Choosing Between a Career in Ophthalmology and Anesthesia

[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.

 

[TheLesPaul]

You haven't really asked the most important question. Are you a surgeon or not?

A surgeon is married to the patient on whom they have done surgery, for life (or until the next surgeon does something else on them). Your hands will directly change (for the better or worse) someone's body. When things go well, it's very rewarding. When things go poorly, there's no place to hide. Do you like that responsibility and autonomy? You can't really "load the boat" in surgery -- there's only one boss in the room.

 

[Slide]

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.

There are some other pros and cons you should consider for each field.

Anesthesia:
Pros - no overhead (unless pain), short term job security due to increasing number of surgeries/procedures, easier to move around the country if need be so

Cons - increasing pressure to staff more CRNAs, PE acquisitions, rough hours

Ophthalmology:
Pros - outpatient only (unless you're in academics or hospital system), opportunity for great lifestyle with good work balance, ability to generate revenue outside of traditional norms, fairly quick surgeries

Cons - decreasing reimbursements hitting harder, PE acquisitions, midlevel encroachment as well, high overhead costs (at least for comprehensive) compared to other specialties

To be frank if you wanted best income w/ quality of life, the best decision would've been to go to nursing school and be a CRNA. But obviously you're probably not going to do that, so pick whatever you like the most. My bias is obviously ophthalmology has better income/QOL tradeoff but it depends on your job situation.

 

[i-doctor]

You sound like me a long time ago! Those were two of my top choices. You must do a rotation in each, if possible, I knew after my second day rotating in anesthesia that I could never be an anesthesiologist. I actually hated it. And I subsequently did an ophtho rotation…and immediately loved watching eye surgery. So I threw my pro/con flow sheet out the window and never looked back.

 

[RetinaDude]

Apparently, ophthalmology is supposed to be the specialty with the third highest shortage by the year 2035. There’s going to be a HUGE need for ophthalmologists. And no, I’m not really worried about ODs taking over. There’s so much work to do for everyone, and I believe ophth and ODs will likely end up working closer together down the road, since there will be a shortage of eye surgeons

 

[NYCNative]

Shortages are helpful, but they don’t automatically translate into high pay. Compensation is mostly driven by government reimbursement and payer mix, unfortunately. Pediatric ophthalmology is a good example: demand is enormous, yet compensation is poor. There is the upside of more choice and flexibility though, especially if you’re trying to land in a specific city or region. I know what you are saying, but I just had to drop that into the discussion

 

[Slide]

Shortages are helpful, but they don’t automatically translate into high pay. Compensation is mostly driven by government reimbursement and payer mix, unfortunately. Pediatric ophthalmology is a good example: demand is enormous, yet compensation is poor. There is the upside of more choice and flexibility though, especially if you’re trying to land in a specific city or region. I know what you are saying, but I just had to drop that into the discussion

Agreed, the bigger issue I think looming down the road is Medicare and insurance reimbursement. There's another thread about how dismal cataract surgery reimbursement is and how premium lenses, once seen as a nice way to generate revenue, is increasingly necessary. ASRS already posted an article of how bad reimbursement has gotten for RD repair and a trend of them being turfed to more central locations (Sign in - The American Society of Retina Specialists article attached). I'm dreading the next five years unless there's a major sea change.

 

[RetinaDude]

Shortages are helpful, but they don’t automatically translate into high pay. Compensation is mostly driven by government reimbursement and payer mix, unfortunately. Pediatric ophthalmology is a good example: demand is enormous, yet compensation is poor. There is the upside of more choice and flexibility though, especially if you’re trying to land in a specific city or region. I know what you are saying, but I just had to drop that into the discussion

Pretty much every specialty is going to face the issue of shortages, some more than others. All are going to face the same issues with decreasing reimbursement. Ophthalmology has usually been pretty good at creating ways to earn more money, whether it’s specialty lenses, optical shops, oculoplastic surgery expansion, building their own surgery centers (cataract reimbursement may be going down but ASC payment is going up), etc…

 

[davidxavi]

Pretty much every specialty is going to face the issue of shortages, some more than others. All are going to face the same issues with decreasing reimbursement. Ophthalmology has usually been pretty good at creating ways to earn more money, whether it’s specialty lenses, optical shops, oculoplastic surgery expansion, building their own surgery centers (cataract reimbursement may be going down but ASC payment is going up), etc…

What has retina been able to do to combat decreasing reimbursements? FA reimbursement has been obliterated that practices can't even do them

 

[RetinaDude]

We still do FAs, but even before reimbursement cuts, we’d already cut way back on them because we use/need OCT so much more.
As far as reimbursement goes, the Good Days fiasco has certainly made things more difficult, but we are all still making really good salaries. I still made a seven figure income in 2025 working 4 days per week so it may not be as high as it used to be but we are certainly not hurting

 

[docdoc2012]

We still do FAs, but even before reimbursement cuts, we’d already cut way back on them because we use/need OCT so much more.
As far as reimbursement goes, the Good Days fiasco has certainly made things more difficult, but we are all still making really good salaries. I still made a seven figure income in 2025 working 4 days per week so it may not be as high as it used to be but we are certainly not hurting

If you dont mind sharing, how are your 4 days a week divided? How many pts are you seeing and how much vacation are you taking? Is it a Pe or non Pe practice?

 

[RetinaDude]

We are not PE. Everyone in my group is very much against joining PE.

My 4 day work week is pretty much three full days of seeing patients in the office and one full day of surgery (usually 4-8 cases). Sometimes I will add additional clinic time on to the afternoon of a surgery day, but not very often. Typical patient load is 50-60 patients per day. Almost never above 60 patients per day, and sometimes only 45 patients per day.

Vacation wise, I’ve taken anywhere from 6-10 weeks off per year. We have a set number, between the partners, but as long as I’m sharing equally in the call, and the overhead, no one seems to care. Plus, each partner sometimes has years where they do the same and take more weeks off, but most of us stick with about six weeks off per year. A few of my partners don’t hardly take any time off, except for CME. They make really good money ($2M+) but they also love to work (60+ patients per day, five day work week, etc…).

 

[docdoc2012]

We are not PE. Everyone in my group is very much against joining PE.

My 4 day work week is pretty much three full days of seeing patients in the office and one full day of surgery (usually 4-8 cases). Sometimes I will add additional clinic time on to the afternoon of a surgery day, but not very often. Typical patient load is 50-60 patients per day. Almost never above 60 patients per day, and sometimes only 45 patients per day.

Vacation wise, I’ve taken anywhere from 6-10 weeks off per year. We have a set number, between the partners, but as long as I’m sharing equally in the call, and the overhead, no one seems to care. Plus, each partner sometimes has years where they do the same and take more weeks off, but most of us stick with about six weeks off per year. A few of my partners don’t hardly take any time off, except for CME. They make really good money ($2M+) but they also love to work (60+ patients per day, five day work week, etc…).

Thats the dream! You guys must keep your overheads pretty tight

 

[RetinaDude]

Thats the dream! You guys must keep your overheads pretty tight

Our admin team does do a good job controlling overhead. Rebates do help a lot, even though it is a much different day without the full assistance of Good Days. But, we have a robust clinical trials program, very efficient teams helping us in the office, and we also have partial ownership in a eye only ASC (usually adds about $120-$160k to my salary each year).

 

[Slide]

What has retina been able to do to combat decreasing reimbursements? FA reimbursement has been obliterated that practices can't even do them

Injections are getting a mild increase which is helping a bit, though it doesn't fully cover the sting of surgical cuts. OCTA is one of the ways to help make up for these shortfalls though it does take longer to obtain them.

If you really are all on board the complement inhibition train, if you make it known that you will treat GA aggressively with it, you'll have plenty of injections. Surgically, I know some of my colleagues are doing more vitrectomies for PVDs but understandably it's a controversial issue.