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                                                                   Exhibit 10.19

                                 AMENDMENT TO
                   AMENDED AND RESTATED EMPLOYMENT AGREEMENT


     THIS AMENDMENT TO THE AMENDED AND RESTATED EMPLOYMENT AGREEMENT (the
"Amendment") is made and entered into effective as of March 9, 2000, by and
between NovaMed Eyecare Services, LLC, a Delaware limited liability company (the
"Company"), and Stephen J. Winjum ("Employee").

                                    RECITALS

     A.   The Company and Employee have previously entered into an Amended and
Restated Employment Agreement dated as of February 17, 1999 (the "Original
Agreement").

     B.   In consideration for the grant of stock options by the Company to
Employee pursuant to the terms and conditions of a Stock Option Agreement of
even date herewith, and the continued employment of Employee by the Company, the
Company and Employee desire to amend the terms and conditions of the Original
Agreement, as hereinafter provided.

     NOW, THEREFORE, for good and valuable consideration, the receipt and
sufficiency of which is hereby acknowledged, the parties hereby agree as
follows:

                                     TERMS


     1.   Section 3.3(b) and (c) of the Original Agreement will be deleted and
replaced with the following language comprising a new Section 3.3(b):

               (b)  If the Employment Period is terminated by the Company
     without Cause (including a termination resulting from the Company's
     election not to renew this Agreement under Section 1.1 hereof), the
     Employee shall be entitled to receive, as severance, the following
     (collectively, the "Severance Pay"): (i) Employee's Base Salary hereunder
     for a period of eighteen (18) months (such time period to be hereinafter
     referred to as the "Severance Period"), payable in regular installments in
     accordance with the Company's general payroll practices for salaried
     employees; (ii) the bonus, if any, that Employee would have received under
     Section 2.2 hereof at the end of the year during which termination without
     Cause occurs had such termination not occurred, which bonus will be (A)
     prorated based on the amount of time that Employee was employed by the
     Company during the year (not including the Severance Period) for which such
     bonus is being calculated and (B) determined and paid to Employee
     contemporaneously with the determination and payment of bonuses for
     comparable employees of the Company; and (iii) continuation of the Benefits
     for the Severance Period. Receipt of Severance Pay is contingent upon
     Employee executing and adhering to a release of all employment claims in a
     form acceptable to the Company. The Company shall have no further
     obligations hereunder or otherwise with respect to Employee's employment
     from and after the termination date, and the Company shall continue to have
     all other

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     rights available hereunder (including without limitation, all rights under
     Article IV hereof) at law or in equity.

     2.   The following sentence will be added at the end of Section 4.3 of the
Original Agreement:

          In addition, at all times from and after the Termination Date,
     Employee shall not contact or communicate in any manner with any of
     Employer's suppliers or vendors, or any other third party providing
     services to Employer, regarding Employer or any Employer-related matter
     (which suppliers, vendors or third party service providers will include,
     without limitation, any third party with whom Employer was, during the term
     of Employee's employment with Employer, contemplating engaging, or
     negotiating with, for the future provision of products or services).

     3.   The following provision will be added at the end of Article IV of the
Original Agreement as Section 4.9:

          Section 4.9    Covenant Not to Disparage.  During the Restrictive
     Period and thereafter, Employee shall not disparage, denigrate or derogate
     in any way, directly or indirectly, any of the Company, its agents,
     officers, directors, employees, parent, subsidiaries, affiliates,
     affiliated practices, affiliated doctors, representatives, attorneys,
     executors, administrators, successors and assigns (collectively, the
     "Protected Parties"), nor shall Employee disparage, denigrate or derogate
     in any way, directly or indirectly, his experience with any Protected
     Party, or any actions or decisions made by any Protected Party.

     4.   Except as expressly provided in this Amendment, the Original Agreement
will remain in full force and effect in accordance with its existing terms.

                                    * * * *
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     IN WITNESS WHEREOF, the undersigned have executed this Amendment as of the
date first written above.

                                       NOVAMED EYECARE SERVICES, LLC

                                       By:  NovaMed Eyecare, Inc., its Manager


                                       By: /s/ Ronald G. Eidell
                                           -------------------------------------
                                           Ronald G. Eidell, Executive Vice
                                           President and Chief Financial Officer


                                       /s/ Stephen J. Winjum
                                       ----------------------------------------
                                       Stephen J. Winjum