If you didn't know, we don't make crazy professional fees. Medicare pays $544 / cataract on average. This includes all the postop care that has to be done (which has its own overhead) as well as the surgery itself. In addition to this, we actually have to find the patient and schedule them for surgery. Anesthesia just shows up. As some of you have described above, we have to give sedation for cataract surgery. We do quite well with oral sedation most of the time but not all of the time. However unlike LASIK, we don't have much opportunity to stop and give more oral sedation. Older patients can react unpredictably. We also do cases under block (retina, plastics, cornea, in addition to complex cataracts). Some older surgeons still do all cataracts under block. What happens if you have get brainstem anesthesia? Salary may be an option but we are not going to give an independent group additional money on top of what they can bill. The margin for cataract surgery is again not that great. We have an option with an out of network group but it just does not feel right and we try to do what's right.