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I’ll be leaving ETS and ophthalmology recruiting altogether for now and wanted to share some thoughts here since I won’t be readily available anymore. Anyone who has worked with me will tell you I gave a level take on the practices I worked with—and even the ones I didn’t. I wanted to use my last posts here to give some general advice I learned while recruiting. All in, I did a full interview with 1,370 unique ophthalmologists in the US - about 8% of the ophthalmologists in the US. I worked with hundreds more as partners and practice owners and there were thousands more I had correspondence with but no interview.
First off, I want to say thank you to the many people I got to work with over the years. It has elevated my thinking and lifted me up in so many ways. I know some ophthalmologists who have 25 hours in a day and 8 days in a week, while still maintaining a strong family life. I got to meet some truly inspiring people in this position.
On finding your next associate: The market is getting tighter. The remaining experienced ophthalmologists are busier than ever and likely making more than they were a few years ago. The national movement from the pandemic is over, and I now see it as harder than ever to get someone with experience. You should absolutely be considering new grads if your hiring need is critical.
While there’s no magic bullet to a good hire, there are markers I noticed that tended to produce above-average work ethics: from very rural areas, engineering undergrad/background, first-generation in medicine, second-career medicine, immigrants, first-generation Americans, doctors with strong religious convictions, and doctors who had kids during their training. These weren’t things I could necessarily say out loud in my official capacity but will say now. Again, these aren’t absolutes—but patterns I noticed. If there was one pattern that was also true, it’s that everyone who ever told me directly “I’m a hard worker” was not a hard worker.
Competition for talent is heating up, and base salaries seem like they’re in a hockey-stick pattern right now. If you want to compete, the best thing you can do is be completely transparent. Open your books, open your life, open your employees and former associates to any new ophthalmologist looking at your practice. You can get an NDA signed—and should—if someone is looking at your books.
I know some great practices in rural locations and, while they can’t always hire in the exact year they want, they’re still able to consistently attract talent by being transparent and making good-faith offers commensurate with the position and location. If these rural groups can still hire, anyone can.
When looking for a practice to join long term (partnership-focused): There is too much attention paid to quantifiable metrics: compensation, call, work time. The only quantifiable metrics you should watch for is the financial health of the existing practice; that will determine your long term, partnership outcome. I also encourage everyone to put more weight on whether you like the people you’re working with. If $50K in base salary is enough to sway you from one practice to another, then both practices are likely not the right choice if you’re looking for something long term.
I have never in my 10 years had a happy partner mention to me that they thought they were upset by how much they were paid in the beginning. Obviously, at 30–32 years old, a $50K difference is almost your entire residency/fellowship salary on top of whatever else you’re negotiating. In 10 years, that initial $50K more in base salary will be about a 1–3% difference in your total career earnings. If you can defer that gratification just a little longer, the returns can be massive both personally and professionally. A good partnership improves both the personal and professional side of your life, and that fulfillment is not quantifiable—especially not in monetary terms.
Your career can be built, and there is no doubt that making a lot of money early on can make a difference in your long-term wealth. I myself took the path of prioritizing money early in my career with this recruitment job that ate into my nights, weekends, and vacations. I invested heavily and lived well beneath my means on about 15–20% of my income total (where I live had a lot to do with allowing this).
Your first job might just be for the money to get on your feet—especially if you have kids during training or lots of student debt. However, if you’re going to prioritize the money, don't spend it at the same time. Live like you make $100K and you’ll be handsomely rewarded in just 5 years. If you do prioritize the money, then let that be the priority. You’ll be hard-pressed to find the money, the partners, work/life balance, and the exact place you want to live. If you take this route, get what you need as fast as possible and move on to somewhere you truly love—then let money be the last thing on the list drawing you there.
On opportunity: Some of the better opportunities right now tend to be in secondary cities. The biggest cities have much more competition and tend to have harder practice environments—insurance, HR, taxes, and overhead expenses. You will succeed much faster and be able to grow practice value more effectively in cities with fewer than 2M people in the MSA. You’ll find higher income for yourself, more appreciative patients, better insurance landscapes, less hospital call, less competition, and more straightforward partners and partnership tracks in these kinds of places.
To be specific: cities like Tucson, Louisville, Kansas City, Milwaukee, Greenville, and the like. Places like LA and NYC have unique aspects, but on a daily and weekly basis, your life likely looks very similar Monday through Friday. Being able to travel to those places will be easier with higher income, lower cost of living, and less stress. The best example I personally knew was a retina surgeon in Iowa making over $3M/year. He didn’t like living in Iowa, but he had a house in Park City and a home on the coast in Florida. He flew private to either one 1–2x/month for the weekend, with vacations in between.
Real-world value comes from doing something others can’t or don’t want to do. You’re all already eye surgeons (something others can’t do). If you go do the things your peers don’t want to do, you exponentiate your value. The most successful and fulfilled ophthalmologists I know embrace the opportunities that lie just outside the standard workday and workweek. This isn't about burnout. It’s about building a practice and a reputation. Saying yes to seeing a few extra patients, covering a satellite clinic in an underserved area one day a week, or taking occasional hospital call can be the engine that drives your growth. One of the most successful surgeons I know started his career in Compton (in the 2000s)—not because he wanted to, but because the patient need was immense. Surgical volume was high, which fueled his cash flow to build his practice in one of the nicest parts of LA. Strategic hustle pays dividends.
I want to give particular attention to a few of the great practices I worked with over the years. These are groups I hold out as examples of great practices:
On finding a partnership: Make sure you actually like the people you’re planning to partner with—and that they’re overall good people, personally and professionally. Partnership varies in more ways than employment does. Employment is very regulated; partnership is not. To understand if you’re getting into something good, look for current partners being very transparent with you on the front end about what partnership takes and what general costs look like. Obfuscating financial details is a red flag (check the debt of the business and the personal lifestyle of your partners).
Costs of partnership should follow a formula, and you should be able to see what others paid. Generally, get a mutually agreed-upon third-party valuation of the practice. Maybe even get a second. Whatever those numbers are, that’s the value of the business. Someone’s personal opinion of what their practice is worth means nothing—it’s worth what someone is willing to pay. If someone tells you, “I was offered $X one time,” cool—why didn’t they take it? Getting the first part of this paragraph right pretty much solves any issues that come up with the rest of it. I knew plenty of practices that shared financial information with candidates considering employment with a partnership track. They just had them sign an NDA. Look for that—it’s a good sign.
On starting your own practice: In my time recruiting, I knew a decent number of people who started their own practice, and only one ever told me it was a mistake. They all said it was scary, hard, and ultimately fulfilling. But it’s not for everyone. Valuations on everything are stretched right now: stocks, real estate, practices. Almost everything is at a relative peak, so if you’re buying an already well-oiled, high-producing practice, it’s going to be hard to grow its value with declining reimbursements. One of the best ROIs in ophthalmology right now is to start your own practice, go to a satellite location where you’re needed, and hustle. You can turn a low seven-figure investment into an eight-figure asset in 10–15 years and build up to a seven-figure income in the meantime in an extremely tax-efficient way. Combine that with owner-occupied real estate and a surgery center, and you can build serious generational wealth. It won’t be easy, and I don’t recommend trying this in a top-10 metro. But if you’re willing to live in places like Waco, TX; Peoria, IL; Bloomington, IN; Reno, NV; Shreveport, LA; Eugene, OR—you have an almost certain shot at making it big. In my first few years recruiting, I thought the solo MD practice was dying. After connecting with Ho Sun Choi and the docs at Independent Practice Partners—and seeing many young doctors go out on their own—I now realize there’s a ton of opportunity.
What am I doing? I’m going out on my own. I’ve earned my Class A Contractor license in Virginia. I’m officially licensed to oversee the building of a skyscraper in Virginia—ridiculous, haha. I’m scared as can be, but I’m hopeful and ready to work hard to make this work. I’ve always loved working with my hands (I’m sure many of you understand), and this gives me an opportunity to do that, use the professional skills I’ve developed as a recruiter, and shift toward a more engineering-focused mindset.
Hopefully, this had something that made everyone nod in agreement and grumble in disagreement at one point. If so, I met my intention here.
I wish you all the absolute best in your incredible careers!
First off, I want to say thank you to the many people I got to work with over the years. It has elevated my thinking and lifted me up in so many ways. I know some ophthalmologists who have 25 hours in a day and 8 days in a week, while still maintaining a strong family life. I got to meet some truly inspiring people in this position.
On finding your next associate: The market is getting tighter. The remaining experienced ophthalmologists are busier than ever and likely making more than they were a few years ago. The national movement from the pandemic is over, and I now see it as harder than ever to get someone with experience. You should absolutely be considering new grads if your hiring need is critical.
While there’s no magic bullet to a good hire, there are markers I noticed that tended to produce above-average work ethics: from very rural areas, engineering undergrad/background, first-generation in medicine, second-career medicine, immigrants, first-generation Americans, doctors with strong religious convictions, and doctors who had kids during their training. These weren’t things I could necessarily say out loud in my official capacity but will say now. Again, these aren’t absolutes—but patterns I noticed. If there was one pattern that was also true, it’s that everyone who ever told me directly “I’m a hard worker” was not a hard worker.
Competition for talent is heating up, and base salaries seem like they’re in a hockey-stick pattern right now. If you want to compete, the best thing you can do is be completely transparent. Open your books, open your life, open your employees and former associates to any new ophthalmologist looking at your practice. You can get an NDA signed—and should—if someone is looking at your books.
I know some great practices in rural locations and, while they can’t always hire in the exact year they want, they’re still able to consistently attract talent by being transparent and making good-faith offers commensurate with the position and location. If these rural groups can still hire, anyone can.
When looking for a practice to join long term (partnership-focused): There is too much attention paid to quantifiable metrics: compensation, call, work time. The only quantifiable metrics you should watch for is the financial health of the existing practice; that will determine your long term, partnership outcome. I also encourage everyone to put more weight on whether you like the people you’re working with. If $50K in base salary is enough to sway you from one practice to another, then both practices are likely not the right choice if you’re looking for something long term.
I have never in my 10 years had a happy partner mention to me that they thought they were upset by how much they were paid in the beginning. Obviously, at 30–32 years old, a $50K difference is almost your entire residency/fellowship salary on top of whatever else you’re negotiating. In 10 years, that initial $50K more in base salary will be about a 1–3% difference in your total career earnings. If you can defer that gratification just a little longer, the returns can be massive both personally and professionally. A good partnership improves both the personal and professional side of your life, and that fulfillment is not quantifiable—especially not in monetary terms.
Your career can be built, and there is no doubt that making a lot of money early on can make a difference in your long-term wealth. I myself took the path of prioritizing money early in my career with this recruitment job that ate into my nights, weekends, and vacations. I invested heavily and lived well beneath my means on about 15–20% of my income total (where I live had a lot to do with allowing this).
Your first job might just be for the money to get on your feet—especially if you have kids during training or lots of student debt. However, if you’re going to prioritize the money, don't spend it at the same time. Live like you make $100K and you’ll be handsomely rewarded in just 5 years. If you do prioritize the money, then let that be the priority. You’ll be hard-pressed to find the money, the partners, work/life balance, and the exact place you want to live. If you take this route, get what you need as fast as possible and move on to somewhere you truly love—then let money be the last thing on the list drawing you there.
On opportunity: Some of the better opportunities right now tend to be in secondary cities. The biggest cities have much more competition and tend to have harder practice environments—insurance, HR, taxes, and overhead expenses. You will succeed much faster and be able to grow practice value more effectively in cities with fewer than 2M people in the MSA. You’ll find higher income for yourself, more appreciative patients, better insurance landscapes, less hospital call, less competition, and more straightforward partners and partnership tracks in these kinds of places.
To be specific: cities like Tucson, Louisville, Kansas City, Milwaukee, Greenville, and the like. Places like LA and NYC have unique aspects, but on a daily and weekly basis, your life likely looks very similar Monday through Friday. Being able to travel to those places will be easier with higher income, lower cost of living, and less stress. The best example I personally knew was a retina surgeon in Iowa making over $3M/year. He didn’t like living in Iowa, but he had a house in Park City and a home on the coast in Florida. He flew private to either one 1–2x/month for the weekend, with vacations in between.
Real-world value comes from doing something others can’t or don’t want to do. You’re all already eye surgeons (something others can’t do). If you go do the things your peers don’t want to do, you exponentiate your value. The most successful and fulfilled ophthalmologists I know embrace the opportunities that lie just outside the standard workday and workweek. This isn't about burnout. It’s about building a practice and a reputation. Saying yes to seeing a few extra patients, covering a satellite clinic in an underserved area one day a week, or taking occasional hospital call can be the engine that drives your growth. One of the most successful surgeons I know started his career in Compton (in the 2000s)—not because he wanted to, but because the patient need was immense. Surgical volume was high, which fueled his cash flow to build his practice in one of the nicest parts of LA. Strategic hustle pays dividends.
I want to give particular attention to a few of the great practices I worked with over the years. These are groups I hold out as examples of great practices:
- Eye Clinic of Wisconsin
- Illinois Eye Center
- Spokane Eye Clinic
- University Eye (Knoxville)
- Colorado Eye Consultants
- Arizona Eye Consultants
- Mann Eye Institute
- Moyes Eye Clinic
- Eye Surgeons of Indiana
- Southwest Eye Institute
- Mid-South Retina
- Advanced Retina
- Nevada Eye Consultants
- Hollingshead Eye Center
On finding a partnership: Make sure you actually like the people you’re planning to partner with—and that they’re overall good people, personally and professionally. Partnership varies in more ways than employment does. Employment is very regulated; partnership is not. To understand if you’re getting into something good, look for current partners being very transparent with you on the front end about what partnership takes and what general costs look like. Obfuscating financial details is a red flag (check the debt of the business and the personal lifestyle of your partners).
Costs of partnership should follow a formula, and you should be able to see what others paid. Generally, get a mutually agreed-upon third-party valuation of the practice. Maybe even get a second. Whatever those numbers are, that’s the value of the business. Someone’s personal opinion of what their practice is worth means nothing—it’s worth what someone is willing to pay. If someone tells you, “I was offered $X one time,” cool—why didn’t they take it? Getting the first part of this paragraph right pretty much solves any issues that come up with the rest of it. I knew plenty of practices that shared financial information with candidates considering employment with a partnership track. They just had them sign an NDA. Look for that—it’s a good sign.
On starting your own practice: In my time recruiting, I knew a decent number of people who started their own practice, and only one ever told me it was a mistake. They all said it was scary, hard, and ultimately fulfilling. But it’s not for everyone. Valuations on everything are stretched right now: stocks, real estate, practices. Almost everything is at a relative peak, so if you’re buying an already well-oiled, high-producing practice, it’s going to be hard to grow its value with declining reimbursements. One of the best ROIs in ophthalmology right now is to start your own practice, go to a satellite location where you’re needed, and hustle. You can turn a low seven-figure investment into an eight-figure asset in 10–15 years and build up to a seven-figure income in the meantime in an extremely tax-efficient way. Combine that with owner-occupied real estate and a surgery center, and you can build serious generational wealth. It won’t be easy, and I don’t recommend trying this in a top-10 metro. But if you’re willing to live in places like Waco, TX; Peoria, IL; Bloomington, IN; Reno, NV; Shreveport, LA; Eugene, OR—you have an almost certain shot at making it big. In my first few years recruiting, I thought the solo MD practice was dying. After connecting with Ho Sun Choi and the docs at Independent Practice Partners—and seeing many young doctors go out on their own—I now realize there’s a ton of opportunity.
What am I doing? I’m going out on my own. I’ve earned my Class A Contractor license in Virginia. I’m officially licensed to oversee the building of a skyscraper in Virginia—ridiculous, haha. I’m scared as can be, but I’m hopeful and ready to work hard to make this work. I’ve always loved working with my hands (I’m sure many of you understand), and this gives me an opportunity to do that, use the professional skills I’ve developed as a recruiter, and shift toward a more engineering-focused mindset.
Hopefully, this had something that made everyone nod in agreement and grumble in disagreement at one point. If so, I met my intention here.
I wish you all the absolute best in your incredible careers!
