Finding a job

Considering several options might increase the likelihood that you’ll find a good fit. Dr Leigh Speilberg says It’s important to keep an open mind regarding the setting in which you want to work.

Leigh Spielberg

Posted: Monday, July 3, 2017

Illustration: Eoin Coveney

So, you’ve completed the first half of your residency training and you’re starting to think about the next step in your career: finding a job as an ophthalmologist so you can put your new skills to work after graduation. But where to begin?
As someone who recently navigated these waters, my advice would be to start broad. Try to consider as many options as possible before deciding that you’ll only accept offers from, for example, small private practices in a large city. After all, there are at least a dozen practice models, ranging from a large, well-established, university-based tertiary referral centre to your own new solo practice. So considering several options might increase the likelihood that you’ll find a good fit.
Most national ophthalmology associations have a section of their website dedicated to matching available positions with people who can fill them. This is probably the best place to start, as it’s likely to be the most comprehensive source of information. However, I’ve noticed that many local hospitals and smaller practices do not participate in this very convenient system.
The next step might be to speak with your current mentor(s). Training centres like to see their ex-trainees well placed after graduation, as it reflects well upon them. Directors of residency and fellowship programmes are usually well-connected people who know the landscape well. They receive phone calls and emails from doctors in the area who are looking for new young ophthalmologists to join them in practice. Speak with them as early as possible.
I found it useful to speak with recent graduates. They were recently in the same position as you are now, so they understand what you’re going through.
Furthermore, because most graduates interview at several practices, they are likely to know what is on offer regarding organisation, salary and surgical possibilities. My experience was that most early-career ophthalmologists are happy to speak at length to give advice. This can be done at conferences or via phone or email.
An often-overlooked source of information are the medical company representatives. These ‘reps’ visit all the regional hospitals and practices, giving them incredible inside information. They know which doctors might retire early, which practices are considering expansion and even which ones might be struggling, financially or otherwise. Many are willing to serve as a liaison for potential matches.
Feel free to contact these reps to ask whether they have useful information. Many will even be happy to introduce you to practices looking for new colleagues.
A last option is to check the websites of hospitals themselves. These usually list available positions in ophthalmology, but often seem to lack crucial information, as they might be written by a human resource specialist rather than by an ophthalmologist.

Once you’ve seen and heard what is available in your selected region, it’s time to consider the various settings. Each type has its pros and cons, and some might have a lasting effect on your career. A university department can offer young graduates visibility and a certain degree of prestige, but may be less attractive for someone uninterested in doing research or working within a rather hierarchical structure.
A large group in a community hospital will allow for subspecialisation as well as the opportunity to refer patients to colleagues within the group rather than referring them elsewhere.
Joining a private practice might offer a great deal of autonomy, but might also come with a lot of administrative responsibility. The same can be said of taking over the practice of a retiring solo practitioner. The ultimate test of nerves (and business acumen) is starting one’s own new practice, and this is not for the faint of heart.
An interesting option for those who remain undecided is to spend a year or so filling in for ophthalmologists who are absent due to, for example, pregnancy. These positions usually last for several months and are usually offered with no strings attached.

A very important factor to consider is whether you will be given an opportunity to continue your development as a physician and especially as a surgeon. This need is particularly acute for those who were fellowship-trained. A year or two of fellowship is simply the first phase of development, but the most challenging situation has yet to follow.
For your own growth, it’s worthwhile to consider working with a more experienced subspecialist. If this possibility is not available, is there someone working nearby to whom you can refer more difficult cases or at least call for advice?
I personally sought, and found, a situation in which I could be assured of frequent interaction with an experienced surgeon on whom I could count to continue my training, and who I could assist (or could assist me) with more complicated cases.
It is also good to know whether surgery will be a possibility. Beware: many practices would love to have a young graduate to run the office hours while the senior partners are in the operating room. This is fine for some graduates but not for those with surgical ambitions.
Ophthalmologists tend to earn reasonably well in most countries. Nevertheless, expectations vary, and when the reality does not match up with expectations, frustration can ensue. Don’t be afraid to ask for detailed information early in the process.
The same can be said of vacation time. Time allowed for vacation is a factor that some early-career doctors find very important, while others tend to ignore it. How much is standard in your country? How much is enough for you to not miss out on all that life has to offer?
Vacation allowances vary to an almost unbelievable degree. Some groups are hesitant to allow more than just a few weeks per year. These are often rapidly growing partnerships with long patient waiting lists or pressure from hospital administrators to deliver financially. On the other hand, some groups might mandate a large amount of ‘off time’ due to financial constraints from insurance companies, which effectively cap the revenue stream, meaning that any ‘extra’ work done above this constraint effectively goes unpaid.
Try to predict your situation a few years down the road: if you (will) have school-aged children, your vacation times will be dictated by school vacations rather than by your own preferences. Either way, it’s important to sort out the expectations prior to signing the contract, so that later misunderstandings can be avoided.
A crucial bit of information is how the on-call schedule is organised. Ophthalmology doesn’t have many serious emergencies, but it’s important to know whether you’ll be on call every other day or just a few times per month. Is the call schedule organised within the group? Is there a local network? Can an operating room be accessed on short notice in case of trauma?

It’s important to keep an open mind regarding the setting in which you want to work. It’s advisable to try to interview widely, so you have a good grasp of what’s available and what the ‘norms’ are in your area. Furthermore, the act of interviewing, even in places you’re not likely to work, gives you some practice, even just to calm your nerves in preparation for that one practice you absolutely want to join.

Dr Leigh Spielberg is a vitreoretinal and cataract surgeon at Ghent University Hospital in Belgium