Can you be a part time vitreoretina surgeon?

[itchypants73]

I'm considering VR but I want the nice ophthalmology lifestyle as an attending and time for my family. Is it possible to be a part-time VR surgeon?

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[MstaKing10]

What do you mean by “part time?” Work only two days a week? Or do VR surgery one day a week and general ophtho 4 days a week? Some other scenario you had in mind?

 

[VikingFavre]

As he said depends on how you define part time. There are practice options such as Kaiser or VA positions where you may be working 3-4 days a week. There are a handful of private practices with a similar work demand.

 

[Slide]

In short, yes, but it depends on how you define it and how much you are willing to take a cut in salary and block time in the OR. If you're medical retina, it may be easier. Surgical VR is trickier due to surgical emergencies and call; retinal detachments don't take vacations when you do, so if your schedule does not allow you to take care of it in a timely manner, you may have to refer it out urgently, and that can be either a good thing or bad thing, depending on who takes it and how it affects your practice.

 

[itchypants73]

Thanks, I was thinking 4 days a week (3 clinic , 1 OR day). The VA would drive me insane, so I am more thinking private practice as part of a retina-only or multi-specialty group. I am curious if there are retina-only groups that are compatible with a part-time working schedule. Would you mind expanding on how referring patients out could affect the practice?

 

[dantt]

If I sent you my patient with a retinal detachment on a Friday and you didn't take care of them, I would send my patients elsewhere next time.

 

[percyeye]

Thanks, I was thinking 4 days a week (3 clinic , 1 OR day). The VA would drive me insane, so I am more thinking private practice as part of a retina-only or multi-specialty group. I am curious if there are retina-only groups that are compatible with a part-time working schedule. Would you mind expanding on how referring patients out could affect the practice?

Open your own private practice and you can have whatever type of schedule you want.

 

[MstaKing10]

4 days a week is very reasonable, as long as the practice you are joining is ok with that. It will affect your compensation and even ability to join as partner but sounds like that may be less of a concern for you. I would recommend joining a group so that call and emergencies can be split more easily. If you are solo this would be nearly impossible, especially if your goal is to spend less time at work and more time with your family not answering calls or doing after hours/weekend surgeries.

 

[itchypants73]

Thanks so much for your help. It sounds like VR is still a possibility for me then!

 

[pianist]

Not easy to work less than a full work week if you will be doing surgery. You will need to be available to your post ops, and any associates will probably quickly tire if they are seeing your post ops frequently. Any patient you do a procedure on will expect you to be available. You will have undoubtedly have things like post op IOP issues, re-detachments, close followups after pneumatics/endophthalmitis, etc that you will need to be around for 5 days a week. Your partners won't want to be stuck doing more than their share of emergencies, nor do they want to be dealing with your post op complications.

In the private practice world, it is not really feasible to refer out your routine emergencies to other groups. Neither your referring doctors, nor community retina doctors, nor associates in your practice, will be happy.

Having said that, in the right private practice you can still have a reasonable life. Find a practice that doesn't take hospital ER call, it will make life a lot easier. Find a practice that doesn't have satellites that are far away. Minimize your commute. You can work 5 days a week, from like 8-4, easily see 40-50 patients a day , do 3-5 cases a week, make a good income and be home at a reasonable hour.

It will be different if you want to see 60+ patients a day, do 10+ cases/week, take ER call, have a long commute, etc. You will make more money, but will have less time at home.

My advice is do medical retina with no emergencies to deal with if you want to work 3 or 4 days a week.

 

[Eye-eye]

I'm curious - how easy would it be to be a part time retina surgeon by doing comprehensive a day or two a week, or at least by throwing in some non-retina surgeries? I'm sure it would be near impossible in a metropolis, and you'd be seen as a poacher in a suburban area, but what if you're rural, and the next comprehensive OMD is a good hour and a half away? Thanks!​

 

[Slide]

I'm curious - how easy would it be to be a part time retina surgeon by doing comprehensive a day or two a week, or at least by throwing in some non-retina surgeries? I'm sure it would be near impossible in a metropolis, and you'd be seen as a poacher in a suburban area, but what if you're rural, and the next comprehensive OMD is a good hour and a half away? Thanks!.​

My question is,..why? Your income is potentially higher if you do straight retina. Just partner with someone to help with comprehensive stuff.

 

[Eye-eye]

My question is,..why? Your income is potentially higher if you do straight retina. Just partner with someone to help with comprehensive stuff..

I'm just curious. Personally I love the retina for many reasons, but there's also some appeal to the quick fix surgeries of cataract, LASIK, etc. Down the road I imagine I may likely just pick one and stick with it, but I think I would like the variety. As to compensation, though, if you only did the surgeries themselves (had ODs funnel you the patients who wanted surgery, or employ an OD, for example), I would think the compensation would also be worth it since the surgeries are so quick. But I'm just going on heresay at this point, since I'm still a med student.

 

[EyecanC]

Probably possible to do retina and comprehensive if you are in a small city. I am just guessing but if you were in Rockford, IL (population 150k) you might be able to do it. They have few retina so you would be available to pick up unmet demand. I heard that in Anchorage, AK, some subspecialists do general ophthalmology, too.

As far as part time work, I wonder if two fellows, both wanting part time, could start a practice and both cover 3-4 days a week and work 2-3 days per week.

 

[Slide]

I'm just curious. Personally I love the retina for many reasons, but there's also some appeal to the quick fix surgeries of cataract, LASIK, etc. Down the road I imagine I may likely just pick one and stick with it, but I think I would like the variety. As to compensation, though, if you only did the surgeries themselves (had ODs funnel you the patients who wanted surgery, or employ an OD, for example), I would think the compensation would also be worth it since the surgeries are so quick. But I'm just going on heresay at this point, since I'm still a med student..

For what it’s worth, I knew a private ophthalmologist in fellowship who did comprehensive and retina initially. He gave up the retina practice because he was making plenty of income with LASIK and phaco, and retina was changing too much for him to keep up with. Essentially, he had to pick one and he’s happy he did.

 

[Eye-eye]

For what it’s worth, I knew a private ophthalmologist in fellowship who did comprehensive and retina initially. He gave up the retina practice because he was making plenty of income with LASIK and phaco, and retina was changing too much for him to keep up with. Essentially, he had to pick one and he’s happy he did.

Fair enough. From what I've been hearing here and on other threads, pretty much everyone picks either surgical retina, comprehensive, or comprehensive plus some medical retina. I guess I just think if I start out broad, I can always narrow thingngs down later. It's good to hear that others have done that with success.

 

[Equality]

If I send you a patient with a retinal issue and you do their cataract, I am sending my next patient to someone else who will fix the retina problem and send the patient back to me with the cataract intact.

 

[dantt]

Presumably they would not do that.

 

[Eye-eye]

If I send you a patient with a retinal issue and you do their cataract, I am sending my next patient to someone else who will fix the retina problem and send the patient back to me with the cataract intact.

I was thinking more like taking any refractive surgery local optoms refer to me (assuming there are nor refractive/comprehensive ophthalmologists around) taking a cataract from a patient another ophthalmologist referred for a retina issue.

 

[Slide]

I was thinking more like taking any refractive surgery local optoms refer to me (assuming there are nor refractive/comprehensive ophthalmologists around) taking a cataract from a patient another ophthalmologist referred for a retina issue.

I know your intentions are good but it does not work this clearly in real life. The obstacles in private practice in doing something like are that:

a) your overhead will be too high. Refractive and vitreoretinal equipment do not overlap very much, and being able to have enough business to cover overhead usually means you have to get really efficient in one. If you're doing 5-10 injections a week, you run the risk of your medications expiring or not having enough of a medication float to cover for unexpected increase in volume. Likewise for surgery, you will likely only be able to operate one day a week, two max. Unless you're working the entire day (as in, >10 hours), you will not be able to recoup the money for your equipment. The base equipment costs over 100K per machine, and that's not including the disposable kits. If you try to do something like this, it's a good way to go broke, fast.

b) there will rarely be a situation where there will be neither VR or refractive support around. The places where these situations exist have so few people that you will not be able to sustain your practice. Also, once other ophthalmologists and optometrists find out you are double dipping in refractive and VR surgery, you'll get black-balled by them and you may find your referral sources dry up.

c) even if you can make the finances work out, it is hard to be proficient in two such divergent fields. A VR fellowship is two years, but no matter how well you train in fellowship, you will still not be ready for the first 1-2 years out of practice, because your safety net is now gone. Likewise for refractive surgery. If your diluting your first several years out in two divergent subspecialties, your autonomous proficiency will be lacking. If I had a family member or friend that needed a VR or cornea specialist, I would tell them to stay the hell away from someone that is doing both refractive and VR surgery because I would bet the odds of a controllable successful outcome are poor.

If you are really dead set on doing two divergent fields, you would have to consider working somewhere in a high need area as an employee, like at the VA, Indian Health Services, or some other similar situation. At least over there, once you get credentialed, you can really do whatever you want as long as you're ok being salaried and dealing with the pitfalls of those situations.

If you want to do a combo subspecialty, there are plenty that make sense. Just not what you're asking for. It may not make sense as a med student but if you do an ophthalmology residency, you'll see why.

 

[Eye-eye]

I know your intentions are good but it does not work this clearly in real life. The obstacles in private practice in doing something like are that:

a) your overhead will be too high. Refractive and vitreoretinal equipment do not overlap very much, and being able to have enough business to cover overhead usually means you have to get really efficient in one. If you're doing 5-10 injections a week, you run the risk of your medications expiring or not having enough of a medication float to cover for unexpected increase in volume. Likewise for surgery, you will likely only be able to operate one day a week, two max. Unless you're working the entire day (as in, >10 hours), you will not be able to recoup the money for your equipment. The base equipment costs over 100K per machine, and that's not including the disposable kits. If you try to do something like this, it's a good way to go broke, fast.

b) there will rarely be a situation where there will be neither VR or refractive support around. The places where these situations exist have so few people that you will not be able to sustain your practice. Also, once other ophthalmologists and optometrists find out you are double dipping in refractive and VR surgery, you'll get black-balled by them and you may find your referral sources dry up.

c) even if you can make the finances work out, it is hard to be proficient in two such divergent fields. A VR fellowship is two years, but no matter how well you train in fellowship, you will still not be ready for the first 1-2 years out of practice, because your safety net is now gone. Likewise for refractive surgery. If your diluting your first several years out in two divergent subspecialties, your autonomous proficiency will be lacking. If I had a family member or friend that needed a VR or cornea specialist, I would tell them to stay the hell away from someone that is doing both refractive and VR surgery because I would bet the odds of a controllable successful outcome are poor.

If you are really dead set on doing two divergent fields, you would have to consider working somewhere in a high need area as an employee, like at the VA, Indian Health Services, or some other similar situation. At least over there, once you get credentialed, you can really do whatever you want as long as you're ok being salaried and dealing with the pitfalls of those situations.

If you want to do a combo subspecialty, there are plenty that make sense. Just not what you're asking for. It may not make sense as a med student but if you do an ophthalmology residency, you'll see why.

Fair enough. I appreciate the honesty, and it's really good to hear about aspects of this that I hadn't been thinking about. Certainly I did consider your points a and b, but c is one I didn't really appreciate before making posts here and elsewhere. As to b, the specific area I'd love to practice in currently has no ophthalmologists at all within an 1.5 h drive (farther for retina), and at least 100k people who I would be closest to for general (more for retina), which is why I didn't think it would be an issue where ophthalmologists would see it as double dipping and blackball you (and I never really considered that optoms would do this either, which I don't fully understand the motivations for). I would hope that 100k people is enough to sustain either a comprehensive or retina practice, but admittedly I don't know that. Regardless, though, it does seem that everyone tends to agree that this isn't the best idea, and I certainly trust your experience over my own thought process. I'm glad to be hearing this now, before I enter residency, so it can help me determine if I want to give up cataracts for retina when the time comes to decide if I want to do a fellowship or not.