Future of Ophthalmology

[Pigmentosa]

I am a 3rd year medical student and I find the field of ophthalmology very interesting. I have done research during all my years at med school and had almost committed to being an ophthalmologist when all of a sudden I find myself doubting if ophthalmology is an economically stable field.

A couple of weeks ago I heard a senior ophthalmology resident say that there are to many ophthalmologist and that the market is crowded. He also told me that optometrists are a constant menace to the ophthalmologists.

There is obviously some truth to that, but how much importance should I give to this.

I like ophthalmology, but other fields like ENT are close behind in my list of top specialties.

Do you guys feel that ophthalmology will be economically stable for the next 30 years or do you guys feel that although it might not pay as much as it used to it is still very reasonably paid.

Any comments on my preoccupations are highly thanked before hand.

PS- Can ophthalmologic (cataracts,) surgeries become boring after a while???

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[GuP]

Hey - The guy who you said too many is right in a sense - it all depends on what part of the country you look at - urban areas like NYC and other major metropolitan will have an abundance of ophthos, just like any other docs. Turf wars are common in many specialties, not just ophtho. Anesthesia has CRNAs, CT surgeons war w/ cardiologists, and there are plenty more. Nothing new there. The next 30 years no one can predict and if they tell you otherwise they are lying. Specialties usually go on the rise and then cool off. This has been the trend in the past and it may or may not continue in the future. "Economically stable" - that is a very loaded and subjective term. Remember, you are going to be become a doctor and you earning each year will be in the top 5% of the American public. Personally, I think ophtho is an awesome field - you make decent money, do cool surgeries, and eyes can actually help you dx many systemic diseases. The field never gets boring IMO. As for CE - I am pretty sure if anything is done too much, it may get boring. This is just life and will happen in any field - doing lap chole after lap chole will be boring, doing hysterectomies 1000x will also tend to get boring. This may happen or may not - it all depends on your personality. As people live longer, ophthos will be high demand. The field should do well in the future.

 

[PDT4CNV]

I am a 3rd year medical student and I find the field of ophthalmology very interesting. I have done research during all my years at med school and had almost committed to being an ophthalmologist when all of a sudden I find myself doubting if ophthalmology is an economically stable field.

A couple of weeks ago I heard a senior ophthalmology resident say that there are to many ophthalmologist and that the market is crowded. He also told me that optometrists are a constant menace to the ophthalmologists.

There is obviously some truth to that, but how much importance should I give to this.

I like ophthalmology, but other fields like ENT are close behind in my list of top specialties.

Do you guys feel that ophthalmology will be economically stable for the next 30 years or do you guys feel that although it might not pay as much as it used to it is still very reasonably paid.

Any comments on my preoccupations are highly thanked before hand.

PS- Can ophthalmologic (cataracts,) surgeries become boring after a while???

First, the market is not crowded overall. Many big cities have more than enough, but smaller cities and rural areas are somewhat underserved. There is also the issue of whether or not you are talking about comprehensive ophthalmologists versus sub-specialists. For example, a medium sized city can support only a handful of oculoplastic/orbital surgeons or neuro-ophthalmologists whereas the same city can support many more comprehensive ophthalmic surgeons or vitreoretinal surgeons.

Regarding optometry, I think this will continue to be a constant battle. Ophthalmologists are not the only physicians dealing with this problem of auxillary health care providers trying to practice medicine. It is for sure, safe to say that it is certainly less of an issue for certain other specialties though (cardiovascular surgery, radiology, neurosurgery, urology, etc..). However, just as we deal with optometry, anesthesia deals with CRNAs, internists and FPs deal with RNPs and clinical pharmacists, OBGYNs deal with midwives, psychiatists have to put up with psychologists, orthopedic surgeons, sports medicine docs and Rehab Medicine docs have to deal with physical therapists and chiropracters.

Less of a problem is competing with other surgical specialties for procedures. Using ENT as an example, some pediatricians place tubes in kids. Thyroids, tracheal, and esophageal cases are also done by general surgeons. ENT competes with general plastics, ophthalmology, and OMFS for cosmetic facial plastic surgery, cancer reconstruction, and repair of facial fractures. A lot of oropharyngeal surgery is often also done by the OMFS folks.

My opinion is that Ophthalmology will continue to be an excellent field. The variety of diseases encountered keeps it interesting (neurologic, rheumatlogic, neoplastic, primary eye diseases, and systemic diseases with ophthalmic manifestations). The wide variety of surgical procedures also keeps it interesting (cataracts, strabismus, ant. and post. segment laser, corneal, vitreoretinal, glaucoma, facial plastic, and orbital). Even if all you did was cataracts, believe it or not, every cataract case is different which keeps it interesting.

ENT is a great field too. I myself had a hard time deciding and acutally registered for both matches. In the end I chose ophthalmology. I really enjoyed the surgical procedures done by ENT, but I did not particularly enjoy ENT clinic.

You just have to go with what you like the best, both surgically and clinically.

 

[7ontheline]

I would worry more about the state of American health care personally. I highly doubt ophthalmologists are suddenly going to not make money while other specialties rake in the cash. It's much more likely that medicine in general will be much more annoying/less lucrative in the future due to something, whether that be managed care or declining reimbursement or socialization of health care, etc. This is not to say that medicine will necessarily be a bad field, but it's possible. If you're already in med school then I would pick whatever specialty you like best. No matter what you pick you're going to be doing the same things over and over - there is enough variability in most specialties though that things stay fresh.

 

[Andrew_Doan]

I would worry more about the state of American health care personally.

I agree with this. The pie is diminishing, and it will be interesting to see what will happen to reimbursements across the board. At the present time, patients do not pay much out of pocket, and people tend to stop going to the doctor and delay surgeries when they have to pay.

 

[boanssi]

So, now that we're in 2014, what are your opinions of the field?

 

[peter2013]

As far as research and innovation, ophthalmology is as exciting as ever and will continue to be that way. I would rather have some sort of eye problem now than ten years ago. I imagine 10 years from now I will say the same thing.

Financially things are a less certain, but that's the same for every specialty. It's hard to predict what innovations will be lucrative and what the political climate will be for reimbursement. If I had to guess, I would predict that in the near future there won't be any dramatic changes. You'll continue to see a relative decrease (or a slowing in increase) in the payments to costly Medicare expenditures, but nothing drastic. This means a modest slowing in increase (or maybe even a decrease) in ophthalmologist compensations in the 5-10 year frame. However, 10 to 20 years down the road I predict there will be a major change to Medicare/Medicaid. My hope is that it'll be a move towards a more libertarian ideal but it's most likely going to be the other way. I wouldn't be one bit surprised if we had single payer system 25 years from now. This would likely mean a significant decrease in physician compensation spread out over a decade or two, and would significantly impact ophthalmologists.

Predicting the future of medicine as a whole or a specific specialty is a difficult game. And I wouldn't let that be a major criteria in your decision-making process for choosing a specialty. It's extremely hard to foretell innovation/discoveries/politics, especially for the most important years of your career which will be 10-25 years down the road.

 

[tarheel1408]

How do you feel about the optometrist lobby that is seeking surgical privileges?

 

[ophthope]

Woah thread resurrection from 7 years ago! I was still in college when this thread was started! Had terms like "meaningful use" even been uttered yet?

I hope Dr. Doan comments again, I'd love to hear his thoughts on these economic issues given the major changes in healthcare that have occurred in the interim.

 

[boanssi]

How do you feel about the optometrist lobby that is seeking surgical privileges?

My thought exactly.

 

[Mirror Form]

How do you feel about the optometrist lobby that is seeking surgical privileges?

I've stopped worrying about optometrists legislating their way to surgery. I think most optometrists have realized that their surgical lobbying hasn't done the average optom any good. As a comprehensive ophthalmologist I have both the training and license to do vitrectomies, anti-vegf injections, trabs, tubes, blephs, etc. Guess how many of those surgeries I do? Zero. No surgery or procedure exists today that pays enough to make it worthwhile to do unless you're doing a lot of them.

In regard to job market, ophtho is unfortunately very saturated. Not just in large cities, but in pretty much any city. You have to go very very rural to find anywhere with any sort of "demand" for ophtho.

 

[tarheel1408]

I've stopped worrying about optometrists legislating their way to surgery. I think most optometrists have realized that their surgical lobbying hasn't done the average optom any good. As a comprehensive ophthalmologist I have both the training and license to do vitrectomies, anti-vegf injections, trabs, tubes, blephs, etc. Guess how many of those surgeries I do? Zero. No surgery or procedure exists today that pays enough to make it worthwhile to do unless you're doing a lot of them.

In regard to job market, ophtho is unfortunately very saturated. Not just in large cities, but in pretty much any city. You have to go very very rural to find anywhere with any sort of "demand" for ophtho.

How bad do you think the problem is with saturation? I graduate in 2017; if I were to go into ophtho would I have trouble finding a job?

 

[peter2013]

.

 

[Bgladney]

The desirable metro areas are extremely difficult to find an opportunity in and for the future will just get worse. With our current economic conditions and the fact that folks are living longer, those who normally would have retired at 62 or so are now staying in the practice for longer. Ran into a 74 year old still doing surgery the other day.

If you are willing to relocate to a "smaller community", and by my standards, that is a community of around 250,000 or so, there are some great opportunities available.

Part of the issue is that folks are not leaving the metro areas either. While they are unhappy in their positions for a variety of reasons (volume, money, practice, etc), they will not leave the "downtown area".

A few months back I spoke with someone who was unwilling to consider a position with a 45 minute commute from the downtown area because "that was too far". Thus, they were waiting for a position to open with one of many 5 or 6 total practices in the target area. Odds of that opening soon....not good.

From my understanding, this is an issue in all specialties, not just ophthalmology and something that really needs to be addressed in the future.