“Young” Ophthalmologists (Relatively New to Practice)

1. “Young” Ophthalmologists (Relatively New to Practice) July 2006 • Prepared for: Prepared by: #7303

2. Background/Objectives • The profession of Ophthalmology is facing numerous challenges during a period of rapid change in the healthcare environment in the U.S. • Non-solicited feedback to an editorial in OPHTHALMOLOGY TIMES indicated that there is a feeling among practicing ophthalmologists that their residency programs did not prepare them well for life after residency. • The American Academy of Ophthalmology has taken a lead in examining this issue in a more scientific manner in order to provide input to U.S. training programs and credentialing organizations. • The specific objectives of this study are to determine how ophthalmologists who are “new” to practice feel about their preparation to practice and to identify areas where training was deficient.

3. Method • A 4-page, self-administered survey was mailed to a random sample of 900 “young” ophthalmologists out of the approximately 1800 available for surveying in the AAO database. “Young” ophthalmologists were defined as those in practice 5 years or less according to the database. • A total of 269 surveys were completed and returned. - This represents a 30% response rate. - The error range at this sample size is +/- 5.0 percentage points at a 90% level of confidence.

4. Overview of Findings • In general, ophthalmologists felt well prepared to practice comprehensive ophthalmology after residency training. About half felt the need for some additional clinical training and two-thirds felt the need in surgical areas. • The key clinical areas cited as training needs were refractive conditions, oculoplastics/orbital conditions and pediatric ophthalmology. • The surgical needs were in the areas of refractive surgery, oculoplastics/orbital, glaucoma, retina and pediatric. • Doctors felt far less well prepared in almost all of the non-clinical areas investigated in this study. - Professionalism with patients was the only non-clinical area where a majority of doctors felt “extremely” or “very well” prepared (77%). - At least 6 of 10 or more felt “not very” or “not at all” well prepared in 6 of the non-clinical areas explored. These were business operations and finance, personal financial management, practice management skills, coding and reimbursement, political advocacy and exposure to practice setting models.

5. Overview of Findings – (continued) • With the exception of personal financial management, a majority of doctors felt that training in all of these non-clinical areas was the responsibility of a residency training program. • Most who felt the need for additional training in these non-clinical areas either sought training from colleagues or took a personal role in getting the training they needed. • Over half of the doctors surveyed said that “financial management” (both insurance and how to run a business) were their biggest surprises after residency training. This was followed by the areas of business issues and administrative issues. • Doctors felt the Academy could play a role in the non-clinical training area. About one-third saw a role for continued education and training while almost one quarter mentioned a role in either financial management or practice management. • The information collected throughout this study was relatively consistent across all of the sub-populations examined. This indicates that the feeling and beliefs expressed are universal among this audience.

6. Implications This study clearly indicates a broad sentiment among ophthalmologists that they were not very well prepared by residency programs in a number of the non-clinical areas related to practice. This echoes and reinforces the anecdotal information collected in an informal survey in the August 2005 OPHTHALMOLOGY TIMES e-newsletter. This information indicates that a clear opportunity exists to better integrate non-clinical training into residency programs or for the Academy to “partner” with these programs to provide and supplement this training need.

7. Key Findings

8. How Well Residency Training Prepared Doctor to Practice Comprehensive Ophthalmology in Various Areas • Generally, ophthalmologists surveyed felt well prepared (extremely, very, or somewhat) to practice comprehensive ophthalmology after residency training. The area of surgical skills was rated less strongly than clinical knowledge, but overall 98% felt at least somewhat well prepared with 86% saying extremely or very well prepared. There were no meaningful differences in these sentiments across any of the sub-populations examined. Q. 1 = Specifically thinking about your residency training program, how well do you feel your residency training prepared you to practice comprehensive ophthalmology in each of the areas below...? (n=269)

9. How Well Residency Training Prepared Doctor to Practice Comprehensive Ophthalmology in Various AreasCompleted Fellowship versus No Fellowship • There is some degree of difference in the intensity with which these groups felt they were prepared in these areas. Generally speaking, the vast majority of both groups did feel prepared in all three. The biggest difference was seen in level of surgical preparedness, where twice as many non-fellowship doctors felt ill prepared (9% vs. 5%). Q. 1 = Specifically thinking about your residency training program, how well do you feel your residency training prepared you to practice comprehensive ophthalmology in each of the areas below...? (n=269)

10. Clinical Areas in Which Doctor Did not Feel Prepared • About half of those surveyed indicated that there were clinical areas in which they need additional training. The main areas cited were refractive conditions, oculoplastic/orbital and pediatric. Subspecialty ophthalmologists were less likely to feel the need for more clinical training (60% felt no need for additional training). Q. 2 = Following residency training, in what Clinical Areas (excluding surgical skills), if any, did you not feel well prepared in order to be successful? (n=269)

11. Clinical Areas in Which Doctor Did not Feel Prepared(Continued) Q. 2 = Following residency training, in what Clinical Areas (excluding surgical skills), if any, did you not feel well prepared in order to be successful? (n=269)

12. How Doctor Plans to Obtain Additional Clinical Training • Most planned to get the additional training they needed by reading books/journals, etc., attending meetings or seminars or contacting and observing other colleagues. Q. 3 = How did you/do you plan to obtain this additional training? (n=269)

13. How Doctor Plans to Obtain Additional Clinical Training – (continued) Q. 3 = How did you/do you plan to obtain this additional training? (n=269)

14. Surgical Areas in Which Doctor Did not Feel Prepared • Almost 2/3 of ophthalmologists felt the need for some additional surgical training. Among subspecialists and those practicing a subspecialty 50%+, this need was lower with only about 60% expressing a need for additional surgical training. Refractive surgery and oculoplastics/orbital were the two areas mentioned most frequently. Q. 4 = Following residency training, in what Surgical Skills, if any, did you not feel well prepared in order to be successful? (n=269)

15. Surgical Areas in Which Doctor Did not Feel Prepared(continued) Q. 4 = Following residency training, in what Surgical Skills, if any, did you not feel well prepared in order to be successful? (n=269)

16. How Doctor Plans to Obtain Additional Surgical Training • Those who wanted additional surgical training planned to get that training through seminars/meetings, by contacting or observing other ophthalmologists, or by reading books/journals, etc. Q. 5 = How did you/do you plan to obtain this additional training? (n=269)

17. How Doctor Plans to Obtain Additional Clinical Training (continued) Q. 5 = How did you/do you plan to obtain this additional training? (n=269)

18. How Well Residency Training Program Prepared Doctor in Non-Clinical Areas • The one non-clinical area of strength was “professionalism with patients” where over three-quarters of the ophthalmologists felt well prepared. While there are some differences in the degree of beliefs across subspecialties, the overall message is consistent - more training in the non-clinical areas would be helpful. Q. 6 = How well did your residency training program prepare you in each of the following non-clinical areas to practice ophthalmology? (n=269)

19. How Well Residency Training Program Prepared Doctor in Non-Clinical Areas – (continued) • Of the ten non-clinical areas explored, respondents felt “poorly” prepared in 7 of the 10 (~50% or greater rating not very/not at all well prepared.) The areas showing the greatest shortcomings (70%+ poor ratings) were overall practice management, personal financial management and business operations and finance. Q. 6 = How well did your residency training program prepare you in each of the following non-clinical areas to practice ophthalmology? (n=269)

20. How Well Residency Training Program Prepared Doctor in Non-Clinical AreasCompleted Fellowship versus No Fellowship • No meaningful differences were noted in the perceived level of preparedness in any of the non-clinical areas between those completing a fellowship and those who did not. Professionalism With Patients Relationships With Referring Doctors Establishing Relationships With Allied Health Personnel Compliance and Risk Management Info. About Various Practice Settings/ Models and Volunteer Opportunities Q. 6 = How well did your residency training program prepare you in each of the following non-clinical areas to practice ophthalmology? (n=269)

21. How Well Residency Training Program Prepared Doctor in Non-Clinical Areas – (continued)Completed Fellowship versus No Fellowship • No meaningful differences were noted in the perceived level of preparedness in any of the non-clinical areas between those completing a fellowship and those who did not. Importance of and Involvement in Political Advocacy Coding and Reimbursement Overall Practice Management Skills Personal Financial Management and Planning Business Operations and Finance Q. 6 = How well did your residency training program prepare you in each of the following non-clinical areas to practice ophthalmology? (n=269)

22. Is It the Responsibility of a Residency Program to Teach Various Non-Clinical Aspects • At least 4 of 5 ophthalmologists felt that each of the areas below were the responsibility of a residency training program. With the exception of professionalism with patients, all represent areas where improvement in training could be warranted. Q. 7a = Thinking about each of the following non-clinical aspects, do you think it is the responsibility of a residency program to teach those aspects as part of your training? (n=269)

23. Is It the Responsibility of a Residency Program to Teach Various Non-Clinical Aspects – (continued) • With the exception of personal financial management/planning, a majority of respondents felt that each of the non-clinical areas below were also the responsibility of a residency training program. Of the 10 areas explored, 9 were felt to be the responsibility of a residency training program by a majority of respondents. Q. 7a = Thinking about each of the following non-clinical aspects, do you think it is the responsibility of a residency program to teach those aspects as part of your training? (n=269)

24. Who Should Be Responsible for Teaching Non-Clinical Aspects - Financial Planning and Management • 136 doctors felt that teaching personal financial management and planning was not the responsibility of residency training. The answers shown below reflect these doctors’ thoughts on who should teach personal financial management planning. Q. 7b – Who do you think should be responsible for teaching you this material?

25. How Respondent Filled Need for More Training in the Non-Clinical Areas • Most received additional non-clinical training from colleagues and co-workers or took personal responsibility for gaining needed training. Q. 8a/8b – Did you need more training in the non-clinical areas? How did you fill those needs for more training in the non-clinical areas?

26. Biggest Practice Management Surprise After Residency • About half of doctors were surprised by financial management issues in their practices. Slightly over one-quarter mentioned a need for learning how to deal with business and administrative issues. Q. 9 – What was your biggest practice management surprise after residency?

27. Role AAO Should Play in Assisting Transition to Practicing Comprehensive/General Ophthalmology Post Residency • More than one-third of doctors felt that the Academy should provide continuing educational opportunities. About one-quarter want more help with financial management. Q. 10 – In your opinion, what role should the American Academy of Ophthalmology play in assisting the transition to practicing comprehensive/general ophthalmology post residency?

28. Appendices: Sample Composition

29. Sample Composition

30. Sample Composition ~ Primary Practice Focus Q. A = Please check which statement best describes your personal primary practice focus. (n=269)

31. Sample Composition ~Primary Specialty Q. B = What is your primary subspecialty? (n=269)

32. Sample Composition ~ Whether Respondent Completed Fellowship in Specialty or Not Q. C = Did you complete a fellowship in your specialty? (n=269) * = Less than 0.5%

33. Sample Composition ~ Number of Years in Practice Q. D = How many years have you been in practice? (n=269)

34. Sample Composition ~ Age and Gender of Respondent Q. E = Please indicate your age and gender. (n=269) * = Less than 0.5%

35. Sample Composition ~ Type of Practice Q. F/G = Which of the following best describes your practice? Did you perform your residency training… (n=269) *= Less than 0.5%.

36. Sample Composition ~ Number of Residents Per Year in Program Q. H = Approximately how many residents per year were in your program? (n=269)