anything you wish you had known before you decided to go into ophtha?

[fizzbot]

Any negatives/drawbacks of this field? Things you wish someone had told you? So far it seems like I have only heard good things about ophthalmology.

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[DiveMD]

I know a plastic surgeon here in Hawaii that describes ophthalmology in the following way: "ophthalmology is the Cadillac of medicine." Enough said…

 

[JR]

Well put!!!

 

[eyerepairman]

Without even trying, I can think of a dozen things bad about ophthalmology. I enjoy the field but realize that there are many negatives about it.

 

[Pembleton]

Without even trying, I can think of a dozen things bad about ophthalmology. I enjoy the field but realize that there are many negatives about it.

Do you mind elaborating?

 

[fizzbot]

ya do you mind elaborating? enquiring minds want to know

 

[fizzbot]

anyone mind elaborating?

 

[PDT4CNV]

anyone mind elaborating?

Here is my list of negatives for the specialty:

1. High overhead and equipment/technology expenses compared to some other specialties.

2. Continued sub-specialization of the field with lack of board certification for fellowship trained sub-specialists.

3. Inpatient consults from non-ophthalmologist physicians (all ophthalmic knowledge vaporizes after medical school).

4. Optometry, and their quest to physicianize themselves via their political lobby.

5. Medicare.

6. LASIK

 

[Donkeyman]

I defintely agree with all of those PDT4 mentioned.

My biggest concern is optometry pushing so hard for surgical rights (and the decisions being made by legislators). With medical expenses continuing to escalate, I feel that the government is going to continue to look for cheaper alternatives than physicians (be it optometrists, PAs, NPs, CRNAs, etc). I still don't see why ophthalmologists are trying to take on the optometrists by themselves. All MDs should be fighting this fight together, as we should be helping in their turf battles.

Also, why did you put LASIK on your list?

 

[PBEA]

I defintely agree with all of those PDT4 mentioned.

My biggest concern is optometry pushing so hard for surgical rights (and the decisions being made by legislators). With medical expenses continuing to escalate, I feel that the government is going to continue to look for cheaper alternatives than physicians (be it optometrists, PAs, NPs, CRNAs, etc). I still don't see why ophthalmologists are trying to take on the optometrists by themselves. All MDs should be fighting this fight together, as we should be helping in their turf battles.

Also, why did you put LASIK on your list?

Dont be too concerned with optometry's agenda to perform "surgery", as it has little to no effect on ophthalmology, or patient care. It is insignificant and should have no bearing on a decision to pursue ophthalmology, at all.

Maybe he put LASIK on the list because he thinks it drags ophthalmology down. Yes, a marvel of modern science, however, to the public, refractive sx is little more then cosmetic or boutique care ("I think Ill get my eyes done when I have my tummy tucked"). As such the typical "side effects" of this image may be felt by doctors wanting to practice "real" medicine. The obvious downsides of refractive sx leaves little "real" indication in "real" medicine. At least thats how I see it, flame away if you like.

Also PDT, I just want to highlight your 3rd negative on your list, regarding non-ophthalmic docs treating or dealing with eyes. I would suggest that there is very little to vaporize in the first place, so the next time you feel the urge to slam ODs for practicing what they were trained to do, you might want to consider (or just recall #3 on your list) that everyday all over the country eyes get treated by people who cant hardly find the macula or even assess simple visual acuity (they are called MDs).

 

[PDT4CNV]

Dont be too concerned with optometry's agenda to perform "surgery", as it has little to no effect on ophthalmology, or patient care. It is insignificant and should have no bearing on a decision to pursue ophthalmology, at all.


Also PDT, I just want to highlight your 3rd negative on your list, regarding non-ophthalmic docs treating or dealing with eyes. I would suggest that there is very little to vaporize in the first place, so the next time you feel the urge to slam ODs for practicing what they were trained to do, you might want to consider (or just recall #3 on your list) that everyday all over the country eyes get treated by people who cant hardly find the macula or even assess simple visual acuity (they are called MDs).

I think optometry's agenda does have an effect on patient care. I think the effect could be negative.

I also disagree with your "very little to vaporize comment." Your comments were more of a distortion of #3 intended to criticize physicians rather than a "highlight". Physicians who read my post will understand the sarcasm, and that knowledge of the visual system (which is covered well in medical school) has very little to do with the reason for the plethora of sometimes absurd inpatient consults, but that other factors are involved. Internists, FPs, pediatricians, and ER physicians are qualified to diagnose and treat many ophthalmic conditions.

Next, I don't slam OD's for practicing what they were trained to do. I criticize OD's who practice or want to practice what they are NOT properly trained or qualified to do.

Your thoughts on refractive surgery aren't far from mine though.

Finally, please don't cause this thread to degenerate into the usual OD squabbling in the MD forum. If you want to squabble, please squabble among those who will be receptive to it. i.e. not the ophthalmology forum.

 

[PBEA]

I think optometry's agenda does have an effect on patient care. I think the effect could be negative.

Really? Please describe effect.

I also disagree with your "very little to vaporize comment." Your comments were more of a distortion of #3 intended to criticize physicians rather than a "highlight". Physicians who read my post will understand the sarcasm, and that knowledge of the visual system (which is covered well in medical school) has very little to do with the reason for the plethora of sometimes absurd inpatient consults, but that other factors are involved. Internists, FPs, pediatricians, and ER physicians are qualified to diagnose and treat many ophthalmic conditions.

Yeah, and the emporer has no clothes. Look, I dont expect all MDs are thoroughly incapable of treating some eye conditions, Im just relating my experience in practicing with, and around MDs, a few PAs and one or two NPs. You want to continue the charade then have at it.

Next, I don't slam OD's for practicing what they were trained to do. I criticize OD's who practice or want to practice what they are NOT properly trained or qualified to do.

I know you are not talking about me, right?

Your thoughts on refractive surgery aren't far from mine though.

I am truly relieved, really, I mean it this time

Finally, please don't cause this thread to degenerate into the usual OD squabbling in the MD forum. If you want to squabble, please squabble among those who will be receptive to it. i.e. not the ophthalmology forum.

Lastly, if you post with the intention of deriding or casting optometry as irresponsible or incapable of delivering excellent care then you get to hear me tell you otherwise. If you dont like it, why dont you PM an administrator so we can close yet another thread (instead of having a rational discussion of the facts). I dont know what stage of your career you are in, but I think you have much to learn. As they say you get what you asked for. The Governor and elected legislature of New Mexico have provided all the rebuke you should require, yet you persist in malicious attack?

 

[rubensan]

Lastly, if you post with the intention of deriding or casting optometry as irresponsible or incapable of delivering excellent care then you get to hear me tell you otherwise. If you dont like it, why dont you PM an administrator so we can close yet another thread (instead of having a rational discussion of the facts). I dont know what stage of your career you are in, but I think you have much to learn. As they say you get what you asked for. The Governor and elected legislature of New Mexico have provided all the rebuke you should require, yet you persist in malicious attack?

do you believe that all of your posts are rational?

 

[Donkeyman]

Sorry guys...I worried that I might invite the usual optometrists into this thread by my earlier post (I did and am sorry). I would like to have this thread continue for the sake of interested medical students, and not turn into the usual debate.

 

[JR]

You haven't violated any rules in your post; the thread remains open (at least for now). But, given your post history on this forum, have you ever thought that ophthalmologists/residents/medical students here just don't want to hear from you ?

Lastly, if you post with the intention of deriding or casting optometry as irresponsible or incapable of delivering excellent care then you get to hear me tell you otherwise. If you dont like it, why dont you PM an administrator so we can close yet another thread (instead of having a rational discussion of the facts). I dont know what stage of your career you are in, but I think you have much to learn. As they say you get what you asked for. The Governor and elected legislature of New Mexico have provided all the rebuke you should require, yet you persist in malicious attack?

 

[qwopty99]

6. LASIK

just a short mention here (don't jump on this just because it happens to be coming from an OD)

an ophthalmologist i know referred to LASIK as having hurt the image of ophthalmology. i wasn't 100% sure of the nuances of his statement (i'm sure he understands better than i do) and i don't necessarily know that i agree or disagree with it, but it was a perspective that surprised me. he was an older (cataract) surgeon, and he did not do LASIK.

anyone care to comment on this?

 

[PBEA]

ophthalmologists/residents/medical students here just don't want to hear from you ?

Oh, trust me the sentiment has been made clear. Should you all miraculously d/c the endless tirade against optometry then I would have no reason to be combative. I imagine that might not occur though, so I guess I'll just have to continue posting responses.

 

[JR]

Aren't we all lucky

And please let's get this thread back to it's original topic.

 

[rubensan]

historically, MDs did not advertise their services on the radio, television or large billboards. in large urban areas such as los angeles, you can not go 1 mile without encountering an advertisment for LASIK. are we nothing more than cash driven factories for a 5 minute procedure? although refractive surgery has revolutionalized eye care, perhaps we have hurt ourselves by oversaturating certain markets. what was once a $2500 procedure is now $489 at some establishments. how would this have played out differently if only cornea trained ophthalmologists could do LASIK? i think this ties into some of PDT4CNV's comments re: continued subspecialization despite board certification. if any ophthalmologist can do every procedure (retina aside) what is the point of becoming fellowship trained? a lot of these same issues were felt by orthopedic surgery about 15 years ago and was the main driving force behind a decision to subspecialize the field with board certification. now they have hand, spine, etc. some of them feel that this has caused a big bureaucratic nightmare. i do not have any answers, just some food for thought.

just a short mention here (don't jump on this just because it happens to be coming from an OD)

an ophthalmologist i know referred to LASIK as having hurt the image of ophthalmology. i wasn't 100% sure of the nuances of his statement (i'm sure he understands better than i do) and i don't necessarily know that i agree or disagree with it, but it was a perspective that surprised me. he was an older (cataract) surgeon, and he did not do LASIK.

anyone care to comment on this?

 

[qwopty99]

i'm not really sure if the MDs comments were advertising-driven. the gist i kinda got was that "a lot" of MDs were abandoning medical ophthalmology in order to just zap eyes. its in that respect, that he felt lasik had hurt ophthalmology's reputation. this conversation occurred perhaps 5 years ago, so i'm not sure how the market might have changed. i'm sure u all remember how many new laser clinics had opened (then subsequently closed) around the turn of the millennium.

for the OD equivalent, he said he used to know a few good "ODs" who had become bad ODs because all they did now was try to convince their patients to do lasik (since the OD would get a 20% cut for the referral - depending on the arrangement).

 

[MR1]

...continued subspecialization despite board certification. if any ophthalmologist can do every procedure (retina aside) what is the point of becoming fellowship trained? a lot of these same issues were felt by orthopedic surgery about 15 years ago and was the main driving force behind a decision to subspecialize the field with board certification. now they have hand, spine, etc. some of them feel that this has caused a big bureaucratic nightmare. i do not have any answers, just some food for thought.

I have a question about this, why hasn't ophthalmology started board certification for the subspecialities and what bureaucratic nightmare are you talking about Ruben?

I would think BC would only help but I have very limited knowledge here. Also i agree most any opthalmologist can do any surgery except retina but what about the line with focal laser or PRP, when is a referral to retina expected.

 

[KHE]

historically, MDs did not advertise their services on the radio, television or large billboards. in large urban areas such as los angeles, you can not go 1 mile without encountering an advertisment for LASIK. are we nothing more than cash driven factories for a 5 minute procedure? although refractive surgery has revolutionalized eye care, perhaps we have hurt ourselves by oversaturating certain markets. what was once a $2500 procedure is now $489 at some establishments. how would this have played out differently if only cornea trained ophthalmologists could do LASIK? i think this ties into some of PDT4CNV's comments re: continued subspecialization despite board certification. if any ophthalmologist can do every procedure (retina aside) what is the point of becoming fellowship trained? a lot of these same issues were felt by orthopedic surgery about 15 years ago and was the main driving force behind a decision to subspecialize the field with board certification. now they have hand, spine, etc. some of them feel that this has caused a big bureaucratic nightmare. i do not have any answers, just some food for thought.

Most of the places that advertise $499 per eye never actually charge anyone that, or at the very least, the number of patients who pay that fee is extremely small.

What usually happens in those places is this:

"Oh! You have astigmatism! Well, that's $799 per eye then." "Oooo, and you want to have it done with intralase instead of a first generation visx? Well, that's $999 per eye then." "And oh wow! Look at how try your eyes are! We're going to have to plug up those puncta so we get the best results. That's an extra $250 per eye."

So before you know it, even low baller fees start to creep up pretty quickly. Again, having run a refractive surgery center, I have a good idea as to how much it costs and if you're charging that little, you're not going to be in business too long.

For fun, if any of you haven't done so already, go to a few of those places and get your "free evaluation" and see what the fee you get quoted at the end of the exam is. I would bet $50 that 9 times out of 10, its way more than $499 per eye.

 

[rubensan]

I have a question about this, why hasn't ophthalmology started board certification for the subspecialities and what bureaucratic nightmare are you talking about Ruben?

in theory, subspecialization makes sense. the more a dynamic field like ophthalmology advances, the more difficult it becomes to stay abreast of the all the medical literature and surgical techniques. in large uban areas, i think there are some well established unwritten rules. the patient with NVG goes to the glaucoma specialist for high IOP. the glaucoma specialist sends them to the retina specialist for PRP or a squirt of avastin, the retina specialist sends the patient back to the glaucoma specialist for a baerveldt. if retina specialists want referrals, they don't do cataract surgery. how would mandatory board certification change any of this?

now, let's take the smaller to mid-size communnities. well, the competent general ophthalmologist does some simple strabs, trabs and PRP in addition to his phacos without necessarily referring them to the pediatric, glaucoma or retina specialist respectively. more complicated cases requiring ahmeds or vitrectomey get referred to larger urban areas and EVERYONE (patients, general opthalmolgists and specialists) benefits. how would this change with mandatory board certification? instead of 3 ophthalmologists in middletown, USA you now need 1 for every subspecialty and everyone is hurting for work. plus it adds more fuel to the fire for the optometry scope expansion campaign. with mandatory board certification, the generalist can no longer do trabs, blephs, ALT, PRP, Focal. and uh-oh, suddenly there is a "shortage of ophthalmic care in rule communities." sound familiar? guess who is eager to fill that void?

i am not saying that i am against subspecialization. in the current light of oklahoma and new mexico, i am suggesting that we approach it very carefully.

what would happen if suddenly there was a board certifying entity for every part of the eye? i hope that it would not dissolve the glue that unites us.

OK..back to work on my ARVO talk. i'll be presenting on Tuesday afternoon @ 400PM in Palm A if anyone is interested. i could use some friendly faces in the audience!

 

[PDT4CNV]

What's your talk on?

And you presented the CON to subspecialty certifcation quite well. And I agree with that. However, my opinion is that subspecialty certification, if implemented correctly, would not necessarily exclude comprehensive ophthalmologists from treating certain problems. Other specialties have managed just fine with this.

 

[Olddog1]

Anyone who finished residency in the last 12 years will need to go through general board re-cert every 10 years. This includes the MOCK, DOCK, and PORT. All very nice money makers for the AAO. Why would anyone want to add more paperwork, time and effort for board cert for subspecialties? Further sub-specializtion certification would make everyone finishing residency feel obligated to do a fellowship even though you are trained to do much more. Then if you decide to general and have a poor outcome the question would be why did you do the focal laser, primary trab or the horizontal rectus surgery when someone with "subspecializtion certification" is only 50 miles away? Would this mean only cornea/refractive docs can do cataracts? That would go over well.

To answer what the point is of fellowship: You see alot more focused pathology during fellowship allowing you to better treat those patients which are not run of the mill. As you build relationships with other docs in town who can't, or won't, deal with those patients they send them to you. In addition, patients are very savy and with the internet many are seeking out fellowship trained docs due to the percieved (or real in some cases) higher level of care.

 

[azzarah]

What!? Are you serious!? There are drawbacks? I thought ophtho was on the ROAD to happiness.

 

[JR]

Welcome back, azzarah!!!

It's nice to hear from you . Please don't forget us little people when you go on to bigger and better things...