Leslie A. Olsakovsky, MD: Three Decades of Patient Care, Education, and Leadership

Leslie A. Olsakovsky, MD, first came to UVA Ophthalmology in the fall of 1987 to interview for residency. The department had only four or five full-time faculty members, and most clinical care took place in the resident clinic. Because residents and faculty worked in the same clinical area, residents could readily seek guidance while remaining responsible for patients they followed throughout training. Caring for the same patients over three years required residents to make decisions about their care over time and recognize when they needed help. Dr. Olsakovsky came to appreciate the value of that experience more fully after leaving UVA for a cornea and refractive surgery fellowship in Florida and two years on the faculty at the University of South Carolina. “Only after you leave do you realize how good it was where you were,” she said. Seeing her UVA training from outside the program clarified for her how much residents learned through continuity with their own patients.

Dr. Olsakovsky returned to UVA as a faculty member in 1995, when the department had only about six faculty members. For roughly 20 years, she provided most of its cornea care with backup from Steven A. Newman, MD. Her cataract practice also became an increasingly substantial part of her clinical work. During those years, the organization of UVA’s clinics changed in ways that also changed what physicians needed from departmental and medical center leadership. Physicians had previously employed their own clinical staff, paid those employees through office accounts, and purchased equipment through the department. When the clinics became hospital-based, responsibility for staffing, equipment, space, and other resources moved to the Medical Center, making coordination with Medical Center leadership a larger part of operating a clinical practice. Dr. Olsakovsky became Medical Director at UVA’s Northridge Eye Clinic around 2004 or 2005. She later became Medical Director for all department clinics. Her work in that role now includes patient access and scheduling, technical staffing, equipment, space, and physician issues that affect clinical care.

In 2008, Dr. Olsakovsky was seeing patients in clinic when interim dean Sharon L. Hostler, MD, caught her by surprise between appointments to ask her to serve as interim chair of the department, as Brian P. Conway, MD, transitioned to chair emeritus. Serving as chair brought Dr. Olsakovsky into Dean’s meetings and regular contact with chairs across the School of Medicine, several of whom remained friends and colleagues after her interim term ended. She said the experience made her feel more connected to UVA because it gave her relationships with people across the institution whom she could call on for advice or assistance.

Leading Ophthalmology presented a different challenge because many of the faculty she oversaw were also longtime friends. They had held journal clubs in one another’s homes, knew one another’s families, and had spent years working together. As interim chair, Dr. Olsakovsky still had to make decisions based on what she believed the department needed, even when an individual colleague might have preferred a different outcome. Experiencing that challenge gave her a clearer understanding of what she believed successful departmental leadership required. “As a chair, your job is to make other people more successful,” she said.

Dr. Olsakovsky accepted the interim appointment knowing that UVA would conduct a national search for a permanent chair, and she did not intend to pursue the position herself. Chairs from other departments encouraged her to apply, but her interests remained centered on patient care and resident education. “I think my strength is in taking care of patients, and clinical education, and teaching residents how to take care of patients,” she said. She has remained part of the department’s leadership as vice chair and medical director, attending Dean’s meetings when Albert S. Jun, MD, PhD, is away.

Her clinical and educational work has also continued to evolve. Dr. Olsakovsky’s cataract practice has grown as she has stepped back from some cornea care, giving her more opportunity to concentrate on cataract education. She had long supervised resident cataract surgery before she was asked to take responsibility for the introductory cataract curriculum in the operating room. Dr. Olsakovsky initially questioned whether she wanted to assume a larger teaching role at that stage of her career, but the experience renewed an aspect of resident education she had long enjoyed. She now carries much of the responsibility for guiding PGY-3 residents through their first cataract cases as they rotate with her, helping them develop as their operative experience increases.

Dr. Olsakovsky believes the residency itself has continued to improve since her years in training. Residents now learn from a wider faculty, care for patients with greater acuity and more complicated disease, and begin their training through an integrated internship year. The resident clinic has remained an integral part of the program, allowing residents to follow their own patients over time and retain the responsibility that Dr. Olsakovsky came to value more fully after leaving UVA. When she finished residency, she did not expect to return three years later and spend more than three decades on the faculty. “And then in the blink of an eye, it’s 31 years later,” she said.