Eyeworld

Reporting from the WIO Summer Symposium, August 11–14, 2016, Williamsburg, Virginia Sponsored by EW MEETING REPORTER 126 September 2016 bipartisan support and fundamen- tally changes the way Medicare determines and updates payments to physicians. This also incentivizes development and participation in alternative payment models (APMs) and establishes the merit-based in- centive payment system (MIPS). With MACRA, there are two pathways to avoid cuts and achieve Medicare bonuses: APMs or MIPS. The APMs have incentives for devel- opment and participation, including a 5% bonus from 2019–2024 and a 0.75% update after that time. There is also exemption from MIPS pen- alties. You must demonstrate that providers have "nominal financial risk," Dr. Rich said. The goal is that 25% (2019–2020), increasing to 75% (by 2023), of practice revenues or patient volume must come from APMs to be eligible for the bonus. Meanwhile, the MIPS program features a compilation of perfor- mance categories: quality, resource use, clinical practice improvement activities, and advancing care in- formation. Physicians will be given a composite performance score based on these factors, with qual- ity reporting accounting for 50%; resource use, or cost, accounting for 10%; clinical practice improvement accounting for 15%; and advancing care information (Meaningful Use) accounting for 25%. The percentages in this composite performance score are proposed for the first year. Editors' note: The speakers have no financial interests related to their presentations. Different career paths and achieving success A session highlighted different possible career paths, exploring such topics as academic medicine, private practice, military, research, and administration. Kathryn Colby, MD, PhD, Chicago, described her top five reasons to explore the option of academic medicine. She counted down, and number five was that the financial bottom line is not the only consideration in working for the greater good. You get to do a variety of activities in academic medicine, she said, including clinical care, research, education, and adminis- trative work. On the flip side, Dr. Colby did note that you will make less money in academics. It's also very difficult to be equally good at diverse activities. Multitasking can be stressful, Dr. Colby added. Additionally, teaching ophthalmic surgery can be challenging and takes a certain personality. Another advantage in academic medicine is that you can have a flex- ible schedule, Dr. Colby said. You are able to work with smart colleagues, which she called "a joy of academ- ics." Creating new knowledge was another key advantage that Dr. Colby offered. Finally, influencing the next generation was the last and top reason that she cited for working in academic medicine. When finding an ideal career path, there are pros and cons in each one, Dr. Colby said. You have to know what makes you satisfied. This requires looking at what you find enjoyable and satisfying and also what you hate. Dr. Colby offered a number of tips for succeeding in academic medicine. You have to want it no matter what you do, she said. Find- ing a mentor, learning to negotiate, and taking care of yourself are all important as well. You may have to multitask and have a lot of plates spinning at the same time, she said. Although it's important to have a long-term plan, you also need to be able to go with the flow, Dr. Colby added. Be very protective of your time, and learn to say no sometimes. You can't have it all at the same time, so recognize that, Dr. Colby said. Captain Cary Harrison, MD, Portsmouth, Virginia, described her work in the military, specifically the Navy. Many start by taking a schol- arship for medical school, and most do their residency training in the military as well, she said. "In addition to being physicians, we take our role as Naval officers very seriously," Dr. Harrison said. This includes leading and mentoring junior troops, setting a good exam- ple, standing inspections and being the inspecting officers, participating in selection boards, and participating in ceremonies. The ophthalmology practice model in the Navy tends to be different from civilian practices. Dr. Harrison described some of these differences, as well as some of the specifics about where ophthalmolo- gists in the Navy are stationed. The associated travel is one of the biggest

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