How To Make Money Has A Retina Specialist

The Industry Side: It's Not All About the Money

Some retina specialists expect that working in the ophthalmic industry will increase their remuneration. Is that always the case?

By The NRMD Editors, As An Interview with Emmett T. Cunningham Jr, MD, PhD, MPH

The last time New Retina MD touched on the topic of industry participation, Emmett T. Cunningham Jr, MD, PhD, MPH, reviewed the state of venture capital in the retina space; you can find a link to his interview at the end of this article.

Dr. Cunningham is back, as promised in NRMD's earlier article, for a follow-up interview. Rather than provide an update on how money flows in the ophthalmic sector, Dr. Cunningham offers professional pearls for young retina doctors considering a jump from practice to a role in industry.

His message is clear: Industry work can be quite rewarding professionally, but it doesn't necessarily lead to increased income.

New Retina MD : The NRMD readership is made of young doctors, many of whom wonder how they can best monetize their careers in addition to salary. What opportunities exist for making some additional revenue in retina?

Emmett T. Cunningham Jr, MD, PhD, MPH: There are quite a few opportunities to increase your revenue steam outside of the clinic and the OR, but I want to make a clear point before we discuss those options. It is difficult to make more, on a dollar-per-hour basis, than you will make as a busy retina specialist. For many practitioners, the satisfaction of having a full patient schedule fulfills their professional and personal wants, and the high salaries retina doctors command allow many of them to live quite comfortably. If you enjoy the pace and challenges of your practice, I advise you to continue to do what you like to do.

That said, some retina doctors dabble in professional areas outside of the clinic. These career enhancement opportunities—I call them that because, again, the money one makes working outside the clinic is not necessarily greater than the amount to be made by seeing patients—take three general forms: clinical trial participation, consulting roles, and working professionally in the pharmaceutical, medical device, and/or investment industries.

NRMD : How does a young doctor get involved in a clinical trial?

Dr. Cunningham: The easiest way to get involved with a clinical trial is to join a practice actively engaged in clinical trials. If you join a practice with a record of reliable clinical trial participation, organizations seeking sites for future trials will likely consider that practice—and you.

If you have not joined a practice with a history of clinical trial participation, there are steps you can take to have your clinic enroll as a trial site. First, you have to sit down and perform some honest accounting of the number of patients you treat in a given week, month, and year with a particular disease. If the number of patients you see with a particular disease does not meet a trial's needs, then you should not attempt to become a site for that trial.

If your patient mix and flow match a trial's population needs, then it's time to try to look like a trial center. By this I mean hiring or dedicating a study coordinator to oversee trials, or at least the first trial. With time, that person's salary will be covered by trial revenues. Before the first trial, you have to pay the cost of a study coordinator at risk. That person can, of course, continue with other duties to help defray the cost.

When you first hire a study coordinator, you should tap the wisdom of colleagues already involved in clinical trial work. Ask your peers specifically how they organize their clinical research efforts.

Next, show the study sponsors that you have the patients, you've done the work, and you're ready to build an infrastructure that can support a clinical trial. If you just go to a group running a trial and say, "I want to be an investigator in your trial, but I don't know how many patients I have and I don't have any infrastructure," then you are unlikely to be selected. In short, make your site easy to choose.

NRMD : How do you know if working with a pharmaceutical company as a consultant is right for you?

Dr. Cunningham: Your ability to serve as a consultant depends on the depth of your expertise and the relevance of that expertise to a given company's interests. If you have a PhD in a narrow topic that touches exactly on a company's drug and its mechanism of action, the company will probably want to consult with you. If the company is studying a new drug for diabetic retinopathy and you know no more about that mechanism or that drug than every other retina doctor, then the company will likely go for a big-name retina physician who has a national presence. Consultant opportunities increase over time. The more you build your reputation, the more they will come around.

NRMD : Can a young retina doctor work for a pharmaceutical company in more than just a consulting role?

Dr. Cunningham: If you want to work closely with a pharmaceutical company, you should consider working on retainer, which means you will consult for a certain amount of time per week or month. Or you could work as a part-time employee for a pharmaceutical company, which might involve helping the company with their medical team as little as once a month or as often as twice a week.

THE KOL NETWORK

Sometimes a company needs to collaborate with key opinion leaders, or KOLs, but lacks the structural means to contact doctors on an individual basis. These companies turn to networks such as the Gerson Lehrman Group, which connects KOLs with the companies who need their guidance. Here's how it works:

You sign on with a network to place your name on a list of on-demand KOLs.

Based on your level of experience and expertise, you negotiate with the network your hourly rate; rates vary, but for retina specialists they usually fall in the range of $300 to $600 per hour.

Investors tap the network when they need a KOL's opinion and choose from a menu of available KOLs.

The network arranges correspondence between you and the company.

"If you're a young retina specialist, you might as well reach out—there is little to lose by joining a KOL network, and the opportunities to network with industry members can only yield positive results," Dr. Cunningham said. "However, be aware that you will not be able to charge a high-end rate until your experience increases, and, for now, you'll likely see more cash earning in the clinic than you would as a KOL."

Dr. Cunningham said time spent as a KOL may pay well, but it costs personal time. "Most of this work is after hours," he said, which is time you could spend with family, friends, or just relaxing.

These options, although they do not provide any greater cash flow than retina practice, per se, do provide opportunities for learning and for exposure that a young retina doctor may not have otherwise.

NRMD : What would you tell a young doctor who wants to work with industry on a full-time basis?

Dr. Cunningham: Some young retina specialists may prefer to work in the industry rather than see patients. One should note, however, that doing so may leave money on the table. The starting salaries of a young retina specialist in practice or in the industry are roughly equivalent. However, the lifetime earnings of a practicing physician are likely to be much higher than those of an industry professional.

Although you may be well-known among your peers, you cannot assume that industry knows much about you—or that you exist at all. Those looking to make the jump into industry must make themselves known. I recommend reaching out to a recruiter or a well-connected retina specialist, either of whom can potentially introduce you to the proper industry contacts. When you contact a recruiter or a well-networked doctor, you should have a clear concept of what area of industry you want to work in and how your expertise would apply to that sector of industry. As with most scenarios in retina, preparation is key.

NRMD : What is your final advice to a young doctor considering collaboration with industry?

Dr. Cunningham: Few careers allow for as much autonomy and purpose as full-time retina practice. If you enjoy seeing patients and improving your skills in the OR, then stay put. Young surgeons and clinicians should focus on honing their surgical and clinical skills. Surgeons and clinicians blossom with experience, and unless you reach a point where you think your surgical or clinical skills have plateaued—a point that may never come—you should continue to focus on what you love. Network and test the waters slowly. Those of us who are relatively more established and who have been able to have multifaceted careers are always happy to provide advice and counsel. n

Emmett T. Cunningham Jr, MD, PhD, MPH
• partner, Clarus Ventures, South San Francisco, Calif.; director, uveitis service, California Pacific Medical Center, San Francisco; adjunct clinical professor of ophthalmology, Stanford University School of Medicine, Palo Alto, Calif.; research associate, Francis I. Proctor Foundation, Univeristy of California, San Francisco, Medical School; partner, West Coast Retina, San Francisco
• founder and chairman, Ophthalmology Innovation Summit
• ecunningham@clarusfunds.com

FROM THE BMC ARCHIVE

VENTURE INVESTING IN OPHTHALMOLOGY AND RETINA

An Interview with Emmett T. Cunningham Jr, MD, PhD, MPH New Retina MD Volume 6, Issue 1 Find online at: bit.ly/cunningham216

WOMEN IN INDUSTRY

An Interview with Anne Fung, MD, and Namrata Saroj, OD New Retina MD Volume 7, Issue 1 Find online at: bit.ly/women216