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Up Front | Sep 2015

I Can’t Get No

I doubt many issues of CRST and CRST Europe fail to contain the word satisfaction, specifically as it relates to patients. We surgeons fixate on this metric, both in terms of clinical outcomes and patients’ overall experiences. Without satisfied patients, no new technology is viable in ophthalmology.

For many, including myself, it is hard to hear the word satisfaction without thinking of the 1965 Rolling Stones hit. As their first US gold record, the song elevated the group to stardom. “(I Can’t Get No) Satisfaction” is widely considered one of the most influential rock songs of all time, and in 2000, it topped VH1’s “Top 100 Greatest Rock Songs.”1 Keith Richards’ famous opening guitar riff supposedly came to him in a semiconscious, middle-of-the-night fit of inspiration, of which he had no memory the next morning.2 Fortunately, he had somehow activated a tape recorder and captured the song. Mick Jagger’s relatively simple lyrics were considered highly scandalous at the time, but his frustration over his love life and his growing disenchantment with excessive commercialism resonated strongly with listeners. In short, everyone can identify with the desire for satisfaction.

Ophthalmology has historically been regarded as one of the most desirable specialties in medicine. It has a reputation of happy practitioners, and many ophthalmologists have encouraged their children to follow in their footsteps. Is this still the case?

In April, Medscape released the results of its annual compensation survey. Involving more than 19,500 physicians in 25 specialties, the survey included questions regarding satisfaction levels.3 Although compensation is only one aspect of satisfaction, the data are sobering for ophthalmology. Whereas compensation rose for 23 of 25 specialties during the previous year, ophthalmology saw zero growth in average physician income. Ophthalmology also ranked dead last among all specialties in terms of the percentage of physicians who felt fairly compensated for the work they perform. Importantly, only about half of all ophthalmologists in the survey described themselves as satisfied overall with their career and their choice of specialty, placing ophthalmology in the bottom half of all specialties. This result seems to be a departure from the historically high levels of satisfaction found in our field.

I happen to love ophthalmology, and I firmly believe that some of our worst days are probably better than the best days of many other specialists. It is easy to forget how great we have it, but I understand the frustrations expressed in the Medscape survey. For those of us who rely upon third-party payers, the regulatory and administrative burdens in ophthalmology have reached an all-time high, and, unfortunately, I do not foresee improvement. Technology allows us to do amazing new things, but as with laser-assisted cataract surgery, we are sometimes forced to come up with convoluted ways to charge for these services. Moreover, because ours is a technologically dependent specialty, we feel extremely frustrated not to have access to drugs, devices, and techniques that our colleagues abroad take for granted.

Nevertheless, we really should not complain too much. After all, being able to sit down when we operate is a big plus in my book. Too many of us have forgotten what it was like as medical students to hold a retractor for a few hours during abdominal surgery. I would choose ophthalmology again in a heartbeat, and, I suspect, upon closer inspection of the alternatives, most of my colleagues would, too. n

Steven J. Dell, MD

Chief Medical Editor, CRST

1. CBS News Staff. Stones had best rock song. CBS News. January 7, 2000. http://cbsn.ws/1HgKp5B. Accessed June 24, 2015.

2. Leahy A. Behind the song: “Satisfaction.” March 9, 2012. American Songwriter website. http://bit.ly/1BAKP6a. Accessed June 24, 2015.

3. Peckham C. Medscape Physician Compensation Report 2015. Medscape. April 21, 2015. http://wb.md/1FBaeaZ. Accessed June 24, 2015.

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