And keep in mind there are right around 20 spots per year for oculoplastics. So I wouldn't necessarily go into ophthalmology if you felt like you could only do plastics. In fact I don't really think I'd do any specialty that I wouldn't be happy in without a fellowship, because those aren't guaranteed.
And I completely understand how terrifying the future with coverage for all, further government control, and downtrending of reimbursements while moving to less expensive care providers are - but keep in mind that at this point pretty much every specialty is threatened by a mid-level care provider, APN, cRNA, Optoms, Audiology, the list goes on. Remember when cRNAs took off everyone was sure that Anesthesia was dead. The cRNA didn't do a residency or medical school and has seen only a fraction of the cases and pathology of an Anesthesiologist and doesn't have nearly as thorough knowledge of medicine, but they still provide good care when an Anesthesiologist is available for back up. If we can move toward this direction in eye care it will be better for us all. Other fields have recognized the validity of less-but-still-well trained practitioners and have embraced them within their practices. It is ultimately probably better for our patients.
I think that for the good of us all the Optometrists are going to have to realize that pumping out a mountain of graduates is a bad idea and control their numbers before eye care is completely saturated and unprofitable for everyone. The single biggest barrier to that in my opinion is OD oversupply. Because lets get real here that's the reason for pushing scope of practice expansion. If we have to fight for patients it's too hard to work together. If that isn't addressed then the future is competition, and for what little I know it may be dangerous to go into ophthalmology if you aren't comfortable with having to fight for business. If you believe the
2012 survey then 1/3rd of ophthalmologists are making less than $150,000 which is terrifyingly low for someone with the amount of debt that most of us have with the prospect of long hours after surviving the hellatiousness of medical school and residency.
Any attendings in private practice comprehensive feel free to correct me, but I don't even know if any comprehensive docs get on these forums.