Dr. Randy Cole of the Boozman-Hof Eye Clinic was kind enough to share about his career as an ophthalmologist. You can find his clinic and services here.
What do you do for a living?
I’m an ophthalmologist or an eye surgeon.
How would you describe what you do?
I’m generally working as a cataract and refractive surgeon. So I do cataract surgery. I do refractive surgery. I see patients too, but the majority of what I do is related to providing cataract and refractive surgical services.
What does your work entail?
It entails being in the operating room during cataract surgery, doing refractive laser surgery, and seeing patients in the examining room. And taking general ophthalmology call covering the emergency rooms of a couple of area hospitals.
It really is quite remarkable in terms of what we can do to improve people’s quality of life, ability to function, and restoring the precious sense of sight to a level better than they’ve ever experienced.
What’s a typical workweek look like for you?
We’re busy. We work hard. I’m taking call every second to third weekend and I operate all day Monday. I’m in the clinic seeing patients all day Tuesday, Wednesday morning, and all day Friday. I’m off Wednesday afternoon but in a typical week I’ll have about a 170 patient encounters. Of those, about 40 are surgery encounters.
How did you get started as an ophthalmologist?
In medical school I just started thinking about what I wanted to do, what I like to do. I knew some ophthalmologists who had been in practice while I was in high school and college in particular. They seemed to like what they did and so really early on in medical school it became apparent to me that that’s the specialty that I wanted to go and try to get a residency position in.
In fact, I applied and got the position in the middle of my junior year while in school. I had a position already nailed down at Little Rock so I didn’t even bother to apply to any other programs or residencies.
What do you like about what you do?
It’s challenging and extremely demanding. I’m dealing in terms of microsurgery, millimeters, and having to be extremely precise. There’s a lot of challenges and stress but it is very gratifying. I tell the people I work with over here it’s difficult but we need be realizing that really we’re in the business of miracles. Doctors and nurses treat, only God heals, but at the same time I feel that we provide a valuable service in helping people in the precious sense of sight.
And modern cataract surgery and modern refractive surgery are truly remarkable in restoring vision to a level that’s better than people have ever had in their lives. Younger people are having refractive surgery and they are not needing glasses anymore.
We’ve been using implants for older people, lens implants now that you can correct for astigmatism and can help them read so they’re seeing like 20 year olds and don’t need glasses. It really is quite remarkable in terms of what we can do to improve people’s quality of life, ability to function, and restoring the precious sense of sight to a level better than they’ve ever experienced.
So that’s very gratifying. At the end of the week you can be tired and be stressed and have some worries but you don’t ever get to the end of the week and wonder, “Did I really accomplish anything or do anything worthwhile?”
What do you dislike about this job?
Well, honestly there’s not any other job that I would rather do. There’s not any other profession that I would say I wish I had not missed. The only thing—like any work, the only thing that’s sometimes unpleasant is there’s stress. You’ve got to try to make people happy. You’ve got to satisfy needs and expectations. You’ve got to deal with insurance companies, medicare. There’s rare lawsuits, so like with any work there’s just stress involved.
How do you make money or how are you compensated in this career?
Well, I’m an owner of the businesses that I’m involved in and I have partners as well. But being an owner in this entity means I have ownership in the clinic and within the clinic I’m paid based on productivity.
And so I’m paid a percent of the profits or distributions of that entity that is derived directly from my productivity in the clinic and indirectly from the profits and percent of my ownership in our optical business and in the surgery center.
It’s all based on fee for service.
So it’s not like being a passive owner of a business. If you park there, you’re working, doing surgery, doing exams, seeing patients then you’ll generate income.
So unlike somebody who may own a factory or a car dealership, they keep on making income whether they are there or whether they’re spending the winter in Florida.
How much money do you make as an ophthalmalogist?
The average income of an ophthalmologist is around $250,000-$300,000 and that income will vary depending upon how busy or productive an ophthalmologist might be. The average productivity in a clinic or a benchmark productivity for an ophthalmologist is producing around $800,000 a year gross and he might keep around 40% of that. And then busier ophthalmologists may produce two, three, or four times that much.
And if the ophthalmologist owns an optical clinic or surgery center that’s profitable, which they aren’t at all profitable, that income can also be supplemented between those other ancillary businesses.
And there are ophthalmologists that go bankrupt. I bet there’s half a dozen I can name in in the last 10 years just in this state that actually have gotten into a bankruptcy and maybe they had to restructure or have their practice closed.
You’re going to have to finish high in your medical school class to get a residency position[in ophthalmology]. So you need to expect and understand that you’re going to have to be in the top 10% of your class to have a shot at getting a position which is real hard because medical school is not easy to get into in the first place.
The dynamic is changing in health care industry. About a half of the new physicians are really not owners but employees of either clinics or health care systems. And so those doctors still make a reasonably good percent of their production but they don’t have a lot of autonomy.
The good news is you don’t have part of the ownership and the risk of going bankrupt and having to have a lot of administrative support people and put in extra hours in terms of leading a company or leading, managing and directing an entity. So it can be that you may work less and have less stress in terms of the business administrative aspects of owning a business but you have less autonomy and you have less decision making latitude. And essentially it’s somebody else who technically tells you what time to come in, what you need to do, and what’s expected of you.
How much money did you make starting out in this career?
Well, I started as an ophthalmology resident making around 25,000 a year, maybe a little less than that back when I first started. I supplemented that by moonlighting in emergency rooms and then my first job in 1983 as an ophthalmologist in Florida was probably base salary of 75,000 with some production incentives.
Would you say there are any perks associated with your job?
Well, I think this job’s biggest perk is just the gratification of doing something really dramatic and helping restore sight and helping improve people’s life.
And that’s essentially life changing service you’re providing for people. So the biggest perk or reward is the gratification of doing dramatic things to improve their vision and their quality of life.
What education and/or skills would you say are needed to do this job?
To become an ophthalmologist, you have to go to college. I actually got accepted to a few medical schools before I got my undergraduate degree after just three years of college.
But generally you have to have an undergraduate degree and go to medical school and become an M.D. And then there’s somewhere between 3 to 5 years of training to be an eye surgeon.
And it requires a certain amount of dexterity and hand-eye coordination to be able to do microsurgery.
And the uncertainty about that is you just never know when you could lose that. If you come down with tremor, a neurological problem, Parkinson’s Disease, arthritis, or have a stroke, you’re done.
As far as determining if you have what it takes, there’s not really a process in this country or sort of an obstacle course or hand-eye testing to see if you can become a surgeon. A lot of it just comes in the training, and in the process of the training, finding out if they can do it and if not they can become just a medical specialist rather than a surgeon.
So when you get in your internship training you kind of find out if this something you’re really cut out for or if you have to do more of a medical specialty in ophthalmology like a medical ophthalmologist. You don’t necessarily have to do surgery.
There are certain specialties in ophthalmology that are less surgically inclined like being an neuro-ophthalmologist or being a specialist pediatric ophthalmologist. They do less surgery and will do more of children’s exam and just some surgeries on the eye muscles.
This job also requires the ability to be able to interact well with patients.
And a successful ophthalmologist has a fairly high overhead with lot of employees in their practice. So they have to have the energy and drive to see a lot of patients and to be able to manage all that.
What is the most challenging about what you do?
I’m a perfectionist and I can’t have complications so the most challenging thing is to try to maintain concentration and diligence to a point that I essentially avoid any complications in surgery at all. So I’ve got to have zero tolerance for ever making a mistake or having a problem or complication related to an error on my part. And that just takes a lot of attention to detail and experience. And it’s mentally taxing and fatiguing. So I’m real hard on myself to avoid problems errors and complications. Number two, people’s expectations as such that even if things go well they aren’t always uniformly happy, so that can be frustrating.
What is the most rewarding about what you do?
Well, the rewarding thing is that we are in the business of miracles and being able to restore the sense of sight to people who are really blown away. Being able to see that is very gratifying.
What advice would you offer considering this career?
My advice would be it’s a good career. I think it’s something worthwhile to do. I would recommend it—for myself, over many other surgical specialties. But you’re going to have to finish high in your medical school class to get a residency position. So you need to expect and understand that you’re going to have to be in the top 10% of your class to have a shot at getting a position which is real hard because medical school is not easy to get into in the first place.
You got to be in the top 5 or 10% of your medical school class and that makes it even tougher.
So ophthalmology, dermatology, radiology, and orthopedics still are very highly sought after residencies.
And the nice thing about ophthalmology also is you’ve got a little more control over your time. The surgeries are not emergencies so you can schedule them out in advance. Not like in appendicitis or a gunshot wound that has to be fixed right now.
So you have a little more control that when you leave work you don’t often get called back at night and when you’re on call on the weekend it doesn’t mean you’re going to have to spend the whole weekend in the ER.
It’s not easy. It’s exacting. It’s stressful. There’s no margin for error but you get to the end of the week and you’ll know that you’re in the business of miracles and you’re not going to reach a point of the week or point in middle age where you look in the mirror and go, “Have I done anything with my life?”
It’s not like as a general surgeon. If they get called on the weekend, chances are they are going to be spending sometime in the O.R. over the weekend.
And that’s not to say there aren’t emergencies. There could be perforating eye injuries, blood eye injuries, trauma, laceration of the eye lids, so there are a lot of things that can require us to have to come in and do surgery or just see somebody in the office for some medical eye problem.
How much time do you get off or do you take off?
Six weeks a year for meetings and vacations.
What is a common misconception people have about what you do?
Let’s see… People probably think that since I’m an ophthalmologist I prescribe a lot of glasses. But I really don’t do much in a way of prescribing glasses because I’ve got a group of optometrists that I work with who take care of the glasses and the contact lenses.
What are your goals and dreams for the future in this career?
It’s hard to believe I’ve been out of medical school now for 33 years. But I’m still young. I’m 58. So I would hope to have the health to be able to continue to work for at least another 10 years. And I had planned on slowing down some and handing over things to one of the newer doctors but that didn’t work out so ironically I’m probably going to be the busiest in my life for the next 10 years doing more surgery than I have ever done before.
What else would you like people to know about what you do?
I would just say that it’s not easy. It’s exacting. It’s stressful. There’s no margin for error but you get to the end of the week and you’ll know that you’re in the business of miracles and you’re not going to have to reach the point of the week or point in middle age where you look in the mirror and go, “Have I done anything with my life?”
I think that it’s also worthwhile for people to know what we do in terms of cataract surgery is probably as high a level of service of cataract surgery as is available anywhere in the world. Furthermore, I like them to know that there are a lot of options now in terms of the refractive lens implant where people can elect for distance vision.
They can elect for getting their stigmatism corrected. They can also do what’s called a multi focal implant that they could actually also read through. So there are a lot of options along the lines of the technology. And I want them to know that we’re a team and staff extremely conscientious who wants to deal with everybody like it’s a family member. And we have some measurable outcomes that are evidence of that. For instance, we have the best record in the world on preventing infection after cataract surgery for example.