Match made in medicine

“In a completely rational society, the best of us would be teachers and the rest of us would have to settle for something else.” ―Lee Iacocca

By Peter J. McDonnell, MD

My colleague, Berthold Seitz, is professor and chairman of ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany. He is also president of the German Ophthalmological Society DOG and a distinguished clinician-scientist who helped conduct much of the early work on laser corneal trephination as a possible means to minimize postkeratoplasty astigmatism. He is also a natural teacher.

Germany, of course, has an excellent overall reputation in medicine. The country has remained economically strong despite the financial crisis that has engulfed many of its fellow European countries.

Recently, I had the opportunity to speak with Dr. Seitz about ophthalmic education in his country. What he told me came as quite a surprise, showing that there are major differences between our countries that had escaped me.

“You have an enviable situation when it comes to applicants to your residency programs that department [chairpersons] in Germany could only dream about,” my friend said.

Finding a match

Berthold had reviewed the statistics from our residency-matching program in the United States that shows a much larger number of qualified applicants than available positions. This is one situation where statistics don’t lie, with most ophthalmology programs in this country filling with students having excellent academic records and glowing letters of recommendation and turning away many very strong students who would obviously make solid contributions to our field.

In the most recent match, about 1,000 of the roughly 29,000 residency positions in U.S. teaching hospitals went unfilled. In a supplemental match, most of the unmatched students found a position. Of the specialties that did not fill, child neurology led the way with 17, followed by preliminary general surgery (10), psychiatry (7), neurology and internal medicine (each with 6), and family medicine (5).

One theme that sticks out in the statistics about unfilled training slots in the United States is that almost all of them are nonsurgical fields (with the ironic exception of “preliminary general surgery.”

I think there may be a lesson there.

In Germany, surprisingly to an American, ophthalmology is one of the fields that struggles to attract strong applicants.

According to Dr. Seitz, this is probably the consequence of German training programs not providing surgical instruction to all residents. Rather, after a standard residency, certain residents are kept on in order to learn ophthalmic surgery.

But Herr Professor has been working on strategies to help ensure that brilliant young minds in his country will pursue careers in ophthalmology. He seeks individuals who are highly intelligent, but stresses that he values not only high IQ but high EQ (emotional intelligence) as well.

He is also after flexible team players with a strong work ethic.

“Geniuses are often difficult to integrate [into a team],” said Dr. Seitz, so he will not offer a position in his department to someone he suspects falls in this category.

He reaches out to young students (undergraduates, young medical students) and exposes them to courses about the eye and ophthalmology. The top medical students are offered a special wet lab course in ophthalmology, taught by the department’s best instructors, to help them understand the exciting and rewarding aspects of our field, including an introduction to operating on the eye.

He provides opportunities for research electives where students can experience the thrill of presenting their work at regional and national ophthalmology meetings. As president of the DOG, he has focused on making sure research grants are available to young ophthalmologist clinician-scientists.

And, in a bow to the Generation Y phenomenon, Dr. Seitz stresses: “Young doctors tick differently than you did 20 years ago.”

By this he means I am old and failed to do a good job with the work-life balance thing (both of which I freely admit).

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