Planning for Success

Nikki Hafezi: There has been a paradigm shift in the mentality of young ophthalmologists in recent years. When Farhad was a young resident, he aspired to climb the traditional academic ladder. He obtained his MD/PhD, garnered fellowships, became a really good clinician and, with time, he was appointed chairman of a university clinic. Any ophthalmologist of his age group would agree that Farhad has achieved what many hope to in their professional careers.

Nowadays, his students and residents have different aspirations. There’s more focus on work-life balance and on quality of life. While dreams of climbing the ladder are still present, the “new” generation have other criteria in their career development plans: innovation, economics and entrepreneurship. We know that income influences almost everyone’s life, but it’s not necessarily the most important factor anymore; people want a blend of quality of life, entrepreneurship, creativity, research, and clinics. They want it all, basically. Providing that will form the foundation of the ELZA Institute, which is on course to open in April.

The planning process

The planning process

NH: We wanted to treat the future institute not as a private practice relying on a specific doctor, but as a business venture. The first consideration when building ELZA was its location in Zürich. Instead of having a private practice in the middle of the city center, we chose to go where patient demand would be the greatest. The northwest region of Zürich has a relatively low ratio of ophthalmologists to patients, and considering the building and expansion plans of the region, the population and industry are booming, that is where we decided to set up our first site.

Farhad Hafezi: Our second consideration was that we needed to focus on our social media and Internet presence. We know our patients are really plugged in. They read, research, talk to each other – and all of that communication is on the Internet. So we put a lot of effort and investment into our online presence to attract patients and build our referral network.

NH: We also needed to reserve time for good and valuable research. Why? We have a term, 4P, which stands for “podium power and peer-reviewed publications.” We believe that 4P is just as important for sales as sponsorship or direct marketing efforts, especially in the medical field. Farhad, for instance, publishes good data; people read about him; he’s onstage at congresses speaking about his research and clinical experience. So he’s an opinion maker, and at the same time, he’s building research collaborations, increasing his referral network, and becoming more appealing to industry, which could be fruitful in terms of funding and collaborations. 4P relates to ELZA in that it will support research collaborations with other opinion makers in the field, indirectly support a referral network, and provide opportunities with industry, like directed research projects.

The most important element of the business plan is human resources. Identifying, recruiting and retaining the “right” employees are the most challenging tasks for any company. So what is ELZA’s unique selling point to potential employees or collaborators? How can we attract the best and the brightest people? With much thought, we decided we want to offer the work-life balance that younger generations say they want – flexibility, competitive income, academic opportunities, creativity and a career future. This increases our chances of recruiting and retaining ambitious young ophthalmologists. And because these ophthalmologists want to balance the benefits of a private setting with the advantages of academia, we will provide lab space and research opportunities. In a nutshell, ELZA will offer them a clear career future so that they can better envision staying with us on a long-term basis.

Attracting patients to ELZA – ultimately, the referrer needs to keep their patients

FH: It’s absolutely essential for private practitioners to have a referral network. The idea of “if you build it, they will come” is too risky in Zürich. While we hope that the location of the building will draw patients, we can’t rely on it happening. So, we asked: why would a colleague refer a patient to us? What is our unique selling point?

One thing we will offer is the assurance that referrers will keep their patients. For example, a general ophthalmologist might have a long-term patient who develops keratoconus – but it may be intimidating to refer the patient to a subspecialist in case the patient does not return. This fear is one of the obstacles specialists need to address to build their patient referral network. Another important aspect is that specialists should provide good, prompt feedback. A referral network goes beyond just medical colleagues; opticians and optometrists often also spot ophthalmic disease, refer their patients to a specialist, and rarely get structured feedback. Therefore, I think the referred specialist should treat anyone who refers a patient with enough respect to provide feedback, regardless of whether the referring individual is an optometrist or a fellow ophthalmologist.

Minimizing the risks involved in building a new institute

NH: One of the most common pitfalls when building a company is to involve emotion when making decisions. From the start, we had to eliminate the emotion and ego aspects. We opted not to play the “famous professor” card; we didn’t want to assume we’d immediately have patients if we just installed ourselves in the city center. We knew that the competition was much higher in the city than in the periphery due to the supply of specialists, not to mention the much higher running costs. We acted as if Farhad were a young ophthalmologist just leaving academia, and simply chose a location where the competition for attracting patients was much lower.

The possible obstacles in our business plan were: how can we obtain patients fastest? How can we reduce the obstacles for referring medical professionals to send their patients outside the city center? Where can we reduce our costs the most? If you had asked Farhad 10 years ago, he would probably not have considered setting up a private institute outside the city center, but now we know that we need to think outside the box to maximize the potential of the institute.

Funding the enterprise

FH: ELZA is 100 percent self-financed. At this time, no investors or shareholders are involved, for all of the good and bad that it entails.

NH: To pick low-hanging fruit, we’re making ELZA as complete as possible. So we’re starting with fully equipped anterior and posterior segment practices. We’ve hired a seasoned medical retina specialist who helped develop the current benchmark OCT technology. While Farhad’s subspecialty is irregular astigmatism, ELZA will be more than happy to operate on patients with simple refractive errors. Farhad is a trained fellow in medical and aesthetic lid surgery, so ELZA will also offer these procedures. Ultimately, our institute will aim to be as comprehensive as possible, even offering pediatric ophthalmology services, to improve its chances of success.

Regarding equipment and infrastructure, it’s important to us that we’re equipped with a state-of-the-art excimer (Schwind AMARIS) which will be fully available for use from the opening of the clinic in April. In terms of cataract surgery, discussions are underway to decide on the best option for both the patients and the institute.

The lasers aren’t the only expensive items, though – ELZA has purchased the full spectrum of anterior and posterior segment OCT technology, Scheimpflug and Placido-based corneal topographers, and instruments for fundus photography and visual field examination. Good practice management software isn’t cheap, either, but it’s worth it to create a network that will allow future growth. The renovation and construction costs for ELZA’s brand new building were high, but we believe our decisions will make ELZA an institute that’s built to last.

Juggling projects and finding time to relax

NH: On a more personal note, the daily grind can be exhausting. Farhad and I are also active parents of two young daughters, so we try to keep a balance between work and family. Anyone who knows us probably knows our daughters because they have frequented many meetings in the past. Some people think we’re crazy to work together and involve the kids, but honestly, we wouldn’t have it any other way.