Meet The Founder: Tom S. Chang, MD

what motivated you to pursue medicine, and more specifically, ophthalmology?

Medicine is a calling, and being able to practice as a physician is an honor. It never ceases to humble me to realize that people are trusting us with their biggest fears, secrets and concerns.

Your question reminds me of a patient I saw who had an unusual appearance in his macula that was typical for a rare condition where almost every patient has a family member that can be traced to the Levantine valley in Switzerland. I probed the patient and his grandmother who attended the visit with him (the patient’s mom had passed away years ago). The patient was very clear that both his parents were from the US and that this was not possible. After the visit the grandmother sought me out privately and confided to me that the patient’s mom had previously had only one indiscretion in her life and that was with a man who was from Switzerland, and that the grandmom had long questioned the parentage of the child. This is an example of how powerful and consequential our day to day experience can be. It is also a reason why I can only use the word “humbled” whenever I describe what it is like to be given the responsibility of being a physician.

As for ophthalmology, it was a field that fit me like a glove. In medical school, I loved every field. When I was doing my neurosurgery rotation and was on call every other night, I often would stay at work till 10pm on the nights I was not on call until my Chief Resident would force me to go home. When I found ophthalmology, I realized that it allowed me three very critical things that other fields simply did not have:

• The sheer beauty of retinal examination where colors, contours and tissue texture provide a backdrop of clues to explain why patients have difficulty seeing.
• Elegant surgical procedures that provide rapid recovery of a special sense - vision.
• The ability to conclusively determine the presence or absence of disease in an organ with a detailed clinical examination.

When I realized these three were all present in the field of ophthalmology, I never looked elsewhere again.

What is the most difficult and most rewarding aspect of your profession?

When I was a resident in ophthalmology, I vividly remember an 82 year old female patient of mine who presented with early signs of wet macular degeneration in her better seeing eye. The other eye lost vision a year previously and was legally blind. Recognizing my trepidation about discussing her poor treatment options (back then, there were no viable treatments once leakage occurred in the center of the macula) she cautiously asked me, “What would you do if you were me?”

I remember this interaction like it was yesterday.  I remember thinking for a while, then telling her that “I would read every book I could and see every face of every person I loved before the day came that I would no longer be able to.” She cried, but was very appreciative of my candor. I did not cry, but the interaction left an indelible mark in my psyche. I am pleased to report that today we have effective treatments for patients with wet macular degeneration and I must have told this story to thousands of patients in my career. That is how much that one experience both haunted me as well as pushed me to work on research approaches to help treat this condition.

When and how did you decide to build your own practice?

I was in academic medicine for the first 12 years of my life as a Professor of Ophthalmology. I realized that my calling was in treating patients and that I did not enjoy giving lectures and writing papers as much. It was a tough pivot in my life, as these activities had mostly defined me up until then. I had a very large practice in the University, but until the point I decided to focus on clinical practice, most of my "self-worth” was built around being invited to give lectures at various universities around the world and publishing papers. It was also around that time that I decided to start a family, so the decision was both natural and obvious.

How would you describe your patient care philosophy?

Simple: Excellence in patient care AND excellence in patient experience.

I often read  reviews of other doctors and practices and they consistently say that “...the doctor was excellent, but I had to wait forever.” In medicine, it is very common to have excellence in patient care, but having excellence in patient experience requires an even greater commitment. In starting Acuity Eye Group, I realized I simply HATE to be kept waiting. In light of this and how I was raised, I made it a point to make sure that we do not keep patients waiting unnecessarily.

We run a human organization, so things fail from time to time. That said, we have built-in metrics to measure each office’s timeliness and responsiveness and we strive every day to keep my promise “not to keep people waiting”.

Did you always envision the company being the size it is now?

Size is a relatively inconsequential aspect to Acuity Eye Group. What I always envisioned was a medical group that had thoughtful doctors who enjoyed each other’s company, respected patients as much as I do, and provided the absolute highest level of care. I felt this way when i was a solo practitioner and will expect to feel this way when we are a national organization.

It is really important that the doctors at Acuity like each other as I have worked in many  organizations where physicians do not get along or friction exists. We have worked very hard to keep this a collegial organization, as I believe that hostilities at any level end up disrupting a cohesive culture.

What is your vision for the future? Where do you see The company in 5 years?

I think the most significant change we will face in the next 5 years is going to be in the area of automation and artificial intelligence. Technological advances have occurred recently to allow introduction of both of these approaches to be applied to clinical care, especially in the field of ophthalmology.  In the past year, we've focused a lot of resources in the area of automation and telemedicine and are now a leader in this field. We currently are one of the largest providers of automated telemedicine exams in the world with Acuity 360. In the next few years, we will be making major inroads into the application of AI.

While I believe that physicians will always need to make the final decision in clinical care, there will be a fundamental change that will take place where AI programs will both guide as well as help monitor the clinical decisions that physicians make. It is clear that patients seek out higher level clinical centers in the hopes of finding clinical care where decision making judgement is perhaps higher than elsewhere. This difference in clinical judgement can and will be both determined but also mined to help provide a more uniform and “better” outcome for patient care. 

The best analogy I can provide is in stock analysis. Previously, large companies like Goldman Sachs would have teams of analysts pouring through data to try to exploit an advantage that was not identified elsewhere. This is commonly referred to as the “alpha” or the amount of gain a fund would obtain above and beyond what the general markets would harvest. It was long assumed that this “alpha” was achieved through excellence in stock analysis. Today, these same companies are now replacing analysts with AI software that look for differences that can be exploited. Software allows these decisions to be performed faster (allowing for self-analysis of their prior decisions - also known as heuristic learning), without bias and without “off days.” I firmly believe that with the imaging technologies that we currently have in ophthalmology that these programs can be developed with heuristic learning capabilities that will help guide Acuity physicians to provide even higher levels of clinical outcomes.

What do you consider the biggest contributor to the company’s success?

This is another easy question: It is and has always been the people. The team at Acuity care about our mission, our company and each other.

What do you enjoy most about being part of Acuity?

I enjoy being around others who care about not keeping patients waiting and ensuring they they have a good experience. As odd as that may sound I have worked in many organizations that simply did not care about this. I care about this profoundly, and have surrounded myself with people who share this ethos. Caring about patients is what medicine is all about. If we only care about the excellence in patient care and simply assume that they will tolerate “waiting” and inefficiencies and lack of respect for others, then we will ultimately not succeed. At least that’s the way I see the world.

What are your hobbies and passions outside of medicine?

I love playing and downhill skiing - I have committed to learn how to carve on skis this year. In addition, I have taken up guitar in the last 2 years, steel string acoustic and self-taught. What others at Acuity probably don’t know is that when I am on conference calls at home I am often muting my line and playing guitar while listening to others. It helps me be in the moment and focus on what is right in front of me. So much of my time is spent thinking about where we are going as a group that I really enjoy having this one guilty pleasure. When I have a guitar in my hands I am forced to stay in the moment or bad sounds occur.

Who is (or was) your role model?

J. Donald Gass was my mentor when I was in Miami. I was fortunate enough to be selected to be his clinical fellow in 1993 and it completely changed my life. He was, in one person, the most humble and more intelligent and prescient individual I have ever met. He defined the field of macular diseases and his contributions would match any doctor in the history of mankind. His humility and graciousness is a constant reminder to me. Even though he was a giant in the field of medicine and was extremely busy, he always had time to hold the door open for his elderly patients when they exited his clinic. I remember him telling me (in his southern accent) "Tom, these patients get dressed up and look forward to this visit for days...sometimes weeks! We have to provide them with everything we possibly can." Words I live by to this day.