Hi all-

I'm in my first year of private practice and I'm wondering what type of volume other people are seeing. On a busy day I will see 25-30 patients, on slower days only 10-12. Average is probably mid teens. I joined an existing practice with one other OMD and 2 OD's. Existing MD sees 40-50/day for 3 days a week. I've been here for 7-8 months now, and volume isn't really ramping up like I had hoped, wondering if that is par for the course or what other people's experience has been.

Hi all-

I'm in my first year of private practice and I'm wondering what type of volume other people are seeing. On a busy day I will see 25-30 patients, on slower days only 10-12. Average is probably mid teens. I joined an existing practice with one other OMD and 2 OD's. Existing MD sees 40-50/day for 3 days a week. I've been here for 7-8 months now, and volume isn't really ramping up like I had hoped, wondering if that is par for the course or what other people's experience has been.

That sounds about right. I posted on another thread about this very subject. What most fail to understand (or be told) is that it takes a while to build a practice. When you think about it, it makes complete sense. If you started out full speed, there is really no room for growth. Even if you are taking over for a retiring doc, not all of the patients will transfer to you (e.g., may not be comfortable with a young doc). Plus, no matter how much of a hot-shot you think you are, it takes a while to establish your clinic flow--the real world isn't like residency or fellowship. Takeover scenarios do have a more rapid growth potential, however. If you are being added as a new doc to a growing practice, as it seems to be in your case, it can take a while longer. I'm in my first year of a new med ret practice, and I'm seeing high teens to low twenties 4.5 days per week. To put that in perspective, I came in with a 7-doc referral base (the rest in my group are comprehensive docs). The established MD in your group likely books out months in advance, depending on how long he/she has been in practice. Eventually, you'll be in the same boat and looking back fondly on those easier, early practice days. Enjoy them, while you can! ;)

Hi all-

I'm in my first year of private practice and I'm wondering what type of volume other people are seeing. On a busy day I will see 25-30 patients, on slower days only 10-12. Average is probably mid teens. I joined an existing practice with one other OMD and 2 OD's. Existing MD sees 40-50/day for 3 days a week. I've been here for 7-8 months now, and volume isn't really ramping up like I had hoped, wondering if that is par for the course or what other people's experience has been.

The question that I would ask is what are YOU doing to increase your patient volume?

The question that I would ask is what are YOU doing to increase your patient volume?

In a way, that was kind of the question I was getting at. . .I'm not really sure what I CAN do, but I'm worried I should be doing more. We have had a couple of dinners with some of the local Optoms, I gave a presentation to some of the local optoms, I've sent out some letters, gone to some of the local primary care clinics to introduce myself. I'm not much of a salesman type, I really don't like hyping myself up. What kinds of things are others doing who are in a similar point in their career? We also do do some newspaper advertising.

Dr. Doan has a good lecture about using the internet to market your practice on the AAO site. You must be a member.


2009 Program Highlights American Academy of Ophthalmic Executives (http://www.aao.org/aaoesite/aaoeprogram/2009programhighlights.cfm)

In a way, that was kind of the question I was getting at. . .I'm not really sure what I CAN do, but I'm worried I should be doing more. We have had a couple of dinners with some of the local Optoms, I gave a presentation to some of the local optoms, I've sent out some letters, gone to some of the local primary care clinics to introduce myself. I'm not much of a salesman type, I really don't like hyping myself up. What kinds of things are others doing who are in a similar point in their career? We also do do some newspaper advertising.

Dinner with optoms is probably a colossal waste of time in your case. The best way to get optoms to refer to you is to refer to THEM.

If you've already got two optoms in your office, how likely is that to occur?

Have you sought out any local nursing homes?

Dinner with optoms is probably a colossal waste of time in your case. The best way to get optoms to refer to you is to refer to THEM.

If you've already got two optoms in your office, how likely is that to occur?

Have you sought out any local nursing homes?

Actually I have gone to one of the local nursing homes and given a presentation as well. Probably that was more of a colossal waste of time than the optom dinners. It was a good idea, just the circumstances that probably frequently arise at nursing homes made it frustrating. They had a lunchtime activity set up every day, sometimes it was arts and crafts, bingo, etc. The day I went it was me giving a talk on the aging eye. About 5 residents showed up as well as a couple of the staff members. However it was fairly frustrating because probably 3 of the 5 were quite demented, and about 5 min into the presentation this lady rolled in on her wheelchair and immediately announced very loudly "I can't hear a $@$@#@ thing you're saying!!!" I tried to speak up as much as I felt comfortable with without outright yelling (I am not a particularly soft-spoken person), but she still couldn't hear and announced so every 2 minutes or so. A couple of the demented residents would intermittently share stories completely unrelated to eyes. After about 10 minutes the wheelchair lady grew increasingly agitated that she couldn't hear and rolled out in a storm of expletives. 5 minutes after that she rolled back in and again complained angrily and loudly that she couldn't hear. It was more comical than anything, but fairly frustrating as well. Probably much more value in the staff members hearing the talk than the residents, but I'm not sure I directly generated any patients via that visit.

Actually I have gone to one of the local nursing homes and given a presentation as well. Probably that was more of a colossal waste of time than the optom dinners. It was a good idea, just the circumstances that probably frequently arise at nursing homes made it frustrating. They had a lunchtime activity set up every day, sometimes it was arts and crafts, bingo, etc. The day I went it was me giving a talk on the aging eye. About 5 residents showed up as well as a couple of the staff members. However it was fairly frustrating because probably 3 of the 5 were quite demented, and about 5 min into the presentation this lady rolled in on her wheelchair and immediately announced very loudly "I can't hear a $@$@#@ thing you're saying!!!" I tried to speak up as much as I felt comfortable with without outright yelling (I am not a particularly soft-spoken person), but she still couldn't hear and announced so every 2 minutes or so. A couple of the demented residents would intermittently share stories completely unrelated to eyes. After about 10 minutes the wheelchair lady grew increasingly agitated that she couldn't hear and rolled out in a storm of expletives. 5 minutes after that she rolled back in and again complained angrily and loudly that she couldn't hear. It was more comical than anything, but fairly frustrating as well. Probably much more value in the staff members hearing the talk than the residents, but I'm not sure I directly generated any patients via that visit.

:laugh::laugh::laugh: Thanks for the morning laugh, I started to visualize her roll in being irrate etc!

Sometimes it just takes persistence. But what KHE said is really good. Sometimes its just a waiting game as well :sleep:

Good luck. :xf:

Actually I have gone to one of the local nursing homes and given a presentation as well. Probably that was more of a colossal waste of time than the optom dinners. It was a good idea, just the circumstances that probably frequently arise at nursing homes made it frustrating. They had a lunchtime activity set up every day, sometimes it was arts and crafts, bingo, etc. The day I went it was me giving a talk on the aging eye. About 5 residents showed up as well as a couple of the staff members. However it was fairly frustrating because probably 3 of the 5 were quite demented, and about 5 min into the presentation this lady rolled in on her wheelchair and immediately announced very loudly "I can't hear a $@$@#@ thing you're saying!!!" I tried to speak up as much as I felt comfortable with without outright yelling (I am not a particularly soft-spoken person), but she still couldn't hear and announced so every 2 minutes or so. A couple of the demented residents would intermittently share stories completely unrelated to eyes. After about 10 minutes the wheelchair lady grew increasingly agitated that she couldn't hear and rolled out in a storm of expletives. 5 minutes after that she rolled back in and again complained angrily and loudly that she couldn't hear. It was more comical than anything, but fairly frustrating as well. Probably much more value in the staff members hearing the talk than the residents, but I'm not sure I directly generated any patients via that visit.

I didn't mean give talks. I meant approaching the nursing director and offering to be their consulting eye doctor. Tell them that you'll come in one morning a month and see as many patients as they need. Not only will you get 15-20 "exams" in a morning, you'll almost certainly scrounge yourself up a few surgical cases as well.

Actually I have gone to one of the local nursing homes and given a presentation as well. Probably that was more of a colossal waste of time than the optom dinners. It was a good idea, just the circumstances that probably frequently arise at nursing homes made it frustrating. They had a lunchtime activity set up every day, sometimes it was arts and crafts, bingo, etc. The day I went it was me giving a talk on the aging eye. About 5 residents showed up as well as a couple of the staff members. However it was fairly frustrating because probably 3 of the 5 were quite demented, and about 5 min into the presentation this lady rolled in on her wheelchair and immediately announced very loudly "I can't hear a $@$@#@ thing you're saying!!!" I tried to speak up as much as I felt comfortable with without outright yelling (I am not a particularly soft-spoken person), but she still couldn't hear and announced so every 2 minutes or so. A couple of the demented residents would intermittently share stories completely unrelated to eyes. After about 10 minutes the wheelchair lady grew increasingly agitated that she couldn't hear and rolled out in a storm of expletives. 5 minutes after that she rolled back in and again complained angrily and loudly that she couldn't hear. It was more comical than anything, but fairly frustrating as well. Probably much more value in the staff members hearing the talk than the residents, but I'm not sure I directly generated any patients via that visit.

Ugh, that sounds pretty awful. This is why I'm beginning to wish I hadn't gone into a field with such little demand. In my city, half the ophthalmologists could disappear tomorrow and there probably wouldn't be any issue access to care for patients.

Hi all-

I'm in my first year of private practice and I'm wondering what type of volume other people are seeing. On a busy day I will see 25-30 patients, on slower days only 10-12. Average is probably mid teens. I joined an existing practice with one other OMD and 2 OD's. Existing MD sees 40-50/day for 3 days a week. I've been here for 7-8 months now, and volume isn't really ramping up like I had hoped, wondering if that is par for the course or what other people's experience has been.

You shouldn't worry. You are doing OK for a first year in practice, considering the practice doesn't sound like it has too large a captive referral base (i.e., there aren't five O.D.s in house sending you new patients). It takes time.

The busiest doctor I know of in ophthalmology was a glaucoma specialist who saw--no kidding--a hundred patients a day in his clinic. Obviously he used several techs and a fellow to do that (and he burned-out one fellow in four months.) His patients really liked him. He said it took five years to build a good practice, and i believe him.

Be nice to the optometrists. They work hard too and your timeliness and willingness will go a long way toward building their goodwill. I made it a personal policy to never say no to any referral for anything. I also do my level best to get a letter back to any referring doc within 48 hours of the patient visit--that means done, signed and in the mail.

The hardest thing is just being patient without beginning to worry. You will get slow periods for no apparent reason and those always make you uneasy.

And it sounds corny, but you should go out of your way to speak well of the referring doctor directly to the patient. Tell them how glad you are to get referrals from that doctor because you are always pleased at how well he or she looks after their patients. Tell them how fortunate you think they are to have someone so well qualified looking after them, and of course, send them back.

Ugh, that sounds pretty awful. This is why I'm beginning to wish I hadn't gone into a field with such little demand. In my city, half the ophthalmologists could disappear tomorrow and there probably wouldn't be any issue access to care for patients.

I remember a residency classmate wistfully and facetiously saying (as he bemoaned the lack of decent offers in his home state of CA) while the AAO was meeting in SFO "all we need is one good earthquake . . . ."

Nnnnend

my FIL is a canadian ophtho, and he claims US ophtho is severly oversaturated. Demand IS low because supply IS high. Throw in huge OD oversupply, opticians, deregulation, confused public, etc and personally I can't believe I can actually afford to work. When I see local OMDs signing up for discount vision plans (that I won't even sign up for), you just know something is out of balance.

my FIL is a canadian ophtho, and he claims US ophtho is severly oversaturated. Demand IS low because supply IS high. Throw in huge OD oversupply, opticians, deregulation, confused public, etc and personally I can't believe I can actually afford to work. When I see local OMDs signing up for discount vision plans (that I won't even sign up for), you just know something is out of balance.

I feel like I've said this in a lot of threads, but the saturation is clearly regional. I get the feeling that most of the folks on this site hail from densely-populated east coast/west coast cities (e.g., NYC, San Fran, also count Chi-town). Perhaps that accounts for the doom and gloom. There is plenty of volume (and growth potential with the baby boomers coming of age), if you're looking in the right places. AAO has actually been talking about projected shortages of ophthalmologists in the next 10-20 yrs. The established docs in my practice each see 40-60 pts/day (based on preference, not absolute numbers), and they book out for months. We just hired another doc to handle some of the volume. If you want to see 100 pts/day or practice in an already saturated metropolitan area, you will obviously have a tough time. Nevertheless, the jobs (and patients) are out there.

I feel like I've said this in a lot of threads, but the saturation is clearly regional. I get the feeling that most of the folks on this site hail from densely-populated east coast/west coast cities (e.g., NYC, San Fran, also count Chi-town). Perhaps that accounts for the doom and gloom. There is plenty of volume (and growth potential with the baby boomers coming of age), if you're looking in the right places. AAO has actually been talking about projected shortages of ophthalmologists in the next 10-20 yrs. The established docs in my practice each see 40-60 pts/day (based on preference, not absolute numbers), and they book out for months. We just hired another doc to handle some of the volume. If you want to see 100 pts/day or practice in an already saturated metropolitan area, you will obviously have a tough time. Nevertheless, the jobs (and patients) are out there.

As an OD, I'm probably not the most qualified to comment on this but I think that in optometry there are a number of parallels.

What is said here is basically true. There are ODs in large areas struggling mightily and there are ODs in other parts of the country who are making money hand over fist. Location certainly does have something to do with it.

I would be a bit more cautious about the pending baby boomers. Yes, there will be an increased demand for opthalmic services and surgeries in particular but one of the things that I've witnessed even in my short 10 years as an OD is how advances in technology allows few doctors to take care of more patients.

A modern cataract extraction in a skilled surgeons hands can take 10-15 minutes and the recovery is extraordinarily fast.

Compare that to 20 years where an intracap would take an hour, the patient would have to be hospitalized and the followup visits required were numerous and the complications higher.

So again, one reasonably skilled doc in a cataract mill can service far more patients than 10 docs could 20 years ago. Is there any reason to think that that trend will not continue?

I don't know. These are certainly interesting times in the eye care field.

What is said here is basically true. There are ODs in large areas struggling mightily and there are ODs in other parts of the country who are making money hand over fist. Location certainly does have something to do with it.

Location is certainly important. But it's not just the big cities like NYC that have too many OMD's. Even many medium sized middle america cities (like mine) are severely saturated with OMD's too. Also, many people have family reasons that prevent them from moving.


I would be a bit more cautious about the pending baby boomers. Yes, there will be an increased demand for opthalmic services and surgeries in particular but one of the things that I've witnessed even in my short 10 years as an OD is how advances in technology allows few doctors to take care of more patients.

I'm also not getting overly optimistic about the aging baby boomers and their effect on the market. The government cannot afford to put much more total money into medicare. Meanwhile, most OMD's in my city could see twice as many patients as they do now. So while OMD's will be busier with more patients, reimbursements will have to decrease even more. We might just end up working harder for the same amount.

Would you all say that it is difficult for comprehensive Ophthalmologists or does the saturation issue apply to specialists such as Vitreoretinal surgeons as well?

Would you all say that it is difficult for comprehensive Ophthalmologists or does the saturation issue apply to specialists such as Vitreoretinal surgeons as well?

This varies highly by location. Most retina doctors I know are busy. Almost all of them service more than one town or city, dividing their clinic and OR time between them. Same for pediatrics. The others: cornea, glaucoma, plastics depends more on the specific location. The cities with large prominent medical centers that have well-known university-based eye research and treatment centers seem to be fairly saturated.

My advice to anyone considering the field of ophthalmology is DON'T DO IT. Hubby is graduating, no job, and no prospects. He's a fantastic surgeon, very personable and likable. All the older docs that are making 800,000+ a year can't spare more than $100,000 for a starting salary, have completely overvalued their buy-ins and won't pay moving expenses for new associates. Out of the 10 graduates in the the two classes before him, only 1 has a job and he joined Daddy's practice. 4 are doing Retina, 1 Oculoplastics, 2 peds, 1 is not working at all, and 1 hung a shingle and is scraping by in a strip mall and a tiny apartment. It's nice to know that my husband worked his ass off for years, only now to be informed that Ophthalmology is a dying specialty. We're thinking of moving to Australia to work in a medicaid clinic.

Sorry to here that. What city are you in?

I know of 6 jobs in my area offering 150K plus for a general op. Get real...moving to Australia......Smells like a troll.

I know of 6 jobs in my area offering 150K plus for a general op. Get real...moving to Australia......Smells like a troll.

I'm not going to assume troll, but I do suspect a regional bias here. There are clearly jobs out there. Like I posted a while back, my group was searching for 6 months for someone to come in and take over for a retiring comprehensive doc. I'm talking ready-made practice. I'd also like to know where it is that comprehensive docs are pulling down $800k. Retina, maybe, but not comprehensive--unless they are ultra-high volume with lots of cosmetic (e.g., LASIK, Botox, bleph) business.

I'm not going to assume troll, but I do suspect a regional bias here. There are clearly jobs out there. Like I posted a while back, my group was searching for 6 months for someone to come in and take over for a retiring comprehensive doc. I'm talking ready-made practice. I'd also like to know where it is that comprehensive docs are pulling down $800k. Retina, maybe, but not comprehensive--unless they are ultra-high volume with lots of cosmetic (e.g., LASIK, Botox, bleph) business.

Agree about the region, maybe high markets, NYC, etc have no offers at all but from my neck of the woods (the south), there are job offers between 200-300 easily in smaller towns for general. As far as 800K for established, yeah that is a little high but there are a couple around here doing 500-600K.

Absolutely not a troll. Where are all these jobs? In small, crappy places with NOTHING to do? Do YOU want to raise your family in small-town Georgia, Kentucky, NC...the list goes on. Oh yes, there are plenty of high-volume practices in larger cities making big bucks. But, like someone said earlier, every ophthalmology practice could close and no one would notice. Optometry is ruining ophtho business...there are just too many of them and they work cheap. Most patients are unaware of the difference in Ophtho and Optometry, and could give a flip about who they see. Almost every practice in the country is seeing a 25-30% dip in bookings. In the town we live in currently, every ophthalmologist has laid off half or more of their staff, and are doing as few as 3 cataracts a MONTH. It's a dying specialty. Wish we would have known this 5 years ago. Many nurses make more than ophthalmologists and have fewer headaches and responsibilities.

Absolutely not a troll. Where are all these jobs? In small, crappy places with NOTHING to do? Do YOU want to raise your family in small-town Georgia, Kentucky, NC...the list goes on. Oh yes, there are plenty of high-volume practices in larger cities making big bucks. But, like someone said earlier, every ophthalmology practice could close and no one would notice. Optometry is ruining ophtho business...there are just too many of them and they work cheap. Most patients are unaware of the difference in Ophtho and Optometry, and could give a flip about who they see. Almost every practice in the country is seeing a 25-30% dip in bookings. In the town we live in currently, every ophthalmologist has laid off half or more of their staff, and are doing as few as 3 cataracts a MONTH. It's a dying specialty. Wish we would have known this 5 years ago. Many nurses make more than ophthalmologists and have fewer headaches and responsibilities.

I'm still curious to know what metro/big city you are talking about.

The ophthalmology job market is not the greatest, but I wouldn't call it a dying specialty. Like everything else, the recession has hit ophthalmology as well. People lose their jobs, lose insurance. In this economic climate, people will put off getting an eye exam or cataract surgery.

I hope that you're a retina fellow, because that's the only area of ophthalmology that will have any business in 5 years. I wish my husband would have never even done an ophtho rotation. With the new health care reform package, the only specialties that will be left in 5-10 years will be IM, Peds and FP. Specialties such as Derm and Ophtho, which do not operate within the confines of a hospital, will not longer be in business. Patients will be waiting 6 mos or more for an appt with the ones that are left, and probably a year or more for surgery. Good times.

You certainly are bitter. I sure hope your husband has a better attitude.

Absolutely not a troll. Where are all these jobs? In small, crappy places with NOTHING to do? Do YOU want to raise your family in small-town Georgia, Kentucky, NC...the list goes on. Oh yes, there are plenty of high-volume practices in larger cities making big bucks. But, like someone said earlier, every ophthalmology practice could close and no one would notice. Optometry is ruining ophtho business...there are just too many of them and they work cheap. Most patients are unaware of the difference in Ophtho and Optometry, and could give a flip about who they see. Almost every practice in the country is seeing a 25-30% dip in bookings. In the town we live in currently, every ophthalmologist has laid off half or more of their staff, and are doing as few as 3 cataracts a MONTH. It's a dying specialty. Wish we would have known this 5 years ago. Many nurses make more than ophthalmologists and have fewer headaches and responsibilities.

I'm sorry you are having such a hard time finding work. . .But I'm going to have to call complete BS on your assessment of ophthalmology. How is it that you have access to "almost every practice in the country" to know what their booking trends are? You don't. You are upset and shooting off at the keyboard. Definitely not a dying profession, its not the glory days of $2000 cataracts but still definitely a viable and desirable profession. You must be severely limiting the areas you are willing to live in, and that is not ophthalmology's fault. Look at the AAO site, there are plenty of jobs out there. If you are insisting on living in Manhattan then fine, you may be right, ophthalmology is a horrible profession for new grads seeking jobs. For anyone with semireasonable expectations it remains a fantastic field with many opportunities.

Absolutely not a troll. Where are all these jobs? In small, crappy places with NOTHING to do? Do YOU want to raise your family in small-town Georgia, Kentucky, NC...the list goes on. Oh yes, there are plenty of high-volume practices in larger cities making big bucks. But, like someone said earlier, every ophthalmology practice could close and no one would notice. Optometry is ruining ophtho business...there are just too many of them and they work cheap. Most patients are unaware of the difference in Ophtho and Optometry, and could give a flip about who they see. Almost every practice in the country is seeing a 25-30% dip in bookings. In the town we live in currently, every ophthalmologist has laid off half or more of their staff, and are doing as few as 3 cataracts a MONTH. It's a dying specialty. Wish we would have known this 5 years ago. Many nurses make more than ophthalmologists and have fewer headaches and responsibilities.

It's not too late. You can leave your husband for a radiologist. Just sayin...

Just to play devil's advocate here; there is certainly some truth to what OP is saying. There are plenty of specialties that can find jobs ANYWHERE while taking various levels of salary hits, if they wish. But they will mostly likely have a decent job without compromising on location. Not so for ophthalmology. Places like LA, NY, etc. offer NOTHING decent (unless you join Daddy's practice, etc.) or you can get a job that pays you $100K and make you cry every day. I do know a few that opened or bought practices cold and they do live in tiny apartment and do drive tiny cars.

The point is some of us just won't go to rural Montana, even if you can make $1M. Some of us are actually from places like LA, NY, etc. and just want to have a decent paying job near family and friends. I do agree with OP, the future looks rather bleak for ophthalmology at this point. Don't get me wrong, we will have patients; the question is how and how much we are going to be paid.

Just to play devil's advocate here; there is certainly some truth to what OP is saying. There are plenty of specialties that can find jobs ANYWHERE while taking various levels of salary hits, if they wish. But they will mostly likely have a decent job without compromising on location. Not so for ophthalmology. Places like LA, NY, etc. offer NOTHING decent (unless you join Daddy's practice, etc.) or you can get a job that pays you $100K and make you cry every day. I do know a few that opened or bought practices cold and they do live in tiny apartment and do drive tiny cars.

The point is some of us just won't go to rural Montana, even if you can make $1M. Some of us are actually from places like LA, NY, etc. and just want to have a decent paying job near family and friends. I do agree with OP, the future looks rather bleak for ophthalmology at this point. Don't get me wrong, we will have patients; the question is how and how much we are going to be paid.


Exactly. No, I'm not talking about Manhattan, LA...I wouldn't even begin to look in those areas knowing what is out there for even mid-size areas. I think that those of you heaping criticism upon me are either: 1. comfortably settled in a practice, 2. a medical student, or 3. a junior resident or fellow who hasn't yet tried to find a job.

I don't have access to EVERY practice, but I have spoken with just about every recruiter/placement agency in the country and they have all conveyed that the majority of practices have seen a downturn in business in the past 6 months. 3 doctors that we visited/interviewed with have called to say they are no longer pursuing a partner due to slow business. The AAO site at the moment has nothing viable if you've done your research on the various practices listed. Some of the practices are running at 70% overhead...factor in a 21% medicare cut...boom, you're out of business. Even the ones that operate at 45-55% are going to be struggling big time in the next year...unemployment only pays $2000 a month...

Just to play devil's advocate here; there is certainly some truth to what OP is saying. There are plenty of specialties that can find jobs ANYWHERE while taking various levels of salary hits, if they wish. But they will mostly likely have a decent job without compromising on location. Not so for ophthalmology. Places like LA, NY, etc. offer NOTHING decent (unless you join Daddy's practice, etc.) or you can get a job that pays you $100K and make you cry every day. I do know a few that opened or bought practices cold and they do live in tiny apartment and do drive tiny cars.

The point is some of us just won't go to rural Montana, even if you can make $1M. Some of us are actually from places like LA, NY, etc. and just want to have a decent paying job near family and friends. I do agree with OP, the future looks rather bleak for ophthalmology at this point. Don't get me wrong, we will have patients; the question is how and how much we are going to be paid.

Well, once again I'm not arguing that people in your boat who want to go to LA/NY etc are going to have it easy. You're not. What I'm saying is, don't make it sound like the whole of ophthalmology is in trouble just because you can't find a job you are happy with in those areas.


Exactly. No, I'm not talking about Manhattan, LA...I wouldn't even begin to look in those areas knowing what is out there for even mid-size areas. I think that those of you heaping criticism upon me are either: 1. comfortably settled in a practice, 2. a medical student, or 3. a junior resident or fellow who hasn't yet tried to find a job.

I don't have access to EVERY practice, but I have spoken with just about every recruiter/placement agency in the country and they have all conveyed that the majority of practices have seen a downturn in business in the past 6 months. 3 doctors that we visited/interviewed with have called to say they are no longer pursuing a partner due to slow business. The AAO site at the moment has nothing viable if you've done your research on the various practices listed. Some of the practices are running at 70% overhead...factor in a 21% medicare cut...boom, you're out of business. Even the ones that operate at 45-55% are going to be struggling big time in the next year...unemployment only pays $2000 a month...

I certainly won't argue that if the 21% cut takes place, the @#$@#$@ is going to hit the fan. And I won't argue that in general I'm sure a lot of
practices probably have seen somewhat of a decrease in business. I am in my first year of private practice and we have been fortunate that our numbers have held more or less even compared to the year before I arrived (I replaced a retiring doc).

Looking on the AAO website there appear to be plenty of opportunites, offering reasonable salaries. True enough I haven't done any research looking into them. I guess its easy enough for me to say ophtho is fine from my standpoint, having a job already and not having to look for one. I don't envy people who are hitting the job market now. But I do think its a bit melodramatic to say that its a "dying profession." Obviously people are going to continue to need eye care, cataract surgery, etc. Specialties don't really die if you think about it. The circumstances may not be as ideal as in the past but in general for those who are flexible in where they will live, it is a great field to be in. I suspect the same is true for most fields in medicine. I would think whatever problems new ophtho grads are having, people in many other specialties are having the same. Sure there will be cycles with certain specialties being "hot" and in high demand for a few years, but I wouldn't recommend anyone choose a field based on what is hot at the time they are applying for residency. (Take pathology for a fun example) Choose what you love, and understand beforehand that you may be geographically limited.

Best of luck in your search.

I don't have access to EVERY practice, but I have spoken with just about every recruiter/placement agency in the country and they have all conveyed that the majority of practices have seen a downturn in business in the past 6 months. 3 doctors that we visited/interviewed with have called to say they are no longer pursuing a partner due to slow business. The AAO site at the moment has nothing viable if you've done your research on the various practices listed. Some of the practices are running at 70% overhead...factor in a 21% medicare cut...boom, you're out of business. Even the ones that operate at 45-55% are going to be struggling big time in the next year...unemployment only pays $2000 a month...

Let me make an observation as a semi-interested observer:

I think far too many young people, whether they are graduating from college or a professional residency program like ophthalmology sort of have this sense of not really entitlement, but that once they are done with their intensive schooling, that they will be on easy street.

And on some level I can't quite blame them. Older people have always said "study hard, stay in school, go to college and you will get a good job."

In ophthalmology, that sense is magnified many fold I believe because to be an ophthalmologist, you usually have to excel in college, get into medical school and excel there, get into a residency and bust your ass there to get trained. As people pursue that goal, outsiders are always saying "wow! an eye surgeon! That's great! You'll make great money and everyone gets cataracts and/or needs glasses so you can pretty much work ANYWHERE YOU WANT and get paid big money! Yay!"

So people naturally have this sense of "ok, I lived up to my end of the bargain. I busted my butt for years. Now someone pay me."

Of course, it doesn't really work that way.

A "good" job or a high paying salary is something that you either create for yourself by starting/buying a practice or you work for someone else but you can't approach working for someone else with the idea of "someone pay me." You have to approach it with the idea of "ok, what can I do to make money for this person/practice/company."

I think that med students in general, are very bad at having that perspective because first of all, thinking about money is sort of taboo in medicine...it's supposed to be "all about the patient" and everyone just sort of gets it into their head that their medical skills should be enough and really it's not.

So try to think of it that way....what can I do to make this person money?

I have absolutely NO sense of entitlement. Yes, hubby has worked HARD...scholarships, loans, you name it. I worked three jobs to get him through medical school. It's just very disappointing to find that even though he is very business-minded (he's a coding WIZARD) and willing to work VERY hard (he offered to see Saturday clinics 3 weekends a month for one practice), no one is willing to give him a chance. There were jobs that were offered and then fell through at the last minute, all at the end of recruiting season, when there is nothing else available. Everyone's February collections were at an all-time low, and NO ONE that I've met has a job this year. 1 practice we looked at hired an OD instead, so they wouldn't have to share any surgeries. I don't think it's too much to ask that after ALOT of hard work, we would like to live somewhere semi-desirable and make an "okay" salary that allows us to save for retirement, and maybe pay back the student loans before it's time to send the kids to college.

It can take six months or longer to get licensed and credentialed--what is a new physician supposed to do in the mean time? And no, the process doesn't start in January. You are unable to be credentialed with Medicare until you have received your letter of completion from your training program, and then it can take 6 months to be eligible for billing/payment. So say you receive your letter July 1, it can be December before you can see a patient on your own and bill for it. The "tough ****" attitude that is being heaped on me at the moment is the EXACT attitude that every practice we've interviewed with has given us. "We can offer you a job with a six month gap in employment, sorry if you have to be homeless and starve in the mean time."

Household goods are going into storage next week, after which we will be staying with friends.

I have absolutely NO sense of entitlement. Yes, hubby has worked HARD...scholarships, loans, you name it. I worked three jobs to get him through medical school. It's just very disappointing to find that even though he is very business-minded (he's a coding WIZARD) and willing to work VERY hard (he offered to see Saturday clinics 3 weekends a month for one practice), no one is willing to give him a chance. There were jobs that were offered and then fell through at the last minute, all at the end of recruiting season, when there is nothing else available. Everyone's February collections were at an all-time low, and NO ONE that I've met has a job this year. 1 practice we looked at hired an OD instead, so they wouldn't have to share any surgeries. I don't think it's too much to ask that after ALOT of hard work, we would like to live somewhere semi-desirable and make an "okay" salary that allows us to save for retirement, and maybe pay back the student loans before it's time to send the kids to college.

It can take six months or longer to get licensed and credentialed--what is a new physician supposed to do in the mean time? And no, the process doesn't start in January. You are unable to be credentialed with Medicare until you have received your letter of completion from your training program, and then it can take 6 months to be eligible for billing/payment. So say you receive your letter July 1, it can be December before you can see a patient on your own and bill for it. The "tough ****" attitude that is being heaped on me at the moment is the EXACT attitude that every practice we've interviewed with has given us. "We can offer you a job with a six month gap in employment, sorry if you have to be homeless and starve in the mean time."

Household goods are going into storage next week, after which we will be staying with friends.


Have you even considered taking one of the jobs available in the less desirable areas? You can always move of course, so if its as bleak as you say that may be what you have to do.


A couple of other things--during my job search I never really got the sense that there was a "recruiting season." Practices that are looking to hire someone do so year round.

As far as credentialing goes, you are right that it takes a fair amount of time, but you can get the process started without the letter of completion. That can be the last thing you send in.

How has your husband become a coding wizard? In most residencies coding is not something that is emphasized much if at all. You know its out there but it tends to be pretty far down the list of things to worry about.

Now you have me curious as to whether or not the market is nearly as bad as you are saying. I find it interesting that I haven't seen other posts complaining of problems finding jobs.

I have absolutely NO sense of entitlement. Yes, hubby has worked HARD...scholarships, loans, you name it. I worked three jobs to get him through medical school. It's just very disappointing to find that even though he is very business-minded (he's a coding WIZARD) and willing to work VERY hard (he offered to see Saturday clinics 3 weekends a month for one practice), no one is willing to give him a chance. There were jobs that were offered and then fell through at the last minute, all at the end of recruiting season, when there is nothing else available. Everyone's February collections were at an all-time low, and NO ONE that I've met has a job this year. 1 practice we looked at hired an OD instead, so they wouldn't have to share any surgeries. I don't think it's too much to ask that after ALOT of hard work, we would like to live somewhere semi-desirable and make an "okay" salary that allows us to save for retirement, and maybe pay back the student loans before it's time to send the kids to college.

It can take six months or longer to get licensed and credentialed--what is a new physician supposed to do in the mean time? And no, the process doesn't start in January. You are unable to be credentialed with Medicare until you have received your letter of completion from your training program, and then it can take 6 months to be eligible for billing/payment. So say you receive your letter July 1, it can be December before you can see a patient on your own and bill for it. The "tough ****" attitude that is being heaped on me at the moment is the EXACT attitude that every practice we've interviewed with has given us. "We can offer you a job with a six month gap in employment, sorry if you have to be homeless and starve in the mean time."

Household goods are going into storage next week, after which we will be staying with friends.

Where is this mythical city you speak of where ophthalmology is on life support? What alternative locations have you looked at?

I have absolutely NO sense of entitlement. Yes, hubby has worked HARD...scholarships, loans, you name it. I worked three jobs to get him through medical school. It's just very disappointing to find that even though he is very business-minded (he's a coding WIZARD) and willing to work VERY hard (he offered to see Saturday clinics 3 weekends a month for one practice), no one is willing to give him a chance. There were jobs that were offered and then fell through at the last minute, all at the end of recruiting season, when there is nothing else available. Everyone's February collections were at an all-time low, and NO ONE that I've met has a job this year. 1 practice we looked at hired an OD instead, so they wouldn't have to share any surgeries. I don't think it's too much to ask that after ALOT of hard work, we would like to live somewhere semi-desirable and make an "okay" salary that allows us to save for retirement, and maybe pay back the student loans before it's time to send the kids to college.

It can take six months or longer to get licensed and credentialed--what is a new physician supposed to do in the mean time? And no, the process doesn't start in January. You are unable to be credentialed with Medicare until you have received your letter of completion from your training program, and then it can take 6 months to be eligible for billing/payment. So say you receive your letter July 1, it can be December before you can see a patient on your own and bill for it. The "tough ****" attitude that is being heaped on me at the moment is the EXACT attitude that every practice we've interviewed with has given us. "We can offer you a job with a six month gap in employment, sorry if you have to be homeless and starve in the mean time."

Household goods are going into storage next week, after which we will be staying with friends.

I was working and billing Medicare within 2 weeks of finishing residency in July. We started the paperwork in March. Lots of residents moonlight and can get credentialed before they have completed residency. Sounds like the "wizard" needs to do some more homework. Maybe the problem is your husband since no one else here seems to be having the same problems.

I have absolutely NO sense of entitlement. Yes, hubby has worked HARD...scholarships, loans, you name it. I worked three jobs to get him through medical school. It's just very disappointing to find that even though he is very business-minded (he's a coding WIZARD) and willing to work VERY hard (he offered to see Saturday clinics 3 weekends a month for one practice), no one is willing to give him a chance. There were jobs that were offered and then fell through at the last minute, all at the end of recruiting season, when there is nothing else available. Everyone's February collections were at an all-time low, and NO ONE that I've met has a job this year. 1 practice we looked at hired an OD instead, so they wouldn't have to share any surgeries. I don't think it's too much to ask that after ALOT of hard work, we would like to live somewhere semi-desirable and make an "okay" salary that allows us to save for retirement, and maybe pay back the student loans before it's time to send the kids to college.

It can take six months or longer to get licensed and credentialed--what is a new physician supposed to do in the mean time? And no, the process doesn't start in January. You are unable to be credentialed with Medicare until you have received your letter of completion from your training program, and then it can take 6 months to be eligible for billing/payment. So say you receive your letter July 1, it can be December before you can see a patient on your own and bill for it. The "tough ****" attitude that is being heaped on me at the moment is the EXACT attitude that every practice we've interviewed with has given us. "We can offer you a job with a six month gap in employment, sorry if you have to be homeless and starve in the mean time."

Household goods are going into storage next week, after which we will be staying with friends.

There are a couple of ways of handling that:

If you're set on a particular area and there are no jobs forthcoming, your best bet is to either try to get in touch with an old guy and make offer to just buy him out or start your own practice.

As far as not being able to work, if you have a valid medical license, one possibility is filling in at Lenscrafters or some other similar venue. It's not too sexy, particularly for an ophthalmologist but it's a good way to make $300, $400, $500 and up a day just seeing essentially routine patients. That will hold you over till you get credentialled.

don't work in the mall, no more soul sucking place on the earth exists, pts come in with glaucoma, diabetes whatever and expect it to be covered by their discount eyeglass plan, and expect to dictate the care they receive (no DFE, VF, etc). If I start to see ophtho in the mall, I'm getting out of optometry. I wonder can an OMD moonlight as a "general" MD? seeing runny noses or whatever, maybe in an ER or urgent care clinic?

I was working and billing Medicare within 2 weeks of finishing residency in July. We started the paperwork in March. Lots of residents moonlight and can get credentialed before they have completed residency.

Credentialed before completing residency? I've never heard of that. And moonlighting in ophtho is very rare as far as I know.

Most people who get crediential soon after residency are the ones who had a solid job contract signed 6 months before graduating. If you don't have a job, it's not easy to get credentialed on your own.

don't work in the mall, no more soul sucking place on the earth exists, pts come in with glaucoma, diabetes whatever and expect it to be covered by their discount eyeglass plan, and expect to dictate the care they receive (no DFE, VF, etc). If I start to see ophtho in the mall, I'm getting out of optometry. I wonder can an OMD moonlight as a "general" MD? seeing runny noses or whatever, maybe in an ER or urgent care clinic?

They could certainly moonlight in an urgent care center, but it would be sort of shady. How many of us keep up to date on the current IM literature?

They could certainly moonlight in an urgent care center, but it would be sort of shady. How many of us keep up to date on the current IM literature?

How often do you need to be right up to date on the current IM literature to be effective in a walk in clinic?

Suggestions for the original question about how to improve referrals -

Always refer to your optoms for refraction for glasses and CTL's - this may be harder to do if you're not a subspecialist though.

Take care of other providers "dumps" and complications. And speak well of the doc that sent them. The docs that refer these patients to you will really appreciate it.

Send photos/ images/ scans/ fields/ etc. with your letters when possible. It's not a huge thing but it's easy and will make your consult letters a little nicer.

It may not be possible depending on your group and contract, but try to use an ASC owned by another referring group. They will appreciate your business.

Just a few thoughts.

Let me make an observation as a semi-interested observer:

I think far too many young people, whether they are graduating from college or a professional residency program like ophthalmology sort of have this sense of not really entitlement, but that once they are done with their intensive schooling, that they will be on easy street.

I wouldn't call it an "entitlement." Most people who graduate residency expect there to be a "demand" for their skills. That has historically been the case for the past century, and it is the case with the large majority of specialties available to medical students. New ophthalmologists have the expectation that they will be able to find a decent job as easily as their peers who did residencies in different areas.

How often do you need to be right up to date on the current IM literature to be effective in a walk in clinic?

Not to be condescending, but I wouldn't expect somebody who hasn't gone through medical school and internship to understand. Most people in urgent care settings are fine, but occasionally people do come in with serious problems. If you don't have any concerns about practicing substandard medicine, missing something serious, and causing harm to somebody, well then fine. You'd be amazed how quickly the standard of care changes in medicine.

Credentialed before completing residency? I've never heard of that. And moonlighting in ophtho is very rare as far as I know.

Most people who get crediential soon after residency are the ones who had a solid job contract signed 6 months before graduating. If you don't have a job, it's not easy to get credentialed on your own.

Moonlighting by residents is not uncommon in my area. Residents in the final 18 months of practice cover for small practices when the docs want to take vacations. Agree that it is difficult to get credentialed if you don't have a job lined up, but the poster was implying that you couldn't get credentialed until 6 months after completing residency, which is just not true.

don't work in the mall, no more soul sucking place on the earth exists, pts come in with glaucoma, diabetes whatever and expect it to be covered by their discount eyeglass plan, and expect to dictate the care they receive (no DFE, VF, etc). If I start to see ophtho in the mall, I'm getting out of optometry. I wonder can an OMD moonlight as a "general" MD? seeing runny noses or whatever, maybe in an ER or urgent care clinic?

Most residencies will frown on that. It is one of those things that if no one comes right out and forbids it, it is better to ask later for forgiveness rather than sooner for permission. In mine, some residents did do urgent care clinic work, but those that did were quiet about it and, like me, had some independent practice experience from the military.

At my fellowship center, some residents worked for a local eyeglass chain doing exams and no one said anything.

Most residencies will frown on that. It is one of those things that if no one comes right out and forbids it, it is better to ask later for forgiveness rather than sooner for permission. In mine, some residents did do urgent care clinic work, but those that did were quiet about it and, like me, had some independent practice experience from the military.

At my fellowship center, some residents worked for a local eyeglass chain doing exams and no one said anything.

Agree most residencies will frown on moonlighting that is not eye-related. Our institution policy was that you had to get departmental approval for the moonlighting, and if you did your malpractice was covered. I don't recall anyone during my time asking to do urgent care, but I'm pretty sure the request would be declined.

Not to be condescending, but I wouldn't expect somebody who hasn't gone through medical school and internship to understand. Most people in urgent care settings are fine, but occasionally people do come in with serious problems. If you don't have any concerns about practicing substandard medicine, missing something serious, and causing harm to somebody, well then fine. You'd be amazed how quickly the standard of care changes in medicine.

People with serious problems walking in can happen within any practice setting. So again, does one really need to always be current with the latest IM treatment protocols to be effective in a walk in clinic?

I wouldn't call it an "entitlement." Most people who graduate residency expect there to be a "demand" for their skills. That has historically been the case for the past century, and it is the case with the large majority of specialties available to medical students. New ophthalmologists have the expectation that they will be able to find a decent job as easily as their peers who did residencies in different areas.

That's precisely why I said "not really" entitlement.

I understand that people expect there to be a demand for their skills but what residents need to understand is that there skill set alone is not nearly enough to make them effective as an employee or partner.

People with serious problems walking in can happen within any practice setting. So again, does one really need to always be current with the latest IM treatment protocols to be effective in a walk in clinic?

Hence his statement about missing something serious, it's not about treatment.

Hence his statement about missing something serious, it's not about treatment.

Let me ask it a different way then....

What percentage of doctors currently working in the walk in clinics of America are actually up on the latest IM treatment guidelines?

Let me ask it a different way then....

What percentage of doctors currently working in the walk in clinics of America are actually up on the latest IM treatment guidelines?

AGAIN, its not about TREATMENT. Its about misdiagnosing a patient. The fact that you don't get the difference is plain SCARY.

AGAIN, its not about TREATMENT. Its about misdiagnosing a patient. The fact that you don't get the difference is plain SCARY.

*sigh*

Ok....fine....

How many doctors working in the walk in clinics of America are up on the latest IM DIAGNOSIS protocols?

How many presentations that are unusual enough walk into the walk in clinics of America every day such that it would be ideal to have an IM doctor who is up on the latest IM DIAGNOSIS protocols?

*sigh*

Ok....fine....

How many doctors working in the walk in clinics of America are up on the latest IM DIAGNOSIS protocols?

How many presentations that are unusual enough walk into the walk in clinics of America every day such that it would be ideal to have an IM doctor who is up on the latest IM DIAGNOSIS protocols?

Well to put it in perspective, I just bought the latest set of IM diagnosis protocols last year, and they already seem out of date. Hope this helps.

Also, the ratio is usually 1-2 out of 100 diagnosis cannot be made without the latest versions of the protocols for each specialty.

knowledge base, training, and experience have all been rendered obsolete by the protocols.

Well to put it in perspective, I just bought the latest set of IM diagnosis protocols last year, and they already seem out of date. Hope this helps.

Also, the ratio is usually 1-2 out of 100 diagnosis cannot be made without the latest versions of the protocols for each specialty.

knowledge base, training, and experience have all been rendered obsolete by the protocols.

The reason I'm asking is not to be argumentative or contrarian. There is discussion in this thread about a new graduate concerned about not being able to make any money for a bunch of months until they get credentialled onto third party plans. A suggestion was made that they work in an urgent care facility for those 6 months though it might be "shady" because as a new ophthalmology resident they would not be up to date on the latest IM protocols.

My question is......are the vast majority of doctors who work in urgent care centers up to date on these protocols?

Does one need to be up to date on these protocols to be effective to deal with the vast majority of urgent care center encounters? Would the poster in this thread be incompetent/ineffective for 6 months in an urgent care center?

The reason I'm asking is not to be argumentative or contrarian. There is discussion in this thread about a new graduate concerned about not being able to make any money for a bunch of months until they get credentialled onto third party plans. A suggestion was made that they work in an urgent care facility for those 6 months though it might be "shady" because as a new ophthalmology resident they would not be up to date on the latest IM protocols.

My question is......are the vast majority of doctors who work in urgent care centers up to date on these protocols?

Does one need to be up to date on these protocols to be effective to deal with the vast majority of urgent care center encounters? Would the poster in this thread be incompetent/ineffective for 6 months in an urgent care center?

For liability reasons, a clinic manager would probably never consider hiring a subspecialist to do primary care work. The competency question will depend on the individual. But I think most would agree that, as residents, we do not keep up to date on many primary care protocols/algorithms (which can change fairly often). Depending on the clinic, it can be like a mini-ER.

To Bitterwife - it's fine to be frustrated. You both have sacrificed a lot to get where you are now. We all have to vent, but your negativity will accomplish nothing. Many practices across the nation are suffering - but, what do you expect when you have the worse recession in 80 years? The medical field is not immune to the economy (as previously thought). Actually, I am not surprised many people do not seek care - many eye diseases are painless.

I could be as bitter as hell. I have joined a practice without a future. My partner has never had an associate (partly my fault for not doing my due diligence). My clinic volume has dropped 2/3rd (yes, 66-67%) compared to residency. Yes, some days, I bitch and moan at home - but in the end, it does nothing.

You have options, but your husband really needs to get licensed in a state (credentialing is another matter)

1. military jobs - you can often apply for out-of-state military jobs. They will accept a medical license from any state.

2. locums tenens - you did not mention having any kids, so this may be an option. No, it is not ideal, but it will pay the bills.

3. fellowship - if the market is really terrible in your area, this can 'buy' you some time. some fellowships are in high demand, even in an area saturated with general guys

4. solo practice - you said he was already a coding expert and that he was hard working. You can work (not many people have that option) while he is building his practice. We receive no training in business or marketing (and fiscally and personally conservative as a group - ie, anti-risk takers) , so this really scares a lot of us from going solo.

5. temporary (2-3 years) job in the middle of nowhere. You can save money to fund a solo practice in a few years.

6. part-time job - in some practices, you can bill under another physician's medicare number while waiting to be credentialed.

7. VAs - some VAs will pay very well for C&P exams. You do not need medicare credentialing.

Good luck.

*sigh*

Ok....fine....

How many doctors working in the walk in clinics of America are up on the latest IM DIAGNOSIS protocols?

How many presentations that are unusual enough walk into the walk in clinics of America every day such that it would be ideal to have an IM doctor who is up on the latest IM DIAGNOSIS protocols?

All it takes is one. Those of us with real medical degrees actually care about patients enough that we don't want to put someone at risk, even if there is a low chance.

The reason I'm asking is not to be argumentative or contrarian. There is discussion in this thread about a new graduate concerned about not being able to make any money for a bunch of months until they get credentialled onto third party plans. A suggestion was made that they work in an urgent care facility for those 6 months though it might be "shady" because as a new ophthalmology resident they would not be up to date on the latest IM protocols.

My question is......are the vast majority of doctors who work in urgent care centers up to date on these protocols?

Does one need to be up to date on these protocols to be effective to deal with the vast majority of urgent care center encounters? Would the poster in this thread be incompetent/ineffective for 6 months in an urgent care center?

Its not always about being up to date on the latest protocols and algorithms. Its about comfort level and I would suspect that ophthalmology residents, and, since they no longer see acute care general medicine patients anymore, they're less likely to have ready access to the knowledge they would need to be comfortable practicing primary care medicine.

All it takes is one. Those of us with real medical degrees actually care about patients enough that we don't want to put someone at risk, even if there is a low chance.

That's a bit uncalled for.

I could be as bitter as hell. I have joined a practice without a future. My partner has never had an associate (partly my fault for not doing my due diligence). My clinic volume has dropped 2/3rd (yes, 66-67%) compared to residency. Yes, some days, I bitch and moan at home - but in the end, it does nothing.

I'm repeating myself, but how far out of residency are you? If this is your first year out, such a drop is not unexpected. In residency, you're seeing patients in a well-established and usually overloaded practice. Once you start your own practice, it can take 3+ years to build up volume. The exception is when you are taking over for a retiring doc. You may not keep all of that doc's patients, but you aren't starting from scratch, as you are when you go out on your own or even join an existing practice. When you are added to an existing practice, building a steady volume will take time, even if there is initially volume to spare. This is not something that is really discussed in residency or fellowship.

I'm repeating myself, but how far out of residency are you? If this is your first year out, such a drop is not unexpected. In residency, you're seeing patients in a well-established and usually overloaded practice. Once you start your own practice, it can take 3+ years to build up volume. The exception is when you are taking over for a retiring doc. You may not keep all of that doc's patients, but you aren't starting from scratch, as you are when you go out on your own or even join an existing practice. When you are added to an existing practice, building a steady volume will take time, even if there is initially volume to spare. This is not something that is really discussed in residency or fellowship.

Two years out, I average 12-13 patients a full day. I understand most say you need 3-5 years to build a busy practice; but compared to my colleagues, I think I am building incredibly slowly - at this rate, it's going to take 5-8 years. There were existing docs here as well, so there should be some built-in volume. Done all the PCP handshakes, nursing talks, community talks. I don't want to get into all the details, but there is too much inertia here (long time employees, antiquated thinking, and inefficiency).

Ie, new patient will call in for an annual exam - they will schedule two weeks out even though I can see the patient today. My pleas for seeing more patients everyday go unheard.
Ie, new patients still split between the doctors even though the other doctor is booked for six weeks and wants to 'retire' soon.
Ie, constant turnover of front-desk and techs.
Ie, time to process check-in is longer than the entire examination

Honestly, I do not know how they stay in business and I'm afraid to even buy in (if ever offered partnership).

Who knows - maybe they are trying to frustrate me to the point of leaving. Maybe, I am not partnership material.

But, it's my fault for believing the false promises of partnership/volume/surgeries and for not doing my due diligence.

I can complain on and on, but it's useless. Hopefully my experience will be an eye-opener for new grads.

Again, too much inertia. I can't move it, so if I secure a loan, I'm going solo. I'm sure the first few years of solo will be very challenging (and probably tougher than my current situation). But, at least, if I fail, I will have no one to blame but myself. If I can't secure a loan, I'm still moving on.

Two years out, I average 12-13 patients a full day. I understand most say you need 3-5 years to build a busy practice; but compared to my colleagues, I think I am building incredibly slowly - at this rate, it's going to take 5-8 years. There were existing docs here as well, so there should be some built-in volume. Done all the PCP handshakes, nursing talks, community talks. I don't want to get into all the details, but there is too much inertia here (long time employees, antiquated thinking, and inefficiency).

Ie, new patient will call in for an annual exam - they will schedule two weeks out even though I can see the patient today. My pleas for seeing more patients everyday go unheard.
Ie, new patients still split between the doctors even though the other doctor is booked for six weeks and wants to 'retire' soon.
Ie, constant turnover of front-desk and techs.
Ie, time to process check-in is longer than the entire examination

Honestly, I do not know how they stay in business and I'm afraid to even buy in (if ever offered partnership).

Who knows - maybe they are trying to frustrate me to the point of leaving. Maybe, I am not partnership material.

But, it's my fault for believing the false promises of partnership/volume/surgeries and for not doing my due diligence.

I can complain on and on, but it's useless. Hopefully my experience will be an eye-opener for new grads.

Again, too much inertia. I can't move it, so if I secure a loan, I'm going solo. I'm sure the first few years of solo will be very challenging (and probably tougher than my current situation). But, at least, if I fail, I will have no one to blame but myself. If I can't secure a loan, I'm still moving on.

Out of curiosity are you paid on salary or by productivity, or some combination? That does sound frustrating with the old doc still taking a lot of the new patients, especially if he's wanting to retire. How good is your communication with him and your relationship in general with him? I would try to bring it up.

Dealing with front desk issues can be a huge pain, especially in the role of recent associate, they all know who is signing the checks and it isn't you so they have every reason in the world to go out of their way to do things for the boss and no real reason to do anything for you. I hate being a schmoozer but I've had to force myself to do a bit with the front office people and it does help some I've found. Then again, the doctor I work with, also looking to retire in the next few years, has instructed them to put all new patients in with me unless they kick and scream and insist to see him. That is really nice, I have to admit.

Looking at it from the other side of the coin, its probably a really scary time to bring on a new associate, with the economy and healthcare being in such limbo.

Two years out, I average 12-13 patients a full day. I understand most say you need 3-5 years to build a busy practice; but compared to my colleagues, I think I am building incredibly slowly - at this rate, it's going to take 5-8 years. There were existing docs here as well, so there should be some built-in volume. Done all the PCP handshakes, nursing talks, community talks. I don't want to get into all the details, but there is too much inertia here (long time employees, antiquated thinking, and inefficiency).

Ie, new patient will call in for an annual exam - they will schedule two weeks out even though I can see the patient today. My pleas for seeing more patients everyday go unheard.
Ie, new patients still split between the doctors even though the other doctor is booked for six weeks and wants to 'retire' soon.
Ie, constant turnover of front-desk and techs.
Ie, time to process check-in is longer than the entire examination

Honestly, I do not know how they stay in business and I'm afraid to even buy in (if ever offered partnership).

Who knows - maybe they are trying to frustrate me to the point of leaving. Maybe, I am not partnership material.

But, it's my fault for believing the false promises of partnership/volume/surgeries and for not doing my due diligence.

I can complain on and on, but it's useless. Hopefully my experience will be an eye-opener for new grads.

Again, too much inertia. I can't move it, so if I secure a loan, I'm going solo. I'm sure the first few years of solo will be very challenging (and probably tougher than my current situation). But, at least, if I fail, I will have no one to blame but myself. If I can't secure a loan, I'm still moving on.

If this is true, then your practice's policies are at odds with your interests. They are even at odds with their interests.

You wouldn't be the first to find yourself in the position you are in.

If they control where patients are being scheduled, and they are not active in reducing backlogs for appointments by filling out your schedule and reducing the older doctor's bookings to reasonable length of time, then they are thwarting your efforts to grow and retarding the overall growth of the practice. That hurts everyone.

Everybody wants to retire. What are the alternatives short of working until your practice dwindles (not pretty) or going out with your boots on (usually is accompanied by dwindling, decline of reputation and other not-so-pretty things?)

You need to meet with your principals in an un-distracting setting with no other practice personnel around and lay out your concerns. Get the data together so you can show them--schedules and whatnot--and tell them exactly what you want them to do to fix the scheduling problem (e.g. you see all new referrals and all new patients and anyone "lost" to followup until the seniors get their backlog under control.)

Really, a practice like yours that has senior doctors frustrating patients with long back bookings is just asking for a competitor to move next door and open up. This is a "move in and eat your lunch" scenario in the making. If your practice can't or won't provide timely service, someone else soon will. Someone else with the credit to open a second office and enough time to staff it or a new associate that isn't being held back by a management suffering sloth, stupidity and fear will grow his practice in exactly the place you would like to grow yours.

If after being told what you think needs to be done and the partners do nothing, then you should work on your exit plan.

If this is true, then your practice's policies are at odds with your interests. They are even at odds with their interests.

You wouldn't be the first to find yourself in the position you are in.

If they control where patients are being scheduled, and they are not active in reducing backlogs for appointments by filling out your schedule and reducing the older doctor's bookings to reasonable length of time, then they are thwarting your efforts to grow and retarding the overall growth of the practice. That hurts everyone.

Everybody wants to retire. What are the alternatives short of working until your practice dwindles (not pretty) or going out with your boots on (usually is accompanied by dwindling, decline of reputation and other not-so-pretty things?)

You need to meet with your principals in an un-distracting setting with no other practice personnel around and lay out your concerns. Get the data together so you can show them--schedules and whatnot--and tell them exactly what you want them to do to fix the scheduling problem (e.g. you see all new referrals and all new patients and anyone "lost" to followup until the seniors get their backlog under control.)

Really, a practice like yours that has senior doctors frustrating patients with long back bookings is just asking for a competitor to move next door and open up. This is a "move in and eat your lunch" scenario in the making. If your practice can't or won't provide timely service, someone else soon will. Someone else with the credit to open a second office and enough time to staff it or a new associate that isn't being held back by a management suffering sloth, stupidity and fear will grow his practice in exactly the place you would like to grow yours.

If after being told what you think needs to be done and the partners do nothing, then you should work on your exit plan.

orbitsurgMD beat me to the punch and, as usual, provides excellent advice. Your scenario is one that's changeable, if appropriate steps are taken. If not, it would be worth looking elsewhere (even if it means starting over), rather than just hanging on until a senior doc retires.

I appreciate the advice.

I have approached the practice manager and senior doctor on many occasions, starting in my first year. I am basically told to be patient and the practice will build. At this rate, I may be dead by the time my practice is thriving. Reading between the lines, they imply that I should be grateful for what I do have. Previous associates have plateaued patient volume - and it's not the typical ceiling (500-600/month) you would imagine. It's more like 250-300 encounters a month.

Frankly, it makes no sense to me. I am salaried (+unattainable bonus), so you would think they would want to build me up as quickly as possible. Changes over the last two years have been done in order to minimize expenses rather than to grow the practice. I think the practice is dying.

I cannot think of why they would do this except (1) the senior doctor is content with 'living off' his current patients, so he has no incentive to re-build another practice. Therefore, he is trying to maximize profits now before retiring and relying on me for a golden parachute (2) senior doc doesn't want me billing/collecting more than he does - giving me leverage in contract negotiations (3) they want me to leave (multiple sources confirm that he has never had a partner).

At least I have favorable non-compete terms (really, none). Will keep everyone updated.

I appreciate the advice.

I have approached the practice manager and senior doctor on many occasions, starting in my first year. I am basically told to be patient and the practice will build. At this rate, I may be dead by the time my practice is thriving. Reading between the lines, they imply that I should be grateful for what I do have. Previous associates have plateaued patient volume - and it's not the typical ceiling (500-600/month) you would imagine. It's more like 250-300 encounters a month.

Frankly, it makes no sense to me. I am salaried (+unattainable bonus), so you would think they would want to build me up as quickly as possible. Changes over the last two years have been done in order to minimize expenses rather than to grow the practice. I think the practice is dying.

I cannot think of why they would do this except (1) the senior doctor is content with 'living off' his current patients, so he has no incentive to re-build another practice. Therefore, he is trying to maximize profits now before retiring and relying on me for a golden parachute (2) senior doc doesn't want me billing/collecting more than he does - giving me leverage in contract negotiations (3) they want me to leave (multiple sources confirm that he has never had a partner).

At least I have favorable non-compete terms (really, none). Will keep everyone updated.

An unattainable bonus is reason enough to exit. If you can't ever see the benefits of the extra patient seen and the extra hour worked, you are being cheated. If the scheduling practices are what are causing this to be the case, then those are what have to change. If they can't understand that, how keeping you from attaining better production will rob you (and them) of the funds needed for you to buy your share of the practice and ultimately of their wished-for "golden parachute," then they are foolish, or they have some other undisclosed plan that doesn't involve you.

As the lawyers like to say, "time is of the essence." They have to get things changed in a timely way. It is not reasonable to string you along while under-supporting you until they feel good and ready to do something else. Every year you live with that is a working year you aren't working under better and more productive circumstances, with them or somewhere else.


Now that I think of it, if you aren't too spendy in lifestyle, you can make it with your present volume on your own. You should write up a business plan and meet with some of the local banks commercial lending departments. Despite all the recent changes, local doctors are good business and good risk. I can tell you for a fact that 12 to 13 patients a day is enough to meet repayment on a modest startup capital equipment loan and a line of credit, pay current expenses on a small office with minimum staff and leave enough to pay yourself and have some money for extra expenses like office lasers. If you bail, maintain good relationships with your former employers if you can; cover their call, don't badmouth them no matter how much you might want to. If their practice is in fact dwindling, you will be around to take patients looking for an alternative. Don't steal their employees, though, that can work against you.

At least I have favorable non-compete terms (really, none). Will keep everyone updated.

Really, a practice like yours that has senior doctors frustrating patients with long back bookings is just asking for a competitor to move next door and open up. This is a "move in and eat your lunch" scenario in the making. If your practice can't or won't provide timely service, someone else soon will. Someone else with the credit to open a second office and enough time to staff it or a new associate that isn't being held back by a management suffering sloth, stupidity and fear will grow his practice in exactly the place you would like to grow yours.

If you have no non-compete, you might consider what orbitsurgMD mentioned. It will take front-end investment, but could pay off in the long term. You've likely accumulated enough business experience and made enough connections in the community that you could pull it off.

If you have no non-compete, you might consider what orbitsurgMD mentioned. It will take front-end investment, but could pay off in the long term. You've likely accumulated enough business experience and made enough connections in the community that you could pull it off.

If he were to pull out and start up on his own, does he have any rights to the patient charts from the old practice? Seems like they would belong to the practice.

An unattainable bonus is reason enough to exit.

I wouldn't say this is always the case, although with the other things going on for Guttata it probably is. I have a bonus written into my contract that I will probably never hit. But, 1. My salary is pretty reasonable and 2. We talked about it while writing the contract and basically I sacrificed a good bonus for very favorable buy in conditions after 2 years of salary. And most importantly I completely trust the senior doc.

If he were to pull out and start up on his own, does he have any rights to the patient charts from the old practice? Seems like they would belong to the practice.

No, but given the way the current practice is being run, Guttata may be able to develop a lot of business quickly with a solo start-up. That was the point orbitsurgMD seemed to be making. There is obviously some risk, but the upside is potentially huge.

I have absolutely NO sense of entitlement. Yes, hubby has worked HARD...scholarships, loans, you name it. I worked three jobs to get him through medical school. It's just very disappointing to find that even though he is very business-minded (he's a coding WIZARD) and willing to work VERY hard (he offered to see Saturday clinics 3 weekends a month for one practice), no one is willing to give him a chance. There were jobs that were offered and then fell through at the last minute, all at the end of recruiting season, when there is nothing else available. Everyone's February collections were at an all-time low, and NO ONE that I've met has a job this year. 1 practice we looked at hired an OD instead, so they wouldn't have to share any surgeries. I don't think it's too much to ask that after ALOT of hard work, we would like to live somewhere semi-desirable and make an "okay" salary that allows us to save for retirement, and maybe pay back the student loans before it's time to send the kids to college.


Broaden your search -- there are definitely jobs out there!

Mrs. Bitter Wife isn't getting much support here but she does have a point.

Ophthalmologists, particularly residents, tend to think they are in a great specialty and make a lot. However, they don't know that there are other specialties where the money is greater. If one is in private practice, the expenses to have a busy practice are high. Equipment and techs are very expensive. If you don't have many techs, you can't see too many patients. An internist can see a patient with a cold in 8 minutes (4 minutes talk, 4 minutes exam) Try refraction and doing all the points of an eye exam. There are too many things to measure in 4 minutes by yourself.

Established ophthalmologists tend to be good businessmen so the offerings to new residents are not very high paying for the workload.

All doctors are hostage to Medicare and politicians. In other professions, your pay is not dictated to you. Private insurance companies based reimbursement on Medicare.

cme2c has the right attitude (I presume). Do eye work because he has some interest and expertise in it and enjoy life earning frequent flyer miles:laugh:

Mrs. Bitter Wife isn't getting much support here but she does have a point.

Ophthalmologists, particularly residents, tend to think they are in a great specialty and make a lot. However, they don't know that there are other specialties where the money is greater. If one is in private practice, the expenses to have a busy practice are high. Equipment and techs are very expensive. If you don't have many techs, you can't see too many patients. An internist can see a patient with a cold in 8 minutes (4 minutes talk, 4 minutes exam) Try refraction and doing all the points of an eye exam. There are too many things to measure in 4 minutes by yourself.

Established ophthalmologists tend to be good businessmen so the offerings to new residents are not very high paying for the workload.

All doctors are hostage to Medicare and politicians. In other professions, your pay is not dictated to you. Private insurance companies based reimbursement on Medicare.

cme2c has the right attitude (I presume). Do eye work because he has some interest and expertise in it and enjoy life earning frequent flyer miles:laugh:

Within the context of a medial practice, what do you all think makes someone a "good" business person vs a "bad" one?

What attributes do you think the good ones have that the bad ones don't?

Within the context of a medial practice, what do you all think makes someone a "good" business person vs a "bad" one?

What attributes do you think the good ones have that the bad ones don't?

I'll bite.

Adaptiblity.

I'll bite.

Adaptiblity.

That's probably a good one. :thumbup:

Anyone else want to chime in?

I'll bite.

Adaptiblity.

Spelling aptitude?