NOV 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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30 EW NEWS & OPINION November 2012 Insights A matter of degree by J.C. Noreika, M.D., M.B.A. I t was a long time ago. August 1986. Ronald Reagan was president, Apple had fired Steve Jobs, doctors wore beep- ers, and I had hair. A long time, indeed. Case Western Reserve University's Weatherhead School of Management hosted an off-campus sleepover to initiate the class of '88 to the gauntlet of its Masters of Business Administration program. There were 37 of us. I was the only physician. My practice was 2 years old; de- ficiencies in the comportment of its business were evident. Two events of serendipity coalesced to propel me into management's sacred mysteries. Once, an experienced and successful ophthalmologist considered my naïve question and responded, "that's business, Jay, and you don't understand." Really? Later, forget- ting my beach read, an airport book- store seduced me into the purchase of Peter Drucker's Innovation and Entrepreneurship. I was hooked, en- tranced by this other road "because it was grassy and wanted wear." Those years were arduous. My solo practice grew, surgical volume increased. I hired the practice's first optometrist. The arcana of opera- tions, statistics, finance, leadership, and information technology vied for attention. The latter was particularly challenging because my Apple IIe with state-of-the-art 5¼ inch floppy drives was only a year old. The se- crets of Lotus 1-2-3 were as daunting as biostatistics had been at Jefferson Medical College. Laptops lay in the future. There was no internet, no Google. It was a long time ago. Two years passed. With apology to the "quants" at MIT's Sloan School, course material wasn't as difficult as learning the Krebs cycle. I collected my diploma and began applying "scientific management" disciplines to my practice. Some worked; some didn't. But, in the early 1990s, organized medicine began to gentle toward its apostates embracing business. By 1993, six medical schools offered combined M.D./M.B.A. programs. Healthcare was changing, California was a hotbed of novel payer tactics, and Washington turned to an unknown economist in Harvard's Department of Health Policy and Management to "rationalize" the compensation of services delivered to the Medicare patient. Voila! The Resource-based Relative Value Scale was birthed into the medical mainstream and practice would never be the same. B-school courses began to appear at annual meetings, and ophthalmologists took notes on queuing theory, balance sheets, the art of negotiation, and supply chain management. Since those halcyon days, the unholy alliance of medicine and business has grown at parsec speed. According to amednews.com, 65 medical schools offer M.D./M.B.A. programs. "As a result, the number of students graduating from M.D./ M.B.A. programs has gone from essentially zero 20 years ago to as many as 500 students a year," not including schools of osteopathic medicine. That's a lot of middle management. Therein lies the problem. The aggregation of healthcare entities will proceed, but its trajectory will flatten. Economic constraints will squeeze these consolidations to become leaner, more efficient. Eyeing continued from page 29 "The real take-home point here is to get patients to an allergist to see if they are candidates for immunotherapy," Dr. Blaiss said. Looking beyond SLIT In addition to SLIT, other im- munotherapy options for allergies are on the horizon, as reported at last year's American College of Allergy, Asthma and Immunology (ACAAI) annual meeting. Intralymphatic immunotherapy is the injection of allergens into a lymph node. The dose and length of treatment might be shorter than with traditional immunotherapy. Another kind of therapy, epicu- taneous immunotherapy, involves the scraping of a patient's skin and the application of a patch to deliver allergens through the bloodstream. Rush and cluster allergy shots, designed to shorten the amount of time a patient needs to get allergy shots, were also discussed at the meeting, according to an ACAAI press release. EW Editors' note: Dr. Bielory has financial interests with Bausch + Lomb (Rochester, N.Y.), ISTA Pharmaceuticals (Irvine, Calif.), and Vistakon (Jacksonville, Fla.). Dr. Sheppard has financial interests with Abbott Medical Optics, Santa Ana, Calif.), Alcon (Fort Worth, Texas), Allergan, Bausch + Lomb, EyeGate (Waltham, Mass.), and Merck (Whitehouse Station, N.J.). Dr. Blaiss has financial interests with Alcon, Allergan, and Bausch + Lomb. Contact information Bielory: 973-972-2768, bielory@rutgers.com Blaiss: 901-757-6100, wheezemd@gmail.com Sheppard: 757-622-2200, docshep@hotmail.com Ironically, fewer compensated physician-managers will be needed. Is it worth it? Reflecting back over 25 years, it was … for me, a sample of one. Self-selection probably played a role; unpolished rehearsals of "innovation and entre- preneurship" can be discovered in my life's resume. But the time and money spent was and is enormous. Tuition at the Wharton School is now over $62,000 per year. Also, there is something called "opportu- nity cost," i.e., the expenditure on the chosen activity relative to the value of its next best alternative. The pursuit of another degree forecloses other possibilities. A very personal decision, it decocts to the most basic question: What do you want to do when you grow up? Don't do it for the hope of mon- etary gain. If this be your objective, the opportunity costs spent in the degree's pursuit will not be recap- tured. An M.B.A. provides opportu- nity for personal growth, intellectual challenge, and a modicum of mas- tery; it will never replace a patient's gratitude for sight saved or restored. In 1989, I invited Dr. Floyd Loop, then CEO of the Cleveland Clinic, to address our county med- ical society. After his talk, I told him that I had just finished my M.B.A. Without pausing, he said, "you don't need it." In all due respect, Dr. Loop was mistaken. But I could be an outlier. EW Editors' note: Dr. Noreika has practiced ophthalmology in Medina, Ohio, since 1983. He has been a member of ASCRS for over 30 years. Contact information Noreika: JCNMD@aol.com

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