“Is it normal to feel like I am rushing every patient just to keep up with clinic volume?”
We hear this often at Real World Ophthalmology.
It usually comes from a young ophthalmologist early in practice—someone who is well-trained, capable, and doing everything they were taught to do, yet finds themselves questioning whether the day-to-day reality of clinic reflects the kind of physician they intended to become.
The schedule is full. The clinic is moving. Patients are being seen.
But the pace leaves little room for conversation, for nuance, or for the kind of decision-making that drew many of us to ophthalmology in the first place.
And over time, a more difficult question begins to take shape: Is this just part of the process—or is something fundamentally misaligned?
When the Issue Isn’t You
In ophthalmology, the default assumption is that if something feels off, the solution is to improve your own efficiency. Move faster. Be more decisive. Optimize your workflow.
And often, early in practice, there is a genuine learning curve that makes this necessary.
But not every problem is a personal one.
There is a meaningful difference between developing efficiency and working within a system that consistently limits your ability to practice the way you believe you should. High-volume clinics without adequate support. Inefficient workflows that compound throughout the day. Pressure—explicit or implicit—around surgical decision-making or premium lens conversations. Limited access to diagnostics or technology that would otherwise inform care.
These are not minor inconveniences. They shape how you practice.
Why This Matters More Than We Acknowledge
From a clinical and legal perspective, environment is not neutral.
Time pressure affects communication. Fatigue affects judgment. System inefficiencies increase the likelihood of missed details and fragmented care. Over time, these factors influence not only patient experience, but outcomes—and ultimately, risk.
And yet, many ophthalmologists remain in these environments longer than they should. Not because they are unaware of the issues, but because they believe they are expected to make it work.
Before You Decide to Leave
Leaving should be thoughtful—not reactive. But it should also be honest. Start by getting specific:
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What exactly is not working? Is it clinic volume that limits meaningful patient interaction? A lack of staffing or operational support? Misalignment in surgical philosophy or patient care approach? Unclear expectations around compensation or partnership? Or a leadership dynamic that is unlikely to change?
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What is within your control? Are there adjustments—however small—that could meaningfully improve your day-to-day practice?
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What would need to change for you to stay? Define this clearly. If you cannot articulate it, you cannot advocate for it. And most importantly—is that change realistically possible within this environment? Not in theory, but in practice.
Perspective Matters
This is not a decision to make in isolation.
Ophthalmology is a small field, and the dynamics of clinic flow, ASC relationships, and referral patterns are nuanced. Speaking with someone who understands these realities—whether a mentor or a trusted colleague—can provide clarity quickly. Often, the answer is not new information. It is confirmation.
Leaving Is Not Failure
There is an expectation, particularly early in practice, that you should be able to make your first position work. But that assumption overlooks an important reality: not every environment is designed for you to succeed in the way you define success.
If you have taken the time to understand the situation, attempted to improve it, and sought perspective—then choosing to leave is not a failure. It is judgment. The same judgment we apply every day in clinical decision-making.
What You Take With You
You do not leave empty-handed.
You leave with a clearer understanding of how you want to practice. What matters in a clinic environment. What you value in patient interactions. What you will—and will not—compromise on.
In ophthalmology, we are trained to recognize when continued management is no longer the right approach. There is a point at which the better decision is not to continue adjusting within the same system—but to change course.
The same is true in your career. That clarity is not a setback. It is direction. OM
This column is produced in partnership with Real World Ophthalmology, an educational resource created by Dr. Nijm that is helping thousands of young ophthalmologists succeed in early practice. RWO covers clinical innovations, business topics, and areas of professional growth. Visit RealWorldOphthalmology.com to learn more.
