bonuses & salaries

[joe123456789]

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Based on reading some old threads on ophtho salaries and comparing it with the surveys out there its easy to see some inconsistencies. My question is is this because ophthomology relies heavily on bonuses? Starting salaries of just 100k are pretty low and there isnt really a way a field like ophtho would remain this competitive if that was truly the average income coming out of residency.

 

[orbitsurgMD]

Based on reading some old threads on ophtho salaries and comparing it with the surveys out there its easy to see some inconsistencies. My question is is this because ophthomology relies heavily on bonuses? Starting salaries of just 100k are pretty low and there isnt really a way a field like ophtho would remain this competitive if that was truly the average income coming out of residency.

What is your particular interest? Are you a medical student? What "surveys out there" are you referring to? What do you think is "inconsistent?"

There is no centrally-governing rule about how individual practices choose to compensate associates, although there are common features to many compensation packages. Bonus pay based on productivity is a common practice.

Are you doubting the amounts you have heard are being offered?

There are reasons other than financial, let alone starting salaries, that ophthalmology remains attractive and competitive in drawing residency candidates.

There is a misperception about how high ophthalmology incomes are, largely the legacy of the times when cataract surgery paid several times what it does today. But that time is more than ten, and closer to 20 years ago. Still, the perception of outsize incomes persists, incorrect as it is. Those that earn large incomes either work where there is a relative undersupply of specialists and see large numbers of patients, or they make income from non-clinical sources, like real estate rental income, optical sales and surgery center profits.

 

[joe123456789]

First of all I am sorry if I touched a nerve, the "surveys" I was referring to were the cejka and allied ones. I am a 3rd year interested in ophthalmology as well as radiology, and yes I understand these are starting salaries, but that doesnt justify 100k. I will continue to explore ophthalmology, I know that the salary does go up as you practice, but I was just genuinely curious as to why ophtho specifically had such a low starting salary compared to other fields that pay about the same later on down the road.

 

[orbitsurgMD]

First of all I am sorry if I touched a nerve, the "surveys" I was referring to were the cejka and allied ones. I am a 3rd year interested in ophthalmology as well as radiology, and yes I understand these are starting salaries, but that doesnt justify 100k. I will continue to explore ophthalmology, I know that the salary does go up as you practice, but I was just genuinely curious as to why ophtho specifically had such a low starting salary compared to other fields that pay about the same later on down the road.

Supply and demand.

The salaries offered by practices in many highly "desirable" coastal cities: Boston, NYC, Philadelphia, Washington, D.C., Miami, San Diego, Los Angeles, San Francisco, Portland and Seattle are often at odds with the high costs of living there. In other places, salaries are better, at least from those practices that want high-quality applicants.

This has been the case for many years

 

[Stark]

Comparing starting salaries of Ophtho to Radiology, my impression is this.

When you start in Ophtho, you have to see x number of clinic patients to generate x number of surgeries. When you show up on day one, you may not have a full patient load, as the patients may prefer to wait a month to see Dr. "X" rather than be booked with you. Dr. "X" may be swamped while you are still starting out your practice. The patient's get to pick their MD.

Patient's don't generally get to pick their radiologist. You join a group. The group has a contract to read all the films for Hospital X and Practices Y and Z. So when you get there, you get to read as many films as you can, splitting them with the other members of the group. The films don't pick their MD either, they just show up on your computer.

 

[Mirror Form]

Basically there are just too many ophthalmologists in most desirable cities. So when you start out in ophtho, you start out small. In some fields like anesthesia or rads, there are private practice groups out there that have tons and tons of work and are willing to pay well just to find someone to help them out. There just aren't oppurtunities like that in ophtho unless you're willing to go to a rural area. And unlike opening a typical small business, if you open an ophtho practice you're competing against some of the smartest and most motivated people out there.

Over time you will build up a base of patients and your income does go up, but it's a competitive market. One nice thing about ophtho is the ability generate extra income outside of billing medicaire/insurance thanks to things like premium IOL's, botox, and LASIK. So ophtho will likely do well in the future as reimbursements continue to decline since the baby boomers are getting old and will all want premium IOL's, etc. However, the LASIK market is highly competitive. Most patient's usually go to the guy with the big name who has radio and TV commercials. The fact that there are a few ophthalmologists in each city making millions helps perpetuate the myth of ophthalmologists all being rich.

In the old days, surgeries reimbursed much much more. New partners in practices did great b/c they could assist the senior partners and bill for "assist" fees. As orbitsurg already stated, those days are long long gone.

Ophtho is a wonderful field. But now that my wife and I are planning to have children, I am starting to wonder if I should have gone into radiology instead.

 

[stanka]

can someone please respond with numbers (even ranges). that would be helpful.

 

[200UL]

This is what I have seen on this front.
1. Larger cities: 100-150. Start earning bonus at 2.5 x your base salary.
2. Smaller cities / more rural: $150-$200. Start earning bonus at 2.5 x your base salary. (The upper end will likely be a practice that has been looking for awhile).
3. For retina, one could probably add $80-100 on top of the above

If a practice is willing to pay a new ophthalmology graduate beyond $200, there is a chance they will loose money on you the first year. Keep in mind that you will have zero collections for the first 2 months as it can take some time to actually get paid for services you deliver.

If money is big issue for you, I do not know if ophthalmology will ever be able to compete with radiology - at least with the current medical economic environment. Radiology reimbursement has not seen the declines that many other specialties have. This is in large part due to the fact that radiology has both the hospital lobby and large coorporations at their back (GE will not be able to sell the next generation of scanners unless reimbursement of each scan is enough to offset costs). Put another way, if it were not for radiology, many hospitals would have a hard time making money. Every hospital would love it if CT scanner would run non-stop as it generates revenue. These same hospitals need radiologists to read the films.

 

[Mirror Form]

If a practice is willing to pay a new ophthalmology graduate beyond $200, there is a chance they will loose money on you the first year.

Actually, unless you live in a rural area, if they pay you more that 50 or 60 thousand they will lose money on you during your first year. When ophthalmologists join a practice, they usually get carried by their practice for about a year. That's because ophthalmologists are over-saturated in most areas, and it takes time to build up a patient base.

 

[orbitsurgMD]

Actually, unless you live in a rural area, if they pay you more that 50 or 60 thousand they will lose money on you during your first year. When ophthalmologists join a practice, they usually get carried by their practice for about a year. That's because ophthalmologists are over-saturated in most areas, and it takes time to build up a patient base.

Even if you are not super busy, most practices that have come to the point of needing to hire a new ophthalmologist have enough business that the new doctor can cover at least his salary and net additional costs to the practice during the first 12 months. You might not cover whatever the nominal "overhead" percentage as well, but most practices are not ballooning overhead on a new hire anyway. Most keep the offices the same and rearrange tech responsibilities to service the new hire, but rarely do they hire new support people unless they were going to do so anyway. Malpractice premiums, wages and taxes are paid incrementally, so the actual length of being carried might only be four to six months, if that. If they know they can put 8-10 patients on your schedule every day to start, then carrying you is generally not a problem.