Comprehensive Practice

[percyeye]

Is this becoming a rarity and pushed less during training?

When I was undergrad 10 years ago and worked as a tech at a practice two Docs were what I would consider Comprehensive Ophthalmology.

One day was for LASIK and laser procedures. They obviously had a busy cataract practice doing toric and MF IOLs. Both did a decent about of plastics like Blephs and even some Strab work on kids and adults. They had a very busy Retina clinic doing injections for your "straight forward" wet AMD and Diabetic patients with some lasers in there. Now they did refer out some things when they felt uncomfortable.

I think this type of practice was more attainable because it was in a smaller city with about ~150,000 or so in population that was fed by smaller towns in the Midwest.

I assume they did very well financially and were obviously always very busy.

But with the push being more specialized nowadays I was just seeing how often now newer grads would even consider a practice like this? Or is it even looked down upon?

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[eyeguyhopeful]

I see this all the time! Not unusual.

Two of my coresidents joined two different practices like this (both within 30-40 min from a top 10 city population). Both do very well financially.

 

[Slide]

This is still possible but yes, it's becoming less of a thing. I think it goes without saying this isn't going to be done in big metro areas, but in smaller areas this is still done on a regular basis (one of my co-residents is comp doing a lot of things).

With that said - it's becoming less commonplace for good reason. Stuff changes so quickly that what you thought out of training was up to date may not be true in 5 years. For more specialty-based work, I am seeing more and more second opinions in my field where there was sometimes almost gross negligence by comprehensive and didn't receive proper care or referral quickly; more often I see patients who received decent care initially but definitely needed a second opinion later in the course. With knowledge in general being more prolific in the community (patients are becoming more savvy in looking up their conditions), more patients are going to want the most up to date care if possible. There's just too much to know and do these days for someone to really do it all well.

From a financial standpoint, it depends on how the practice is run, but at least based on what I do, there's a certain number of patients or procedures you have to do in order for it to be worth it, like injections and PRPs. If you're only doing 5-10 intravitreal injections a week, I don't know how that's really worth it financially for the upkeep, if you factor in costs like injection prep/storage and manpower to prep injections and manage PAs/drug float. Plus, why slog through surgical glaucoma/retina patients when you just mill cataracts and multi-focals and have good parity in pay relative to effort.

I personally thought the legal ramifications would be an issue but surprisingly not; often the medicolegal concerns are state/location dependent. In a saturated city, yes it's an issue, but elsewhere I'm surprised what you can get away with.

 

[MstaKing10]

What is the primary source of referrals to these comprehensive practices?

 

[percyeye]

What is the primary source of referrals to these comprehensive practices?

From what I can remember Optometry referrals. They also had 3-4 Optometrists working there seeing exams while they did a little bit of clinic but mostly surgery and procedures.