Dr. Gary Wortz of Commonwealth Eye Surgery on Managing Busyness and Burnout

Episode Transcript: Dr. Gary Wortz of Commonwealth Eye Surgery on Managing Busyness and Burnout

Crawford: Hello everybody, and welcome to another episode of The Medical Marketing Podcast.

today, we’re gonna take the podcast in a little bit of a different direction. Today’s conversation isn’t about healthcare marketing per se, but more about life as a physician and how to deal with it all.

Today, we have Dr. Gary Wortz on the show.

Dr. Wortz is a busy physician, the Chief Medical Officer of an ophthalmic device startup, and a podcast host and regular contributor to industry publications. We’re going to get some of his thoughts and insights about achieving work-life balance, learn how to deal with things like burnout, and get some valuable advice for residents and younger doctors just starting out in private practice.

Dr. Wortz, welcome to the show!

Dr. Gary Wortz: Crawford, thanks for having me, I appreciate it.

Crawford: My pleasure. So just by way of background for those who are tuning in, just tell us a little bit about yourself and then about your practice.

Dr. Wortz: Yeah, happy to do. So I’m an ophthalmologist practicing in Lexington, Kentucky at Commonwealth Eye Surgery with Dr. Lance Ferguson. It’s a pretty busy practice, a referral center-type practice in Lexington. We serve most of Central Kentucky. It’s kind of a regional practice.

So I grew up in Michigan and moved to Kentucky for undergrad. I went to Asbury University and I met my wife who is from Kentucky. Decided to stick around the state and did my training at University of Louisville School of Medicine and then finished my ophthalmology training at the University of Kentucky.

I finished in 2008, so I’ve been out now for almost 12 years which doesn’t really seem possible, but had a number of different interesting roles and jobs throughout the past 12 years, and happy to dive into any or all of that.

I also have two wonderful children. My daughter is a freshman at Furman University, we’re really proud of her and my son is a junior in high school, and I also, obviously extremely proud of him too…

What made you choose ophthalmology as a specialty?

Dr. Wortz: Yeah, I remember it pretty clearly.

And just to be honest, I wasn’t the kind of guy going through medical school, where I just loved everything and I had to pick the thing I loved the most.

As a matter of fact, I sort of just didn’t like a lot of it. I realized that I went to medical school thinking I wanted to be a trauma surgeon. I did research in the department of surgery, and I met some trauma surgeons and just realized that that just wasn’t probably what I wanted for my life for a number of reasons.

And we need to have great surgeons and I’m not trying to drag general surgeons or anything of the sort, but I just realized I wasn’t a good fit for me.

I did OBGYN, I did pediatrics, I did internal medicine, and it was really like, I don’t know, I just don’t know if I see myself doing this. It was sort of this chronic frustration of having a hard time really impacting someone in a meaningful way.

A lot of that had to do with the variability of the complexity of multi-system disease processes, as well as relying on patients to actually do what you tell them to do – so patient compliance or non-compliance or lifestyle modification. You see diabetics, you see patients with hypertension, and obesity and smoking and all the other risk factors that you know are going to really ravage their body and you’re sort of like, you have the mechanic, you’re the auto body shop and every time they break down, they’re coming in. And I did not find that to be really appealing.

Fast forward to a day when I spent some time with the doctor in Louisville Dr. Asim Piracha who’s not only hero of mine, but now I get to call them a friend and a colleague. I got to see him do cataract surgery and it really checked a lot of the boxes that I wanted.

I wanted to really make an impact. Everyone says, why did you go to medical school, or why do you wanna be a doctor?

I want help people. And we do. That’s not a euphemism or a cliche – we really do like helping people.

But for me I just wanted to make an impact. I wanted to make a lasting impact on someone’s life. I thought that was going to be in the realm of saving someone’s life who was acutely injured in trauma.

It’s such an amazing thing we can do – it’s palpable, the gratitude that is exchanged between doctor and patient. It’s long-lasting, meaning no matter what they do beyond the extremes they’re going to continue to have a good result based on what you did for them.

And it was also pretty quick. And it’s elegant, it’s a very elegant micro-surgical procedure. And I was sort of leaning towards microsurgery, in general, I just thought I enjoyed the challenge of that for me, it just really checked all the boxes. I saw surgery, I saw how elegant it was, and I really at that moment said, I think I could do this for the rest of my life. I’d be pretty happy

And I’m glad I was right about that.

What does a typical day look like for you?

Crawford: So what does a typical day look like for you when you’re at your practice doing surgery or meeting with patients?

Dr. Wortz: Yeah, so we have a pretty surgically-focused practice. So average day, I’m waking up at 6:30 and leaving the house. I’m in the operating room at 7:30 and I’m really operating all day long, usually running multiple rooms, including a laser room.

We do a lot of femtosecond laser-assisted cataract surgery, and so basically running until 2 or 3, depending on how quick things go. Trying to do as many surgeries – obviously, the numbers don’t matter, it’s about the quality – but we’re trying to balance efficiency and quality, and we’ve been very successful at that.

So my typical days are spent mainly in the operating room. I’m seeing patients as well from time to time when need be, and obviously if there’s any issues or otherwise, we’re always available.

Managing Relationships Among Doctors

Crawford: So you obviously have a number of optometrists at your practice, but you’re one of only two MDs. So what does it look like to share the load with your partner, and maybe what would you say to physicians who might just be starting out or might be one of many partners at a practice and are trying to navigate those relationships?

Dr. Wortz: Yeah, I’m a big advocate of the letters after your name, don’t tell anything about what your aptitude or capability is. It just demonstrates the level of training that you’ve had, and what you’ve done in the past.

So I don’t get too hung up over who’s an ophthalmologist or who’s an optometrist. I’ve met incredibly smart people with all combinations of degrees.

And so what I will say is this: in our practice, we have a very egalitarian approach. We try to put people in a position where they are going to be able to use the skills that they have learned and honed over the years to the highest degree of their ability, and we all basically just look at this as a big team.

So, in the past, there’s been a lot of animosity perhaps between ophthalmology and optometry. Whenever you’re competing for resources that are scarce or resources that are limited obviously a competition will creep in and then people tend to get their feathers ruffled about that.

I try not to do that. I basically think about we’re one big team.

I love the optometrists I get to work with: Drs. Hal Findley, Marty Smith, and Tania Patel… They’re just among the most capable smartest, wisest, amazing, eye doctors I’ve ever had the privilege to work with. And so I’m just so happy that I have them to rely on. They do a lot of work for our practice, and I think would kinda be in a world of hurt without them.

I guess to answer the question specifically, for younger physicians out there, look to build a team with people that you respect and trust. Don’t build of hierarchy. The hierarchies kind of form and there’s probably some level of good in having some structure to an organization, but at the end of the day, you need people who are willing to basically just, I guess put their pants on one leg at the time, buckle up, and come to work just like anywhere else and not get too hung up on who has what degree or whatever.

Crawford: Gotcha. So it’s really about the cohesiveness of a team and building that team around you. That’s really what matters.

Dr. Wortz: Yeah, it really is. And it’s also just trying to put everyone in that position where they can do the most efficient good for the team, and for the patients.

Crawford: So you’ve been practicing medicine for a while, I think you said you’ve been out of residency in 2008, is that right?

Dr. Wortz: Yeah, that’s right.

How to Establish Work-Life Balance as a Young Physician

Crawford: So what advice would you give to residents who are looking at entering the workforce or younger physicians who maybe just joined a practice? What advice would you give them about establishing that work-life balance from the get-go when they are young?

Dr. Wortz: Well, I don’t know that I’m necessarily qualified to answer that. I do feel like in some ways I look at things a little bit differently. I’m from maybe a little bit different generation.

I do think that the guys and gals coming out now, I think tend to have a more healthy approach to that. They’re more mindful of it from the get-go. So I think that the generation coming out now is actually probably positively influencing their senior partners and challenging the lack of work-life balance that has been the pre-supposition in medicine since the dawn of time, I would say.

So, with that preamble aside meaning I may not be the best person to answer this question, I will say that it’s the most important time in your life to be patient, and it’s the most important time in your life to look long-term.

If you’ve gone straight through from preschool all the way through ophthalmology, and you don’t do a fellowship you would be 30 years old. If you do a fellowship you’re 31- 32. And then if you took a couple years off you’re in your mid-30s before you’re even really getting started with your professional career.

So, telling someone who is up to their eyeballs in debt, who has been sleep-deprived for a decade, and ready to start their life to look for a practice that is maybe not gonna give them the highest salary the first year, but it’s gonna be a great long term fit is like trying to tell a man who’s starving at a buffet that salad is really what they should be going for. It’s just not practical.

I think that that’s sort of the problem that we get into with young residents coming out of training: they’re vulnerable because of all the things I mentioned, and they’re often taken advantage of, and that’s unfortunate.

I’ll also say this: there’s a balance there. Coming out of residency, maybe it does take some time to ramp up and getting efficient at seeing patients and making clinical decisions without an attending over your shoulder and being able to actually pull the load in the operating room and doing a number of cases. So I think that it’s unreasonable for residents coming right out to really demand a high salary and demand a lot of vacation time and other things.

But I think it’s also unreasonable for practices to take advantage of the relative weakness or the vulnerable spot that the residents are coming out looking for a new job. So I know that’s kind of a long way around the answer but I’ll say that it’s a precarious situation that I see getting may be exploited and also misused a lot.

Crawford: So it sounds like from a resident’s perspective, even though the temptation is to jump right in and get started and finally be out there in this career that you’ve waited so long for it is still important to maybe make some of those short-term trade-offs in order to find a better fit for you over the long-term of your career.

Dr. Wortz: Yeah, but everyone who has the opportunity to make more money probably is gonna ignore the advice I’m giving them, because that’s what I did.

I went for what I thought would give me the quickest payday, because that’s what was most important thing at the time. Looking back on it, I could see how that was maybe a mistake or if I did it a different way, it may have led to a different outcome quicker for me.

But at the same time, sometimes you have to learn those lessons the hard way, and when you do learn them the hard way, they stick a little better. So I don’t necessarily have any regrets, but I do know that if I knew what I know now, I probably would have made some different choices.

Crawford: Terrible puns aside, hindsight really is 20-20.

Dr. Wortz: Yeah, exactly, exactly.

How to Balance Work and Family Life

Crawford: And of course, your clinical practice and your work as a doctor is only one part of your life. You mentioned earlier, you have a family as well, and if I remember correctly, you had both of your kids while you were in residency? Is that right?

Dr. Wortz: Actually in medical school. I had my daughter between my first and second year medical school, and then my son between my third and fourth year, so we had two kids.

Honestly, I think that was among the most important things that has ever happened to me. Not just being a parent. I think every parent who those sentiments –myself included – but what I mean by that is I was on this track to doing a very life-intensive residency in general surgery, and then probably doing trauma and I did realize that that was not the work-life balance that I wanted. Not that I don’t wanna work hard, I do enjoy working hard and I like being productive. I just didn’t like the culture of a lot of the programs that I saw and some of the things I saw I didn’t think were very healthy.

I wanted to be around and be a big part of my kids’ lives. And again, I’m not saying that all general surgeons are bad parents – that’s not what I’m saying at all. Everyone finds a way to make it work.

But for me, I knew that I thought ophthalmology would give me a better opportunity to achieve the goals I wanted, particularly with being a pretty involved dad.

Lessons Learned During Residency

Crawford: So if you look back on that time and just thinking about how crazy it is: you have your med school, you have a new family with young kids at home…what lessons did you learn during that season that were valuable to you that you may be still carry with you today?

Dr. Wortz: Probably that I’m unbreakable…and I don’t mean that I think I’m invincible – I’m obviously saying that tongue-in-cheek – but it’s kinda like one of those moments of, if this doesn’t break me and if I can make it through this, then probably nothing else is gonna break me. I have the mental strength and fortitude to make it through tough times.

Crawford: Yeah, you learn what you’re made of.

Dr. Wortz: Yeah, exactly and I think it’s really important in your 20s, to work really, really hard. Because I think that in some ways it sort of sets the bar for how you define hard, work in the future.

So when you’re a medical student, and you’re a resident, you’re spending more than 80 hours working a week.

You might do 80 hours as a resident in the hospital, but you still have to go home and study at night. You still have to be prepared for your examinations. Your whole life revolves around this.

So when, for example, last year, my partner got injured and was out for about three months and I was carrying a double surgical load.

Was that hard? Absolutely.

In some ways, it was really tough because you’re the boss, and you’re responsible for a lot of people, making sure that they have their hours and you’ve gotta make sure everyone’s surgical come is perfect, so there’s a little bit of pressure in that regard.

But I leaned on those years when I was an intern – poor, hungry and driven and working all the time, and it was nothing compared to the stress and the workload I endured in my younger days.

Even on my hardest day, it’s nothing compared to like it was back then. So it gives me a great sense of perspective – even when I have a hard day, it’s really not that bad.

What it’s like to be a Physician and Startup Founder

Crawford: So shifting gears just a little bit…aside from your clinical work in your practice, you’re also the Chief Medical Officer of Omega Ophthalmics, your start-up. So for our listeners who maybe aren’t familiar with Omega, just give us a quick run down of kind what the company is trying to do.

Dr. Wortz: Yeah, so startups are always about finding an unmet need and filling that.

And so when I was just a few years out of residency, I was sort of frustrated with some of the lack of reversibly or exchangeability of the lens platforms that we have.

So the cataract surgery, we’re typically putting in the lens after removing the cataract. And we think about that as a one-way trip – the lens we implant is generally gonna be there for the rest of the patient’s life. The downside of that is there’s a number of technologies that can have some side-effects in some patients.

You don’t know that going into it, you’re not sure which patients the technology may not work ideally for, and so there’s some patients that the lenses are gonna need to be removed. And that process is pretty stressful both on the physician in on the eye. And so it’s something that is really not ideal.

Additionally, lens technology is becoming more and more advanced. Every year we’re getting new lenses that are coming out that are providing a real a ton of amazing benefits. So, patients who’ve had cataract surgery for five years ago, really are not eligible to benefit from the increased technological improvements.

So Omega Ophthalmics is a company that exists really to fill that void. It’s company that we’re creating a prosthetic capsule that is a liner, if you will, that goes in the capsular bag after cataract surgery and can hold a technology of all sorts.

Generally, we think about the Gemini Capsule holding lens implants and allowing for those lenses to be added together in interesting combinations, or exchanged if need be, or even upgraded in the future. So we’re really creating a platform technology that allows other technologies to exist safely inside and be upgraded, exchanged, or removed as the patient’s needs and desires change over time.

Crawford: So what does life look like both as a physician and as a startup co-founder? How does your start-up fit into your clinical work?

Dr. Wortz: I think it’s the best of times, and the worst of times. Some days, there’s not a lot of work to do because projects sort of come in phases, and sometimes you’re in a really busy season.

So that’s the thing that’s interesting about running a startup: there’s sort of a cyclical nature to the work. And so at times there’s not a whole lot to do, you’re waiting on the project to be completed by a consultant or someone else who’s manufacturing, maybe it’s intellectual property. And then there’s other times when you’re running 90 miles an hour in your hair on fire.

And so throughout all of that, you trying to balance the family life and also the clinical and surgical side of being an ophthalmologist, it can be hectic.

But again, I kinda go back to the idea that I know what it’s like to work hard. I enjoy working hard. I enjoy doing things I feel like matter and have a potential to not just matter to me, but to matter to my practice and my profession.

So it is sort of a passion project – you have to have a passion for what you do to stay engaged. That’s sort of what drives I think can drive you forward, when times are tough or you’re tired. You think about not only the investors who are counting on you, but also you know all the patients in the future who might benefit from this technology.

So for me, I think it’s more about just knowing that I’m passionate about creating some disruptive change in ophthalmology and knowing that I’m on the path to do that, it kinda drives me forward.

Crawford: So there’s really a purpose behind it. It’s not just, “Oh here’s something else I’m involved in.” You’re really driven by that passion and that purpose both to advance the field and ultimately, sounds like to better improve outcomes for patients.

Busyness vs. Productivity

Dr. Wortz: Yeah, one of my favorite sayings is, “Don’t mistake activity for productivity.”

So busyness in general is not something that we should strive – for we should really strive for being productive. And so I think to the extent that I can, I try to remain productive and all the things that I do.

By the same token, I don’t mind sitting down and watching some TV with my kids or going out to a nice dinner. I really enjoy my free time as well. So I think trying to prioritize your time and being efficient and productive – that’s what I worry about. I don’t really worry about being busy. I try to maintain some balance there if possible.

Crawford: Gotcha, and as if you didn’t have enough going on, you’re also a podcast host, and a regular contributor to a bunch of publications around the industry. I mean how on earth are you fitting it all in?

Dr. Wortz: Well, I think, just like I said before, I enjoy, I enjoy the things that I do. If I don’t enjoy it, then I generally flake out and will just sort of say, no, or stop doing it. So if I enjoy something it doesn’t really feel like work.

I really do enjoy talking to people I enjoy exchanging ideas and figuring out what makes people tick, and what they’re doing in their practice.

So I think the podcast in some ways is sort of a hobby more than it is a job, it’s something that I really enjoy doing and enjoy connecting and also enjoy sharing that with other people who find it interesting, perhaps.

How to Deal with Burnout Effectively as a Physician

Crawford: With so many things going on, both in family life in your clinical life and all the other things you’re involved in, I imagine that sometimes you can experience some burnout. And I think that’s a popular topic among physicians today. And rightly so, because doctors, by and large, are all so incredibly busy with everything that’s going on. What are some of your strategies for dealing with burnout when it does come up?

Dr. Wortz: Yeah, this is a topic that doesn’t…we talk a lot about it, but we don’t talk enough about it.

I will say that I think every resident or a young physician that’s out there is probably, I would imagine, dealing with burnout on a daily basis.

They’re probably burned out. And if we could send them all to the beach for three months, just to let their mind relax, I think that would be fantastic. But short of a pandemic that we’re in right now, and work stoppage, that’s not gonna happen.

So I think what we have to do is figure out how do you retreat from the brink? Burnout is one of those things that is sort of like a fire, and if it becomes a wildfire then it can really cause a lot of damage in someone’s life or they start making destructive decisions with their life and they stop tuning in to their responsibilities and the things that they used to value in the past no longer are valuable. And we see a real breakdown in the person.

And so what I think we need to do is think about strategies every day to keep the margin between you and really the big burnout which is where you really can’t function anymore and you just have to really take a sabbatical or take a break and step away.

So I think part of it has to do with prioritizing the things in your life that are things you have to do and the things that maybe if you didn’t do them they wouldn’t necessarily be that big of a deal, especially for residents.

It’s easy when your attending wants you to take on another project, or you’re trying to do extra research and you’re trying to gun for that fellowship position. All those things are great, and if you have the capacity to do it, go for it, but just remember that sometimes you have to keep a little margin in your life in case there is a crisis, you get sick, you have a financial issue, a family member gets sick, your pet gets sick.

There’s a lot of variability in life, and when you’re running on red-line, there’s not a lot of margin in your life to deal with the things that inevitably come up.

So I would encourage – especially residents to the extent that you can– and I know that it’s impossible for a lot of folks, so I know this is may not be the greatest advice, but to the extent that you can, keep a little bit of margin in your life.

I think that’s really important. That prevents burnout, because when those things come up, you’ve got a little extra gas in the tank that you can apply to whatever situation you’re trying to deal with.

I would say that once you’re out in the real world after residency, it’s your life becomes a lot more what you make it. You have a little more control, but you’re used to being a workaholic because you worked so hard for so long in residency.

Another favorite saying is, “don’t make your red-line your new baseline.”

So you’ve been working really, really hard for a long time, but realize that that’s a season of life. You can’t sprint forever. At some point you’re gonna have to gear back and it’s okay to not work to complete exhaustion every day.

I didn’t really realize that for a long time. I thought if I took a break or decided to say no to some things that I was a slacker or that opportunity I was chasing wouldn’t be there.

What I realized is that it’s okay to take some margin, it’s okay to really own the decisions you make. And if that means that you’re gonna make less money or be less productive or whatever it is, there are costs to those decisions, but it’s okay to own those and be responsible and realize that at some point you have to start thinking about the long game, not just the every four-year-cycle that you’re in when you’re a student: four years of high school, four years of college, four years of med school, four years of residency.

And so when you think about that, I think it’s important that you start creating some new habits.

If you haven’t worked out for a long time, you start walking and start running if you start doing some body weight-based training – getting into an exercise routine I think there’s another great stress reliever, and it’s a great way to keep yourself healthy, prevent injury from behind the slit lamp or operating microscope… And that’s great stress relieving for me, too, so…

And then beyond that, I think having your family and having your faith, I think those things are vitally important.

We don’t talk enough about that either, but there’s a lot of studies have been shown even beyond the I guess you would say spiritual benefits, there’s a lot of physical benefits for being connected in a community. I think those are things that are all very, very important to me and have been vitally important to getting me to this point where I do feel like I have a little bit of balance my life despite being very, very, busy and very productive.

Crawford: So it’s really about finding that margin taking some space for self-care…because really, when you view your life through the lens of your entire career, it’s really more like a marathon, it’s not a sprint of one concentrated period of time. You really do have to play the long game.

Dr. Wortz: Yeah, but residency is like a “sprint-a-thon” where it’s a marathon of sprints. At some point, you have to realize that’s not healthy.

Crawford: Not sustainable over the little term.

Dr. Wortz: Exactly, got it.

What’s the best piece of marketing advice for younger physicians or residents?

Crawford: And I’d be remiss if I didn’t ask you something about marketing since this is a marketing podcast after all. So if you had one marketing pearl to offer to younger physicians who were either joining an established practice, or maybe starting out on their own, what would that be?

Dr. Wortz: Be your authentic self and get to know the other doctors in your community. Some of the greatest referral sources will come from the other doctors in your community whether those are optometrists or primary care doctors.

But the problem becomes if you’re doing that in a way to just gain referrals, it really is disingenuous.

Meet the other doctors. Figure out how you can help them. I’ve always found that I’ve tried to when I wanna have given the most I’ve actually gained the most.

Transactional relationships are pretty fragile, and when the next greatest thing comes along, those relationships can be pretty easily severed.

But you know when you really invest in someone, you know them, you know their wife and kids, and you’ve helped them either personally or with a troubled patient, you’ve been willing to come in and see someone or take care of something no one else would be willing to take care of? And there’s great communication? You’re sending letters back, you’re maybe even having a phone call. Especially the young ophthalmologist, if you get a referral from an optometrist it’s a great idea to call the optometrist to let them know after surgery, how the patient did if there was any issues that you want them to look for the next day on the post-op exam or down the road.

Having that great communication and being in it for more than just what you can get out of it, I think is probably the most important thing that I’ve found.

Crawford: So, it’s really about forming those relationships and nurturing those relationships over time, not just being transactional, “oh well, what can you do for me?”

Dr. Wortz: Yeah, and I think that people can see that coming from a mile away. So there’s always a component of that. At some point, you’re gonna have to ask someone for their business and you shouldn’t be ashamed of that.

It was hard for me to do – knocking on a door and asking for a referral. They knew why I was there, and I didn’t really want to sell myself…but at the same time, it’s okay to ask for the business, but I think it should be more than that. It should be more than just the business.

Crawford: Well Gary, thanks so much for joining us on the podcast. There’s a lot of great stuff you shared here and I hope our listeners can get a lot of value out of this conversation, so I really appreciate you taking the time.

Dr. Wortz: Thanks, Crawford.

Next Week…

Well, that’s all for this week’s episode of the Medical Marketing Podcast – thanks for listening.

Whether you’re new to the show or have been listening for a long time, check out our website at www.messenger.md. We’re always sharing helpful resources and know-how to help you improve your practice marketing, grow revenue, and take your patient experience to the next level.

That’s all for today’s episode – I’m Crawford Ifland. See you next week.