Our Academy of Ophthalmology issue has a different feel this year. Timing is only part of it. Knowing that you’ll essentially return from New Orleans and sit down to a turkey dinner tells you that it’s certainly later in the year than the norm. While we’ll be here in December, we’ll have much less to say, far fewer pages to fill. So there’s something of a finality about this one. But I think it’s more a feel of transition to something new that pervades our cover series of features this month.

That change is in the offing in medicine is undeniable, and in this issue we’ve gathered a series of articles we hope will help you prepare for the New Normal. Whether that’s through a bountiful offering of efficiency improvements (p. 26) or a look at some of the ways that you might tap alternate income streams (p. 42), there are ways to fight back.

The next article in the series, on failed EHR implementation and how to avoid it (p. 48), may be reflective of a bigger problem. The article itself is  full of sound advice on dealing with an EHR lemon. On a higher level, it turns out there may be something inherently destructive in the idea of putting health-care providers in the position of having to fight back. No one promised you a rose garden in residency, but a Rand Corp. study on physician satisfaction released this week takes particular aim at the role of EHR implementation in physician attitudes and satisfaction.

“EHR usability,” the report says, “represents a unique and vexing challenge to physician professional satisfaction. Few other service industries are exposed to universal and substantial incentives to adopt such a specific, highly regulated form of technology, one that our findings suggest has not yet matured. On one hand, only one in five physicians we surveyed would prefer to return to paper-based medical records. Nearly all physicians we interviewed saw the benefits of EHRs ... and believed in the ‘promise of EHRs.’ On the other hand, physicians cannot buy, install, and use a promise to help them deliver patient care. The current state of EHR technology appears to significantly worsen professional satisfaction for many physicians—sometimes in ways that raise concerns about effects on patient care.”

This too shall pass. Most of the surgeons we talk to find a way to fix what’s broken and move on.

On a more positive note, our good friend Dr. Rob Kershner took some time this month to share some of his experiences and insights about what the future holds for the profession (p. 66). Finally, while not part of the cover series, the FDA remains an object of fascination and we have an enlightening look at how the agency got where it is and what the prospects are for fixing what’s broken there.

Have a great Academy meeting and enjoy your turkey.