RetinaLink is honored to feature George A. Williams, MD, partner with Associated Retinal Consultants and Chairman of the Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan. He is the American Academy of Ophthalmology’s Secretary for Federal Affairs and the Academy’s delegate to the RUC. He also serves as the Chair of the Ophthalmic Mutual Insurance Company.
Dr. Williams candidly discusses his training at the Medical College of Wisconsin, shares his advice for second year fellows, provides a healthcare “snapshot” with the upcoming November election and the one thing he needs in his surgical armamentarium during our interview. Many thanks to you, Dr. Williams, for your insightful remarks.
RetinaLink (RL): Dr. Williams, Please outline your training and include any of your mentors.
George A Williams, MD (GAW): I attended Medical School at Northwestern University and completed both my Residency and Vitreoretinal Fellowship at the Medical College of Wisconsin in Milwaukee. Milwaukee was and still is one of the premier fellowships and an “epicenter” for retina training due to their faculty, surgical innovation, progressive techniques and ongoing work on retinal diseases.
When I applied to residency, there was no match. It was my great privilege and good luck to train at Milwaukee with Tom Aaberg, Sr., MD, Trex Topping, MD, Gary Abrams, MD, Travis Meredith, MD, and Fred Reeser, MD. I knew early on as a resident that retina was the future of Ophthalmology and quite frankly, I wanted to be part of that future.
After residency, there was no match for retina fellowships, but I somehow convinced the faculty to let me stay on for my fellowship. I received a National Research Service Award and had the amazing opportunity to work with two outstanding Basic Science professors, Henry F. Edelhauser, PhD and Diane Van Horn, PhD. During the first year of my fellowship, I worked with them in the lab conducting translational research on a variety of clinical problems and the pathogenesis of retinal diseases. Bill Mieler, MD and David Parke, MD were my co-fellows.
As I was completing my clinical year of fellowship, Tom Aaberg asked me to come into his office. Dr. Aaberg told me “Trex Topping was moving back home to Boston and asked if I would be interested in joining the faculty.” I immediately said, “yes”. I felt it was the opportunity of a lifetime to be able to work with my mentors. I enjoyed the Medical College of Wisconsin immensely and stayed until Mark Blumenkranz invited me to visit Detroit in 1988. He presented me with a new opportunity to direct the retina fellowship and I decided to join Associated Retinal Consultants in Royal Oak, Michigan.
RL: How many Fellows have you trained over the years?
GAW: I had to check on this… The number is 58, clinical fellows, and another 12 international fellows.
RL: What’s your advice to Fellows starting their first job in July?
GAW: I have two career advice comments that I share with my Fellows as they embark on interviewing for their employment after Fellowship.
One, there are many good jobs and business models. However, no one business model is best. The crucial piece of the puzzle is “where do you fit?” It’s all about culture. The most important question to ask yourself is “are you going to be compatible in this new culture?” A few of my fellows over the years have signed on to cultures that they were incompatible with or thought they could change the existing culture. The culture will not change but, you may get a life lesson in the process.
Secondly, your first job most likely won’t be your last job. Finishing your training is one opportunity in your professional journey, but recognize that there will be others. In other words, don’t get locked into a position.
RL: What’s your advice to Fellows who are starting their Fellowship in July?
GAW: Embrace the opportunity. Realize that there is rarely a single “right” way to do anything. Critically examine why people do things the way they do and challenge them for explanations. As you see different approaches, try to determine what works best in your hands. Do not be afraid to make suggestions. I have learned more from my fellows than they ever learned from me.
Over the two years, try to identify your niche. Ask yourself, “What do I want to do with my career? Where can I make a difference?” It may be clinical care, teaching, research, advocacy or a combination of all. It doesn’t matter what it is as long as you are passionate about it.
RL: What has surprised you most during your career? Healthcare changes, patients, evolution of medical devices or retina pharmaceuticals?
GAW: That is a tough one. I still get surprised almost everyday. When I started in Milwaukee, macular holes were inoperable, no useful treatment was available for wet Age Related Macular Degeneration or Retinopathy of Prematurity. We could repair Complex Retinal Detachments but, all too often with not much functional vision. Endolaser was a novel concept and heavy liquids and silicone oil were in their infancy. We have come a long way.
The anti-VEGF revolution has been a game changer for many diseases. If you would have told me barely 10 years ago that patients would be giving me hugs almost everyday for sticking a needle in their eye, I would have wondered what you were smoking.
The improved instrumentation of today makes the first generation of vitrectomy instrumentation seem primitive. As I look forward to the future, it will be truly amazing with stem cells, gene therapy, improved retinal prostheses, better drug delivery systems and neuroprotection. Potential major breakthroughs that we could only dream of when I finished my fellowship are on the horizon and at some point soon, they will be a reality. I envy what today’s fellows will be able to accomplish over their careers. “I have had a great ride so far, but I wish I could start over.”
RL: Where do you see Healthcare going after the November election? Will there be a repeal of Obamacare whether the Democrats or the Republicans win the upcoming election?
GAW: Obamacare will never be repealed. There will be some changes and tweaks, but The Supreme Court has spoken and it is now the Law of the Land. Let’s take a moment and look at healthcare historically… Many in health care fought tooth and nail to prevent Medicare and now we can’t imagine practicing without it. Eventually, Obamacare will become the norm. We have a moral obligation as a country to provide healthcare to everyone.
Very few government programs remain unchanged, and certainly the ACA or Obamacare is no exception. Regardless of who becomes President, at most there will be incremental changes. Actually, I am more concerned about the long-term effects of MACRA on physician payment and practice models. Remember that unlike the ACA, MACRA was passed by large, bipartisan majorities in response to the call for an SGR fix. Well, it now looks like a case of careful what you ask for. It is becoming increasingly clear that fee-for-service payment in a private practice setting is an endangered species. The recently released proposals for MIPS and alternative payments models (APM) are a deliberate attempt to drive physicians, and particularly specialists, into institutional based practice.
Retina specialists starting their career now will have a different practice experience than I and my contemporary colleagues. Quite frankly, a lot different… However, if they are practicing medicine for the right reasons, focused on the ability to impact patient’s lives while applying fascinating science, then, they will not be disappointed.
RL: What is the one item in your surgical armamentarium that you always need for any case?
GAW: It’s not a surgical platform, instrument or retina pharmaceutical. It’s clinical judgement, yet that is the hardest thing for a surgeon to acquire. There’s an old surgical adage that “Good clinical judgment comes from experience and experience comes from bad clinical judgment.” You may do 1,000 surgical cases during your fellowship training, but until you are the one making the final call on what to do or not do, you are not developing the clinical judgment you need. It requires experience… plain and simple. There’s no substitution for experience. I still remember after finishing fellowship and when I looked to my right or left, Drs. Aaberg, Abrams and Topping were not there and I had to make the decisions. It was both terrifying and exhilarating.
RL: What advice would you offer to industry? How can they serve the Retina community better?
GAW: Industry should realize the increasing pressure doctors are under each day. Docs must deal with practice management and delivery of care issues on a daily basis. Better, faster and more efficient products do provide improved patient outcomes, but this better, faster model results in less reimbursement for doctors. We need industry partners to provide us with improved technology. However, industry must recognize every new product launched can’t have a premium price associated with it. The current model is simply not sustainable. Understanding the physician perspective is key in this relationship.
RL: I know you enjoy spending time with your family. Where are your favorite places to travel when you have time for a vacation?
GAW: My wife and I enjoy spending time with our adult daughters who live in New York City. They are busy with their lives so our time together is very special. When they were children, they loved to go to Disney World and still do today so we make a point of spending time together at Disney World around the holidays.
George Williams, MD can be reached at George.Williams@beaumont.edu