Dr. Tasman to step down at Wills Eye, Jefferson

Philadelphia-William S. Tasman, MD, is preparing to step down from his positions as ophthalmologist-in-chief at the Wills Eye Institute and chairman of the Department of Ophthalmology at Jefferson Medical College of Thomas Jefferson University here.

The City of Brotherly Love native has held these roles since 1985 and-except for a year away for a fellowship in Boston-has been affiliated with Wills Eye since 1959, when he started his residency there.

Officials at Wills Eye and Thomas Jefferson hope to name a successor this spring, with the chosen candidate beginning his or her new duties by July, according to Thomas J. Nasca, MD, senior vice president of academic affairs at Thomas Jefferson University and dean of Jefferson Medical College.

“We have a significant number of applicants interested in exploring the position,” he said, adding that the search has been aided by the reputations and geographic location of the institutions.

Dr. Tasman is quick to point out that he’s not retiring.

“I have every intention of remaining, and I plan to continue seeing patients and practicing” as well as teaching, conducting research, and staying active in the profession in other ways, he said.

Dr. Tasman is a former president of the American Academy of Ophthalmology, the Retina Society, and the American Ophthalmological Society; a founding member of the Retina Society and the Club Jules Gonin Retina Society; and the former chairman of the American Board of Ophthalmology. He remains active within these and many other organizations.

A highly regarded institution awaits his replacement. Wills Eye ranks third in the ophthalmology category of U.S. News & World Report’s current listing of best hospitals. In addition, the institution was rated fourth overall, its clinical program was ranked third, and its residency program was ranked fourth in the 2006 Ophthalmology Times Best Programs survey of ophthalmology department chairmen and residency program directors. The institution consistently has earned high marks in such surveys.

“I think it’s due to the fact that we have a superb staff. We have several stars on each of the subspecialty services, whereas many institutions are lucky if they have one star in the whole department,” Dr. Tasman said, deflecting any personal credit. “And it’s not just senior people who occupy these positions. We have great young people who are stars, and I think that’s one of the things that bodes well for the future, because they’re already in place.”

In addition to the quality of the faculty members, he said, the relationship between Wills Eye and Jefferson makes the position an attractive one.

The two institutions have been affiliated since 1972, when Wills Eye began serving as Jefferson’s ophthalmology department. The relationship was altered this past July, however, when the increasingly outpatient nature of the practice of ophthalmology led Wills Eye to transfer ownership of its inpatient program as well as its ophthalmology residency program-one of the largest, and the oldest in the country-to Jefferson. (See “Jefferson assumes ownership of Wills Eye inpatient, residency programs,” Ophthalmology Times, Oct. 1, 2006, Page 1.) At the time, Dr. Tasman said it made sense for Jefferson to assume responsibility for the residency program when it assumed control of the inpatient program because “resident reimbursement is based partially on indirect Medicare reimbursement, which relies on filling beds.”

The residency and fellowship programs remain very competitive, he said.

“This year, we had around 500 applications for eight places, and these youngsters are just exceptional,” Dr. Tasman said of the residency program. As one example of fellowship desirability, he noted that the retina program recently received 85 applications for three positions.

After the agreement with Jefferson was announced in July, Wills Eye gained access to the basic research infrastructure at Jefferson and has continued to provide outpatient care.

“I think that now that we have dovetailed more with Jefferson, a lot more things are going to be possible, especially along the research lines,” Dr. Tasman said.

The opportunity to conduct research is one of the attractions of practicing ophthalmology in an academic setting, he said, adding that it is more difficult for a physician in private practice to perform investigations.

Challenges in academia

Yet for all of the opportunities that will greet the person who is the new ophthalmologist-in-chief at Wills Eye and chairman of ophthalmology at Jefferson, academic ophthalmology is facing its share of challenges, Dr. Tasman said.

“There are a tremendous number of vacancies for chairs in ophthalmology,” he said. Dr. Nasca estimated that more than 30 department-head positions in the specialty remain unfilled across the country.

“It’s tough to run a department today, because of all the hoops you have to jump through because of the fiscal restraints and reimbursements,” Dr. Tasman said. “Some people will say, ‘Why do I need this? I’ll just stay in private or academic practice.’ ”

Dr. Nasca agreed. “I think we’re seeing a fair amount of challenge in most disciplines in people stepping up and desiring to be chairs. In a number of disciplines, the projected tenure of service of chairs is less than 4 years,” he said. “There are not a lot of people who are willing to take those kinds of risks with their careers and deal with the hassles that they have to deal with to be a chair. It’s not as attractive as it was in the past, when it was a position of authority and one where there were not as many pressures on the chair to perform in areas outside the specialty.

“The pressures on the chair now are management pressures, fiscal pressures, and institution-wide kinds of responsibilities that go far beyond what the responsibilities of a chair were even 10 years ago,” he continued. “That’s part of it. And I think the other is that the practice of ophthalmology and the conduct of research in ophthalmology are extremely exciting right now, and there are many opportunities. There are needs in most subspecialty areas for clinical ophthalmologists, so there are many other competing opportunities for these bright young people, and mid-career people as well.”

To address some of the fiscal issues facing department leaders and their institutions, Dr. Tasman said, “You have to be involved with the political system and know your representatives both in Congress and the Senate and make your feelings known to them, because that’s the only way you’re going to get the legislation changed.”

Reductions in Medicare reimbursement levels affect individual clinicians and institutions as well, Dr. Tasman said. Congress has tried to offset costs related to expensive drugs by “cutting back on the hospitals and doctors,” he said. “You can only do that for so long. That is one of the things that will discourage people from continuing to be in an academic position.”

The relative number of ophthalmologists is small compared with the size of some other groups, he said, “so it’s tough to have a big impact on a legislator, but most of them-or their aides-will listen to a reasoned presentation.” The bottom line is patient welfare, Drs. Tasman and Nasca said.

Changes over the years

Dr. Tasman-who has an interest in pediatric vitreoretinal disease-said he has seen medicine evolve over the course of his career.

In his area of expertise, he said, “One of the biggest problems we have with children are prematures, who 50 years ago would have been blind. Today most have a visual expectancy of 75 years. That was not possible back then.”

The delivery of health care also has changed, he said. “I was in this before we had Medicare. And then we had Medicare, then the HMOs. They have influenced the delivery of health care. And the technology has been fantastic. When I started, a cataract patient was admitted for a week, sometimes with sand bags. Now it’s an outpatient procedure, and they see immediately.

“On the other hand,” Dr. Tasman continued, “there’s a price to pay when that happens, because you get super-specialization. That is one of the drawbacks I’ve seen. Patients often are shuttled from one specialist to another, and I think that has eroded the patient-doctor relationship to some extent. I’ve had patients come in, and they’ve seen so many physicians that they don’t really know who’s putting the whole picture together.”

On the positive side, Dr. Tasman said, funding for ophthalmology-related research has increased dramatically over the years through agencies and organizations such as the National Eye Institute and Research to Prevent Blindness. “I can remember when the National Eye Institute was established in the 1960s. Before that, we didn’t have funds available for the types of research we do today,” he said. “There was an emphasis on clinical ophthalmology, and there still is. The bottom line is to deliver good patient care. But there are opportunities now to continue the technological explosion and look beyond that at causes of disease and hereditary components to the different eye conditions, things that we had some inkling about but not the knowledge that we have today-and not the knowledge that we’re going to have in the next 10 or 15 years.”

Advice for the future

As Dr. Tasman prepares to hand the reins to a successor, he said he is proud of the high caliber of faculty, fellows, residents, medical students, and programs at Wills Eye and Jefferson.

During his tenure, more than 225 residents and 66 retinal fellows have been trained.

When asked what advice he would offer today’s medical students and ophthalmology residents and fellows as they prepare to enter their careers, he said, “I would tell them that they want to be honest with their patients and do their best to provide honest care, but I also would tell them to pay attention to their families and don’t get so caught up in the profession that they don’t have time, for example, to be home for dinner and go to the soccer or football games. In the final analysis, when it’s all said and done, it’s not going to matter how many cataracts you did. It’s going to matter how your family turned out.” Dr. Tasman has been married for 45 years, and he and his wife have three adult children and five grandchildren.

Wills Eye and Jefferson, in turn, are proud of Dr. Tasman.

“We’re very excited about the opportunity to continue to build on the legacy that Dr. Tasman has created and extended at Wills. It’s a tremendous asset not only to Jefferson and the city but really for the region and for the country,” Dr. Nasca said. “We’re especially excited about continuing that legacy of excellence in education, which stimulates medical students to go into ophthalmology in large numbers and provides the country with outstanding physicians who are ophthalmologists and subspecialists in ophthalmology.”

One visible and lasting way in which Wills Eye will pay tribute to his contributions to the institution will be through the William Tasman Endowed Chair in Ophthalmology. A $2.5 million campaign to fund the honor, one of many earned by the outgoing leader, is well under way, and Dr. Tasman said he hopes that his replacement will be the first person to hold the title.OT