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    Hail to Wall Street!

    Whether you watch the news on TV, read a newspaper, or get your fill of current events from a website (such as the authoritative TheOnion.com), there is no way you could not know that the major stock indices in the United States have recently reached an all-time high. This, of course, is a wonderful development.

    I don’t say that because I was smart enough to buy a bunch of shares when the market dipped dramatically a while back (because I wasn’t). Nor do I rejoice at high stock prices because they necessarily mean that unemployment is low and the average American is enjoying greater prosperity (neither being the case).

    No, the reason to celebrate the rising stock market is its ability to predict greater demand for academic ophthalmologists. According to a study by Professors Adelman and Nwanze of Yale University, the need for academic ophthalmologists in the United States is correlated with the stock market (specifically, the Standard & Poor’s 500 index).1

    They examined the number of advertisements for open academic job positions that appeared in three popular peer-reviewed ophthalmology journals over a 26-year period and found that the openings waxed and waned as our economy expanded and sputtered. The two economic variables that foretold changes in the number of help-wanted ads from universities were the level of the stock market and the level of national research expenditures.

    Wall Street versus Main Street

    On the other hand, private-practice ophthalmology positions correlated with “the national economic well-being, as measured by gross domestic product.” Stock price was not a predictor of openings for my brother and sister ophthalmologists in the private sector. So when people talk about a difference between Wall Street and Main Street (i.e., stock prices versus overall economic growth), it turns out that they are talking about the difference between academic and private-practice ophthalmology.

    Professors Adelman and Nwanze draw the logical inference that rising stock markets allow the hiring of more academicians because philanthropically minded Americans, feeling rich as their stock portfolios grow, give more generously to support research in our universities. At the same time, university endowments expand, prompting our institutions of higher learning to build new research buildings and recruit more clinician-scientists and teachers.

    Impending changes

    The impending changes in our health-care system and the emergence of accountable care organizations, predicted in some quarters, might change things. More and more, young physicians are reportedly opting to join large groups (e.g., Kaiser), hospitals, or universities and turn down opportunities to start new practices or join small ophthalmology groups.

    Young physicians, some say, prefer lifestyles that involve predictable working hours, limited emergency call, and not worrying about payroll and human resource issues. This may mean that more and more of us will practice in a corporate world, for better or worse.

    The key difference between private-practice and academic ophthalmologists is what happens when their children become teenagers and we ask ourselves where we went wrong.

    “It must have been all the time I spent running and worrying about my practice,” thinks the private practitioner, whereas his or her academic counterpart thinks, “It must have been all the time I spent in the lab, writing papers, and traveling to meetings.”


    1. Adelman RA, Nwanze CC. The impact of the economy and recessions on the marketplace demand for ophthalmologists (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc. 2011;109:49-65.



    Peter J. McDonnell, MD
    He is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of ...

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