Retina Vs Glaucoma

[LASIKguy]

Hello everyone,

I am a PGY3 resident and having a hard time deciding what subspeciality to go into. Your feedback would be appreciated.

Retina:

I started my residency with an interest in retina. Its a great field with awesome surgeries and advancing technology BUT after i did cataracts, i think its a lot of fun and is not boring (looks like that when you watch it) and also I like CE more than retina surgery plus i liked the outcome of CE....vs retina (same vision or slightly better). The new IV injections are cool but they got monotonous even in residency after doing 20 of them.

Glaucoma:

I started my residency hating glaucoma because everyone said its dry. It is dry at times but i think it is an interesting subspeciality. Plus, most glaucoma guys can go cataracts and general stuff which you cannot do as retina specialist.

Cornea: i dont like weird K infections and dont plan to do refractive (even though my nick is LASIKguy )

My Take:
I like cataract surgery, trabs/tubes and retina surgery but if i do retina I have to give up everything else while if i do glaucoma i only give up retina i.e PPVx

I am now thinking of going into glaucoma.

Glaucoma guys -> how is the job market? job security? reimbursement? Any feedback will be appreciated.

Thanks

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[EyeFormation]

I say go off the board and do Peds . Actually, I am doing a Peds fellowship next year, and just felt like giving my chosen specialty a shout. Unfortunately, most people can't get too excited about a new muscle hook !

 

[fatman41]

I worked for a group in college as a tech for a group with a cornea, retina and glaucoma specialist. These guys (including retina) had a day a week in their own ASC in which they knocked out 20cats before starting their subspecialty cases. For retina in particular, is this practice set up common or do most retina surgeons/subspecialist do only subspecialty cases and not do so many cats?

 

[MR1]

I worked for a group in college as a tech for a group with a cornea, retina and glaucoma specialist. These guys (including retina) had a day a week in their own ASC in which they knocked out 20cats before starting their subspecialty cases. For retina in particular, is this practice set up common or do most retina surgeons/subspecialist do only subspecialty cases and not do so many cats?

From who I have talked to, both retina and comprehensive ophtho's, it is dangerous for a retina guy to do CE. The reason is they want a healthy relationship with the comp guys in the community and don't want them thinking they are stealing their CE. As far as cornea and glaucoma, I think most do CE as well, esp the cornea specialists.

Now I have heard of retina specialists in smaller towns doing CE if there is not enough retina to sustain a practice, but I would imagine that is the exception to the rule. Lastly every retina guy I have worked with was too busy with retina surgery to have time for anything else. BUt I am only a M4 hopefully getting into a ophtho residency tomorrow, so my anecdotal experience may not be correct everywhere.

Oh as far as job market for glaucoma specialists, on the interview trail every program it seemed was actively recruiting them. In PP I have no idea the job market.

 

[BTS]

The market is very good for fellowship-trained glaucoma specialists. Most expanding practices are looking for someone who brings something to the table other than comprehensive (ie - glaucoma training). Reimbursement is obviously better for retina than glaucoma (probably by a factor of 2, or maybe more in private practice depending on where you go). Many generalists feel that they can handle medical glaucoma and at least primary trabs (whether this is actually true or not is a topic for another time ). Most retina folks will NOT do cataracts - pisses off the referral base - unless there's some need (can't find someone to take out the cataract in a combined case, or practicing in the middle of nowhere).

Retina specialist lifestyle is less flexible than glaucoma specialist, but not as bad as you probably see wherever you are training right now.

Hope this helps!

 

[IOP]

I think you should do whichever field interests you most.
Having said that, you can't go wrong with either glaucoma
or retina. Here are some pros/cons about each subspecialty.

Glaucoma Pros: Get to do phaco, albeit a lot of the cases
are small pupil and pseudoexfoliation cases. Great job
prospects given a lack of qualified glaucoma specialists
currently. Variety of cases including tube shunt, trabs,
laser procedures on top of the phacoemulsification.
Easier life style...virtually free most wknds.

Glaucoma Cons: Although it pays well enough, it's not retina
money. Clinic can get very busy once you build up patient
base because unlike general or cataract pts, glaucoma pts
require constant follow-up.

Retina Pros: Great money. Interesting pathology.
Cool surgeries.

Retina Cons: Reimbursement for retina procedures will come
down. Look at what happened to all other ophthalmic procedures.
Busier call and life-style is generally worse than anterior segment
ophthalmologists.

 

[GuP]

Do most retina guys have private practices or are they hospital based?

 

[7ontheline]

Currently the glaucoma job market is very good, especially if you are willing to go outside of the large cities. Even in the large cities there are jobs, although of course any urban market is going to be much harder to find a job in.

Some retina guys do phacos, but previous posters are correct in saying that most do not. No one is going to refer you patients if you steal all their surgery.

 

[HannahDH]

Do most retina guys have private practices or are they hospital based?

I am sure there is, but very few I've heard of.

 

[GuP]

Is retina still the highest paid subspecialty of ophtho?