Eyeworld

OCTOBER 2020 | EYEWORLD | 71 I Contact Lowrance: mlowrancedo@gmail.com Schneider: ESchneider@tnretina.com Williamson: blakewilliamson@weceye.com Zavdoni: zacharyzavodni@gmail.com ourselves needing to make changes to our stan- dard contract structure," he said. "Compared to a typical contract for a new associate, we reduced the guaranteed base salary, as a means of the practice protecting itself from a large expenditure in the event of another COVID shutdown. To counterbalance this change, we increased the production-based incentive model such that if the practice is fully operational, the new associate will be able to bring home a more typical compensation." While Dr. Lowrance said opportunities still are plentiful, a culture shift not related to COVID is leading many practices away from a partnership model. "There seems to be a decreased interest in traditional ownership models from newer grad- uates," Dr. Lowrance said. Dr. Lowrance explained that exiting physi- cians looking to sell their ownership to younger ophthalmologists have different expectations. "The doctors who are approaching retire- ment seem to have a different idea of what their practices' value is relative to a newer graduate's expectation," Dr. Lowrance said. "This can create quite a perception gap." When there are fewer interested buyers, demand for partnership opportunities is lower, but the partnership supply is high. Dr. Low- rance said healthcare consolidation has been happening for everyone, especially with the move toward value-based care. "As we move toward a more consolidated healthcare delivery system, I think it's going to be more difficult, and the competitive opportu- nities for independent practices are going to be fewer," he said. COVID might have accelerated the consol- idation process for practices that were already struggling and looking for an exit. Couple this with reimbursement cuts that continue to happen to cataract surgery, and efficiency becomes paramount for survival. Dr. Lowrance said those coming out of training these days have largely seen what efficiency looks like. "They are unbelievably well-trained and the skillset the new residents have today is off- the-chart good," he said. "They are better equipped to take on all of these issues. I'm optimistic and confident in the future of eyecare." Dr. Schneider said the uncertainty of consolidation is something new hires should consider when they are joining a private practice. With ophthalmology among the hard- est hit medical specialties in the pandemic, it's important to ask about possible consolidation plans if that's not something you're interested in in the future. There is some stability in larger, consolidated practices that offer a salary-based model vs. a volume-based model, Dr. Schneider said. Doctors might consider academia, but he thinks academic medicine has become more clinic based to fund research as outside funding has become scarcer. He also said he has seen a trend toward some doctors pursuing solo practice. "They have a good network to discuss how to do it, how to support each other," Dr. Schneider said. Dr. Zavodni said he thinks practices are teetering on the edge. While the Paycheck Protection Program has helped keep private practices going, there is real concern of what might happen if there is another shutdown. "That said, the financial crunch of another 'rainy day' will fall onto private practices, private equity, and large hospital systems alike," he said. "I think it is more likely for practices to join together in cases of financial hardship than for PE firms to spend capital when the economy is tanking. Obviously, every community and prac- tice will be slightly different in their approach." Dr. Lowrance said he doesn't think cer- tain conditions will ever be the same "after" COVID. Telemedicine, for example, is here to stay, and technology should continue to be used in its fullest capability to communicate with patients, he said. Working in groups or teams is essential as well. "Residents should be able to adapt in teams in order to survive. … [The pandemic] forced Relevant disclosures Lowrance: None Schneider: None Williamson: None Zavodni: None continued on page 72

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