In this latest episode of the Ophthalmology Times® “Beyond The Walls” podcast, host Deborah Ristvedt, DO, sits down with her ophthalmology practice partner and mentor Vance Thompson, MD, to explore the origins and ongoing impact of a team first culture at Vance Thompson Vision. The conversation covers Thompson's early frustrations with practice dynamics, his turn toward business education, and the philosophy that has guided his career and practice growth.
Thompson traces his thinking back to the late 1990s, when despite working with what he describes as "nice people," his practice was seeing more team and patient complaints than he expected. Encouraged by his brother-in-law, a physician-turned-hospital administrator, Thompson began studying the business side of medicine. He attended a course in Boca Raton, Florida, and worked with Jim Gilmore, coauthor of The Experience Economy, whose framework—"work is theater and every business a stage"—helped him reframe how he thought about patient care delivery.
The pivotal insight came when Thompson recognized that teachings focused on the customer, while he was focused on the patient. "The team experience is something that I have to have perfect, we have to have perfect before we're gonna have a great patient experience," he explains. This realization led to what became his signature and deliberately provocative principle: The patient comes second.
Thompson acknowledges the reaction that framing typically draws. "I've heard audible gasps from groups of surgeons," he says, adding that the point is not to deprioritize patients but to challenge a culture in medicine where staff are treated "less than." His argument is that an authentically cared-for team creates an environment patients feel immediately. "I don't know exactly what's going on here, but I love how they treat each other and I love how they treat me," he describes patients saying.
He also connects team first culture to burnout prevention, recounting a colleague who told him he feared he was burning out. Thompson's response: "Are you operating on eyes or are you operating on people?" Reconnecting with the human dimension of the work, he suggests, is central to sustaining energy across a career. "I always want to remember I'm a doctor first, I'm an ophthalmologist second, I'm a refractive surgeon third."
