Is Ophtho falling from grace?

[Doc mu]

- Almost half of the work comprehensive ophthos do in clinic could be handled fine by an optometrist + optometrists gaining surgical rights in some states

- Low flexibility since most hospitals do not hire ophthos and would rather contract with PP groups (he said this was because they don't generate ancillary income from consults, labs, imaging...etc) + PP groups offering low salaries due to no competition with hospitals

- Start up costs are prohibitively high (100,000+ for equipment) and maintenance of equipment like opthalmoscopes, lenses...etc is very costly

- Dying surgical volumes (he claimed a cataract surgeon today can service more patients than 10 surgeons could back in the day making the market more of a monopoly where few surgeons do the crushing majority of cases )

- No longer lucrative due to reimbursement cuts, he said he could make more money in-office than doing surgeries and that staying in office is not what he became a surgeon for (he said the only way to make doing procedures worth it was owning an ASC)


I got these from my research on reddit/sdn/other forums, what do you guys think of these points are they true?

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[MstaKing10]

this is poorly researched and not well informed. Too much to discuss here. maybe someone else has more time to discredit this. kind of a non-starter for me. troll level post here.

 

[Trefoil]

Take what I have to say with a grain of salt, as I don’t work in private practice, but I am planning to either buy or start one in the future.

Hospitals can be a pain to negotiate with, but most of our work is outpatient. The main form of competition for PP would come from HMO employers such as Kaiser which offer the flexibility of being an employee that they are referring to. You could also work for PE, but we have a number of threads on that already. Depending on your region, these health system options may or may not be good alternatives to PP.

The overhead to start a practice is high, but not extraordinarily so. I think if you are placing a PP in an area where there is a high need you wouldn’t have an issue with the overhead. If you place it in a saturated market, you are going to make a lot of people angry and not have a referral base.

It’s true that owning an ASC is lucrative, but it’s not necessary to make money. I think the amount of money you make from surgery also depends on your ability to identify good candidates for premium lenses, which can be an annoying aspect for some people.

There is actually a ton of need for ophthalmologists. The problem is that many want to live in NYC or LA. Thankfully, many of us would never want to live in those areas. If you move to North Dakota you will probably find a wealth of underserved patients. Medium metro areas similarly often have ample opportunity.

Optometrists can be assets when incorporated correctly. I think ophthalmologists and optometrists function best when working together. There are a few rogue optometrists that want to overthrow our surgical rights, but the vast majority I have worked with have no interest in doing surgery, but they can really optimize a refractive practice and post-op care. They regularly check with me about medical issues and ask me to take over care. If your practice isn’t optimized, you may see a lot of optometry level referrals, but that doesn’t mean they can do our work.

All of this is before considering fellowship, which can create niches in markets that are crowded if you really want to live in a big city.

In short, ophthalmology may require more entrepreneurial skill than some other fields. You aren’t entitled to anything and choosing a saturated market is your own fault. Being afraid to start a PP outside of that market indicates that either a strong desire or need is anchoring that person to an area where they can’t find work.

Sure, you can totally find yourself in a bad situation, but currently the need for ophthalmologists is growing and not shrinking. If you are flexible and reasonably business savvy, it can be a great field for work-life balance.

Unlike the previous poster, I am not certain that this is troll level, but the title is kind of clickbait, which makes it more suspect. I’m giving you the benefit of the doubt here.

 

[dantt]

What the above posters have stated plus a few more.

Actually more flexibility than most since you are not tied to the hospital. You can go anywhere you'd like and hang a shingle. You can't so that in EM,
Gas, rads, path, rad once, etc.

Most important thing to learn entering medicine that they don't teach you in medical school / residency is that you're not entitled to anything. If you want something, go and get it.

 

[Doc mu]

Take what I have to say with a grain of salt, as I don’t work in private practice, but I am planning to either buy or start one in the future.

Hospitals can be a pain to negotiate with, but most of our work is outpatient. The main form of competition for PP would come from HMO employers such as Kaiser which offer the flexibility of being an employee that they are referring to. You could also work for PE, but we have a number of threads on that already. Depending on your region, these health system options may or may not be good alternatives to PP.

The overhead to start a practice is high, but not extraordinarily so. I think if you are placing a PP in an area where there is a high need you wouldn’t have an issue with the overhead. If you place it in a saturated market, you are going to make a lot of people angry and not have a referral base.

It’s true that owning an ASC is lucrative, but it’s not necessary to make money. I think the amount of money you make from surgery also depends on your ability to identify good candidates for premium lenses, which can be an annoying aspect for some people.

There is actually a ton of need for ophthalmologists. The problem is that many want to live in NYC or LA. Thankfully, many of us would never want to live in those areas. If you move to North Dakota you will probably find a wealth of underserved patients. Medium metro areas similarly often have ample opportunity.

Optometrists can be assets when incorporated correctly. I think ophthalmologists and optometrists function best when working together. There are a few rogue optometrists that want to overthrow our surgical rights, but the vast majority I have worked with have no interest in doing surgery, but they can really optimize a refractive practice and post-op care. They regularly check with me about medical issues and ask me to take over care. If your practice isn’t optimized, you may see a lot of optometry level referrals, but that doesn’t mean they can do our work.

All of this is before considering fellowship, which can create niches in markets that are crowded if you really want to live in a big city.

In short, ophthalmology may require more entrepreneurial skill than some other fields. You aren’t entitled to anything and choosing a saturated market is your own fault. Being afraid to start a PP outside of that market indicates that either a strong desire or need is anchoring that person to an area where they can’t find work.

Sure, you can totally find yourself in a bad situation, but currently the need for ophthalmologists is growing and not shrinking. If you are flexible and reasonably business savvy, it can be a great field for work-life balance.

Unlike the previous poster, I am not certain that this is troll level, but the title is kind of clickbait, which makes it more suspect. I’m giving you the benefit of the doubt here.

Thanks for the reply, I will read it with cqre when i am back from my flight btw this is 100% not a troll everything i listed above I got from reddit and this forum

 

[Doc mu]

this is poorly researched and not well informed. Too much to discuss here. maybe someone else has more time to discredit this. kind of a non-starter for me. troll level post here.

Why? I got the stuff here from reddit and this forum

 

[Doc mu]

What the above posters have stated plus a few more.

Actually more flexibility than most since you are not tied to the hospital. You can go anywhere you'd like and hang a shingle. You can't so that in EM,
Gas, rads, path, rad once, etc.

Most important thing to learn entering medicine that they don't teach you in medical school / residency is that you're not entitled to anything. If you want something, go and get it.

how do you think PP compensation compares with hospital revenue sharing compensation?

 

[LightBox]

I would quit Medicine if I had to work in a hospital. Ophtho is a phenomenal profession and allows you time to be a business person in other fields as well. I have a large real estate portfolio and several small businesses in addition to my Ophtho gig. But it was Ophtho that served as the base for all of these assets. And having more time associated with Ophtho was key.

 

[RetinaDude]

- Almost half of the work comprehensive ophthos do in clinic could be handled fine by an optometrist + optometrists gaining surgical rights in some states

- Low flexibility since most hospitals do not hire ophthos and would rather contract with PP groups (he said this was because they don't generate ancillary income from consults, labs, imaging...etc) + PP groups offering low salaries due to no competition with hospitals

- Start up costs are prohibitively high (100,000+ for equipment) and maintenance of equipment like opthalmoscopes, lenses...etc is very costly

- Dying surgical volumes (he claimed a cataract surgeon today can service more patients than 10 surgeons could back in the day making the market more of a monopoly where few surgeons do the crushing majority of cases )

- No longer lucrative due to reimbursement cuts, he said he could make more money in-office than doing surgeries and that staying in office is not what he became a surgeon for (he said the only way to make doing procedures worth it was owning an ASC)


I got these from my research on reddit/sdn/other forums, what do you guys think of these points are they true?

Looks like info gathered by someone who really knows very little about ophthalmology, what ophthalmologist know and actually do, and how the PP works.

There is a huge need for ophthalmology, and it’s not going away anytime soon. Dying surgical volumes?!?! Tell that to the pts around here who are waiting 1-2 months to get in for cataract surgery. And all the cataract surgeons are beyond busy

I’m beyond thankful we no longer deal with hospitals. You can have the hospital BS if you want it. My life is better without it.

A monkey could be trained to do almost any of the procedures we do in any medical/surgical specialty. It’s the decision making before, during, and after that requires the mind/skills of a well trained MD/DO. Work with enough ODs and you’ll quickly learn they are good at what they do but there’s no way they can properly take over the medical, or surgical, skills/knowledge of ophthalmologists.

No longer lucrative?!?! Ha ha ha. Definitely info from someone, or a group of people, who have no clue

 

[Doc mu]

It’s true that owning an ASC is lucrative, but it’s not necessary to make money. I think the amount of money you make from surgery also depends on your ability to identify good candidates for premium lenses, which can be an annoying aspect for some people.

The evolution of ophthalmology economics

Ocular Surgery News | I am going to take a little stroll down memory lane in this commentary and present some personal thoughts on the economic past, present and future of ophthalmology.I committed to ophthalmology in 1972 in my senior year of medical school after completing a 6-week rotation at...

www.healio.com

Acc to this source you can generate about 300,000$ doing cataracts in the current reimbursement rate while you can do 900,000$ from the office, im not sure how accurate this is but if true then doing procedures over just office would not be worth it IMO

 

[Trefoil]

The evolution of ophthalmology economics

Ocular Surgery News | I am going to take a little stroll down memory lane in this commentary and present some personal thoughts on the economic past, present and future of ophthalmology.I committed to ophthalmology in 1972 in my senior year of medical school after completing a 6-week rotation at...

www.healio.com

Acc to this source you can generate about 300,000$ doing cataracts in the current reimbursement rate while you can do 900,000$ from the office, im not sure how accurate this is but if true then doing procedures over just office would not be worth it IMO

Why are they seeing us in the office? Because they know we can manage their issues which includes surgery. I’ve heard that argument from a number of subspecialties. We are more sensitive since a large proportion of our reimbursement comes from Medicare. That is why in the article he recommends adding premium lenses and refractive surgery to your practice. These procedures are cash only, so the numbers he provides are actually based on Medicare rates with no cash procedures. I’ve heard of people doing refractive surgery twice a week and making $450,000. I wouldn’t find that particularly interesting personally, but clearly you can make money with surgery.

Also, the article basically argues that we are doing more surgery and generating more surgery. Medicare just reimburses less. Again, they are seeing us because we can do surgery. They go hand and hand.

He also ends his article with this quote:

‘With a little foresight and planning, the ophthalmologist of the future will continue to enjoy a personally and financially rewarding practice preserving, restoring and enhancing vision. The opportunities in our field are nearly endless. Take a moment to create a 1- and 5-year business plan for yourself and your practice. As Louis Pasteur said, and I repeat regularly to our fellows: “Fortune favors the prepared mind.”’

Which suggest that either you didn’t read the entire article or you are in fact a troll

 

[MstaKing10]

Why? I got the stuff here from reddit and this forum

nuff said

 

[Hanky]

This feels troll-ish. Our surgical days are very lucrative, with the usual variance between surgeons/practices. 20 standard cataracts is a lot of money, and the opportunity to implant premium lenses is a unique opportunity in medicine. The population is getting older, we're doing cataracts in patients who are younger, and cash pay clear lens exchanges are on the rise (think LASIK for middle age). I don't know anyone who has better post-op conversations than a cataract surgeon. "You're 20/20!!! Yes, you can hug me, and thank you for the cookies! I know, it's unbelievable that you forgot how vivid colors could be."

I don't know any optometrists doing cataract surgery.

And this is all just one pathology of the lens in the eye. Now add cornea, glaucoma, retina, etc. Ophthalmology is amazing.

 

[dantt]

This feels troll-ish. Our surgical days are very lucrative, with the usual variance between surgeons/practices. 20 standard cataracts is a lot of money, and the opportunity to implant premium lenses is a unique opportunity in medicine. The population is getting older, we're doing cataracts in patients who are younger, and cash pay clear lens exchanges are on the rise (think LASIK for middle age). I don't know anyone who has better post-op conversations than a cataract surgeon. "You're 20/20!!! Yes, you can hug me, and thank you for the cookies! I know, it's unbelievable that you forgot how vivid colors could be."

I don't know any optometrists doing cataract surgery.

And this is all just one pathology of the lens in the eye. Now add cornea, glaucoma, retina, etc. Ophthalmology is amazing.

Now to be fair those cataract surgeons that are doing dozens of surgeries a day typically do not have those postop conversations.

 

[forchinet121]

I would quit Medicine if I had to work in a hospital. Ophtho is a phenomenal profession and allows you time to be a business person in other fields as well. I have a large real estate portfolio and several small businesses in addition to my Ophtho gig. But it was Ophtho that served as the base for all of these assets. And having more time associated with Ophtho was key.

Can you comment more about how you started businesses and do real estate in addition to being a surgeon? What kind of businesses? That seems very hard to do

 

[Hzreio]

This feels troll-ish. Our surgical days are very lucrative, with the usual variance between surgeons/practices. 20 standard cataracts is a lot of money, and the opportunity to implant premium lenses is a unique opportunity in medicine. The population is getting older, we're doing cataracts in patients who are younger, and cash pay clear lens exchanges are on the rise (think LASIK for middle age). I don't know anyone who has better post-op conversations than a cataract surgeon. "You're 20/20!!! Yes, you can hug me, and thank you for the cookies! I know, it's unbelievable that you forgot how vivid colors could be."

I don't know any optometrists doing cataract surgery.

And this is all just one pathology of the lens in the eye. Now add cornea, glaucoma, retina, etc. Ophthalmology is amazing.

“LASIK for middle age”

You mean LASIK?

 

[Doc mu]

Why are they seeing us in the office? Because they know we can manage their issues which includes surgery. I’ve heard that argument from a number of subspecialties. We are more sensitive since a large proportion of our reimbursement comes from Medicare. That is why in the article he recommends adding premium lenses and refractive surgery to your practice. These procedures are cash only, so the numbers he provides are actually based on Medicare rates with no cash procedures. I’ve heard of people doing refractive surgery twice a week and making $450,000. I wouldn’t find that particularly interesting personally, but clearly you can make money with surgery.

Also, the article basically argues that we are doing more surgery and generating more surgery. Medicare just reimburses less. Again, they are seeing us because we can do surgery. They go hand and hand.

He also ends his article with this quote:

‘With a little foresight and planning, the ophthalmologist of the future will continue to enjoy a personally and financially rewarding practice preserving, restoring and enhancing vision. The opportunities in our field are nearly endless. Take a moment to create a 1- and 5-year business plan for yourself and your practice. As Louis Pasteur said, and I repeat regularly to our fellows: “Fortune favors the prepared mind.”’

Which suggest that either you didn’t read the entire article or you are in fact a troll

I mean yeah sure I get you but I don't think I have ever seen a specialty that is making more out of office than Bread and Butter OR procedures, in ophtho (unless the pt get premiums, LASIK...etc as you said) that is pretty much the case which IMO people should fight against, doing procedures is hard and harrowing especially ophtho microsurgery and Medicare should compensate that fairly

 

[Doc mu]

nuff said

Well, maybe the first 2 points are a bit subjective but you can easily find sources online for the others
Startup costs:

How to Start a Successful Ophthalmology Practice

Ready to maximize your earning potential as an ophthalmologist? With your license and some serious dedication, you can start your own ophthalmology practice!

physiciansthrive.com

Ophthalmology solo practice equipment costs, 2017 version

The 2017 version of buying equipment to outfit an ophthalmology solo practice.

solobuildingblogs.com

The evolution of ophthalmology economics (overhead has increased for the comprehensive ophthalmologist to approximately 70% from the 1972 number of 50%)

Cataract surgery:
The constant evolution of cataract surgery : It is more effective than ever but not available to many who need it (For an experienced surgeon a routine phacoemulsification procedure takes about 15 minutes and is suitable for day case surgery under local anaesthetia.)
Cataract surgery among Medicare beneficiaries - PubMed (While only 5% of cataract surgeons performed more than 500 cataract surgeries annually, these surgeons performed 26% of the total cataract surgeries)


Making more money in the office than OR:
The evolution of ophthalmology economics (Today’s typical comprehensive ophthalmologist generates three times more revenue per year in the office than they do in the OR, unless they own their own surgery suite)

 

[Trefoil]

I mean yeah sure I get you but I don't think I have ever seen a specialty that is making more out of office than Bread and Butter OR procedures, in ophtho (unless the pt get premiums, LASIK...etc as you said) that is pretty much the case which IMO people should fight against, doing procedures is hard and harrowing especially ophtho microsurgery and Medicare should compensate that fairly

Oh, yeah AAO fights Medicare constantly. We are generally at the front line fighting cuts. The cuts are in every specialty though.

What makes ophthalmology a little bit different is that our bread and butter surgery became super efficient! It used to be a much longer surgery with a much longer recovery time. Phacoemulsification basically changed things in a few years. It took Medicare a few years to realize what had happened, so surgeons became very rich for a period. Now the goal is to prevent Medicare from making surgery not worth it. Believe me, I know cataract surgery is stressful and more than worth fair reimbursement.

Medicare is coming for all of us that work on geriatric patients. The population continues to increase, so they are trying to cut costs, but the reality is that they may end up pushing out poorer patients that can’t afford premium treatments if they aren’t careful.

LASIK has always been cash only. The people I heard making $450,000 working two days a week were employees of a large multi center practice. The nice thing about ophthalmology is you can kind of pick your practice mix if you are in the right location. The overhead might be higher, but you can certainly make it work. It’s a specialty that favors the entrepreneurial spirit. Staying in a saturated market is not very business savvy. If you encounter someone that is sour, it’s probably because they are trying to practice in a already established market.