Retina Today - RETINA IN THE ASC: Challenges of Being a Well-rounded Retina Specialist (October 2010)

摘要

The integration of efficiency concepts in our practice has beneficial implications beyond patient care. J. Fernando Arevalo, MD, FACS, is an internationally renowned retina surgeon who has incorporated the ambulatory surgery center (ASC) as part of his practice to improve his both his professional and personal worlds. In this column, he elegantly details how ASC efficiencies can be leveraged to provide better patient care, be more productive, and improve the surgeona??s quality of life. To boot, when managed properly, the ASC can also be a profitable investment. It is indeed rare to find such a win-win-win endeavor. -Pravin U. Dugel, MD Like many retina surgeons, I maintain a hectic schedule. I made the decision many years ago that in addition to practicing retina and performing surgeries, I also wanted to devote a portion of my time to research. As many like myself can tell you, this is a daunting but not impossible task. The key components that I have found to be helpful in balancing my clinical practice with research and spending time with my family include prioritizing, working efficiently, and putting family first. PRACTICE AND RESEARCH PROFILEThe Cl?-nica Oftalmol?3gica Centro Caracas contains a 250-square-meter ambulatory surgery center (ASC) facility with one OR, one pre-post surgical room, five examination suites, one laser room, and two ancillary tests rooms. The OR is equipped for general anesthesia to be performed in children or uncooperative adults. The staff is comprised of an administrator, two secretaries, three nurses, an anesthesiologist, two retina fellows, and cleaning personnel. We perform vitreoretinal surgery twice a week (Tuesdays and Thursdays), dedicating the ASC to anterior segment surgery for the remainder of the week. Every vitreoretinal surgical day we include four to five cases, for a total of eight to 10 cases per week or approximately 30 to 40 cases per month. In 1 year, we perform approximately 300 to 400 vitreoretinal procedures. This is taking into account the weeks that I am away and that I make up for these off times upon my return. When I am in town for 2 weeks in a row, everything levels up to normal. I am also a member of the Pan-American Collaborative Retina Study Group (PACORES). PACORES is currently working on 23 different protocols, both medical retina topics including age-related macular degeneration and diabetic macular edema, and vitreoretinal surgery including the use of vital dyes in macular hole and epiretinal membrane surgery. Several of theses projects are now in the manuscript phase, and I participate in that writing committee. I collaborate with many colleagues around the globe on different projects and am currently working on two new books—one in Spanish titled Diabetic Retinopathy, sponsored by the Pan-American Association of Ophthalmology and one in English titled Retinal and Choroidal Manifestations of Selected Systemic Diseases, which will be published by Springer. My lecturing commitments in 2010 alone have taken me to 16 international locations in the United States, Brazil, Peru, Germany, Italy, Costa Rica, Canada, Ecuador, Japan, and Iran. It is rare that I attend a medical conference without giving at least one presentation. PRIORITIZE YOUR RESPONSIBILITIESAlthough it is difficult to prioritize at times, when a surgeon has a busy schedule, it is critical. I try to limit my travel to no more than twice a month (and when possible, once a month). When I am in Caracas, my days are filled to capacity seeing patients and fulfilling teaching and research commitments with my retina fellows. I see many patients who have few financial resources at the Arevalo-Coutinho Foundation for Research in Ophthalmology (which was founded in 2001 to honor my father, a pediatric ophthalmologist). Monday through Thursday I begin my day at 7:30 am with fellowsa?? reviews of retina topics and finish at 7:30 pm. Frid