Job Market

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odieoh

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I was just wondering how the soon-to-graduate residents are doing as far as job searches go. Someone on the young ophthalmologist forum is complaining bitterly that the market is catastrophic. Her husband is about to graduate, and it sounds like they want to live in a metropolitan area, which I suspect is a big part of their frustration.

I am only one year out from job hunting and at the time I was looking there seemed to be plenty of opportunities. I haven't seen anyone else complaining of having problems. Sooo. . . how is the market out there?

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I like how you mention "she wants to live in a metropolitan city" with such disgust. G-d forbid, a wife of an ophthalmologist wants to do that. No, we should all live on a farm like you?

By the way, in response to your reply in the referenced thread: you know nothing about me and do not just assume I personally have a hard time finding a job in a location of my choice (you know what happens when you assume, right :)). I am happily employed making probably in the >95th precentile for 2 years out.

I was just wondering how the soon-to-graduate residents are doing as far as job searches go. Someone on the young ophthalmologist forum is complaining bitterly that the market is catastrophic. Her husband is about to graduate, and it sounds like they want to live in a metropolitan area, which I suspect is a big part of their frustration.


Here you go:
http://more.studentdoctor.net/showthread.php?p=9452274

You want me to find more similar threads?

I haven't seen anyone else complaining of having problems
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I like how you mention "she wants to live in a metropolitan city" with such disgust. G-d forbid, a wife of an ophthalmologist wants to do that. No, we should all live on a farm like you?

By the way, in response to your reply in the referenced thread: you know nothing about me and do not just assume I personally have a hard time finding a job in a location of my choice (you know what happens when you assume, right :)). I am happily employed making probably in the >95th precentile for 2 years out.

Here you go:
http://more.studentdoctor.net/showthread.php?p=9452274

You want me to find more similar threads?

.

Wow, why so angry? How are you reading disgust into that sentence? I think its perfectly accurate and not putting any spin on things one way or another.

As to my reply to your post on the other thread. . .not sure how you are seeing it as me thinking anything about you personally. Essentially I was agreeing with you that people who want jobs in bigger cities may have a hard time finding them. I disagree that this is the outlook for the entire country. But thank you for sharing your 95th percentile Epeen, it has been admired by all.

I find it somewhat ironic that you are upset thinking that I am somehow biased against metropolitan lifestyle (which I'm not), yet you have no problem throwing out farm comments to those who choose to live in smaller cities. Who seems disgusted?

As for forum links, yes I would love you to link more if you can find any good ones. The one you linked basically can be summed up with the OP saying "I heard from a friend. . ." and then Mirror Form going on to say that the market is abysmal, then saying there are jobs out there just not good ones, then going back to saying its abysmal. I didn't see a single post saying "I personally am having a hard time finding work." I didn't start this thread because I disbelieve that people are having trouble, I am genuinely curious as to how the market is. I am quite doubtful that is as bad as Bitterwife makes it sound.
 
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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.

As to my reply to your post on the other thread. . .not sure how you are seeing it as me thinking anything about you personally.
You wrote this, right? And thanks for admiring percentiles.

I am not upset, believe you me. You ripped into this person for being frustrated with her situation and made it sound like it is her fault for wanting to live in a "metropolitan area" How dare she.

I find it somewhat ironic that you are upset thinking that I am somehow biased against metropolitan lifestyle (which I'm not), yet you have no problem throwing out farm comments to those who choose to live in smaller cities. Who seems disgusted?


You admitted yourself you have never looked for an ophthalmology job in one of these so called metropolitan areas. So listen to others that have. This person and her husband obviously spent a lot of time looking at opportunities available to them. I am hoping many others reply to these thread so you can get a better perspective.

As for forum links, yes I would love you to link more if you can find any good ones. The one you linked basically can be summed up with the OP saying "I heard from a friend. . ." and then Mirror Form going on to say that the market is abysmal, then saying there are jobs out there just not good ones, then going back to saying its abysmal. I didn't see a single post saying "I personally am having a hard time finding work." I didn't start this thread because I disbelieve that people are having trouble, I am genuinely curious as to how the market is. I am quite doubtful that is as bad as Bitterwife makes it sound.
 
I was just wondering how the soon-to-graduate residents are doing as far as job searches go. Someone on the young ophthalmologist forum is complaining bitterly that the market is catastrophic. Her husband is about to graduate, and it sounds like they want to live in a metropolitan area, which I suspect is a big part of their frustration.

I am only one year out from job hunting and at the time I was looking there seemed to be plenty of opportunities. I haven't seen anyone else complaining of having problems. Sooo. . . how is the market out there?

Doctors of all specialties are starting to find out that they are actually humans and can be affected by our current economic strain just as much as "Joe the Plumber."

Jobs exist, maybe not in desired areas, but they exist. The real problem is that the number of careers are MUCH less than jobs now.
 
I am not upset, believe you me. You ripped into this person for being frustrated with her situation and made it sound like it is her fault for wanting to live in a "metropolitan area" How dare she.


Look, I think for the most part you and I agree. I completely agree that the job market in highly desirable cities is tough right now. I did not rip into the OP for being frustrated with this, or at least that is not what I intended, I'm sorry if it came off that way. In addition I do not have anything against anyone who only wants to live in such areas.

What I do get upset about and what I intended to rip into her for is the way she somehow translates her frustration with job opportunities in areas she likes into ophthalmology somehow now being a "dying field." Regional oversaturation is very very different than it becoming a "dying field." In fact I don't think there is anything different about ophthalmology at all compared to other specialties in regards to high end markets. The biggest most desirable cities will always be tougher to make a living in because there will always be more competition. End of story.

You admitted yourself you have never looked for an ophthalmology job in one of these so called metropolitan areas. So listen to others that have. This person and her husband obviously spent a lot of time looking at opportunities available to them. I am hoping many others reply to these thread so you can get a better perspective.

I agree completely. It won't surprise me a bit to learn that people who are limiting their options to large metropolitan areas are having a frustrating time. The thing I am more curious about is whether people are having a hard time across the board as the OP implies. I am doubting it.
 
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Unfortunately, job market is only a part of this.

This is what we should be worried about:

Long-Term SGR Fix in Limbo
Despite Grassroots Efforts, Necessary Votes Unlikely
In conversations with Senate leadership staff, the Academy has learned today that the proposed three-and-a-half-year Medicare physician pay fix is on life support and the plug will likely be pulled because there are not enough votes to pass the measure. In addition, despite our efforts calling for a long-term sustainable growth rate (SGR) fix, the 19-month reprieve passed in the House is in jeopardy in the Senate because of the cost of the bill.
We will continue to push the Senate for a long-term Medicare physician pay fix. However, given budget pressures, Congress may be forced to pass another 30-day extension to reverse the 21 percent SGR cut that went into effect June 1. Anticipating eventual Congressional action, CMS instructed its contractors to hold claims for the first 10 business days of June, which ends Monday. The Academy recommends that offices continue to submit claims (either way, we expect CMS to automatically reprocess any claims that were paid with the 21 percent cut).
 
Unfortunately, job market is only a part of this.

This is what we should be worried about:

Yes. If the cut actually passes I think there will be some very serious chaos throughout medicine. We have kind of talked about it in my practice, we would have to look very carefully at whether we would still accept medicare. Unfortunately it is a large part of our population, as it is with most practices i would imagine.
 
If the 21.3% Medicare cut stays, that will definitely hurt. I don't think that should be part of the specific job market outlook for ophthalmology, however. No one in medicine will be untouched. Maybe I should try and become a politician. They seem to do pretty well, and the benefits are amazing. You also don't have to really accomplish anything! ;)
 
If the 21.3% Medicare cut stays, that will definitely hurt. I don't think that should be part of the specific job market outlook for ophthalmology, however. No one in medicine will be untouched. Maybe I should try and become a politician. They seem to do pretty well, and the benefits are amazing. You also don't have to really accomplish anything! ;)

It will be a devastating and extremely disruptive event. A lot of practices will no longer participate with Medicare if that happens, i.e., drop assignment. The result will be drop in volumes and further contraction of the employment market in ophthalmology which, while not a field exclusively affected, but which will be among the fields most affected. The unknown effect of dropping a carrier that requires staffing to support billing and coding in most offices may be a broader reevaluation of staffing in typical outpatient practices. Keeping a billing/coding/collection enterprise going is costly, and eliminating all of those overhead costs might turn out to be the only practical alternative to the reduced collections from seeing fewer Medicare patients who will have to pay in full at the time of their service (remember, the current law limits the non-par payment to 115% of the Medicare allowable, which itself is being cut 21.5%, so that the only way to retain even the former allowable payment is to go private contract--completely excluding Medicare coverage from the practice for at least two years and denying payment to the patient for any services obtained under the contract.) Reducing the billing enterprise may make keeping any post-service payment arrangement impractical. The result may be withdrawal from all third-party payment contracts for all payers, not just Medicare. It takes far fewer people to run a cash-pay practice.

Some practices will close. They won't be able to function on the reduced Medicare payment, and they will lose patients because the patients won't be able to afford to pay up front, whether it be amounts "non-par"--less than the former "par"-- or contracted payment.) One of the conditions of any market system, whether free or not is "no market", that is no one can afford to buy at a price that a provider can offer. That is what obtains in many parts of the world, particularly the underdeveloped parts. But it also existed in the East Bloc before 1989. Market failure is not unknown at all; we just have experienced very little of it here, so far.
 
It will be a devastating and extremely disruptive event. A lot of practices will no longer participate with Medicare if that happens, i.e., drop assignment. The result will be drop in volumes and further contraction of the employment market in ophthalmology which, while not a field exclusively affected, but which will be among the fields most affected. The unknown effect of dropping a carrier that requires staffing to support billing and coding in most offices may be a broader reevaluation of staffing in typical outpatient practices. Keeping a billing/coding/collection enterprise going is costly, and eliminating all of those overhead costs might turn out to be the only practical alternative to the reduced collections from seeing fewer Medicare patients who will have to pay in full at the time of their service (remember, the current law limits the non-par payment to 115% of the Medicare allowable, which itself is being cut 21.5%, so that the only way to retain even the former allowable payment is to go private contract--completely excluding Medicare coverage from the practice for at least two years and denying payment to the patient for any services obtained under the contract.) Reducing the billing enterprise may make keeping any post-service payment arrangement impractical. The result may be withdrawal from all third-party payment contracts for all payers, not just Medicare. It takes far fewer people to run a cash-pay practice.

Some practices will close. They won't be able to function on the reduced Medicare payment, and they will lose patients because the patients won't be able to afford to pay up front, whether it be amounts "non-par"--less than the former "par"-- or contracted payment.) One of the conditions of any market system, whether free or not is "no market", that is no one can afford to buy at a price that a provider can offer. That is what obtains in many parts of the world, particularly the underdeveloped parts. But it also existed in the East Bloc before 1989. Market failure is not unknown at all; we just have experienced very little of it here, so far.

Great post and explanation, as usual.

The cut is in effect now. They are trying to do a 1 month extension. But 3 1/2 year fix likely won't happen, per AAO email.
 
It will be a devastating and extremely disruptive event. A lot of practices will no longer participate with Medicare if that happens, i.e., drop assignment. The result will be drop in volumes and further contraction of the employment market in ophthalmology which, while not a field exclusively affected, but which will be among the fields most affected. The unknown effect of dropping a carrier that requires staffing to support billing and coding in most offices may be a broader reevaluation of staffing in typical outpatient practices. Keeping a billing/coding/collection enterprise going is costly, and eliminating all of those overhead costs might turn out to be the only practical alternative to the reduced collections from seeing fewer Medicare patients who will have to pay in full at the time of their service (remember, the current law limits the non-par payment to 115% of the Medicare allowable, which itself is being cut 21.5%, so that the only way to retain even the former allowable payment is to go private contract--completely excluding Medicare coverage from the practice for at least two years and denying payment to the patient for any services obtained under the contract.) Reducing the billing enterprise may make keeping any post-service payment arrangement impractical. The result may be withdrawal from all third-party payment contracts for all payers, not just Medicare. It takes far fewer people to run a cash-pay practice.

Some practices will close. They won't be able to function on the reduced Medicare payment, and they will lose patients because the patients won't be able to afford to pay up front, whether it be amounts "non-par"--less than the former "par"-- or contracted payment.) One of the conditions of any market system, whether free or not is "no market", that is no one can afford to buy at a price that a provider can offer. That is what obtains in many parts of the world, particularly the underdeveloped parts. But it also existed in the East Bloc before 1989. Market failure is not unknown at all; we just have experienced very little of it here, so far.

Well-stated. I don't think the clowns in Washington have any comprehension of what the repercussions of this will be. What many fail to understand is that health care in the US is NOT A FREE MARKET, by any means. We already have a form of socialized medicine: Medicare. Medicare sets the reimbursement rates for everything. Sure, private carriers may pay 110-120% of Medicare allowable, but they always adjust relative to the practices of Medicare. This cut will hit everyone in health care, regardless of the payer mix. Those who have a high percentage of Medicare patients, such as ophthalmology, will obviously feel it first, but the pain will spread like wildfire. Boutique medicine, anyone?
 
agree that times are tough right now... came across a recent radiology resident (or maybe fellow) graduate in the CHICAGO area who has been looking for a job for the past 8 months. no luck... his wife is a dentist in the area which are his geographic limitations.. he said much of his failures are due to the political volatility (gov't compensation) as well as it being a saturated market.
 
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If the 21.3% Medicare cut stays, that will definitely hurt. I don't think that should be part of the specific job market outlook for ophthalmology, however. No one in medicine will be untouched. Maybe I should try and become a politician. They seem to do pretty well, and the benefits are amazing. You also don't have to really accomplish anything! ;)

Seems like your colleague Rand Paul understood this point well :idea:
 
Well, so far there have been zero people reporting personal difficulties finding jobs. . . I am led to believe that the market in general is at least tolerable. We'll see what the future holds.
 
Well, so far there have been zero people reporting personal difficulties finding jobs. . . I am led to believe that the market in general is at least tolerable. We'll see what the future holds.


Well, you can believe what you want but both you and I have been around here long enough to know that there are about 10 attendings who semi-frequently post here (including Andrew who primarily posts to promote his websites and sell products now). If you want to base your opinions on posts (or lack of posts) of 10 people, be my guest :).
 
Eh I'm not claiming this is a scientific poll or anything, it is what it is. Yeah there's not that many people that actually post, but there is a fairly large number who browse the forum. In a way this thread was unnecessary, If there were a huge problem in the job market people would have been on here griping about it already. But I think you have to admit that the fact that not one single person is claiming to have difficulty says something. (Aside from Bitterwife). Not even a single solid secondhand account of someone having difficulty.
 
Just to add to the previous thoughts - obama is apparently trying to prevent the 21% cut. I guess they finally get that w/ that cut, docs are just going to start dropping or not taking medicare patients. I think things for ophtho w/ regards to that will be fine.
 
Just to add to the previous thoughts - obama is apparently trying to prevent the 21% cut. I guess they finally get that w/ that cut, docs are just going to start dropping or not taking medicare patients. I think things for ophtho w/ regards to that will be fine.

I wouldn't assume that to be true. If the cut went through, seeing Medicare patients could become a real money-loser for some doctors. Not every ophthalmologist is getting surgical fees from their encounters with their Medicare patients and those that aren't are in no better place to deal with a substantial cut than are the non-procedural specialties that really would start to withdraw in large numbers.

The remedy will be another kick of the can down the road. The problem is, every time the can re-appears, it gets bigger, as long as the legislation mandating reductions to keep total Medicare expenditures within the spending cap imposed by Congress remains in effect.

In a couple of years, that cut will grow to 33%.
 
Well-stated. I don't think the clowns in Washington have any comprehension of what the repercussions of this will be. What many fail to understand is that health care in the US is NOT A FREE MARKET, by any means. We already have a form of socialized medicine: Medicare. Medicare sets the reimbursement rates for everything. Sure, private carriers may pay 110-120% of Medicare allowable, but they always adjust relative to the practices of Medicare. This cut will hit everyone in health care, regardless of the payer mix. Those who have a high percentage of Medicare patients, such as ophthalmology, will obviously feel it first, but the pain will spread like wildfire. Boutique medicine, anyone?


What fields have a realtively lower percentage of Medicare patients?
 
Just to add to the previous thoughts - obama is apparently trying to prevent the 21% cut. I guess they finally get that w/ that cut, docs are just going to start dropping or not taking medicare patients. I think things for ophtho w/ regards to that will be fine.

Well, the Senate failed to pass a delay of the 21.5% scheduled cut. In most Medicare regions, the delay on payments has reached the final deadline, extended this week until yesterday. Services performed after 1 June will be subject to the cut.

The practices most in jeopardy are primary care and non-procedural specialists. If a wave of Medicare disengagement is to come, I suspect that it will start from there, as these folks are usually busy enough not to be worried about filling schedules. I will feel this possibly since for some of my patients, I rely on having rheumatologists and neurologists being available to see patients with systemic disease who will need workups.

This will not be a good thing for ophthalmology practices. As more than half of the typical practice's patient load is covered by Medicare, those cuts will be felt significantly and immediately. This will have effects on practice capital investment, staff retention and many other aspects of daily practice activity. I expect also that it will have a negative and damaging effect on both the near-term job market in ophthalmology and in the relative appeal of the field to those who might be interested but whose decision might rightly be influenced by prospects for adequate income and the high capital equipment and staffing costs typical for ophthalmology.
 
From AAO:

Senate Votes to Push 21 Percent Medicare Physician Pay Cut to Nov. 30
Appears House Will Vote on the New Plan Next Week
The week has been a rollercoaster for Medicare physician pay, highlighting the urgent need for permanent repeal of the sustainable growth rate system. The Senate this afternoon passed legislation that temporarily reverses the 21 percent Medicare physician pay cut in place since June 1 and provides a 2.2 percent update through Nov. 30. However, because of Senate delays, the House has recessed and is not due to return for votes until Tuesday evening.
CMS today directed contractors to lift the hold on claims for services paid for the first 10 business days of June and begin processing June 1 and later claims under the law’s negative update requirement.

Well, the Senate failed to pass a delay of the 21.5% scheduled cut. In most Medicare regions, the delay on payments has reached the final deadline, extended this week until yesterday. Services performed after 1 June will be subject to the cut.

The practices most in jeopardy are primary care and non-procedural specialists. If a wave of Medicare disengagement is to come, I suspect that it will start from there, as these folks are usually busy enough not to be worried about filling schedules. I will feel this possibly since for some of my patients, I rely on having rheumatologists and neurologists being available to see patients with systemic disease who will need workups.

This will not be a good thing for ophthalmology practices. As more than half of the typical practice's patient load is covered by Medicare, those cuts will be felt significantly and immediately. This will have effects on practice capital investment, staff retention and many other aspects of daily practice activity. I expect also that it will have a negative and damaging effect on both the near-term job market in ophthalmology and in the relative appeal of the field to those who might be interested but whose decision might rightly be influenced by prospects for adequate income and the high capital equipment and staffing costs typical for ophthalmology.
 
From AAO:

Yeah, I got that.

Interesting that they kicked the can just far enough down the road to pass the mid-term elections. My guess is that nobody in Congress wanted to run while Medicare was imploding.

So we can have the same thing in December, being hung out the fourth-story window by the ankle once again.
 
Yeah, I got that.

Interesting that they kicked the can just far enough down the road to pass the mid-term elections. My guess is that nobody in Congress wanted to run while Medicare was imploding.

So we can have the same thing in December, being hung out the fourth-story window by the ankle once again.

I think its a good thing they are extending six months. At least then we should be able to get a couple years of extension. Pretty sad that we are happy for the short term fixes.
 
I think its a good thing they are extending six months. At least then we should be able to get a couple years of extension. Pretty sad that we are happy for the short term fixes.

Not all of us are happy with a "short term", "short sighted" solution.
 
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