DR. STEVEN SIEPSER
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.
Dr. Steven Siepser has over 30 years of experience as a cutting-edge anterior segment surgeon in Swedesford, PA. He is known nationally and internationally for developing innovative surgical techniques such as the Siepser Sliding Knot. He was the first FDA-approved laser vision surgeon in the Delaware Valley.
hear from dr. Steven Siepser
Our host, Polly Neely had the pleasure of sitting down with Dr. Steven Siepser for an exclusive discussion regarding his life and industry experiences. Get to know Dr. Siepser a little deeper in this episode of “Focus Through the Generations”.
Polly Neely: Welcome to our Focus Through the Generation series. We're so glad that you joined us this evening (to Dr. Siepser). I've known Dr. Siepser forever, it seems like. So it's really good to have my friend here talking with me today. Thank you for joining us.
Dr. Siepser: Thanks, it's great to be here. As you know, I'm an ophthalmologist here in the Philadelphia suburbs and have been for 40 years. I think I bring up the upper end of what happens to senior ophthalmologists and I'm just having a great time now practicing just the way I want. We have a fairly big practice, but I only operate now; and I only see pre and post-op surgical patients. With having been around this long, I still see a lot of complex problems and weigh in on things that are quite interesting. Recently, I removed two of the Verisyse implants. I think I put them in 20 years ago and they were referred from elsewhere because no one wanted to touch them, and that predated the ICL, the Visian ICL from STAAR, which is behind the iris. It was an anterior chamber iris claw lens which was quite a thrill but worked beautifully for over 20 years for these patients.
Polly Neely: Well, you did my ARRAY lens back in 2002.
Dr. Siepser: Oh my gosh, you know, I see that lens quite a bit, and you know, that I still use the Crystalens, the B&L Crystalens. I had a great experience the other day a patient came in and she looked like a very astute lady and she really spent a lot of time. She said, “You know Dr. Siepser, I want an Alcon Acrysof lens.” And I said, “I don't really use those, you want maybe the PanOptix or something multifocal. I really have gotten away from those and I use the only pseudo accommodating implants. It seems to work really well in my hands. I've done 4,000 of them.” And she said, “But listen, 80% of the doctors in the country use that lens, and over 82% of the lenses in this country are Alcon lenses.” I said to her, “You know, you ever play golf?” She said, “Well, what do you mean talking about golf?” I said, “Well, 80% of the golfers can't break a hundred!”
I had a better analogy for her really. I said, “You know, when I get to a meeting and everything, people sort of line up for the escalator, right? It's easier, it takes you up, but they're waiting for the escalator. I always walk up the stairs, there's no line there and it's better for you.”
Polly Neely: I like it.
Dr. Siepser: And so, being an outlier most of my life, I want to assure you, it continues.
Polly Neely: I love it. I love it. Well, I still like my ARRAYS, but I would like to upgrade. So maybe we can talk later.
Dr. Siepser: We’ll have to. You know, I did 900 ARRAY implants.
Polly Neely: My mom's 96 and she just started wearing readers only because she has macular degeneration, but not for any other reason.
Dr. Siepser: That's amazing. I'm glad your mom's still trucking on!
Polly Neely: She’s still kicking. Well, you just answered one of my questions I wanted to ask you. I have another one to ask you. What is your most memorable patient or experience in your career? I'm sure you have many.
Dr. Siepser: Oh, wow. That's, that's a great one. My, one of my favorites, I wrote an article about her. This little old lady really, hadn't been to a doctor in years and years and certainly not the eye doctor. She came in with pretty advanced glaucoma, pretty bad cataracts and I said, “You know Mrs. Jones, I think I can take care of this. I'll take out your cataracts, I'll do intraocular cyclophotocoagulation, I'll put in and iStent and I think I can get you really all better and you won't have to use drops and your vision which is really quite poor from your glaucoma loss will be stopped.” So I go ahead and I do both eyes and like she was just one of these charmers who came through and she had pressures like 16 and 20/25, 20/30 vision and felt really great. And so she's in seeing me and I look at her and I go wow this is amazing, you know. Oh, but I don't want to break my arm patting myself on the back. She sits back and she says, “Dr. Siepser, it's a sad dog that can't wag its own tail.”
Polly Neely: You tell her, you are not a sad dog.
Dr. Siepser: I don't have any trouble wagging my tail, but, you know, she didn't know that.
Polly Neely: And I figure, why not, if I'm the only one that does it, it's a good thing. I love that story though. That's really cool. You do a lot of complex surgeries. I know that about you. And you’re like the guy that everybody sends the “can't be dones” to.
Dr. Siepser: Very interesting, I was just reviewing, reading an article in Ocular Surgery News by this guy, Agarwal from Chennai.
Polly Neely: Yes, I know Dr. Agarwal
Dr. Siepser: Yeah, he's come up with this four pass sliding knot, and it always irks me because if McCannel hadn’t said before me well, you can actually suture iris. Back then we'd put a big cut in the eye and reach down, grab up the iris and tie it together and drop it down. We didn't even realize you could suture the iris. And then, I invented the Siepser Sliding Knot where I actually externalized the tying of the knot using a fly-tying method. So when you do fly ties, you sort of slide the knot onto the fly, and that's sort of what precipitated my saying, “Oh, I'll just slide the knot into the eye.”
And so of course, a bunch of ophthalmologists, it's the Osher Knot, the Snyder Knot not the Agarwal Knot, but most people are pretty kind you know they mentioned your name or they say something because you know, cause we all built on the shoulders of our predecessors. I wouldn't have come up with the sliding knot if Peter McCannell hadn't said, well you can suture the iris. Because what I could remember of my senior partner back then when I was starting suturing iIrises, because he did sector iridectomies and I had a hundreds of patients with sector iridectomies from the old intracap days.
I closed so many of those. In fact, the other day, I remember Mr. Geist and I actually found a slide of one of the first ones I ever did. So that's been a lot of fun and getting patients from really all over the United States to come in to get iris repairs. And one of my favorites is from Alaska. He came down to see Gary Condon at Pittsburgh and Gary said, “Well why did you come see me, Siepser is right down the road.” And so he's been a lot of fun and taking care of these here-to-fore untreatable eyes has been very rewarding
Polly Neely: And that's been your career. And I think that's what you're known for. I know you're known for the Siepser Sliding Knot because I've been with you too many times when I mention your name and they go, “Yeah, that's the Siepser Sliding Knot.” And I'm like, “Yes, that's the one.” So I love that. But Dr. Agarwal that’s okay, because the biggest form of flattery is imitation. Right. So, you know, if they want to imitate me, I'm okay with that, especially him, he's awesome. What do you think is the biggest problem facing the ophthalmologist today and the ophthalmic industry today, given where we are right now?
Dr. Siepser: So, it's interesting Polly, since you've you haven't been met Bob Curran, our new president, you really have to meet him. Bob, he was a pitcher for the Dodgers and he came up with Grey Poupon mustard and A1 Steak Sauce, this guy’s great fun and I'm his retirement project, I think. But we’re having the greatest time and he has divided our practice into properties now into Siepser Properties, Siepser Technologies, Siepser Eyecare, Siepser Laser Eyecare and Siepser Dry Eye Center. He’s really put the whole thing together, and I was thinking about that and I said, the problem I think in medicine is because we're a very dedicated group, all doctors are. They have to spend every waking hour learning what they know and they don't have time.
I read one of my all time favorites, The Wealth of Nations by Adam Smith, and when I read that book I realized that the business interests it's a different plan it just has nothing to do with medicine and what we do on a daily basis. I think business has taken advantage of medicine because we are mission-driven, moralistic, and business folks, they are all about profit and amoral behavior really as I see it. I have this President now who's a really sharp business guy, he protects me. As I see what's facing the physicians now is that we're terribly under paid, it's awful. I was figuring out that in reality, we now are paid 5% in real dollars. For a cataract surgery compared to 1984, very simple, we got near $2,000 in 1984 in 1984 dollars. And with 1984 dollars, you did five cases, you could buy a car. Cars were, you know, 3, 5, 8 thousand dollars. Now cars, nice ones are $80,000 and we're getting $500 for a cataract… and with your profit margin, it must take us 200 cataracts to buy a car. It's a problem throughout medicine and I always find one of my favorite thoughts is someone once said, “I don't need politicians, I don't need actors and actresses, I don't need sports people and I don't need professional athletes. What I need is doctors, teachers, and nurses.”
Polly Neely: That's a great thought, I like that…
Dr. Siepser: I think I was reading an article in New York Times recently where they were saying that all these first heroes, the frontline folks in medicine they didn't get raises, they're not valued for what they did, they give you a cupcake and they say, well thanks for the near death experience. You know, it's just a sense that we need to be business trained, which a lot of us are.
I spent time at Wharton, it helped a little bit. But I really don't have interest when somebody puts a contract in front of me. I don't really care about that. I want to say where's the next patient, what's the next operation? And I read voraciously, the amount of magazines, journals, and online information I gather in a week and talk to colleagues and I mean, it's exciting and fun what I do. I’d just like to be paid a little better, that's all.
Polly Neely: Well, I think that is the biggest to me. I think the biggest challenge facing us right now is profit versus overhead.
Dr. Siepser: That's one of my favorite stories. So my girls went to Andover and Exeter, and I got friendly with Mr. Tingley at Exeter. Claire was a really good student there, he was the head of school. I said, Mr. Tingley, “How many kids are going into medicine?” And he says, “Oh Steve, these kids are too smart, they're going into finance.” So all the best minds are not in medicine. I mean, there are a lot of brilliant people and wonderful people, but I mean when you sit down with some of the folks in finance and they have amazing minds, but they're gamblers.
Polly Neely: But it's a fear. It's a fear that we're, we're coming up on. You mentioned a book, I know you read a lot. What is your favorite book of late that you've read and why?
Dr. Siepser: Well, of late, it was Malcolm Gladwell's David and Goliath. It was great fun. I have a story about books. It's really interesting, so my kids aren't readers, they play games on the computer and everything. When I was in high school, I read every significant book in the high school library. Mr. Blaney, my history teacher, arranged for me to have a private library. I remember reading, Go Tell It On The Mountain by James Baldwin, and I could order any book I wanted and of course I plowed through. I was a voracious reader and when you asked me what's your most influential book, there are so many and I find each one fits into a piece. You know, those classics. I want to make my kids read the books about interpersonal relations. Emotional Intelligence is a great book. How To Raise An Adult by Julie Lythcott-Haims out there at Stanford, really about how to have your children accept responsibilities of life early so they don’t get to college wondering how to do their laundry and cook.
The David Goliath book, I really enjoyed because I have these kids going to college and I had Susanna spend some time with it too. Because my older kids, here I am 50 year old, I want them to go to the best schools and send them to Exeter and Andover and Reed and Smith, they're barely employed now. They have great lives, they're artists and very, very interesting people, but they don't bring in a paycheck. Our kids have worked on the farm, they're not going to any fancy schools. We are going to send them to schools that are appropriate for their skills in their desires. Mostly on a smaller liberal arts experience. And Ben, I'm trying to get him to try a trade, he would make a great electrician, rather than this college thing. I just have a different perspective as an older parent and I'm not into, well, my kid went to wherever, you know, and I'm certainly not going to pay some guy to get them into someplace where they don't really belong.
Polly Neely: And that's where wisdom is so key. Right.
Dr. Siepser: I don't know if it's wisdom or experience, but I'm saying they say a smart man learns from his mistakes and a wise man learns from other people's mistakes. I think I'm only smart.
Polly Neely: I don't know. I disagree. Well, I'm going to get down to our final question because I don't want to take any more of your family time, but I love talking to you. I could sit here and do this all night. You know that. I have one question that we're asking every person that we interview and that is how have you seen technology in ophthalmology transition since your career started? And what technology do you foresee in the realm of the future coming into our industry that may forever change our industry?
Dr. Siepser: Well, the big one is artificial intelligence. It's amazing how often I'll just go on Dr. Google, because the patients already had been on Dr. Google when they came in. So I think it's going to be in the information side, the analytical triage. The equipment, of course, will be light years ahead of what we've done. When I started doing, don't forget, I was a surgeon trained in intracapsular cataract surgery. I mean, think about it. Charles Kelman was a friend of mine and actually very influential in my life. When I was graduating college, I had been a ski racer and on the lacrosse team, and I'd had a really good time and then the Vietnam War was on and everybody wanted to go to medical school, and I just didn't have the grade point average. I got into Hahnemann and a couple of other places with all these wait lists, I know I’d get deferred. So through a friend, I called Dr. Kellman and he said, well, don't worry you know, I went to school in Lausanne, I'll get you in there. And so on my way to Lausanne I actually stopped in Belgium at a school there and it was Leuven. And I just had, it was tough, which was considered the Harvard of Northern Europe. And I mean, it was tough, but I had a great experience. Then of course when I came back and after I tried pediatrics and didn’t like that and then discovered ophthalmology, which was using my hands.
I had been an electron microscopist in college. I worked my way through college and medical school doing electron microscopy. So I was always using one of these AO biomicroscopes, so when the microscope hit ophthalmology in the late seventies, I was set. So these technical things are important and they definitely change the way we practice. But you know, if I had to have like one piece of equipment right now, I think I keep my VISX Excimer Laser.
It's the one thing that really supports the practice and all the fun we have, because it actually makes money for us. And that's a little unique in medicine today.
So going forward these devices are going to be more integrated and more talking to one another, and more independent of a physician, and also reminding us that's why being a senior ophthalmologist now is so easy because we’ve got Google and you just need a piece of what you're thinking, and if you're disciplined, you go back and say what other things could this be and where else could this be? I mean, I just had a patient come in with a non-arteritic optic neuritis,and in two seconds I could show him the picture, it's a superior altitudinal effect. This rarely will be a tumor, but I’m going to send you down to a neuro-ophthalmologist. That assistance, from the knowledge base that exists at your fingertip, is enormous. I mean in the old days, I'd have to go look in a book or try to remember something. You don't have to do any of that now, just a few keystrokes and off you go.
Polly Neely: That's true. That's very true. Dr. Siepser, thank you so much for joining us this evening, and I'm so happy to get to talk to you and be the one to interview you. That makes me very proud.
Dr. Siepser: It is a special moment. And thank you for having me.
Polly Neely: You're amazing. Thank you.
Focus Through the Generations is supported by Bruder Healthcare Company.
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