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Eric Donnenfeld, MD's Roadmap to Success for Ophthalmology Residents

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17 min read

Eric Donnenfeld, MD shares with us his top three tips to succeed as an ophthalmology resident: irrational confidence, attention to detail, and never abandoning a patient.

Eric Donnenfeld, MD's Roadmap to Success for Ophthalmology Residents

Dr. Eric Donnenfeld, MD, is one of ophthalmology’s most prolific and well-respected innovators and surgeons. Over the course of his career, he’s performed surgery on more than 100,000 patients as well as 1,000 ophthalmologists and their families, participated in 40 FDA trials, and authored 1000 articles, 210 peer review papers, and 40 books or book chapters on topics relating to refractive surgery, corneal transplantation, cataract surgery, and a host of other subjects. He’s patented six instruments for refractive surgery use, and he’s currently Chief Medical Editor of EyeWorld, on the editorial board of nine journals, and a Clinical Professor of Ophthalmology at New York University Medical Center.

We’re delighted to present his advice to ophthalmology residents, gleaned over the course of a storied career lasting nearly four decades. Read on for an exclusive look at the traits and habits that have defined success for Dr. Donnenfeld.

When I was an ophthalmology resident from 1981 - 1984 at Manhattan Eye and Ear, I didn’t have a clear roadmap for success. I just knew that I had a passion for ophthalmology and that I would ultimately have a successful career if I could maintain that devotion.
As I reflect back on my last 35 years since residency, it’s important to me that I help ophthalmology residents become as successful as possible in their careers. What follows is a high-level road map for how to reach your professional goals.
One of the most exciting things about ophthalmology is that the opportunities in the field are limitless. All it takes to succeed is a prepared mind, education, and a willingness to work hard, and you can develop new techniques and technologies that will shape the way ophthalmology is practiced.

Three elements for success

In my decades of practicing ophthalmology, I’ve found there are three things that make a successful ophthalmologist. These are:
  1. Irrational confidence
  2. Attention to detail
  3. Never abandoning a patient
As an ophthalmology resident, you’re smart and well-educated. But so is everyone around you: that’s how you got this far. To become a truly great ophthalmologist, you’re going to need to work harder than you ever did before; you’re going to need to demonstrate a generosity of spirit to your patients and your fellow ophthalmologists; and you’re going to need to pick what you’ll focus on for the rest of your life.
When you finish your fellowship, that’s when you really start working. If you want to make a contribution to the profession, you need to take the same drive that got you into ophthalmology, that got you through your fellowship, and continue to apply that to your work. That will often mean early mornings, late nights, and weekends. The extra time you put into ophthalmology will show—everybody puts in the basics. Going beyond the basics is what will help you create deeper relationships, greater opportunities, and a more successful practice.
Sure, that might sound intimidating—but at the end of the day, these are the traits and habits that make this profession, and those in it, truly great.

Irrational confidence means knowing you will succeed

There are moments that change your life and set you on a path to who you’re going to be.
I’ve known I wanted to be an ophthalmologist since I was eight years old. I grew up in a rural part of Long Island, and one day a neighboring farmer slaughtered a pig. That farmer gave me the pig’s eye, and when I took it home my dad walked me through my very first dissection. I kept that pig’s eye in a jar of formaldehyde in my room for two years, and it’s one of the many reasons I’m writing this today.
When I was in my final year of medical school, I was summoned to the Dean’s office. The Dean of the medical school and the chief of surgery were both there, and they were ready to hold an intervention, because I’d submitted my application for ophthalmology residency.
These two doctors told me that there was a residency reserved at Mass General, and they had plans for me to become a general surgeon. The Dean looked me in the eye and asked: “You have great potential. Why would you throw your life away to become an ophthalmologist?”
I think, in that moment, if I’d been less confident in my own path, I might have caved. Instead, I looked back at him and said, “Ophthalmology is all I’ve ever wanted to do.”
Irrational confidence is at the core of my philosophy, and it’s one of the main traits I advise ophthalmology students and residents to foster in themselves. It’s a crucial trait for three reasons:
  1. Irrational confidence prevents self-doubt
  2. Irrational confidence keeps you joyful
  3. Irrational confidence lets you say yes to opportunities

If irrational confidence gets you in trouble, it also keeps you from doubting yourself

That irrational confidence carried me through to my residency at Manhattan Eye and Ear. My very first night on call, my chief resident pulled me aside and said, “You can call me anytime you like, Eric—I’m always here for you. But remember one very important thing: calling is a sign of weakness.”
That night, a patient came in with NLP and a Hollenhorst plaque in his central retinal artery. I did everything we’re taught to do: digital massage, glaucoma medications, and the patient was still NLP. So I called my resident and told him that I needed to do an anterior chamber paracentesis.
The chief resident gave me permission, and I performed the procedure—and the patient’s vision came all the way back to 20/20. This was one of those moments (and you’ll have them, if you haven’t already) where it felt like I had created fire. I’d restored a man’s vision!
The next morning, I got called into Dr. Larry Yannuzzi’s office, where he congratulated me for restoring the vision of this CEO of a major financial company. Then Dr. Yannuzzi looked me dead in the eye and said, if you ever do that again, you’re out of the residency.
And that’s how Dr. Yannuzzi became one of my mentors.
The whole scenario was an illustration of the importance of irrational confidence. As surgeons, we need it—without it, we couldn’t do what we do. Don’t ever let the fear of censure or of failure stop you from doing what you know has to be done.

Identify what it is about surgery that sparks your passion, and keep that alive

The best advice I ever received about ophthalmology was this: the difference between being a great ophthalmologist and just having a career is how much you enjoy what you do.
When you perform your first surgery, you will feel so much pride and joy. As you grow in your career, and you get more responsibilities and learn more techniques and perform thousands and thousands of surgeries, you have to make sure you never lose that joy. That joy is what will push you to be a great surgeon.

Always say yes to opportunities

One of the greatest things about ophthalmology is that you can be innovative and entrepreneurial at the same time. While it takes work, your training in graduate school and your residency set you up to take advantage of the opportunities that will come your way.
Of course, part of taking advantage of opportunities is creating them. That means knowing when your own ideas have weight. Many of the patents I’ve made have been from ideas I had that I realized were significant, because I was paying attention and knew that no one had done that before, but it was needed. These patents have led to one of the more interesting parts of my career—working with industry.
Saying yes to opportunities when they come your way doesn’t just mean waiting for people to invite you to do things—it means actively seeking out voids in the profession, identifying where need exists, and then providing what’s needed.
In 1988, I was the resident instructor at Manhattan Eye and Ear, and one of my mentors reached out and asked if I’d be interested in running the Excimer Laser program there. It would mean an extra day of work every week for five years, he told me. He was wrong about that: it wasn’t until 1995, seven years later, that we saw a return on this amazing technology that has become one of the cornerstones of my career.
This happened because I’d done a cornea fellowship, I’d done some refractive surgery, and I was willing to participate in a trial without being remunerated for it. You put in the work, and the rest follows. There is very little overnight success. I believe the old saying is correct: “The harder I work, the luckier I get.”

From patient care to your career, pay attention to the details

One of the best pieces of advice I was ever given as a young ophthalmologist was to take care of the little things. This applies to both patient care and your career in general.
When you first start practicing, you’re going to want to dive straight into corneal transplants, refractive surgery, and all the big, splashy surgeries. But taking care of what seem like little things—blepharitis, corneal ulcers, dry eye—will not only lead to better outcomes for your patients, but it will also give you a better view of the industry as a whole.
Seventeen years ago, the idea of using cylcosporine to improve outcomes after cataract surgery was almost unheard of. Now, everyone knows that if you treat dry eye, you’re going to be a better cataract surgeon. By treating dry eye, I’d come to realize that you could improve the ocular surface and get better results with a multifocal lens, and many other cataract surgeries, and that became my very first patent.

Don’t specialize too quickly

When you’re starting out in ophthalmology, don’t concentrate on one specific area. Too many doctors pigeonhole themselves: they become very narrowly focused, and while they might become subject matter experts in one very specific aspect, I believe that unnecessarily limits a young ophthalmologist’s opportunities.
For instance, I was put in charge of developing a microbiology group, which might sound unusual since microbiology is an area that is of very little interest to most ophthalmologists. However, I had a real interest in that after I became involved in corneal transplants, and then refractive surgery, and out of that grew my interest in microbiology.
Each part affects the whole, and vice versa.
Over time, as you expand your knowledge in many different areas, you start seeing how each subfield of ophthalmology affects all the rest. It can lead to greater diversity in your ideas, and greater flexibility in your thinking.
If you’re practicing ophthalmology today and you’re not willing to adapt to changes, you’re going to fall behind. We have so many exciting new technologies, and adapting to changes—no matter how big or small—is the most important thing we can do.

Focus on what’s best for patients, not what industry wants to hear

This piece of advice is especially true for ophthalmologists getting involved in industry. In my career, I’ve done patient care, clinical research, and I’ve worked with industry. All three are parts I value, but if I had to choose, I would always go with patient care.
Ultimately, that’s what makes doctors valuable to industry. While there are some people in industry who will want you to repeat the message they want to hear, or simply agree with everything the company wants to do, that’s not an ophthalmologist’s role in consulting. We’re brought on to tell the truth.
When we’re being honest, we’re not giving them the answers they want to hear: we’re giving the answers we believe will benefit our patients. Eventually, that translates into success for the industry, for your patients, and for you.

The industry is made of people; put them first, and the rest will follow

Industry spends an inordinate amount of time working to find new leaders in ophthalmology. They’re always looking for people who are hardworking, willing to make a difference, and good at what they do—if you demonstrate those qualities, industry will come find you.
However, you have to be willing to do the work; to give talks, to travel, to develop those relationships. When it comes to that, my best advice is to find a person you work with who you really like, who you click with, and to support them. Industry is made up of people, and if you support your colleagues, they will remember that and they’ll support you right back.

Never abandon a patient

In 2008, the FDA called a meeting to decide whether or not to ban laser surgery after receiving 140 complaints about LASIK. I was one of three ophthalmologists who were invited by ASCRS to speak on behalf of LASIK, and there were 40 activists who arrived to speak against it. As an ophthalmologist, I went there expecting that these 40 people were going to have extraordinarily ridiculous, overblown stories, and I arrived expecting to be completely underwhelmed.
However, after listening to testimony from all these patients, I realized that the number one reason these patients were unhappy wasn’t because their surgeries hadn’t had positive outcomes. The procedures had gone well for many of them—but the number one reason why these patients were unhappy was that they felt like their doctors had abandoned them.
Listening to this testimony, I swore that no patient would ever feel abandoned by me or my practice—and since then, I’ve done my best to live up to that ideal.

To put patient care first, listen to what your patients tell you

Too many ophthalmologists perceive unhappy patients as having unreasonable demands. While it’s true that not every unhappy patient has real problems, most patients do—they just might not be expressing them in ways you understand at first.
Always listen to your patients, and furthermore, make sure that they know you’re listening. If you can’t help them, don’t abandon them. Try to find another doctor who may have more, or different, expertise than you do. Success for you is your patient ending up with the right doctor, whether that’s you or someone else.
Never disparage another doctor—everyone has complications, and everyone is going to have unhappy patients. As an ophthalmologist, you’re an ambassador for the profession. If you can take an unhappy patient—whether that’s your patient or someone else’s—and make them happy, you’re doing something great. That patient is going to become an ambassador for you and the entire field.
Whenever a patient comes to me, I try to give them hope. I tell them that while I can’t guarantee that I’ll be able to solve their problem, I can guarantee that I’ll do everything in my power to solve it, up to and including finding the best person to help.

Treat your staff well: if they succeed, you succeed

Nothing in your practice is possible without your staff. They have the hardest job in the world—making us look good. You’ll spend more time with your staff than you will with almost anyone else except your family, and it’s critical that you support them and give credit where it’s due.
The one thing that I will never tolerate in my office is a patient or anyone else disparaging my staff. If a staff member comes to me with a complaint, I’ll sit down with the patient and let them know that this kind of behavior isn’t allowed—everyone on their team is doing their best, and they should all be respected. No one wins when a patient is angry in the office.
This means that you have to be willing to stand up for your staff and yourself. If you don’t like taking care of a patient—if they’re abusive to you or your staff, don’t feel like you have to suffer through that. Refer them out to someone who will be able to work with them, and your practice will become more enjoyable.
Your staff will appreciate it, too.

The only secret is hard work

As a final note, I want to reiterate that to make a contribution to ophthalmology, “smarts” is the least important thing you need. You need hard work, you need empathy, and you need a support system—and the best thing you can do for your career is to start developing those now.
Passion and diligence are the cornerstones of your practice. You’re going to work extraordinarily hard, but that drive will be what makes you, your practice, and the profession grow and succeed.
Eric Donnenfeld, MD
About Eric Donnenfeld, MD

Eric Donnenfeld, MD is one of the ophthalmology industry's leading experts. With a career spanning over 20 years, he has helped to revolutionize the field. He is highly passionate about ophthalmology, his career, and helping his patients.

Eric Donnenfeld, MD
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