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… then why is his opinion even relevant?
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The money has "dried up" in almost every field as reimbursements continue to be slashed and doctors are forced to do more procedures to maintain the same income they used to get (ie. cataracts, arthroscopy, Mohs). So yes the very easy money and sky high reimbursements from 20 years ago are gone.
That being said ophthalmology is still highly lucrative and the average is much higher than 200k, with no real income ceiling for partners or business savvy doctors. People starting in the 200s as a general ophthalmologist are hopefully on a partnership track and will be doubling or tripling their income after 2-3 years. For whatever reason, ophtho tends to have lower starting salaries, which tend to go up drastically after a few years (potentially explained by the number of private groups?) Optho has a pretty good job market, and unbeatable lifestyle, and very good compensation.
This guy is basically saying that ophtho used to be even better in the past, which is probably true, but honestly every field used to be better 10-20 years ago. The only real reason not to do ophtho is if you don't find enjoyment or satisfaction with the specialty and its patients.
Been hearing for 15+ years now from everyone except radiologists about the impending doom of the field due to AI and how it's dead in the water, meanwhile job market is hotter than ever.
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Most salary surveys have ophtho as the lowest paying salary sub usually a bit below anesthesia/radiology. I never understood why those 2 aren't more competitive and why ophtho is still so competitive
spidermedic
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Many ophtho start at $200-$280k for a 2-4 years but the lifestyle is unbeatable and more autonomy than Rads/Anes which is why its much more competitive. So if you consider that rads/anes start ~$450-550k (in the right locations), going the ophtho route is like paying a $1m tax in exchange for a better longterm lifestyle (and pay goes up to $450k)
Rads at least requires a certain type of person who enjoys the type of work. For some people the lack of being "the patient's doctor" or having your own clinic, etc is gonna be a dealbreaker. Also rads boards are notoriously difficult with a lot of physics and other memorization, so for some people the idea of having to have a step 1 level breadth of knowledge again is less appealing than being an expert it one thing. The top places in rads are extremely competitive but there are just enough spots at community programs to even it out into a mid-to-high competitive tier rather than a derm ENT ortho tier.
Can't speak to gas but it's also a very different type of daily flow than most clinic/rounding/surgery based specialties and similarly does not really provide ownership of the patient in most circumstances. But these fields work well for those inclined to them.
What is it about ophtho that is better than rads? From what I understand many rads jobs are 1 on 2 off even.
Those tend to be midnight gigs so you're being compensated a premium for working the hours nobody else wants.
spidermedic
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Those are nighthawk jobs. They're compensated very well (1.5-2x) but when you're 40 years old you want to see your family, and making an extra $200k isn't worth it if it means you miss out on important life events and sleeping when the rest of the world is awake
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Got it, got it.
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As I understand it, outpt surgical specialties derive bulk of their income (millions, despite decreasing Medicare reimbursements) from ambulatory surgical center ownership: money from ancillaries like glasses, employee billings (optometrists, jr surgeons).
Experienced ophthos can see a huge amount of patients, unlike junior surgeons. Two experienced partners can take all patients in a local market. Jr ophthos have to be employees because they can't compete. It also takes $$$$$$ to start an equipment intensive private practice, and hospitals aren't interested in employing ophthos because they don't generate millions in additional tests and referrals. Ophtho only generates about $500k in additional tests, referrals, and bed fees for a hospital, I think. Ophtho sees eye problem, ophtho fixes, so not many tests, referrals, or bed fees are generated. BTW the avg non-ophtho Dr generates $2-3 mil in tests, referrals, and bed fees for a hospital.
But there's the danger of older surgeons preying on young physicians by luring them with a 2 yr partnership track but then firing them 1.9 yrs later, or offering partnership buy-in at outrageous price.
So, jr ophthos have a potentially high ceiling at 45-50 hrs/week, but little leverage at the start.
But it doesn't matter what specialty you're in, The Man will always try to stiff you because med school/residency doesn't teach you about the medicine business.
Experienced ophthos can see a huge amount of patients, unlike junior surgeons. Two experienced partners can take all patients in a local market. Jr ophthos have to be employees because they can't compete. It also takes $$$$$$ to start an equipment intensive private practice, and hospitals aren't interested in employing ophthos because they don't generate millions in additional tests and referrals. Ophtho only generates about $500k in additional tests, referrals, and bed fees for a hospital, I think. Ophtho sees eye problem, ophtho fixes, so not many tests, referrals, or bed fees are generated. BTW the avg non-ophtho Dr generates $2-3 mil in tests, referrals, and bed fees for a hospital.
But there's the danger of older surgeons preying on young physicians by luring them with a 2 yr partnership track but then firing them 1.9 yrs later, or offering partnership buy-in at outrageous price.
So, jr ophthos have a potentially high ceiling at 45-50 hrs/week, but little leverage at the start.
But it doesn't matter what specialty you're in, The Man will always try to stiff you because med school/residency doesn't teach you about the medicine business.
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Had a surgeon tell me in third year of med school tell me I was a ***** for applying to rads because “AI can do it anyway. Not like I need a radiologist to read a scan for me anyway.”🙄
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I know some ophtho guys making 250k and some making comfortably over 7 figures. There are tons of factors at play, but it definitely has not dried up from those I know. Of note, the one making 250k is a new grad and took an employed position where they work less than 40 hours a week. They have no desire to change jobs.
spidermedic
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... lol anesthesia does start at these numbers. Maybe lower in academics but 400k+ in PP is typical. I know PM&R grads getting offered 325+ and 550+ if they do pain. That same group starts gen anesthesia at 450+ and pain anesth also 550+
There is more demand for anesthesia than CRNA expansion can handle. The population is aging and is generally unhealthy.
Another factor not mentioned is younger surgeon employees being left in the cold before partnership when the older surgeons sell the practice to Private Equity…
There is still great income potential in ophthalmology. I’ve heard the same doom and gloom for over 20 years. But things shift and evolve. The retina surgeons used to make the most money. Now it’s the general/cataract surgeons…with revenue from Premium IOL’s, surgical center ownership, and +/-MIG’s, many have surpassed the retina surgeons.
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I only met them since I started med school, so I'm not sure what it took to get there. Of the two I know who make that much one has a pretty crazy life and practices in multiple states (but also would not be surprised if they were making an insane amount of money) and the other has a pretty chill life probably about 40-45 hours of office work weekly. I'm not sure if they have other business or call obligations on top of that though. Both are middle-aged.
I'm not interested in ophtho though, despite their best efforts. So I haven't dug too much on their career paths.
Not necessarily. There are still positions in good practices with partnership potential. Not all employed positions are bad!
The compensation in ophtho gets asked about regularly in the ophtho forum. Just go there to view the discussion from actual ophthalmologists.
There was a brief period where cataracts reimbursement was very high and the surgery had gotten to modern levels of efficiency (i.e., 6-12 minutes). That was the 'golden age.' Ophthalmologists still continue to do very well and most feel that the salary data published my medscape etc is an underestimate. Ophtho is still majority private and the associates (pre-partner) start slow, like $200K but you go much higher once you reach partner. In terms of threats to ophtho, the core billing is typically Medicare so reimbursements may become more of an issue (but all of medicine suffers this), and PE has moved into the space big time. Do not work for PE owned companies when you get out of training. In terms of upside, the field has so much innovation, and there are many cash products that go straight to the bottom line, e.g. laser assisted cataract surgery, premium IOLs, refractive surgery etc.
There was a brief period where cataracts reimbursement was very high and the surgery had gotten to modern levels of efficiency (i.e., 6-12 minutes). That was the 'golden age.' Ophthalmologists still continue to do very well and most feel that the salary data published my medscape etc is an underestimate. Ophtho is still majority private and the associates (pre-partner) start slow, like $200K but you go much higher once you reach partner. In terms of threats to ophtho, the core billing is typically Medicare so reimbursements may become more of an issue (but all of medicine suffers this), and PE has moved into the space big time. Do not work for PE owned companies when you get out of training. In terms of upside, the field has so much innovation, and there are many cash products that go straight to the bottom line, e.g. laser assisted cataract surgery, premium IOLs, refractive surgery etc.
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I think the most important factor as a newly fellowship trained Surgeon is that it takes years to build a practice. This is from an Ortho perspective but as a Junior Attending you do not get the exciting procedures as the senior attending have dibs. You may find yourself having to take more calls than the other seniors and need to build a good relationship with your practice. I'm sure academic jobs it may be less so bc you are salaried by the hospital you are hired by. But there are so many factors to consider...location, size of practice, hospitals you are covering that determine your salary. Yes you may get paid less than someone in another specialty...
At the end of the day the average surgeon make more than primary care. But that is just an average.
My advice is put yourself out there and find the specialty that you love. It is a career with significant hours especially during residency and regardless of what specialty you choose things will get mundane...you gotta find the one where you don't lose that excitement after years and years into practice!
At the end of the day the average surgeon make more than primary care. But that is just an average.
My advice is put yourself out there and find the specialty that you love. It is a career with significant hours especially during residency and regardless of what specialty you choose things will get mundane...you gotta find the one where you don't lose that excitement after years and years into practice!
Avoid PE practices like the plague. As other posters mentioned, the major benefit of ophthalmology is autonomy. PE takes that away, and with it, the high ceiling income potential ophtho offers.
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Couldn't you just tune in to read imaging from a beach in Australia?
Rads is a great field. I'm not sure it's better or worse than ophtho, just different. The right gig in private practice rads has similar or higher income to ophtho and more vacation, although I hear that imaging volumes can be very high.
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If it's not about money then why even worry about that?
This premed/med student “Don’t do it for the money” attitude and community judging of those who even mention the slightest whiff of money has to stop seriously. The world runs on money. There is a difference between being greedy and reasonable. Of course it’s reasonable to think about money, you go into massive debt, miss almost a decade of real earnings and work ridiculous hours for 14$ an hour. You can care for your patients, be kind and empathetic and make a comfortable income all at the same time. Should you make a residency choice solely on money? Of course not, but to ignore money as part of it would be irresponsible and to judge others based on that would be a bit pretentious. Just my two zinc slugs jacketed in copper. Fully expect to be flamed now.
You’re correct! But to choose anesthesia, for example, over ophtho because the “average” salary is $35K greater is a mistake (if you like ophtho a lot better.)
I personally see a huge number of Ophthalmologists retiring. Many are in their 50’s and 60’s, and most who got P.E. buyout money are flush with cash will quit in the next few years... P.E. will die out, and the field will become wide open with jobs everywhere and great salaries.
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I am a training Interventional Radiologist. So let’s first define a lot of money 500k or is 1M? Let’s start with the bigger number for employed positions. Neurosurgery and maybe cardiothoracic in the right scenario and you are going to work a lot! Those are the only two specialty’s that could possibly generate an employed position salary that high in my opinion. Radiology 500k jobs in Private practice are easy to come by 750k 2 year partnership tracks real not that difficult. Having spoke to veteran optho docs that have had a busy private practice for years the majority are making 500k. So yes they likely start a junior off at 200k-250k. So why has Radiology pay stayed high and optho pay gone down? Here is my take. Most radiologist and most ophthalmologist make there living off the professional fee (the fee the doc gets for there service). The professional fee has gone down a lot for optho over the last 25 years! In the 90s optho could realistically make 1M a year. I would say in my opinion to make 1M off the professional fee alone would be impossible in today’s world. But why hasn’t the salary gone down for radiology then?! Again just my take. Complex imaging studies have sky rocketed over the last 25 years. Yes believe it or not there was a time (not that long ago) that not everyone that walked into the ER with chest pain (supposedly radiating to the back) got a CTA. But now they do! So the professional fee probably has gone down for radiology but the increased volume has made up for it hence why it’s not hard to find 500k jobs as a radiologist. So how do you make 1M and not be a neurosurgeon on Q2 call? There is no easy answer. But the answer lies in the getting your hands on a portion of the global fee (the fee the institution gets). If your an optho that means partnering with or starting your own surgical center (yep that’s probably hard to do!). Optho is a great field! But those 90s 1M years private practice jobs are mostly gone.
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idk what people talkin about. salary rises every year based on doximity/merrithawkins recruiting, out pacing inflation for almost every specialty. FM more in demand than ever. Maybe optho is just a different beast because it's outpatient? But primarily hospital based specialties, specially things like cardio, gas, etc. are raking it in. It would be a shame if your an interventional cardiologist for example and not making 1m+ in private practicce you not doing something right.
I completely agree. I was just speaking as to the unfortunate community judgement and ridicule for the mere mention of money being a part of decision making. It is pretentious and derogatory to cohesion needed in medicine especially with how Drs are viewed in society, ie being sued for not prescribing sheep anti parasitic for a virus then being sued for malpractice when they don’t. We have to stand together not drag each other down.
How hard is the rads partner making 750K a year working? When I hear folks throw around those numbers and 10+ weeks vacation it genuinely seems there is no better gig in medicine.
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Ohh don’t mistake it! They get crushed!
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completely anecdotal but my cousin is a partner at a busy retina practice in southern california, pretty well populated area, he clears 1.5-2 million per year. He GRINDS and sees like 80-90 patients on clinic days, but yeah, whoever said the money is gone.....it just depends on how hard you really want to work. And I'm over here grinding for pennies in primary care....he's actually the only doctor i personally know making over a million these days.
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The key in procedural specialty’s is making it so you have a piece of the global fee not just the professional fee. Just my 2 cent resident view.
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Definitely agree with this statement 100%. I mean why is it that Ortho for example is one of the most competitive specialty in USA for this cycle with 1800~ applicants vying for what 850 spots? Whereas, in Canada where the compensation is much much lower theres 60i-70sh applicants for 50 spots. Money is a huge motivational influence where we want to admit it or not. And yes, I agree people that say money should be a non-issue are just straight up lying or have lived a very cush entitled life and lack perspective.
You just have to balance what you desire, $$$, family, prestige, procedural, primary care etc... I mean honestly I know family docs making more than surgeons but bet money this family doctor is working hard seeing a hundreds of patients per day...possibly forgoing weekends to be on call.
A lot of mentors told me you can choose time, $$$, location preference. Easy to have 2 out of the 3 but challenging to have all 3. Priorities also change from when you are a med student at 25, versus 50 when you have family, kids, and a ton of other life factors you have to deal with.
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Never believe salary surveys. I've never filled one out, and from what I see about ophthalmology salaries, they are VERY inaccurate.
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Any retina doc with a couple jonathans is raking in big time. I've seen it personally.
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I can tell you, because I currently live that life.
Ever since I've been in PP, I've heard "this is the Golden Era and soon our incomes are going to go down". Well, so far that has not come true. My income has pretty much gone up or stayed similar for the past 10-12 years.
Never ever let starting salary be your determining factor to decide on a specialty or practice. I think I started at like $150,000 my first year, but I saw what the potential was for the future and bet on myself instead. Glad I did because, once I became partner, I've not made less than $1M per year (usually much more).
I'm retina but the general ophthalmology docs are killing it too. I know retina docs who "only" make $750k/year, but I also know retina docs who bring in $2.5M+/year. Same with general......I'd say a lot of these docs are in the $500k range, but there are a lot who are bringing in $900k-$1M+.
The ones on the higher end do see a lot of pts but there's other ways to bring in side income. Many ophth own (or jointly own) an ASC. A productive, and well run, ASC can generate $150k-$250k per partner per year in additional income. I just show up and do my surgeries every Tuesday and I get an additional $225,000 in my pocket every year. Typical day is starting at 7:30 and being done by 1-2:00 (sometimes done by noon and rarely past 3:00). Pretty good money for a day's work. One of the best investments I've ever made (and I bet a lot of ophthalmologists would tell you the same).
My call is not bad. I don't operate in the middle of the night, and handle most of my call by phone. General ophth is similar. A typical workweek is rarely ever over 40 hours for me, and I'd say its more like 35-38 hours per week. Many of the cataract docs I know only work 4 days per week (including their surgery day) so they are probably only working about 30 hours per week.
There are more ophth retiring each year than are coming out of training. Our population is getting older and requires A LOT of eye care. Yes, ophthalmology is a great field and I would have zero concerns advising any med student to choose it as a career.
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I see you follow Dr Glaucomflecken too
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And you will notice he gets a piece of the global fee (ASC).
Very useful as a student to understand this. Any other critical reimbursement things one should know?
Also in your above post when you say radiologists making bank are getting crushed, what does that functionally mean?
Your posts always give me hope for the future of medicine. Can I ask how much vacation time you're able to take?
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Means when they are working they work really hard!
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I can tell you, because I currently live that life.
Ever since I've been in PP, I've heard "this is the Golden Era and soon our incomes are going to go down". Well, so far that has not come true. My income has pretty much gone up or stayed similar for the past 10-12 years.
Never ever let starting salary be your determining factor to decide on a specialty or practice. I think I started at like $150,000 my first year, but I saw what the potential was for the future and bet on myself instead. Glad I did because, once I became partner, I've not made less than $1M per year (usually much more).
I'm retina but the general ophthalmology docs are killing it too. I know retina docs who "only" make $750k/year, but I also know retina docs who bring in $2.5M+/year. Same with general......I'd say a lot of these docs are in the $500k range, but there are a lot who are bringing in $900k-$1M+.
The ones on the higher end do see a lot of pts but there's other ways to bring in side income. Many ophth own (or jointly own) an ASC. A productive, and well run, ASC can generate $150k-$250k per partner per year in additional income. I just show up and do my surgeries every Tuesday and I get an additional $225,000 in my pocket every year. Typical day is starting at 7:30 and being done by 1-2:00 (sometimes done by noon and rarely past 3:00). Pretty good money for a day's work. One of the best investments I've ever made (and I bet a lot of ophthalmologists would tell you the same).
My call is not bad. I don't operate in the middle of the night, and handle most of my call by phone. General ophth is similar. A typical workweek is rarely ever over 40 hours for me, and I'd say its more like 35-38 hours per week. Many of the cataract docs I know only work 4 days per week (including their surgery day) so they are probably only working about 30 hours per week.
There are more ophth retiring each year than are coming out of training. Our population is getting older and requires A LOT of eye care. Yes, ophthalmology is a great field and I would have zero concerns advising any med student to choose it as a career.
I usually take any where from 6-9 weeks
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Is this type of lifestyle/income only possible in certain areas (ie. not the coasts or right outside a major city)?
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The new grads probably get taken advantage of in PP by their senior colleagues (who profit significantly from their work, in exchange for the new grads becoming partner a few years down the line), and as a new grad you also probably don't have the patient volume that the more senior ophthalmologists have (ophtho is mostly outpatient so it's up to you to attract and retain your patient panel). In contrast, in rads and anesthesia you generally don't own your patients, but instead do shift work for a hospital, so it's easier to have adequate volume on Day 1 on the job.
Also, only the fellowship-trained procedural/surgical ophthalmologists will make a lot more. The ones that are only doing medical management (and are usually not fellowship-trained) make a lot less, so $200ks starting out doesn't seem low for ones that don't do procedures. And with steep declines in insurance reimbursement for many bread and butter ophtho procedures like cataract surgery, even those procedures have small profit margins nowadays and require large volumes to maintain a decent salary. The procedure that are most profitable are the cash-based elective ones like LASIK, but of course that relies on being a good marketer to get people to pay cash for them.
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You’re not being taken advantage of if you sign in as an associate and then make partner. It’s a normal pathway. The practice needs to fill you out and vice versa. New associates lose money for awhile and there is risk to hiring someone with a guaranteed salary. Starting salaries are low because new ophthalmologists don’t generate much revenue. It takes time to build a practice.
The only ophthalmologists that don’t do procedures are neurology trained neuro-ophthalmologists so I have no idea what medical management ophthalmologists you are referring to. As mentioned, having ownership in an ASC significantly supercharges earning potential. Cataract surgery still has significant potneitsl for cash up charges like premium IOLs and laser assisted surgery.
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That’s definitely what I thought you meant by “crushed”.
Also, I don’t think people who go into radiology or ophthalmology got into it slacking off either! Genuine when I say this - good on you for making it into your program!