Well, apparently, I'm no longer receiving e-mail notifications of thread updates, so sorry I haven't responded yet. Disclaimer: What I post here is my opinion combined with what facts I may know from having practiced for about 3.5 years. I'm trying to present honest information, much of which is important and often left out of the discussion as "taboo" (e.g., actual numbers), but I don't profess to know everything.
Visionary--Do you find the other averages listed (Cornea making roughly 400, general 380s) to be accurate? Also, with changes in healthcare, do you find one branch of ophtho especially susceptible or particularly impervious?
To be honest, I think retina stands to lose out the most, as we have essentially no cash-only aspects to fall back on (I'm
not going to start peddling friggin' vitamins out of my office!). When bundling of services becomes a reality, we'll be getting a set amount for management of particular diseases, regardless of how much or little imaging and treatment is involved. The more efficient may actually see small revenue increases, whereas the rest will likely see drops. If this goes anything like capitation did back in the 90s, you'll see practices folding, docs retiring early, and the like. It was bad. Those who do cataract (premium IOLs), refractive, and plastics (cosmetic procedures) can fall back on cash-only, in some cases, as many cash-only items and services won't be affected by such cuts. Depends greatly on how the practice is setup, though.
If one owns his own practice, what type of volume is necessary to equal these same numbers? I imagine less?
Again, depends on the practice setup. Volume is only one factor in what you make. How tightly the ship is run is arguably a greater factor. If you have high overhead, that cuts your profits. So, you want to run your practice as efficiently as possible, as you would any business. I know most of us didn't go into medicine to be businessmen and did not receive any significant instruction on it, but there it is. I currently see 30-35 patients per day, 4.5 days per week. There is a tech doing primarily imaging that is available to help out with prepping injections occasionally. I have 2-3 other techs (availability varies depending on illnesses, vacations, etc.). I do not use a scribe (don't see myself doing it either, as I'm not sure I could trust someone enough to document the way I do). Speaking of volume specifically, revenue growth as a function of patient volume is
not linear. If you can squeeze in more patients comfortably with the same staff support, your profits will be higher than if you have to add more staff. Again, efficiency is key.
Are you serious? Is this a common schedule for retinal surgeons? Is this common for ophtho in general?
As stated above, I'm medical retina, so I never see the inside of an OR. No surgical call. No after hours/weekend cases. My schedule is closer to a generalist than a surgical retina doc.
About to make 620k a year working four and a half days a week? That is sick!!!
Of course, with 40-50 patients a day, that averages out to about 200 patients a week. That is a lot! I know some academic docs who see more patients per day, but are only in clinic about 2-3 days a week, so their production is probably not as good as yours. Plus, as you said, their one to two days in the OR are not as productive as your time in clinic.
Are you doing a lot of procedures as well? If you feel comfortable, can you share the average number of procedures you do?
Also, as a medical retina guy, do you take care of retinal tears also? If so, I was just curious as to what you handle as tears versus what you refer out as detachments. Do you do pneumos at all, or are all detachments sent out?
Thanks for all the info you share with us, and congratulations. You have a great gig there!
I do
many more injections than lasers. I probably average about 1-2 lasers per week, and that includes PDTs. I leave all RDs, except small subclinical ones, to the surgeons. No pneumatics. Injections are probably 8-10 per day on average. Most I've done in a day is 21. I schedule lasers (except retinopexies), but I do the injections on the fly. They only take about 10 min to prep and do, and I find they dovetail just fine with the clinic flow. My techs do the prep (the long part), and I just come in for the injection. I can usually see a patient or two during the prep time. I do all bilateral injections same day, even though I only get 50% of the reimbursement for the 2nd injection. It's more convenient for me and the patient that way. Imaging is also a large portion of what I do. For retina, per patient reimbursement is roughly twice that of a generalist. That's where the revenue difference lies.
I personally know of several retina docs that get ICGs on every diabetic retinopathy and ERM pt. These are the same docs that will do multople focals on any diabetic pt (even without csme) and PRP pts with moderate DR. They also always add a few shots of endolaser at the end of PPV/MP cases. I know you don't do this Visionary, but people are foolish to think this abuse is rare, especially when the pts (and insurance companies) are clueless. There is just not enough oversight or "checks and balances" and the professions' reputation suffers because of it.
ICGA for diabetes = no sense. There is no indication for it. Don't see how it could be reimbursed. I'll agree that there are some (perhaps more than I'd like to believe) that overtest and even overtreat for what are perhaps unethical and financial reasons. I don't condone it, but I can see the driving force behind it. You get used to a certain revenue level, then you get cut, so you either 1) drop your personal income, 2) cut your overhead (lay off staff, most likely), or increase your production (order more tests, different tests, etc.). It's sad that this is what medicine has become. Instead of focusing fully on patient care, we have to jump through hoops, cut through red tape, and pray our reimbursements don't get cut again. And before someone comes on about greedy doctors just wanting more and more, I have no problem saying that I spent a couple hundred thousand dollars, 14 years of my life (9, if you take out graduate school, which isn't the norm), and considerable time away from and stress on my family to do what I am doing and I feel I should be compensated well for it. What you'll see, if physician pay keeps dropping, is fewer and fewer people willing to go through what we've been through to become a doctor.
Why would an insurance company pay for an ICG on diabetic retinopathy? I would guess that would be an automatic and easy denial of payment for them.
I'd actually be curious to see what an ICG in DR would even look like.
And I agree with Visionary, ICGs should be done more often in AMD. I'm predicting that they probably will be when Fovista comes out.
I know I'll be doing that. I've seen some of the lesion regression data from the clinical trials. It's going to be a game-changer.
