Choosing Between a Career in Anesthesia vs Ophthalmology

Started by bubblypuff
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bubblypuff

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I am currently a 3rd year medical student starting to think about where I want to apply for away rotations. I am unable to decide between Anesthesiology and Ophthalmology. To be completely honest, income and work-life balance is extremely important to me and I would hope to eventually be able to work part time and still make good money while having a family.

Anesthesia:

Pros - shift based schedule, whole body physiology, no clinic, literally saving people's lives on a daily basis, lots of variation within the field

Cons - midlevel encroachment with CRNAs, cannot be your own boss (unless you are in pain), at the mercy of the hospital, litigation

Ophthalmology:

Pros - surgeries and technology are insanely cool (the eye is such a beautiful organ), ability to own your own practice, grateful patients, restoring sight is pretty damn cool

Cons - clinic seems like it could get monotonous, see so many patients per day (more than 50)

To be honest, I really love medicine as a whole and could see myself in any field which is why I would like to focus on what would give me the best income w/ quality of life. Could anyone speak to their experience? Are you happy in your field? Any advice at all would be appreciated.
 
Eyes all the way. I don’t know how long the anesthesia market will last. But eyes is a safer bet long term. Harder to be replaced.

Even better go to psych. Way more flexible to work from home.

That’s my best advice for you.

My nephew at a top medical school is going into eyes. And both his parents are anesthesiologists if that tells you something.
 
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I was back and forth on the two. Ophtho was always the plan when I went to med school, but in the end I loved anesthesia/critical care/the OR and hated clinic. Anesthesia was a better fit for me in the end. There are things I would change about my job, namely call and early mornings, but overall, I have zero regrets.
 
Since the eye board is usually slow, I’ll reply over here. The work environments are so different that it’s a little hard to compare the two.

Maybe I’m reading it wrong, biased (always), or both, but sounds like you’re a little bit higher on ophtho. I like what I do (surgical retina). If your real priorities are lifestyle and reimbursement, the first is hard to beat. I’m supposed to have all the emergencies etc. but work <35 hours a week. Almost never go in overnight, see a patient or two every 2-3 call weekends. The salary numbers I see everywhere strike me as low unless me and my partners are unicorns. Despite the scourge of private equity, it’s still very much possible to own your own practice, which if (big caveat) you have set up well, there’s not a ton of admin work.

The clinic concerns are real, although I would argue that pretty much every field gets monotonous after a while. You still get more than enough weirdness.

You grow into the pace (I comfortably see ~10 patients/hour). If you’re a people person, you get your continuity of care if you want it and surprisingly that’s enough time to chat up the chatty folks if you want. I just saw a patient who I’ve seen literally every month since I’ve been an attending, and she still bakes something for my staff every visit despite me giving her injections.

All of my anesthesiology colleagues tell me they’re happy as well. I think it comes down to a personality thing. Which side of the drape do you want to be on? What kind of pace do you want? Do you want to potentially run a business? There’s never a perfect answer.
 
eyeeye_captain said:
Since the eye board is usually slow, I’ll reply over here. The work environments are so different that it’s a little hard to compare the two.

Maybe I’m reading it wrong, biased (always), or both, but sounds like you’re a little bit higher on ophtho. I like what I do (surgical retina). If your real priorities are lifestyle and reimbursement, the first is hard to beat. I’m supposed to have all the emergencies etc. but work <35 hours a week. Almost never go in overnight, see a patient or two every 2-3 call weekends. The salary numbers I see everywhere strike me as low unless me and my partners are unicorns. Despite the scourge of private equity, it’s still very much possible to own your own practice, which if (big caveat) you have set up well, there’s not a ton of admin work.

The clinic concerns are real, although I would argue that pretty much every field gets monotonous after a while. You still get more than enough weirdness.

You grow into the pace (I comfortably see ~10 patients/hour). If you’re a people person, you get your continuity of care if you want it and surprisingly that’s enough time to chat up the chatty folks if you want. I just saw a patient who I’ve seen literally every month since I’ve been an attending, and she still bakes something for my staff every visit despite me giving her injections.

All of my anesthesiology colleagues tell me they’re happy as well. I think it comes down to a personality thing. Which side of the drape do you want to be on? What kind of pace do you want? Do you want to potentially run a business? There’s never a perfect answer.
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agree, OP thought the eye was cool - i think most anesthesiologists think optho is kind of nerdy/boring
 
I’m happy with my choice overall. One of my co-residents switched to ophthalmology after his PGY-2 year when a spot opened unexpectedly. He always hated the anesthesia trauma call and was kind of like that early scene in Top Gun after a few particularly difficult cases where he lost his edge and didn’t feel he could do it anymore. He was happy with the switch and is a busy LASIK guy today. Probably making a lot more money as well.
 
These specialties could not be more different. I get that work-life balance and income are priorities for you, but do not make those alone your deciding factors bc whatever you choose you are going to be doing nearly everyday for the remainder of your working life. So choose which you actually enjoy more! That should be the number one factor.

-Do you enjoy working in a team environment? Are you a morning person? Do you dislike clinic? Anesthesia all the way.
 
eyeeye_captain said:
Since the eye board is usually slow, I’ll reply over here. The work environments are so different that it’s a little hard to compare the two.

Maybe I’m reading it wrong, biased (always), or both, but sounds like you’re a little bit higher on ophtho. I like what I do (surgical retina). If your real priorities are lifestyle and reimbursement, the first is hard to beat. I’m supposed to have all the emergencies etc. but work <35 hours a week. Almost never go in overnight, see a patient or two every 2-3 call weekends. The salary numbers I see everywhere strike me as low unless me and my partners are unicorns. Despite the scourge of private equity, it’s still very much possible to own your own practice, which if (big caveat) you have set up well, there’s not a ton of admin work.

The clinic concerns are real, although I would argue that pretty much every field gets monotonous after a while. You still get more than enough weirdness.

You grow into the pace (I comfortably see ~10 patients/hour). If you’re a people person, you get your continuity of care if you want it and surprisingly that’s enough time to chat up the chatty folks if you want. I just saw a patient who I’ve seen literally every month since I’ve been an attending, and she still bakes something for my staff every visit despite me giving her injections.

All of my anesthesiology colleagues tell me they’re happy as well. I think it comes down to a personality thing. Which side of the drape do you want to be on? What kind of pace do you want? Do you want to potentially run a business? There’s never a perfect answer.
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Do you think this is the case for all fields of ophtho or specifically retina? I would be interested in peds ophtho
 
bubblypuff said:
Do you think this is the case for all fields of ophtho or specifically retina? I would be interested in peds ophtho
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…well, that throws a massive wrench in things. For everything other than peds and neuro, relatively confident.

Peds is a strange market for sooo many reasons.

If you’re primarily kids, your volume is cut by ~half because they take longer. Staffing is a problem. You have a high Medicaid payer mix. You need an OR comfortable with (sometimes sick/complex) kids. Are you doing academics or private practice (sounds like PP)? How much adult stuff are you planning to do (comp/cataracts can supplement you if you maintain your skills)? Are you still taking general call for a group, and do they want to put up with extra peds call?

The demand is absolutely there, but the finances generally aren’t.

Lifestyle wise it’s fine, but you’re taking a significant cut to do peds, and I wouldn’t be surprised if you never made what a new grad gas kid makes now.
 
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I went into anesthesiology to have good hours and make good money. I have good hours and make good money.

Foreseeable future is probably fine. CRNAs have definitely elevated the floor when it comes to salary. Worst case scenario I’ll be just fine taking their job for 400k working 36 hours per week. Plus 3 breaks and guaranteed off by 3pm.
 
Theres absolutely no comparison btwn the fields. Anesthesia is grub work, common as mud, easily replaced. I liks my job dont get me wrong, just not a major fan of how admin perceives us. I like being able to keep a hamburger alive indefinitely.
Optho is elite, something completely diff. No one is telling you what to do
 
eyeeye_captain said:
Happy to clean those retinas as a professional courtesy
Click to expand...

How has private practice ophthalmology maintained salary post-covid ? Seems overhead costs (I.e. staffing) would’ve risen significantly but insurers, at least for anesthesia, haven’t risen rates at all. A private ophtho group wouldn’t have a lot of places to go when salaries dipped thanks to insurers screwing you year in year out. Anesthesia groups turned to hospitals.

I’d go ophtho for the autonomy if I enjoyed the work. I think the eye is pretty amazing.

I’d describe anesthesia as fine and a rewarding career.
 
Southpaw said:
How has private practice ophthalmology maintained salary post-covid ? Seems overhead costs (I.e. staffing) would’ve risen significantly but insurers, at least for anesthesia, haven’t risen rates at all. A private ophtho group wouldn’t have a lot of places to go when salaries dipped thanks to insurers screwing you year in year out. Anesthesia groups turned to hospitals.

I’d go ophtho for the autonomy if I enjoyed the work. I think the eye is pretty amazing.

I’d describe anesthesia as fine and a rewarding career.
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There’s some bits and pieces that have sorta kinda kept things the same-ish (while not adjusting for inflation). Too many moving parts to elaborate, but basically industry to some degree keeps us around in retina at least.

Some of the general folks do more cash pay stuff. I don’t do premium lenses or aesthetics or anything. Even that probably doesn’t make nearly what it used to.

The cuts this coming year make surgery, which was already a money loser, even more unpalatable. I don’t know how things are for you folks with units etc., but a full OR day pays like a slow clinic for me.
 
PpfSuxTube said:
Theres absolutely no comparison btwn the fields. Anesthesia is grub work, common as mud, easily replaced. I liks my job dont get me wrong, just not a major fan of how admin perceives us. I like being able to keep a hamburger alive indefinitely.
Optho is elite, something completely diff. No one is telling you what to do
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yes.
you can build your own brand much easier in ophthalmology.
 
10 pph is ****ing nuts, but even more so that it uses the same e/m coding/reimbursement system as medical specialties that would be completely impossible to do in 6 minutes. Can't wait for the whole healthcare system to collapse and see what comes up from the ashes because it is impossible to be dumber than what we have now.
 
chessknt said:
10 pph is ****ing nuts
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It’s a combination of things. I have an established panel and experienced staff. I also have an above average memory for patients’ histories.

Think of it as if it was mostly frequent flyers with a limited workup and imaging done by competent nursing with your imaging usually done by the time they’re roomed. Then a relatively limited exam, conversation, and if a procedure is needed, it’s quick and was set up by nursing in between your next visits. Up to half of them are procedure only.

With an established panel you know who wants to chat and who wants out the door. They’re mostly repeat customers who know the deal. Surgical conversations and weird stuff slow you down, but it averages out.

You could even argue I’m slow. Some old school retina docs (and a few still floating around) did/do like 15 pph.
 
eyeeye_captain said:
It’s a combination of things. I have an established panel and experienced staff. I also have an above average memory for patients’ histories.

Think of it as if it was mostly frequent flyers with a limited workup and imaging done by competent nursing with your imaging usually done by the time they’re roomed. Then a relatively limited exam, conversation, and if a procedure is needed, it’s quick and was set up by nursing in between your next visits. Up to half of them are procedure only.

With an established panel you know who wants to chat and who wants out the door. They’re mostly repeat customers who know the deal. Surgical conversations and weird stuff slow you down, but it averages out.

You could even argue I’m slow. Some old school retina docs (and a few still floating around) did/do like 15 pph.
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What’s the typical patient per hour or per day for ophthalmologists? I imagine the visits are quick but seeing that many people per day would burn me out.
 
MifflinDunder said:
What’s the typical patient per hour or per day for ophthalmologists? I imagine the visits are quick but seeing that many people per day would burn me out.
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Very wide range, depends on subspecialty, practice environment, and doc.

General-ish folks are probably 40+ a day.

It’s just a different personality thing. Do you want small bites or big ones? Moving constantly or moving when things are going south?

I’d probably burn out babysitting 1-3 big cardiac or neuro cases for the day as well.
 
bubblypuff said:
I am currently a 3rd year medical student starting to think about where I want to apply for away rotations. I am unable to decide between Anesthesiology and Ophthalmology. To be completely honest, income and work-life balance is extremely important to me and I would hope to eventually be able to work part time and still make good money while having a family.

Anesthesia:

Pros - shift based schedule, whole body physiology, no clinic, literally saving people's lives on a daily basis, lots of variation within the field

Cons - midlevel encroachment with CRNAs, cannot be your own boss (unless you are in pain), at the mercy of the hospital, litigation

Ophthalmology:

Pros - surgeries and technology are insanely cool (the eye is such a beautiful organ), ability to own your own practice, grateful patients, restoring sight is pretty damn cool

Cons - clinic seems like it could get monotonous, see so many patients per day (more than 50)

To be honest, I really love medicine as a whole and could see myself in any field which is why I would like to focus on what would give me the best income w/ quality of life. Could anyone speak to their experience? Are you happy in your field? Any advice at all would be appreciated.
Click to expand...
Anesthesiologist/pain doc chiming in.

This board in general is very financially minded and there are a number of threads on financial optimization with regards to employment and investments. From a financial perspective, retina/generalist/cornea/oculoplastics could be very appealing as they can offer very good business investment opportunities with a higher salary/working time ratio than you would find in anesthesia. If peds/neuro is your end goal anesthesia will come out ahead financially. That being said, I was very interested in ophthalmology at one point in time and worked with some very reputable peds ophtho docs who wouldn't have wanted to work in any other field and loved what they did even though it wasn't the highest reimbursing.

However, there is another dimension where I think anesthesia docs might come out ahead that I wasn't as aware of as med student/resident and that is scaleable work. It seems to me and what I've read (and again I'm not an ophthalmologist) is that there is a sort of minimum amount of time you REALLY do need to spend in clinic in order to meet overhead and this could limit the raw number of weeks off you could take in a year. Associates and those on salary might have 3-4 weeks off a year to start. Eventually when you are on productivity, I recognize you can take off as much time as you want, but I do see partners comment on other boards that it may be hard to take more than sixish weeks off a year. Again, your mileage may vary on this one.

My base contract in anesthesia provides me with 9 weeks off which is even on the low side for some folks on this board. I could drop to 0.6-0.9 FTE eventually and have even more time (15-24ish weeks off) at the expense of a lower income. This could then be scaled back up as I desire at some point later. For some people who have very young families in our group, this arrangement has been really important to them and has enabled them to spend real quality time with families in the newborn/pre-school years. I'm not as certain you could pull this off with an ophthalmology group.

There's also no buy in to my group. I don't have to worry about paying thousands of dollars for group buy in, or buying into an ASC and wondering if I'll turn a profit. That being said, I'll also never enjoy the fruits of these investments in a sell out either.

One final dimension to think about would be your significant other's thoughts about family life and what their pathway into this looks like. Are they a high earner? Do they want to keep working full time in family years? Are you looking to land in a HCOL area with them? Do you both crave an affluent lifestyle with premium cars and trips and a fancy house or can you be happy with a slightly simpler approach? If your significant other will also be making mid-high six figures and intends to work full time, you'll have a lot of flexibility in what you can do. If you are the primary generator and career motivated person and your spouse might be looking to drop back during early family years, it may make sense to optimize your potential earnings.

You're gonna have a great life no matter what I think, and either option will provide you with career satisfaction.
 
eyeeye_captain said:
The cuts this coming year make surgery, which was already a money loser, even more unpalatable. I don’t know how things are for you folks with units etc., but a full OR day pays like a slow clinic for me.
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That's interesting. Its mainly a money loser for us too - seems like the facility is the only one making money..
 
bubblypuff said:
Cons - midlevel encroachment with CRNAs, cannot be your own boss (unless you are in pain), at the mercy of the hospital, litigation
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OP - they're both good fields. It's a bit futile to game it out like that - I'd go with gut feel on whichever field you enjoy more.

One comment on your quoted post above... sadly very few in medicine are their own boss these days. Private practices are going away and even when they exist there's a huge headache in managing dwindling finances against the cost of running a business - plus you get wildly tied down. The likelihood that you'd be running a PP optho clinic with an adjoined captive ASC by the time you graduate is extremely low. Most likely you'll be hospital employed like everyone else.

Theres great autonomy and a sense of freedom in anesthesiology now with the robust locums market and low job-switching costs. You aren't tied to a clinic or to a patient cohort. You could switch to half time or switch cities or do a year in New Zealand with little lead time - and it wouldn't be tough.

The other day I had an after-work patient issue that required me calling the patient at home and arranging to be seen in the ED (long story but they had an issue entirely unrelated to anesthesia, but I wanted to be sure they got connected to care ASAP for their peace of mind). This type of thing happens almost never in anesthesia life, but it must happen all the time in any clinic based speciality.

It's all to say that anesthesiology these days let you be the boss of your own life, if that makes sense. You aren't so tied down as you are in the clinic-based fields.

Also the fear of litigation is misguided - the current data show that anesthesiologists are right at the all-specialty median in terms of rates of being sued.
 
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My guess is that if you actually made the anesthesiologists on this board take only 3-4 weeks of vacation a year, and told them it’d be that way their entire career that they may sing a different tune with regard to ophtho.

That said I have no idea how much vacation ophtho takes. Maybe they take more than we do!

For my part, I think you need to love what you do, the payout needs to be worth the work you put in, and you need to have a nice balanced lifestyle. If you gave me the opportunity for ophtho right now I may be like ‘cool sure I’ll give it a try’. But if you then told me I wouldn’t be able to ski nearly as much as I currently do then I may sing a different tune. Or that I wouldn’t get spring break with my kids. Or the summer vacations we like. Or just the random weeks off throughout the year where I like to do my hobbies.
 
eyeeye_captain said:
Very wide range, depends on subspecialty, practice environment, and doc.

General-ish folks are probably 40+ a day.

It’s just a different personality thing. Do you want small bites or big ones? Moving constantly or moving when things are going south?

I’d probably burn out babysitting 1-3 big cardiac or neuro cases for the day as well.
Click to expand...
Now imagine you instead had to manage their diabetes, hypertension and a new unrelated issue (shortness of breath that started a month ago or a shoulder pain that is getting worse)--that bills for exactly the same as what you are doing and is functionally impossible to accomplish by walking in a room then back out with a note done in 6 minutes. Or even better pretend your patient is on a biologic therapy for a chronic medical condition and is having side effects and needs to be changed to a different one with different risks. Yet CMS says what you are doing is worth exactly the same because they place such minimal value on time or complexity.
 
You can be totally mediocre in anesthesia and be successful
In ophthalmology you have to be on your A game pretty much all the time. Mediocrity has zero place in eye surgery. you wont have any business.
 
NPJR said:
You can be totally mediocre in anesthesia and be successful
In ophthalmology you have to be on your A game pretty much all the time. Mediocrity has zero place in eye surgery. you wont have any business.
Click to expand...
It's insane is how people weaponize their mediocrity in anesthesia to do the least amount of work possible. They exploit physicians who give a damn about their patients and their work because they know we'll pick up the slack.
 
There are mediocre surgeons too and the complication dumps and hot potato games with add ons I have seen on the surgical side far eclipse anything you can possibly punish someone with as an anesthesiologist.
 
bubblypuff said:
I am currently a 3rd year medical student starting to think about where I want to apply for away rotations. I am unable to decide between Anesthesiology and Ophthalmology. To be completely honest, income and work-life balance is extremely important to me and I would hope to eventually be able to work part time and still make good money while having a family.

Anesthesia:

Pros - shift based schedule, whole body physiology, no clinic, literally saving people's lives on a daily basis, lots of variation within the field

Cons - midlevel encroachment with CRNAs, cannot be your own boss (unless you are in pain), at the mercy of the hospital, litigation

Ophthalmology:

Pros - surgeries and technology are insanely cool (the eye is such a beautiful organ), ability to own your own practice, grateful patients, restoring sight is pretty damn cool

Cons - clinic seems like it could get monotonous, see so many patients per day (more than 50)

To be honest, I really love medicine as a whole and could see myself in any field which is why I would like to focus on what would give me the best income w/ quality of life. Could anyone speak to their experience? Are you happy in your field? Any advice at all would be appreciated.
Click to expand...
If you are competitive for optho..you should be for anes as well

Away rotations dont matter that much in anes if your CV is good.

Do rotations in both and test out what you like
 
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