Hi guys/gals. My first post and loaded with questions......I've been a board certified, emergency medicine trained (USC) physician now for 9 years. Over the past year I've had a change of heart, but not burn-out, over the type of practice I've been interested in. Though I enjoy the challenges of emergency work and do it very well (so I'm told by my peers and fellow partners which is a great compliment), I do miss the patient relationship/continuity of care and a steady surgical work. Unlike USC in California where I was busy puting in chest tubes, central lines, cricothyrotomies and even one crash c-section, I find myself doing more emergency MEDICINE than emergency SURGERY in real life emergency departments. I've been shadowing a friend whom is an ophthalmologist in his clinics and surgical days for over 8mos now (not continuously) and I'm convinced that this is what I want to do until I croak. I have almost as much books in Optho compared to Emerg.

So,......How do I go about getting into a decent program? Being that I have all this experience under my belt, will it help me get in? Will I get a raised eyebrow or uncustomary consideration by programs due to my age (42) and my board status in Emergency Med? The only scores I may be able to pull out are Board Exams parts I, II, III. We had no USMLE (did I get this right?). I did very well in Med school and got into USC-which is quite competative for ER. I've been reading the CAS and most of the direction apply to newly graduating medical students. Anybody with any direction/opinions?? I would greatly appreciate it.

Program directors wouldn't even know what to make of your scores on the NBME. People will take you for what you have achieved since medschool, not so much for the numbers (even in the USMLE there has been a score-drift over the past 10 years 1995 scores are not comparable to 2005 scores).

Go for it. I am not an ophtho myself, but the field is a close runner-up to the one I have chosen (and my wife happens to be in it). It is only a 3 year residency, with your EM boards you should be able to have some decent moonlighting on the side to pay the bills. Don't get too hung up about getting into a 'name' program. You want to get good surgical training. At times a place with a large VA and/or a public hospital can be more rewarding in that regard than a chi-chi highly private center (you don't want to wrestle your attendings for cases).

You'll have to circumvent the usual application process a little bit. Otherwise some GED level secretary will toss out your application because she doesn't know what NBME stands for. Call/email program directors in the area you are interested in, tell them your story. In addition to the buddy you are shadowing, try to get some contacts in academic ophthalmology. It is a small field. Nepotism plays a big role in the selection of residents. Try to use every channel you've got. See if you can re-heat some connections from your residency. That ophtho resident you were hitting on 10 years ago might be well positioned in some program today. Contact your PD from your ED residency, see if he/she can hook you up with the right person in the ophtho department. See if you can shadow someone there to get another ophtho letter of recommendation.

If ophtho is what you really want to do, why not apply? what do you have to loose? i know someone in their late 30s who is a derm resident after 5 years of FP, these things happen. PM me if you want to talk about california programs or USC in particular. I'll be at Kaiser sunset for a year of medicine and then will come back to USC for ophtho residency...just can't get enough of 1350 ;) !

Good Luck!

P.S. I want to clarify something from f w's post: Don't get too hung up about getting into a 'name' program. You want to get good surgical training. At times a place with a large VA and/or a public hospital can be more rewarding in that regard than a chi-chi highly private center (you don't want to wrestle your attendings for cases).

There is a difference between a chi-chi program and a "name" program. These 2 terms are not synonymous as I am sure our good friend, JR will be able to attest to in a few weeks. Many of the top ophtho programs have excellent clinical exposure in many different settings: VA, county and private.

Didn't want to imply that ALL of the 'name' programs are lacking in operative experience. I just wanted to emphasize that the key factor in a surgical residency is the surgical experience, and not how many NIH $$ some lab-rat affiliated with the program brings in (a common metric used for 'rankings'). And for surgical experience, you get most bang for the $ (your precious time) out of charity and VA hospitals.

There is a difference between a chi-chi program and a "name" program. These 2 terms are not synonymous as I am sure our good friend, JR will be able to attest to in a few weeks. Many of the top ophtho programs have excellent clinical exposure in many different settings: VA, county and private.

Agree. Many "name" or great ophthalmology programs do, in fact, have a VA and/or a charity/county hospital.

BTW, Aaron Miller is a resident at San Antonio program, NOT Baylor. I believe he was a Baylor medical student before his residency days...

[COLOR=Navy]BTW, Aaron Miller is a resident at San Antonio program, NOT Baylor. I believe he was a Baylor medical student before his residency days...

thanks for the clarification. (no sarcasm) regardless of where Aaron is, his post on eyeOrbit
really struck a cord with me and inspired me to donate $50 to my PAC and write a letter to my congressman. his entire post is worth reading: http://www.eyeorbit.org/article.php?story=20050410060801157. i think i got the baylor bit from his signature which i will change. well, at least he lives in the city with the better basketball team. go spurs!

Now back to the original spirit of this thread: go for it emergencyguy! "you can do it!" -Rob Schneider

Hey guys. I just got talking with CAS and they are also at a loss as to what to do with the lack of USMLE scores. "just fill out as much as is appropriate". Hmmm, sounds too easy. Since I've already done my rotating internship, and infact 9 years of the same (essentially), I'll be looking to get into a PG2 position hopefully as early as 7/06-even if it means scrambling for a spot. I just don't see myself waiting for a spot for 7/07 just because everyone else needs to do the one year rotation. Ihope all goes well.

You are at a disadvantage being 9 years out of medical school. However, a few programs will consider you an oddity and may interview you out of curiosity.

Try to improve every aspect possible. If overweight, lose weight. If you are not old looking, tall, and not overweight, you may get a spot. Reviewing how interviewed applicants were ranked, I now think that looks are very important, sometimes more so than USMLE scores. Consider Botox and at least microdermabrasion. I'm not hideous looking so I got into an ophthalmology program.

:wow: visioncam is correct in that you won't get this kind of advice too often.

If overweight, lose weight. If you are not old looking, tall, and not overweight, you may get a spot. Reviewing how interviewed applicants were ranked, I now think that looks are very important, sometimes more so than USMLE scores. Consider Botox and at least microdermabrasion. I'm not hideous looking so I got into an ophthalmology program.

Gaawd that was funny! Made me chuckle. In reality I do think there is some truth to this advice. Humans are humans, and so first impressions are as important as other characteristics and attributes. Guess I'll get some summer highlights on my hair, and a great tan. Dermabrasion not needed, nor botox (can't believe I'm talking about this!). I guess 9 years creep up on you, but I don't feel it, guess that's the most important part.

A girl in my program had done around 10 years of family practice, and she made it through ophtho training & has never looked back. She loves it. It was a big sacrifice though - all that extra study & lower pay, but she is glad she did it.

Emergency Guy,

I will tell ya what I did. After spending some time in a categorical general surgery spot, I decided I was tired of the ridiculous hours and wanted to do ophth. instead. I looked on the San Fran Match site for open spots and was disappointed to find few selections for PGY2 that were "unexpectedly" open. Of course, I did call those places listed (I think there were two) and was told to send all my stuff in and they would put my application in with the others.

Next, I just decided to start calling places I wish I could go, even though they were not listed on the SF Match site. One placed I called was the Univ of Kentucky. The secretary said "funny you would call, we just had an unexpected opening develop". She told me to call back one week later, which I did. During the next phone conversation, I was told to send my application in and they would contact me about an interview. One or two weeks later I was in Lexington, KY with a cople of other folks (I think they were mostly internal folks from other residency programs at UK). I got the call about a week or so later telling me I would be starting as a PGY2 at UK. The lesson here is cold calling does work. This may be obvious, but be as nice and courteous as possible to everyone you speak with at each program.
Be as flexible as possible. Make a list of potential places and just start calling.....you may get lucky. I did. The University of KY was fantastic for faculty, surgery volume, and available moonlighting opportunities.

And keep calling throughout the year. Positions do open up (through additional funding available, new community affiliate hospitals etc). And yes, sometimes even residents in ophtho decide that it is not their cup of tea (or their coveted neurosurgery position becomes available).

(If nothing works, you might have to send your cousins 'Luka' and 'Vinnie' to 'open' up a position for you.)

Hello all... just wanted to clarify things for you. Thank you rubensan for quoting me.

Over the last several years, I have been amazed at the lack of involvement of medical students in organized medicine. Medical school is set up to train an individual to "think" a certain way. Traditionally, this has been to think as an independent individual, which is the source of much of the deep competition that arises during medical school. (Reminds me of a joke I heard in MBA school: Trying to get a group of doctors to agree on something is like trying to heard a bunch of cats.) Anyway, this type of training works against many organization's attempts at lobbying and pushing important medical issues. As a group, physicians have an enormous amount of political power... it is just getting us to agree. Too many physicians focus on the details of an issue and loose touch of the overall big picture. This is where we become weak and late in responding to issues.

Overall, I predict things will get much better. I feel that there has been a renowned push to get medical students and residents involved. It should be an exciting future for organizations such as the AMA and Academy of Ophthalmology.

As far as my training...

I just finished my Ophthalmology Residency Training at UT San Antonio.
I start my Ophthamology Pediatric Fellowship at Baylor next week.
I went to Texas Tech for medical school where I enrolled in the combined MD/MBA program.

Thanks!

Aaron M. Miller

I also decided to change careers from internal medicine to ophthalmology. I am still in the middle of my medicine residency. One thing you should realize is that some programs won't even consider your application since you are not a medical student. The reason is that the US government (Medicare) funds most residency positions. Medicare does not like physicians changing fields. For example, I decided to apply for an internal medicine residency which is 3 years. My salary during residency will only be subsidized by Medicare for 3 years. Since I decided to change fields, Medicare will no longer subsidize my salary, and the residency program will need to find other means to fund my salary. Salary meaning more than just what they pay me. This has to include malpractice insurance / life insurance / health insurance. Even though we all get paid around $40k, it really costs the hospital ~$90k to employ us.

Since ophthalmology is a competitive field, some programs immediately ignore those people who are not medical students since they don't want to deal with the hassle of finding additional sources of funding. However, I did apply to 80 programs and received 17 interviews. I did end up matching at my #3 choice which surprised me a great deal. Overall, ophthalmology residency programs are very well funded and finding more money for an unsubsidized resident is possible.

The bottom line is if you really want to become an ophthalmologist, get to know an academic ophthalmologist that is well known and willing to write you a strong recommendation letter. Email me if you have any questions: victorkomd@gmail.com.