systems in place was the most consistent variable in all their flatlines and failures.
In other words, just when they started to think they had everything figured out, the walls came crashing down around them.
The realisation was painful, but it was also strangely comforting.
Again….MICHAEL WASN’T ALONE!
None of his peers were. (And you aren’t, either.)
And most comforting of all, it wasn’t just Michael’s peers who identified with this experience.
Michael soon discovered that his mentors, the people he respected the most because they had “been there and done that,” had gone through the same experience…many of them MULTIPLE TIMES in their journey.
“I wish you would have called me before you let things get that bad,” one of his mentors said. “I could have told you that what you’re going through is nothing new, and it isn’t your fault. It’s just a normal part of the eye surgeon burnout cycle which many experience.”
So, “Is this normal?” I hear you ask.
Yes. And we know how to get around it.
Understanding the eye surgeon burnout cycle
Our research and experience have led us to conclude that the vast majority of cataract and refractive surgeons follow a similar burnout cycle.
The Eye Surgeon Burnout Cycle is not a new concept. Psychologists call it occupational burnout syndrome, and researchers have documented certain aspects of burnout as early as the Old Testament.
The coining of the term ‘burnout’ in a clinical sense is typically attributed to Freudenberger, who described it as particularly pertinent to “helping” professionals.
“Burnout is a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress. It occurs when you feel overwhelmed, emotionally drained, and unable to meet constant demands.”
Burnout is especially prevalent in medicine, where work-related stressors tend to be more extreme, responsibilities are numerous, and one is surrounded by and constantly compared to successful peers.
Now considered a billable condition in the International Classification of Diseases, 10th edition (ICD-10) with code Z73.0, burnout is officially defined as a “state of vital exhaustion.” It is widely prevalent in all of medicine, with more than half of physicians reporting at least one symptom of burnout when assessed with the Maslach Burnout Inventory.
Ophthalmologists report burnout and depression at a high rate of 35%.
Women in ophthalmology report an even higher rate at 43%, and middle-career surgeons reported higher levels than those in the early or late stages of their careers.
This mental state affects productivity and work environment. Nearly half of ophthalmologists reporting depression also express frustration in front of staff/peers, become easily exasperated with colleagues and patients, and are less engaged/friendly.
We should all be concerned with burnt-out clinicians rating patient safety as a lower priority.
Are ophthalmologists burned out or depressed?
How severe is ophthalmologists burnout?
Studies show that a substantial proportion of surgeons experience distress or burnout, conditions that can negatively affect themselves, their families, their colleagues, and their patients. And while it’s one of the aspects that may have attracted them to the job – ophthalmology is one of the fastest moving technical fields in medicine. Staying on top of all the new technical and clinical developments in ophthalmology can be an extremely challenging part-time job in itself!
“About 6 in 10 ophthalmologist respondents who reported burnout consider it serious enough to have at least a moderate impact on their lives. Around 1 in 10 find it so severe that they are thinking of leaving medicine altogether, an unexpected outcome after having spent so many years in training to become a phyisician.”
Surgeons work hard. They work long hours. They regularly deal with life-altering situations with their patients. They make substantial personal sacrifices to practice in their field.
These attributes of surgical practice, along with the rigours and length of training for this profession, attract individuals of a particular character and determination.
These individuals share an unwritten but understood code of rules, norms, and expectations.
This code includes coming in early and staying late, working nights and weekends, performing a high volume of procedures, meeting multiple simultaneous deadlines, never complaining, and keeping emotions or personal problems from interfering with work.
We should all celebrate and reward these hallmarks of dedicated professionals. However, there is a fine line separating dedication from overwork. If unchecked, overwork could lead to counterproductive, unhealthy, or even self-destructive behaviour that may affect patient care.
Furthermore, sixty-three per cent of ophthalmologists who reported burnout pointed to
“the growing number of bureaucratic tasks as the leading contributor. Other factors include having too little compensation and reimbursement.”
Burnout not only affects your psyche and productivity, but the literature also points to burnout having significant adverse health consequences.
A review by Salvagioni et al. showed that burnout was a predictor of 12 physical conditions including hypercholesterolemia, diabetes, coronary heart disease, severe injuries, and mortality below the age of 45 years.
These statistics indicate that a substantial number of your colleagues are struggling with personal and professional distress at a level that should concern all ophthalmologists (and their patients)!
What contributes most to ophthalmologist burnout?
Scroll over the bars below to see the strongest contributors to burnout
What’s going on here? All these pathetic ophthalmologists experiencing burnouts are all just overly emotional and disorganised, right?
Surely, I won’t reach this point?
Chances are…yes, you might.
Introducing: The Eye Surgeon Burnout Cycle
Just as Fortune 500 CEOs burn out after years of near-superhuman stamina and resilience on the job…
…fresh-faced surgeons who have only just dipped their toes into the world of private practice can too.
This is what we now refer to as the “The Eye Surgeon Burnout Cycle”.
Next, I’m going to break down each phase in the Eye Surgeon Burnout Cycle.
As I do, note which phase best describes where you are right now in your journey.
Diagnosing where you’re at along this cycle is the first step to avoiding professional burnout while opening the door to growing a successful independent cataract and refractive surgery practice.
Ok, let’s dig in…
Phase 1: The newly-qualified consultant /specialist
“Is this all there is?”
If you’re at this stage, you’re between 30 and 35 years of age (depending on where you train). You’ve finished your 12 to 19 years of training and are freshly minted as a qualified consultant or specialist ophthalmologist – congratulations!
At this point, you’re likely working more than 50 to 60 hours a week (and then being on-call 24/7) in public or corporate healthcare systems.
If you’re in the UK, the starting salary for a Consultant Ophthalmologist is £82,096 per year (±$113,254 USD in 2021).
In the US, you’re averaging $200,890 per year as a junior ophthalmologist.
The starting ophthalmologist gross salary in Australia is $256,281 (±$189,366 USD in 2021).
Female ophthalmologists across the world, inexcusably, make far less than their male counterparts.
If you’ve chosen to be a gun-for-hire for one of the corporate chains, what you get depends on the chain. Some of the highest-volume corporates in the US and the UK pay eye surgeons as low as the equivalent of $150-200/eye for a LASIK! The generous ones pay more (we’ve heard of up to $500/eye).
If you’re in this boat, your peers might see you as a C-List surgeon that’s “undercutting” them and only helping corporates to commoditize medicine (which automatically ejects you from the “KOL-crowd”).
If you’ve chosen to supplement your income with reimbursements from private medical insurance, the picture isn’t any rosier. As one eye surgeon put it,
“Cataract math in 2020 is disappointing, to say the least. If a practice had an overhead of 71% before the reimbursement cut—a common overhead for many ophthalmology practices—a 15% reduction in reimbursement reduces take-home profit from cataract surgery by a whopping 51%.”
So, it’s likely fair to say that you probably feel overworked, underpaid and underappreciated for the extraordinarily high level of education and value you bring to your role and your patients every day.
During an average day, it’s not unusual to feel a little rushed or under-empowered. You likely feel a soul-crushing lack of autonomy in how you practice medicine.
After climbing what you thought was the ladder of success, you’re starting to wonder if it was leaning against the wrong wall and routinely start asking yourself…
“Is this all there is?”
It can’t be.
You know you’re better than this. You should be paid what you’re worth. You should be able to practice in a way that’s most beneficial for your patients.
So, you decide to strike out on your own, get yourself a little website, and start offering yourself as a brand.
Phase 2: The “sole practitioner”
You’re breaking free and building momentum
Once you break the chains of institutional servitude, you start making a name for yourself.
At this stage, you might be getting most of your patients from private medical insurance referrals. Perhaps the facility in which you operate refers patients to you. You might enjoy referrals from the network of optometrists and opticians that you’ve managed to assemble in your copious amounts of free time.
You’ve likely dipped your toe into the internet by registering with some insurers, private practitioner directories and patient review websites.
The bottom line is – you are dependant on referrers to have patients to operate on. This often means that you’re being paid by insurance companies who take a heavy chunk of your procedure fee as well as a glacially slow amount of time to pay after you’ve performed your service.
If you want to grow your practice, you know that you can’t depend on these channels alone. Yet, your tiny digital footpring hasn’t yielded the results you’re looking for.
It can feel like a LOT of outside forces are conspiring to discourage you on a daily basis. In the words of a fellow surgeon:
“If we didn’t have insurance companies in the mix, and this was a simple patient-to-doctor cash pay business – life would be SO much better.”
It’s a real squeeze.
Your average day likely consists of seeing many patients in and out of your appointment room and doing surgery one or two days a week. Because you work in multiple facilities, you’re likely travelling a LOT – which can negatively impact your quality of life both at work and at home. Furthermore, you likely have little control over where or when you work and daydream about having more control over how you practice your craft.
Perhaps you could escape the C-List and get into the B-List of eye surgeons…
Perhaps you think it isn’t right that patients who really need YOU just get seen by whichever eye surgeon is randomly available or has the deepest old boy’s network.
Perhaps you’ve decided that you’ve had enough.
It’s time to dig a little deeper, take control and make a real step towards some independence – even if that little step is just renting a consulting room with some diagnostic equipment and hiring a part-time secretary on the side.
“Maybe this is it,” you think… “If I build it, they’ll surely come. Maybe, just maybe, “
Phase 3: The “tenant”
You’ve taken a seat at the bigger-stakes table now – and it’s time to ante up
If you’ve reached this stage, then you’ll be excited, but you also might be getting worried that you’ve bitten off more than you can chew. Your outgoings are increasing, and the pressure is mounting to bring in more patients.
“I made the decision to leave the public health sector and focus full time on private practice. I need a certain growth in my business. I’ve tried various marketing activities and designing my own website. I’ve even had a specialist company design a website for me. I’ve taken it as far as I can with my limited knowledge of business and marketing.”
Eye surgeons that reach phase 3 are often running on empty.
And unfortunately, you often feel as though your family and personal well-being is suffering as a result.
That’s because you’re wearing too many hats, have too little help, and rarely have enough patients to fill the often over-priced rooms you’re paying for.
It’s not unusual at this point to feel like you’re out of your depth and lack the expertise to run a successful practice.
You may feel anxious that you’re not hitting patient volume targets to pay bills and tired from doing everything yourself, from screening patients to marketing, sales and customer service.
It’s no wonder that this group of eye surgeons are typically highly caffeinated and stressed.
Perhaps your average day consists of getting up early to answer emails you didn’t get to yesterday or dodging medical device reps telling you how to manage your practice.
In between patients, you might attempt to learn about and do the business aspects of your practice while watching your bank account go down from a lack of patients.
It’s likely that you get home very late at night and don’t spend enough time with your family.
“Thanks to second-rate marketing, I look like a second-rate doctor.”
Other professionals in your field aren’t likely to perceive you as a threat or anyone to watch.
You might feel that you’re an excellent surgeon and that it shouldn’t be this difficult to attract attention and grow your practice.
You’re at the moment of inflection. It’s either up or down from here because staying where you are is untenable.
So, you decide it’s time to increase your share of the pie. The only way to do this is to invest in better technology, more experienced staff, probably a little more space, and the dreaded “M” word… MARKETING.
Phase 4: The “entrepreneur”
You’re a business owner now – it’s time for growth or decline (and the choice is yours)
If you make it to phase 4, our hats off to you.
At this stage, you’re running a comprehensive medical office or eye surgery clinic. By now, you’ve spent hundreds of thousands on high-end medical equipment. You’ve spent uncountable hours and treasure on recruiting, hiring, training and managing staff. There’s also little doubt that by now, you’ve spent heaps of resources on unforeseen marketing expenses – much of it wasted.
But still, you haven’t made it yet – and you often find yourself thinking…
“I just want to focus on surgery, and doing more of it”
But you can’t.
Because you now truly have a million other things that only you can seem to do.
You might have great surgery results, a promising team and awe-inspiring testimonials, but you know your practice could be 10x more efficient.
Many eye surgeons strive for “perfection” but feel that nearly everyone around them isn’t doing what they’re supposed to as efficiently as they could do it. After all, it can be difficult to find competent, quality commercially-savvy employees.
Do you find that when you arrive at the clinic, you’re ready to drive the team to produce excellence, but instead, you end up putting out fires left, right and centre?
“I often walk into the office in the morning wondering ‘What’s going to fall apart today?'”
Maybe you’d like to be able to trust someone else with mission-critical decisions – like marketing, practice management, finance, and human resources – but finding good people and then getting them to do these things well takes far too long.
All the while, the clock is ticking.
If you’ve set yourself financial goals or an exit strategy, you might have about 10 to 15 years left to make this work before you cash out.
The last thing you want is to spend a lifetime of hard work and savings to end up disappointed.
So, now it’s up to you. Do you invest in professional support and expertise to go all-in for hyper-growth?
Or do you retreat from the challenge, understandably accepting that life was a whole lot simpler when you didn’t have all of these hats to wear and mouths to feed.
Phase 5: The “CEO”
You’re a business owner shooting for standardisation and high-performing systems
Assuming you do not choose to retreat, the next level is to grow the practice, and assume the role of CEO. As you expand, you’ll observe that an optimal ratio of reports to managers is 7:1. Therefore, if you’ve built an organisation of around 50 people plus – you’re going to need a leadership team of about 7 managers – each running a team of 7 (±2). But even at the C-level, life can be tough.
“Although my practice has grown a lot, I’ve reached the stage where I need a little more professional help. We’ve plateaued and I need to make us more visible, productive and efficient.”
Eye surgeon CEOs at this level are often troubled by semi-functioning teams of clinicians, administrators, marketing, and sales/patient service staff who are supposed to get it, want it and have the capacity to do their jobs – but often don’t.
They likely have hodge-podged their own systems, and every team ends up fighting with the other for more recognition of their value.
That means that you’re likely bleeding money every month due to the lack of standardisation and systems in place.
At this stage, it can feel as though you’re addressing many issues without making a big dent in the problem. You might feel pressure from the board to make a change in performance and increase revenue.
A typical day might go like this…
An early morning meeting with one of your associate doctors complaining that the nurses have not correctly set up the operating theatre.
Thanks to Dr Smith taking personal calls, the service staff informs you that the clinics have been running late all day long – resulting in several patient complaints.
An evening meeting with the board reviewing the numbers (which are down) demanding an action plan.
If this sounds like you, then you’re likely struggling with Impostor Syndrome.
“I’m a doctor. I was never prepared for this. Yet people are looking to me to make all the right calls.”
Your days are stressful, and people’s demands mean you have little time to create action plans to improve things.
This often results in you always being behind the 8-ball and can cause doubts in others minds that you’re not the right person for the job.
It’s not your fault. Unfortunately, it’s impossible to fix all of these problems alone. It would take a lifetime.
Uh-oh, here it comes…
So, to be really clear, you can burn out at ANY of these phases.
Burnout is that point that all eye surgeons ultimately reach when they experience stress and hardship for a sustained period of time – with no relief.
During a burnout, depending on the phase you’re in, you might not be making money, you certainly aren’t having fun, and worst of all, you don’t know how to fix it.
In short, you’re stuck.
When you have a quiet moment to think, you remember how simple things were when you worked for someone else.
“I liked it better when I just did my job and received my pay-check at the end of the month. Maybe I just need to take a few steps back.”
In other moments, you let your frustrations get the better of you and toy with the idea of just “blowing it up” and starting over again.
“Why am I paying for all of these people and expenses? They were supposed to make my job easier, but it’s only gotten harder! Maybe I should just fire everyone if I’m going to have to do all the work, myself!”
And in your darkest moments, you consider just throwing in the towel…
“Maybe it’s time to shut it down…call it quits…see if I can get my old job back.”
If you have ever thought these thoughts or felt these feelings, don’t fret…you’re in good company. But, unfortunately, this is the mindset many eye surgeons are in when they go at it alone.
We’re going to show you how to get through your phase, but first, let’s discuss your options…