Fellows: Why They Chose Retina
Their Plans, Priorities, and Practice Selections
■ Retinal Physician recently surveyed a number of second-year fellows to see why they chose retina as their specialty, what they were looking for in a practice, and why they feel this is a good time to be entering the retina field.
Michael J. Davis, MD, chose the subspecialty for two reasons. On a personal level, his grandmother has macular degeneration and has lost much of her vision. She was diagnosed before the anti-VEGF era.
“I have seen her struggle with vision loss, and this prompted my interest in helping patients like her,” says Dr. Davis, a vitreoretinal surgery fellow at Illinois Retina Associates/Rush University Medical Center. On a professional level, he sees vitreoretinal surgery as one of the most challenging subspecialties in the field of ophthalmology.
Growing up, Arghavan Almony, MD, was told she would lose her vision.
Dr. Davis sought a challenging specialty.
“My mother — an incredible and very accomplished woman — has counting-fingers vision and significantly reduced visual fields. She was incorrectly diagnosed with Best's disease, and my younger brother and I thought we would suffer the same fate,” explains Dr. Almony, a fellow at the Barnes Retina Institute.
Each year, she and her brother would breathe a sigh of relief as their eye doctor told them that their dilated fundus examination was normal. They never had ERGs or EOGs and didn't realize these should be part of the evaluation. Once in college, with proper evaluation, she realized she had nothing to worry about in terms of inheriting her mother's poor vision.
“I chose retina because I know how precious sight is and I want to have the skills to save vision in my patients. For patients that we can't help yet, I want to be the person that supports them, gives them hope, and provides resources for them,” says Dr. Almony.
Kyle Alliman, MD, says that “the breadth and nature of the pathology seen on a routine basis” is what drew him to retina. “Both medical and surgical retinal diseases often require innovative problem-solving skills that greatly appealed to me,” says Dr. Alliman, who will soon return to his home state of Iowa, joining the Wolfe Eye Clinic in West Des Moines.
Dr. Davis says that the main reason he chose the practice he's joining is that it is a relatively young practice with a great deal of opportunity for growth. He did not interview for academic positions, but rather focused on private practice groups that had a strong interest in research and other academic endeavors.
Dr. Almony's mother has severe vision loss.
Tushar Ranchod, MD, a fellow at Associated Retinal Consultants in Royal Oak, Mich., says that now is a good time to get into retina because of the growing elderly and diabetic populations.
“In addition, there is a policy shift towards supporting high-value therapies and reducing incentives to provide expensive low-impact treatments,” says Dr. Ranchod. “In quality-of-life terms, the therapies provided in our field — preventing blindness or improving visual acuity — are highly beneficial to both patients and society, and there is a growing literature supporting this concept.”
“I would expect that in the span of my generation's career, we will experience unrivaled growth and development in our subspecialty. I think one would be hard-pressed to find a more progressive discipline in all of medicine,” concludes Dr. Alliman.
Medical Offices: Rent Space or Buy?
This May Be a Good Time to Purchase a Property.
BY JERRY HELZNER, SENIOR EDITOR
The market for medical buildings has been a stable niche in a badly slumping commercial real estate market. The building pictured is used only as an example and is not for sale. PHOTO COURTESY OF NOVAMED
■ With interest rates about as low as they are likely to go and prices for commercial real estate scraping bottom, retina practices that have been leasing space may be thinking about buying their own building. In addition, practices that are ready to expand may be contemplating adding a satellite office. With the exception of newly formed practices, this may be the perfect time to purchase a medical building.
“In a difficult commercial real estate market, medical buildings are a safe, recession-proof niche,” says Jessica Ruderman, director of research services for Real Capital Analytics, which monitors all aspects of the commercial real estate market worldwide. “Given the positive demographics for ophthalmology, the long-term nature of relationships with patients and the potential of millions more people to be covered by health insurance, medical buildings represent the safest type of asset and should be attractive to mortgage lenders.”
Ms. Ruderman says that nationally the prices of medical buildings have fallen somewhat over the past two years but at nowhere near the rate of other types of commercial real estate. Also the pace of medical building transactions has held up much better than the rest of the office-building marketplace and now makes up about 11% of all office building sales.
“This should be a good time for ophthalmology practices to buy a building because who knows when you will get these prices again ” says Ms. Ruderman.
The one exception: business consultants say that newly formed practices are better off renting. Physicians' energies should be focused on staffing, purchasing state-of-the-art equipment and adding to their patient base.
By leasing space at the outset, a newly formed practice can determine if the location is one that will be suitable over the longer term. In addition, given current market conditions, a landlord may be willing to offer several months of free rent or interior improvements in order to land a good tenant.
Leasing has several other advantages, such as being able to deduct rent as a business expense. However, all leases are different and a practice should be aware of any responsibility to pay for utilities, property taxes, insurance and/or minor repairs.
Once a practice has decided to purchase a building, a few other factors come into play. The following should be considered:
■ Location. In the past, a location near a hospital was considered prime. Now, with many more procedures being performed on an outpatient basis, a location near an ophthalmic surgery center may be preferable.
■ Size of the property. Do you want a building for your sole use or do you want to lease some of your space to other medical providers? Being a landlord can be a headache but close proximity to other providers such as primary care can help in obtaining referrals.
■ Type of property. Condo properties offer ownership but with many restrictions such as limited possibilities for future expansion. Condo deals should be thoroughly scrutinized as they have not always worked out well for medical practices.
In the article “Surgery for Primary Rhegmatogenous Retinal Detachment” in the March 2010 issue, the first author was misidentified. The author who should have been credited is Steven D. Schwartz, MD, of the Jules Stein Eye Institute at UCLA.
In the April 2010 Coding Q&A column, the coding for the vitreoretinal surgeon should be reversed. The pars plana vitrectomy (67036) should be coded first to maximize reimbursement. The removal of lens material (66850) procedure should be coded second.