As a resident physician, are you thinking about where you want to build your future in medicine? Meet David H. Aizuss, MD, an ophthalmologist in private practice in Encino and Los Angeles, California, and a featured voice in the AMA’s “Finding My Place in Medicine” series.
In this series, physicians reflect on what influenced their personal decisions when choosing where to work—and what they wish they had known earlier. Explore Dr. Aizuss’ journey to help guide your own path toward a fulfilling medical career.
If you are looking for your first physician job after residency, get your cheat sheet now from the AMA. In addition, the AMA Transitioning to Practice series has guidance and resources on deciding where to practice, negotiating an employment contract, managing work-life balance, and other essential tips about starting in practice—including in private practice.
“Following” Dr. David Aizuss
Specialty: Ophthalmology.
Practice setting: Ophthalmology Associates of the Valley, a private practice multispecialty ophthalmology group.
Years in practice: 40.
Key factors that led to me choosing to work in private practice: I first started in practice in Chicago and its suburbs immediately following my fellowship because I was from Chicago and returned home. However, having done my training in California, I could not deal with the miserable weather and chose to return to California when an opportunity presented itself only one year after starting in practice in Chicago. I have stayed in my current practice since 1986.
What stood out to me during the process of starting my practice: The need for me to call on physicians in practice in the area in order to introduce myself to them. It was a slow, tedious, unfulfilling process and many did not want to give me the time of day. Their referral patterns were established and there was no desire to meet someone new. The other thing that stood out was my biggest source of patients was referrals from other happy patients. So long as I treated people as I would want to be treated and ensured they were happy, felt cared for, and felt that I cared—that was the most important marketing tool that I could employ.
The biggest challenges of recruiting physicians to my practice: I have hired four new associates during my years in practice and have made three of them partners. I have also hired half a dozen physicians who never planned to be on a partnership track.
The challenge in recruiting and hiring is ensuring that my associates or partners-to-be shared a similar philosophy of patient care, that they were willing to work just as hard or harder than I worked and that they would practice at the highest level of surgical and medical ophthalmology. They also had to have a vision that a starting-base salary might be lower but that with incentive arrangements and future partnership they would do far better financially than they would do if they joined a large system even if their initial base remuneration was lower.
It is always a gamble for both the hiring physician and the new physicians. There needs to be a level of confidence that, as the hiring physician, you are committed to their success and as the newly employed physician, that you have confidence in your potential future with the practice. I have truly wonderful partners who I trust with my own care and that of my family, and vice versa.
How feedback from peers and mentors influenced my evaluation process: I must admit that I had essentially no advice when I went looking for my first position. At the time, the AMA sponsored a starting-out-in-practice workshop, which was a two-day event that I attended and I learned an incredible amount.
When I joined my first practice, I felt they were doing everything wrong. They brought in outside business consultants to get an opinion about what I was telling them, and the outside consultants confirmed my viewpoint. They then offered to sell me the practice at a number that I felt was way over my ability to afford. Instead, I chose to leave and returned to California, where I continue to practice. There were few resources back then to help one evaluate employers or practices. Now I often mentor young physicians and help them get established.
Factors I considered as I chose a practice setting to work in: I never considered anything but a private practice or a university academic practice when I was ready to begin practice. Since I have an independent personality, I felt private practice with an academic affiliation would be best rather than pursuing a purely academic position.
The top three qualities for a great place to work: First and foremost is control over your practice life, your schedule, your staff support. Second is having colleagues available to consult with and confide in when needs arise. Third is ensuring that there is an understanding of the need for work-life balance.
How my current practice supports physician well-being and work-life balance: My current practice shares call equally between all of the partners and one nonpartner. We don’t require physicians to take call if they are not partners or on a partnership track unless they choose to do so. We recognize the need for vacations, time off for family needs and we are mutually supportive of each other.
Benefits and workplace attributes that have contributed to my job satisfaction: My ability to control my situation from whom I employ to who I want to see is very important. If a patient is inappropriate by being nasty to either me or my staff, I have no hesitation to have them see someone else in another practice. Our practice partners are mutually supportive and enjoy each other’s opinions. But we also recognize that we are not married to each other but rather to our spouses. Our families and our family lives take priority and we support each other in ensuring that we always put family ahead of practice needs.
The biggest challenge I faced transitioning from residency to practice: I found the transition, particularly in surgery, to be most difficult. In my training program, everything was set up perfectly for every case at the university, although less so at the VA’s or county facilities—but there was always backup or someone more senior to help figure things out.
In practice, you needed to make sure everything was the way you wanted it to be, and I often had to fight hospital administrators to ensure that I had the equipment I needed and the staff trained to properly support me in surgery. I also had to train my senior associates in updated surgical skills and techniques, which I was not expecting. Dealing with office staff was also something I never thought about, or the fact that the equipment in an older practice might also be outdated or poorly maintained.
What I wish I had known about evaluating a job offer before choosing my first position: What the going salary was in the area that I was looking at and what the competition was like. I wish I knew what the degree of collegiality was among same specialty colleagues in the area. I also wish I had researched opportunities to establish my own practice in the event that the group I joined turned out to be the wrong group—which was the case, unfortunately.
What I would have done differently when choosing my first job: I would have thought more carefully about the geographic location that I wanted to live in versus the availability of family nearby.
How I knew I was ready for a change: I moved because I was unhappy with my practice location and practice support.
How my current role compares with what I imagined: I have had an amazing career and am incredibly happy and fulfilled.
