I’m back. There may be some of you who remember my monthly column here from decades past, usually railing at the wind, the Fates and our regulatory overlords. Interspersed were vignettes from life in a small private practice. Lest you think I had run out of screeds, life had gotten very busy. Turns out it’s not so easy to build and run a practice, teach, advocate and have a home life. But I’m sure many of you already knew that. 

It really was more work every year, much of it just to keep it all together. So many fingers to point. Where to start … EMR, MIPS, private equity, predatory insurance companies, reimbursement cuts ... I could go on. And just when you thought there wasn’t a fresh hell to visit upon us, COVID arrived. As you all know, ophthalmology has been the most significantly impacted specialty in all of medicine. Sure, why not? Bring it on. What doesn’t kill you makes you stronger—or kills you.

COVID has caused the demise of practices, careers and an entire way of life—but not for everyone. For some, life goes on as usual. For the vast majority of us, though, this past year has been beyond challenging. It’s been life- and career-changing. In polling for Review of Ophthalmology early on in the pandemic, it became clear that private practices were more severely stressed than those in academia or private equity. Some private practices have closed, and some have been acquired under duress. The impending death of private practice seems not to have been exaggerated, but accelerated.

But let’s get to the core of this lament: Is all this bad? Can’t change be unexpected, painful, but, inadvertently, good? It may not be the path we thought we would take, but given our impressive skill set as ophthalmologists, can’t we redirect our energies and plans in new directions? Is this kind of redirection even needed? Perhaps perseverance is the answer. Finding our way to our “new normal” may entail something new, or it may simply be a realization that what we had—what we had planned—remains our best path forward. If only we can get there. 

2020 was always going to be a year of transition for me personally. I had long planned to move from high-volume, full-time private practice and managing partner to something less stressful— less Sisyphean—as I pushed the practice up that never-ending hill. Little did I know that COVID would put a huge exclamation point on my last year. In the end, I didn’t change my plans: I stepped down from my practice and from full-time clinical. And after a short sabbatical this winter, I’ll return to teaching, staying surgically sharp and working with industry. These are the things I’ve enjoyed the most. 

It does pain me to see how the delivery of eye care is changing, but really, when hasn’t it? So, like many of you, it’s time to just put one foot in front of the other, make the best decisions possible and continue to find employment, enjoyment and gratification in the best specialty in medicine: Ophthalmology.

As we see the beginning of the end of the pandemic, I’m hoping all of you are finding your direction, whether new or established. I’ll be back periodically to shake my fist at the sky, give you updates on how my new normal is working out, and commiserate when the next crisis arises. 

Be safe, be well, be vaccinated. 

Dr. Blecher is an attending surgeon at Wills Eye Hospital.