1. After spending a year working as an engineer at Procter & Gamble, why did you decide to attend medical school?

My brief employment as an engineer was a detour from the medical track, as I actually entered college as a premedical student. I was living at my parents' home in Toledo, Ohio, working a full-time job from 4 pm to midnight in an engineering laboratory at Dana Corporation, commuting during the day to the University of Toledo, and working hard to maintain a 4.0 grade point average so as to maximize my odds of acceptance to medical school. While studying at home 1 Sunday late in my sophomore year, I was feeling pretty unhappy and, out of the blue, voiced the thought, “I'm not going to apply to medical school!” With that simple utterance, relief washed over me, and the self-imposed pressure that I had been experiencing receded. However, the next question became “What am I going to do now?” I was majoring in chemistry but didn't think that I wanted to work or obtain a graduate degree as a chemist. I had read a great deal about corporate America and was impressed by how many Fortune 500 CEOs started their careers as engineers. So I thought, chemistry... chemical engineering? It sounded interesting. I spoke with the chair of the chemical engineering department about changing my major, and he informed me that because I hadn't taken any introductory engineering classes, it would take me at least 1 extra year to earn a BSChE degree. However, he had previously been a professor at Carnegie-Mellon University and was aware that its chemical engineering department had a special program in which they accepted non-engineering college graduates to their graduate engineering program and, after a grueling summer course focused on basic engineering principles, threw them in with the regular incoming graduate students in September. So I applied and was fortunate to be accepted into that program.

Then, late in my first year of graduate school, I visited a college friend who was attending medical school. As he spoke to me about his classes and showed me around his campus, my interest in medical school and medicine was rekindled. I went back to Pittsburgh and wondered, “Will I look back with regret 1 day if I don't at least apply to medical school?” I decided to go for it, and, while still working toward my MSChE, I volunteered at the University of Pittsburgh Medical Center emergency room, reviewed all the basic sciences, took the MCAT, and applied. In the meantime, I finished my master's degree and, realizing that acceptance to medical school was not guaranteed, decided to start my career as an engineer. I was fortunate to be offered a job with Procter & Gamble, which led to my 1 year of real world corporate experience. During that time, I was accepted to medical school and elected to attend. I often wonder what would have happened if I had stayed in the corporate world. I kid my wife that I would have become CEO at P&G!

2. What is your most memorable experience in surgery?

There are, of course, several memorable experiences. The first was when I operated solo on my first 270˚ giant retinal tear a few days after finishing my fellowship. It was in the days before heavy liquids, and I was so anxious that I didn't sleep a wink the night before. Fortunately, the surgery went well, the retina was nicely attached at the end of the case, and the patient recovered good vision. It was then that I knew with certainty that I could fix any retinal detachment thrown at me. The second was when I was repairing a traumatic total detachment with a posteriorly dislocated crystalline lens in a 12-year-old girl. I was using a new vitrectomy unit and fragmatome with the company representative in the room. There was miscommunication, and the aspiration was left quite high after the vitrectomy. In an instant, the fragmatome ate about 40% of the retina. The remaining retina was anatomically attached after surgery, but the vision was impaired by my mistake. You don't forget those cases.

3. What inspired you to earn your MBA, and how have you found it to be most applicable to your profession?

I entered practice in St. Louis in the early 1990s, and, in an environment eerily similar to today, the rage was the coming transformation of our health care system. HMOs and capitation were widespread. The intelligentsia told us that “primary care” was ascendant, and that it was quite likely that many “specialists” were going to have to retrain in primary care or be left without patients. This was a silly premise, but there was fear in the air. Physician Practice Management Corporations (PPMCs) were acquiring ophthalmic and even retina practices with the promise of bringing professional management and economies of scale to “inefficient and poorly managed medicine.” All of those PPMCs eventually failed, but it was during that time I decided that if the business types were going to restructure medicine, I wanted to compete with them on their own turf by learning how they think via acquisition of an MBA. This aspiration was also a holdover from my time in engineering when I thought that, if I didn't get into medical school, I'd work a few years and then go to business school before starting my ascent to CEO. It turned out that my time in St. Louis wasn't conducive to the demands of pursuing the MBA, but after I moved to Minnesota in 1995 and had settled into my current practice after a few years, I decided it was time to finally pursue that knowledge.

There is nothing magical about an MBA, and obtaining the degree certainly doesn't transform one into a management guru. However, the education and experience can promote new perspectives on business problems and promote unique solutions that might not otherwise be considered. If you are in a well-managed practice, an MBA may not add much advantage. The credential can, however, be valuable if your practice has major challenges or if you work in a managed care environment or an academic institution with aspirations to advance in administration.

4. What advice would you give to colleagues trying to balance multiple professional activities, such as teaching, publishing, and holding a board position with an ophthalmic society?

It's all about time management, knowing when to say no, and establishing balance in your life. There is a great tendency for our most accomplished and well-known colleagues to feel that they can never decline an opportunity to take on another professional obligation. This mindset is beneficial, as it can provide professional satisfaction, advance our profession, and allow each of us to contribute maximally; however, on the other hand, it is important to realize that life is about more than work and that finding balance is the key to a good life. Try to stay supremely organized to maximize your professional productivity, but it is OK to say no when you are already over-scheduled. Don't neglect yourself or your family and friends. Exercise, read for pleasure, travel to places that don't involve professional meetings, spend time with those you like and love, and sometimes just sit for a while, listen to good music, and do nothing!

5. What are you interests outside of ophthalmology?

I feel immensely better both physically and mentally when I exercise regularly, so I've adjusted my work schedule in recent years to exercise with a trainer in the late afternoon 3 days each week. I used to do it at 5 or 6 am before going to work for 12 hours, but now I'm smarter! I use a trainer not because I need the instruction but because making an appointment and paying someone a fee greatly increases the odds that I'm going to “just do it” compared with exercising solo. The Twin Cities has a great network of biking trails, so in good weather I bike regularly for low-impact aerobic exercise. I try to spend as much time as possible (and yet never enough!) relaxing at our vacation home in Aspen, Colorado, skiing in the winter and biking the surrounding valleys in the other 3 seasons. Other travel, reading for pleasure, keeping up on current events and politics, watching movies, gathering with friends and family, and collecting a little wine takes up the rest of my time. Oh, and after living in the “Land of Ten Thousand Lakes” for the past 17 years, my wife and I finally bought a small weekend house and a boat on nearby Lake Minnetonka, so beginning this year, I'll be inviting family and friends from near and far to spend time hanging out on the lake in the beautiful Minnesota summer!