DR. NELSON PRESCHEL
Focus Through the Generations (FTTG) offers insight from four different generations of the nation's top ophthalmologists. Hear from the experts themselves on their varying life experiences in the industry.
Nelson Preschel, MD is exceptionally skilled ophthalmic surgeon with fellowship training in cornea and glaucoma, Dr. Preschel’s practice is focused on refractive and cataract surgery, as well as the medical and surgical treatment of corneal, external eye diseases and glaucoma.
hear from dr. Nelson Preschel
Our host, Polly Neely had the pleasure of sitting down with Dr. Nelson Preschel for an exclusive discussion regarding his life and industry experiences. Get to know Dr. Preschel a little deeper in this episode of “Focus Through the Generations”.
Polly Neely: Hi, this is Polly Neely, and I'm with Dr. Nelson Preschel this evening and we are doing an interview for our Focus Through the Generations series. We are interviewing four generations of actively practicing ophthalmologists to get their viewpoints, their life stories, and what they think the future holds. Dr. Preschel, thank you for joining us.
Dr. Nelson Preschel: Thank you so much, I'm happy and honored to have this chance for you allowing me to be here today and tell you about what I think.
Polly Neely: Well, we're ready to hear it. I wanna ask you just to introduce yourself to us.
Dr. Nelson Preschel: My name is Dr. Nelson Preschel, I'm an ophthalmologist, I practice in Southeast Florida, specifically in Broward County, that's North of Miami-Dade County. I've been here for the last 17-18 years now. I was born and raised in Venezuela where I went to medical school, and then after I finished school I came to New York, and I did my internship, and I did a fellowship in ophthalmic pathology. I did my residency at New York Eye and Ear, and then I did a combined fellowship in cornea refractive and also in glaucoma with Minnesota Eye Consultants up in Minneapolis. After I finished my training, my formal training, I returned to Venezuela where I spent five years in private practice and academics. And as many of you know, the country's not doing well, that's quite an understatement. But when we realized that, my wife and I, who also trained in the US, she's a dentist we decided to return to the US and we've been here in Florida for the last 18 years now. I practice general ophthalmology with emphasis in cornea refractive, and a lot of glaucoma. I do a lot of glaucoma work these days. And that's pretty much who I am.
Polly Neely: Well I had the pleasure of meeting you many years ago I think I don't even remember how long ago now. Long enough for me to call you mom. Yes he calls me mom. Not because I'm old enough to be his mom we need to set that straight. It's because I'm nicer than that!
Dr. Nelson Preschel: That's right, I'm the second one in those four generations.
Polly Neely: Yeah, I just made him aware that he's in the second category and he wasn't happy to know he was in the second category.
I have a question for you, which is really an interesting question I wanna start out with. If you could have lunch with anyone alive or dead, who would it be?
Dr. Nelson Preschel: Oh, Picasso.
Polly Neely: Picasso?
Dr. Nelson Preschel: Oh, yeah.
Polly Neely: Why?
Dr. Nelson Preschel: Or Sandy (Alexander) Calder. Why? Because what I really wanna be in life is an artist. And that's what I really wanted to be, and I think I'm training to be an artist. I think the hardest part of trying to be an artist is developing a language. Art is for me letting go things, and it's very hard to make that connection between what you wanna let go and what you build. So it's not something that you can learn in art schools, because they show you technique basically, but to learn a language that's very difficult and he's one of my idols in art. I have many other people that I would like to have lunch with. I only have one, but most of them would be artists, to be honest, but he probably would be one of my favorites. I actually have a photo of him in front of my computer at work, in which he's laying on a beach on the sand, with a cigarette on his hand, and you can see the guy's just savoring life. And that's what I like from him the most, is the intensity of his life and how he squeezed life out of life. And yeah, he would probably be the number one guy.
Polly Neely: I like that. I've seen Picasso in your office actually.
Dr. Nelson Preschel: Yeah.
Polly Neely: I hate to say I even know who it was, but yes thank you for clearing that up.
Dr. Nelson Preschel: Yeah, that's him.
Polly Neely: Yeah, I didn't know that. Okay, tell me about your most memorable patient.
Dr. Nelson Preschel: It's like if you asked me what's my favorite food. I don't have a single most memorable patient. I have many memorable patients you know. Polly, how about a memorable moment? One thing that I do invariably, every time I have a new patient is I ask them, well of course I ask them how did they find me but I always ask them, what do they do? And most of them are retired, because as an ophthalmologist I see, you know, most of them are elderly people, and if they're retired I ask them what did you do, during your working years? And I've had so many incredible stories, of people who you wouldn't even think that they have all that time in their lives. Then I started. I'm doing it, I'm compiling their photos, and I write a story about what they told me, and you would be impressed with these things I've heard from them. You can write a book. I started putting all that on an Instagram page. But it's a lot of time. One day I'll sit down and write them all down. But I can't tell you about a single one because I have so many impressive people that I've met through ophthalmology or through medical practice in general, that I cannot tell you this is the one memorable one. I have so many, so many, so many. I have movie producers, I have even war heroes, people who landed in the heel of Italy and walked away after WWII as rangers and survived, I have so many things. I have people. I have a patient whose role was he worked in the Park Lane Hotel in New York, and his role was to take care of the celebrities that came to the hotel and make them pass without being noticed. It's amazing the things that you hear from these people and you would never know, so I don't have a single one. I have so many, at least based on their life experience and the impact that has in me. If you ask me about my most memorable surgical case, I also have several that I can't tell you which one. I just have so many, that's how they become memorable to me.
Polly Neely: I like that. That's the best answer I've had yet. I like that. What would you say to the millennials that are coming out of school now, that it's a horrible time, number one, for them to come out of school right now, because we all know reimbursements are low, and COVID and whatever, but what would you say to them if they wanted to hang out their own shingle, what's the best piece of advice you could give to them?
Dr. Nelson Preschel: Well, you need a coach. You need someone to coach you. You're probably not gonna find a coach in the same market where you are working because it's cut throat and nobody wants to coach you. So you have to find someone that you admire, that you like, perhaps an attending in your residency years you met someone who's in private practice, who you admired, who's doing well, maybe after you finish your fellowship if you do it in a private environment, but you have to pick a coach that can help well, and that person has to be willing to help you, and to answer questions, and to guide you through the first years. It has to be someone that's always available that you can call, you are one of my coaches Polly, that would be the first thing, you need a coach. Like in any business, it's not only in ophthalmology. Any business that you want to have a coach. Someone knows about it, so who has years ahead of you in the same area and knows that, how do you say the word ? The way you have to do things to be successful. Then you have to read the right books and the right articles. You know up until I started my own practice, I was reading ophthalmology. But if you're gonna start private practice, you've got to stop reading ophthalmology, you're gonna start reading about the business of ophthalmology. And then you have to be careful with what to read. I'm not promoting anyone's business here, but I personally know John Pinto, I have known him for many years. John helped me when I transitioned from Venezuela to the private practice group where I work at the beginning here, probably many people that are listening or seeing this representation know who John is, he's the editor for the practice management section at Ocular Surgery News and he published a book. He publishes many books, but there's one book that should be like a Bible, to anyone that's going into private practice. It's called a "Little Green Book of Ophthalmology". And John has compiled I mean, pretty much everything you could think about. About how to run a private practice, that should be something they have to read from cover to cover. And there are many other things but I think that would be a good way to start. You have to have a good accountant. You have to have a good lawyer.
Polly Neely: Yes.
Dr. Nelson Preschel: You have to have a good lawyer, you have to. And it may be a little difficult to find, you don't want a huge firm, you want someone who's a little below that, who's accessible, and a CPA, you're gonna have to do your research but those are two key players in your team that you need to have. So coach, lawyer, CPA, read the right books, and that's good to start. That's a mini startup kit there. You should visit people you admire and see how they work. That's something that I had done before I returned to the US, because I spent five years out in Venezuela. I went and spent another week with my mentors up in Minnesota just to see how things were being done because five years in ophthalmology is a lot of time. So often things change so rapidly in our field. So I did that. So invest in preparing yourself for the battle because that's what it is in my opinion, yeah.
Polly Neely: That's very true. So what do you think is the biggest either problem or opportunity facing our industry today?
Dr. Nelson Preschel: Problem or opportunity? I'll tell you what my problems with ophthalmology are right now. I spend too much time dealing with compliance, with paperwork, with crap. Honestly, not being a doctor. Another problem that I have is insurance companies dictating how I practice ophthalmology. It's been years since I was allowed to prescribe brand medication to my patients. In the recent months, I had to do a procedure that I was you know, it was my second choice to do because the insurance company did not cover amniotic membrane of ocular surface reconstruction and my patient didn't do as well as I wanted. I hate that someone else is dictating how I practice ophthalmology. As for opportunities, Well you tell me and I'll pursue that. I'm sure there are some, you know, I'll tell you what things I'm doing. To me a big challenge here in Florida is finding good human resources. It's been very hard and you know that for a fact cause you've been in my practice. It's very hard to find good technicians. And it's very hard to find good employees in general. It's like an endemic problem here, people just don't care. They want a nine to five, they want their paycheck and that's it and there's no passion. And accountability is a problem, reliability and so with the new things that are coming out, with all the advances in information technology, and artificial intelligence, for example, and you have helped me with this. I'm gonna start... Because COVID really made COVID really made a difference. I have decided not to rely so much on employees and to replace some of my employees with more reliable systems. So I don't like my answering service, and how they were scheduling appointments for me. Now we're gonna replace that with a new digital check-in service that will allow patients to check into the practice, in the same way you check into an airport. It's a very simplified way. So, that will hopefully, if it can be properly implemented, because of course there is a gap there. The old people are not very familiar with computers. We are gonna have to train them, but we're gonna have to try to make it more what’s going on. That's gonna, you know, probably lower my costs, and increase the reliability of the systems we have to book appointments, and help patients check-in. My office manager is acquiring more and more responsibilities, she happens to be my head technician as well. This is a small office, so she happens to be my head technician as well . You know, Carrie, she can do it all. So I'm hiring a secretary, an assistant for her, who's gonna be abroad. You know, I have a friend who this what he does. He finds employees who are bilingual, people who are highly educated and are willing to do the work for a lower wage, which for us is a lower wage, for them it's good payment.
Polly Neely: Right.
Dr. Nelson Preschel: Because of their economies being different than ours, and you know slowly but surely, I'm trying to minimize the amount of local human resources that I have to hire here that I have to depend on here, because it's just a problem. So that's an opportunity there. I think human resources has been a big issue for a lot of practices. I worked in Florida for seven years, you know that. And it is an issue more and I've talked to other ophthalmologists there who said the same thing, and I think that it takes you so long to train an employee to get them where they need to be, and then they're gone and it's a transitional state.
Well, think about this, let's say I have four or five employees, if one employee doesn't come to work, that's 25% of my employees. It decompensated our day, or our week or whatever, and it's just extremely painful, every time someone leaves we have to train them again and again. So it's like not having someone for the term that it takes to train them, and be efficient and quick. It's extremely painful and it's very uncomfortable to depend on people who just don't care, unfortunately.
Polly Neely: And in your office they have to be bilingual as well.
Dr. Nelson Preschel: Well, you see people come to see me. I ask them what made you come see me? And on many occasions, I would say more than 50% of people who found me on the internet decide to come see me because I'm bilingual. Because you know the geographic area where I'm located, and the fact that I'm Venezuelan. They don't care about my diplomas and all that training that I have. It's just that I could speak Spanish. You know, not only they speak Spanish, but I happen to be South American so it's more than just languages, it's cultural competence. So all of my employees have to be bilingual. Patients come in expecting that. And actually I enjoy that. If you ask me, why did you come to Miami? That's probably the reason, number two was the language part. I really savor much more the encounters with my Spanish speaking patients when we speak the language that I was raised with. You can tell that my English is not perfect right?
Polly Neely: I was telling our crew here that the first time I went to your office and I followed you because that's what I do when I go in practices and I shadow people and physicians, and I said, I told you I'm of no value here because I don't understand anything you're saying to the patient or anything that patient is saying to you. I have to read sign language here to figure out if you're doing a good job. I have no idea.
Dr. Nelson Preschel: Or you should spend more time in Florida, you get to learn.
Polly Neely: True, true. I am, when I come down and stay at your house after COVID.
Dr. Nelson Preschel: Real Florida, and not Central Florida. You have to come down here to Miami and, yeah you'll learn.
Polly Neely: The real Florida. Well I have one another question for you. What is your hobby right now, outside of ophthalmology?
Dr. Nelson Preschel: My one hobby, you know the answer to that. I have so many, I don't even know I have too many. My main thing right now is I'm training to be a sculptor to build art. I like woodwork, I'm a woodworker. I'm thinking about learning metal work. As I told you, we're in the process of building a small organic farm here. I have been practicing photography since I was in my early teens, I was 11 I think. I actually worked as a professional photographer. So I have so many hobbies. I spear fish, I free dive, I just don't have enough time in life to do all the things that I wanna do. You know, but I have many, many hobbies. I mean the main focus right now is to develop, you know an artistic language to let it out.
Polly Neely: Yep, we're gonna end with this question because we have one question we've asked everybody who has participated with us. How have you seen technology in ophthalmology transition since your career started, and how do you foresee the technology in the next 15 years being a part of that industry?
Dr. Nelson Preschel: Well, when I was training I've seen many things, drug delivery has changed significantly. You know, when I trained we were still using pilocarpine four times a day, now we have medications that you can put in the eye, and have a slow release, and that's one thing that I've seen. I've seen the transition from blasting someone's macula because they had corneal neovascularization to injections that now control that without destroying the tissue. And I foresee that getting so much better that people won't have to go through the torture of having injections every three months, or I'm not a retinal specialist especially, but I'm familiar with that. So that for sure is gonna change, and it will take accountability, well the compliance factor of the medical treatment will and definitely improve medical treatment. The patients won't have to remember to use the medication and won't have to fear an injection. Surgically, I started making decisions that were like doing phaco and making 3 millimeters, 3.5 millimeter incisions. Then I had to enlarge the incision to 6 millimeters to put in a PMMA and IOL. Then followup lenses came in, and now we have a femtosecond laser to make a perfect capsulorrhexis that I trained for years on how to make... To reproduce it and without problems it's the most critical part of the procedure. Now you have a laser that will do a 5.5 round, perfectly round incision. I don't promote femtosecond lasers, but I liked that part, and I think that that's going to improve to a point where it's really gonna be something that totally replaces what we do with our hands. So I'm seeing that the most critical parts of many surgical procedures are being replaced by systems like this that are computer guided, by real imaging. I was reading about OCT guided retinal surgery today. During my residency training, we were still doing RK. When I finished my residency training, we were doing LASIK. I mean, I was probably the first generation of cornea fellows that started doing LASIK. And a few days ago, I was reading about lasers to change the refractive index of the cornea. I mean I was reading about changing the refractive index of the intraocular lens and improving refractive, residual refractive errors, even turning monofocal lenses into multi-focal lenses with the laser. Now we're gonna be able to do that in the cornea without having to cut a flap, or remove tissue, or anything like that. So it's very impressive. In summary, I think that things are going to be way, way less invasive and less dependent on hand skill, which is probably what makes a difference between good ophthalmologists and good surgeons I should say, and average surgeons hand skills. I guess one day everyone's gonna be a great surgeon, you know.
Polly Neely: We'll end with that and I'll hope that's what happens. Thank you for joining us, Dr. Preschel.
Focus Through the Generations is supported by Bruder Healthcare Company.
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