By the NumbersPublication Exclusive

It is not the practice you pass on to others that counts

Your current everyday actions will help shape your legacy.

“No legacy is so rich as honesty.”
– William Shakespeare

“My mother always told me that as you go through life, no matter what you do, or how you do it, you leave a little footprint, and that’s your legacy.”
– Jan Brewer

“It’s not about my leaving my fingerprints or a legacy. It’s more important to be part of a process by rolling up your sleeves, being on the ground, initiating projects, you know, building stuff.”
– Queen Rania of Jordan

In a humdrum, workaday 30-plus-year career, the typical ophthalmologist labors about 60,000 hours, earns about $10 million and passes the reins down to a replacement surgeon. He or she then has about $3 million left in the bank to spend during another 20 years or so of retirement, thinking and rethinking his or her legacy. Sometimes with a smile, sometimes not so much.

Because the baby boom bulge is reflected not just in the older age distribution of patients but also in the graying distribution of surgeons, and because practice stresses are rising sharply, I have more clients than ever before who are retiring, moving on and starting to talk to me about what they thought their legacy would be. Or what they wished it could have been.

Some focus on the building they built or the infrastructure they filled it with, perhaps because these tangibles might last a bit longer and be something they could drive by years later, point to and say, “I did that.”

But only a minority of eye surgeons leave behind such tangible legacies.

Because of the shrinking pool of young ophthalmologists, it is hard today to sell a practice in less choice parts of the country for any more than salvage value, leaving a vacant suite where a practice once thrived.

Many of your colleagues are understandably frustrated with this because from the start of their careers they had pinned their legacy hopes on the next generation taking over their “baby.” Closing up shop can be a profound disappointment. (And it is even more disappointing when your practice is taken over by an unworthy successor.)

But the wisest peri-retirement eye surgeons I know use a different currency to count up their legacy. Interestingly, and not surprisingly, these are the same ophthalmologists who enjoyed both the clinical and surgical components of their careers, not just the OR time and the monthly case counts.

Nobody is as obsessed with how we will be remembered as we are ourselves. So for your own equanimity and inner calm, no matter your career stage, it is a healthy ego exercise to spell out now how you, alone, are going to define the sum worth of your professional arc, your personal legacy.

To do this, you need a frame of reference. And the wisdom of a few more years. So for the rest of the time it takes you to read this column, imagine yourself as an older man or woman, about the age of your average patient today or even older. Fully retired, sitting on your porch, examining your legacy from the vantage point of the winter of your life.

And think on these things.

  • Did you give people — patients and staffers alike — a second chance instead of being dismissive because (surprise, surprise) they were not as smart as you and did not quite understand what you were saying the first time around?
  • Were you gentle and not harsh? Did you avoid jamming patients’ foreheads into the slit lamp and then shoving them back again, or throwing instruments, or bellowing so the whole clinic could hear?
  • When the day was long and you were tired, did you still take the time on the way home to puzzle through a difficult case or call an anxious patient because that was your job?
  • At any one time, did you have at least one person who you actively, overtly mentored: a peer, a member of your support team or even a high school intern?
  • When you came upon advanced surgical maneuvers that were beyond your competent grasp, did you “retrain or refrain?”
  • Did you avidly refer out cases beyond your understanding, simultaneously aiding your patient and your own development as a life-long learner?
  • Did you accentuate the positive? Did you redirect staff and mold their performance by pointing out their successes rather than harping on their failings?
  • Did you hold your patients’ hands? Give them a reassuring touch on the shoulder? Wink at them when you shared a joke? Laugh at their jokes? Weep from time to time at their tears?
  • Did you scrupulously preserve confidences?
  • Did you say several times a day, “I am sorry,” “You are right,” “Please” and “Thank you?”
  • Did you cleave to the community standard of care first and practice financial considerations second?
  • Did you censure colleagues who acted against the best interests of patients, staff and the practice?
  • On those rare days when time permitted and a patient wanted to talk about her husband who had just died, did you listen patiently with compassion?
  • When you malpracticed (and all do before a career is over), did you disclose, apologize and correct the damage?
  • Did you put the company and your partners’ interests ahead of your own?
  • If you were the managing partner of your practice, did you pursue the group’s will and not your own?
  • As you worked each day, did you contemplate your teachers and honor what they taught you? (Remembering that you are their legacy.)
  • Did you, like the happiest, most self-actualized surgeon I know, whistle a tune down the hallway as you worked?

If you did these things, or still do, then your legacy — beyond any building, inventions or bank account — is secure. Nice job, doc.

“No legacy is so rich as honesty.”
– William Shakespeare

“My mother always told me that as you go through life, no matter what you do, or how you do it, you leave a little footprint, and that’s your legacy.”
– Jan Brewer

“It’s not about my leaving my fingerprints or a legacy. It’s more important to be part of a process by rolling up your sleeves, being on the ground, initiating projects, you know, building stuff.”
– Queen Rania of Jordan

In a humdrum, workaday 30-plus-year career, the typical ophthalmologist labors about 60,000 hours, earns about $10 million and passes the reins down to a replacement surgeon. He or she then has about $3 million left in the bank to spend during another 20 years or so of retirement, thinking and rethinking his or her legacy. Sometimes with a smile, sometimes not so much.

Because the baby boom bulge is reflected not just in the older age distribution of patients but also in the graying distribution of surgeons, and because practice stresses are rising sharply, I have more clients than ever before who are retiring, moving on and starting to talk to me about what they thought their legacy would be. Or what they wished it could have been.

Some focus on the building they built or the infrastructure they filled it with, perhaps because these tangibles might last a bit longer and be something they could drive by years later, point to and say, “I did that.”

But only a minority of eye surgeons leave behind such tangible legacies.

Because of the shrinking pool of young ophthalmologists, it is hard today to sell a practice in less choice parts of the country for any more than salvage value, leaving a vacant suite where a practice once thrived.

Many of your colleagues are understandably frustrated with this because from the start of their careers they had pinned their legacy hopes on the next generation taking over their “baby.” Closing up shop can be a profound disappointment. (And it is even more disappointing when your practice is taken over by an unworthy successor.)

But the wisest peri-retirement eye surgeons I know use a different currency to count up their legacy. Interestingly, and not surprisingly, these are the same ophthalmologists who enjoyed both the clinical and surgical components of their careers, not just the OR time and the monthly case counts.

Nobody is as obsessed with how we will be remembered as we are ourselves. So for your own equanimity and inner calm, no matter your career stage, it is a healthy ego exercise to spell out now how you, alone, are going to define the sum worth of your professional arc, your personal legacy.

To do this, you need a frame of reference. And the wisdom of a few more years. So for the rest of the time it takes you to read this column, imagine yourself as an older man or woman, about the age of your average patient today or even older. Fully retired, sitting on your porch, examining your legacy from the vantage point of the winter of your life.

And think on these things.

  • Did you give people — patients and staffers alike — a second chance instead of being dismissive because (surprise, surprise) they were not as smart as you and did not quite understand what you were saying the first time around?
  • Were you gentle and not harsh? Did you avoid jamming patients’ foreheads into the slit lamp and then shoving them back again, or throwing instruments, or bellowing so the whole clinic could hear?
  • When the day was long and you were tired, did you still take the time on the way home to puzzle through a difficult case or call an anxious patient because that was your job?
  • At any one time, did you have at least one person who you actively, overtly mentored: a peer, a member of your support team or even a high school intern?
  • When you came upon advanced surgical maneuvers that were beyond your competent grasp, did you “retrain or refrain?”
  • Did you avidly refer out cases beyond your understanding, simultaneously aiding your patient and your own development as a life-long learner?
  • Did you accentuate the positive? Did you redirect staff and mold their performance by pointing out their successes rather than harping on their failings?
  • Did you hold your patients’ hands? Give them a reassuring touch on the shoulder? Wink at them when you shared a joke? Laugh at their jokes? Weep from time to time at their tears?
  • Did you scrupulously preserve confidences?
  • Did you say several times a day, “I am sorry,” “You are right,” “Please” and “Thank you?”
  • Did you cleave to the community standard of care first and practice financial considerations second?
  • Did you censure colleagues who acted against the best interests of patients, staff and the practice?
  • On those rare days when time permitted and a patient wanted to talk about her husband who had just died, did you listen patiently with compassion?
  • When you malpracticed (and all do before a career is over), did you disclose, apologize and correct the damage?
  • Did you put the company and your partners’ interests ahead of your own?
  • If you were the managing partner of your practice, did you pursue the group’s will and not your own?
  • As you worked each day, did you contemplate your teachers and honor what they taught you? (Remembering that you are their legacy.)
  • Did you, like the happiest, most self-actualized surgeon I know, whistle a tune down the hallway as you worked?

If you did these things, or still do, then your legacy — beyond any building, inventions or bank account — is secure. Nice job, doc.