Luke Rebenitsch, MD is an internationally acclaimed board-certified and fellowship-trained refractive surgeon. As the Chief Medical Director of ClearSight Center in Oklahoma City, he works with refractive surgery fellows daily.
Eyes On Eyecare sat down with Dr. Rebenitsch to find out what private practice ophthalmologists should know about adding a refractive surgery fellowship to their practice.
What are the three primary reasons to start a refractive surgery fellowship at a private ophthalmology practice?
Rebenitsch: The number one most important thing is you have to love teaching. If you don't love teaching, you won’t love having a fellow.
Number two, if you are looking for ways to grow your practice with good people, this is a great way to meet a bunch of up-and-coming, ambitious doctors who want to do exactly what you're doing. For those looking to grow, this is a great way to do that.
Finally, these fellows make you better. They ask questions that sometimes you don't know the answers to, but you find out together. I'm a better ophthalmologist and a better refractive surgeon because my fellows ask questions.
What are the cost considerations when launching a refractive surgery fellowship?
Rebenitsch: First and foremost, you have to pay your fellow. Look at your local university to find the market rate for ophthalmology residents and fellows.
There's also the cost of your time. If their cases take twice as long as yours, you have to factor that in. You have to give your fellows surgical volume. Some people discount procedures done by fellows to bring in extra cases, but we no longer do this.
We discontinued this practice because we found those discounted surgeries had a lower perceived value by patients. Remember, though: the attending is always there in the room, and it's the same technology and the same patient outcomes.
Your fellows are capable surgeons—it’s why you hired them. Your patients must see them that way, too. After all, these are all surgeons who could go into comprehensive practice on their own. And lastly, you have to teach them. We use the curriculum from the Refractive Surgery Alliance (RSA). Otherwise, we would have to create a curriculum for them on our own, and there's a cost to that. Through the RSA, our fellows attend lectures throughout the month and their training follows a structured curriculum.
Is there any pedagogical training you would suggest ophthalmologists seek before adding a fellow?
Rebenitsch: All physicians have gone through an academic program of some kind, so they have some idea of what it means to be an attending. That being said, most purely refractive fellowships are in private practice, so they're not necessarily associated with universities. The first thing you have to do is talk to other doctors, visit other practices, and talk to surgeons who have been doing this for a long time.
You need a curriculum. It is no longer good enough to say, “Hey, just follow me for a year. We'll try to get you some cases.” You need to have required reading, presentations, research, et cetera. Luckily, this industry tends to be collegial. You could call any handful of doctors and say, “Hey, would you mind sending me your curriculum?” Then you can modify it accordingly to ensure it's a good fit for your practice and your fellow.
What are your top three tips for success in adding a refractive surgery fellowship?
Rebenitsch: You have to love teaching. You have to look forward to this every single day. You also have to be patient. These are not surgeons who have done thousands of refractive cases. These are surgeons who are very good at cataract surgery and what their program taught them, but they're not going to be as good as you are and you have to be ready for that.
Finally, I strongly urge any physician considering starting a fellowship to define your core values. What kind of values are you going to instill in your future fellows? These potential fellows may be some of the greatest surgeons in the world, but if their personalities and their goals don’t align with your practice, that's a potential pitfall that may cause some problems going forward.
What other pitfalls should you avoid?
Rebenitsch: As a surgeon, you need to know who you are and find a fellow with goals and beliefs that align with yours.
There's a large difference between how you practice in residency and how you practice in private practice or fellowship. Words matter; don’t just let your fellow go off and see patients by themself right away. Help with verbiage, prepare them for the structure of your practice, and show them how to talk to a patient beyond just medical jargon.
Show them how to talk to the typical 25-year-old who wants LASIK, or the refractive cataract patient who wants to see better. There's huge variability among residencies out there and how to talk to patients is at least half of what we teach our fellows.
Finally, don't assume that they know anything. Don't assume that they are good cataract surgeons. Don't assume that they can even do a YAG capsulotomy. Most of them are very good ophthalmologists, but it still behooves you to follow them and ensure that they can do any procedure before you sign off on them and let them out on their own.
What have you found is the most effective way to find applicants for your new fellowship?
Rebenitsch: If you're starting a new fellowship, it's not good enough to just post it. You have to go where they are: attend meetings and give talks. The Refractive Surgery Alliance is a great resource for meeting potential fellows, and after you've done a fellowship for a couple of years, your reputation precedes you.
Do a good job, and word of mouth will increase the number of quality potential fellows that come to you. One of the added benefits of going to meetings is developing friendships. If I'm looking for fellows, I can call my academic friends and ask who's interested in refractive surgery, and they can recommend someone.
I started my refractive fellowship program 4 years ago, and it has been one of the most rewarding, yet most challenging things I've ever done, and I would never give it up.
