considering a glaucoma fellowship, pros and cons?

[tofusatay]

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i am an ophthalmology resident considering glaucoma. i was wondering if there were any glaucoma fellows/glaucoma specialists on this forum who could weigh in on the pros and cons of the fellowship/specialty. how many fellowship programs are there? how competitive (obviously it is not plastics/retina), what to look out for as far as red flags of a fellowship program, etc.

also, could you please touch upon job satisfaction, easy of getting a job, whether or not you still are able to practice general ophthalmology, compensation compared to other subspecilaities, and why you did it.

would also welcome any thoughts from any 3rd year residents currently applying.

thanks!

 

[Pastrami King]

I'm not a glaucoma fellow or specialist (I do comprehensive/cataract) but I can say that most glaucoma specialists still do a good amount of comprehensive with the vast majority doing a fair amount of cataract surgery. Almost all glaucoma patients will need cataract surgery at some point in their lifetime, and glaucoma patients stay with you a long time (no matter how hard you may try to pawn off some of them 😉

Many comprehensive or cornea practices are interested in having a glaucoma specialist around for tough cases, second opinions, or just when the cornea guy wants to stop looking at fields and start looking at more topos.

Downside is of course the sometimes challenging patients and rocky postoperative course at times. You do a fair amount of testing which helps compensation though glaucoma patients do have frequent postoperative visits at least initially. SLT when medically appropriate bills OK. It remains to be seen if/how some of the less-invasive surgical procedures will impact things.

 

[Dusn]

pro: the job market compared to most of the other ophtho specialties.

I'm not glaucoma either so I won't try to give more advice than that.

 

[Mirror Form]

I'm not a glaucoma specialist but:

Pros:
1. significantly better job market.
2. usually higher pay
3. Still get to do comprehensive

cons:
YOU HAVE TO DO GLAUCOMA SURGERY! I'm really glad somebody else out there wants to do trabs and tubes!

 

[Eyefixer]

I actually find glaucoma SURGERY and be very elegant. It's glaucoma POST OP that's a PIA.

I'm not a glaucoma specialist but:

Pros:
1. significantly better job market.
2. usually higher pay
3. Still get to do comprehensive

cons:
YOU HAVE TO DO GLAUCOMA SURGERY! I'm really glad somebody else out there wants to do trabs and tubes!

 

[KHE]

I am obviously not a glaucoma fellow, I'm just the local optometrist so I can't speak to the issues asked about but personally, I hate treating glaucoma.

The vast majority of the population is old and cranky but even more so, the thing I really don't like about it is that in all but the rarest of cases, you never improve anything. You just try to stop it from getting worse. I don't like that and can't imagine trying to build a career or practice around that type of thing.

 

[Zorro12]

The vast majority of the population is old and cranky but even more so, the thing I really don't like about it is that in all but the rarest of cases, you never improve anything. You just try to stop it from getting worse. I don't like that and can't imagine trying to build a career or practice around that type of thing.

Welcome to my world, but somebody needs to do it. You will get no Christmas cards or bottles of wine from your post trab/tube patients who now have wound leaks, bleb disasthesia, back on drops due to "botched" glaucoma surgery, etc... You will watch people go blind, ideally slower than without treatment. You will see patients who were watched/dropped into blindness, then urgently referred so you can "save" their 20/20 vision in their only eye with a five degree field. That being said, the job market is good. I am about 50% general, 50% glaucoma. There are some glaucoma specialist only practices around, but I would drink too much if I joined one of those. My fellowship year was great, did alot of surgery, felt comfortable with whatever came my way (even though you will learn more your 1st year out). There is alot of testing and reimbursement remains good for HVF and decent for photos/OCT, so you tend to have a good income (but more overhead) than a general opth. You can still do glaucoma surgery without a fellowship, you do maybe 10 during residency, your next one is a year after residency. A fellow who likely does around 125-150 tubes/trabs during their fellowship will most likely have better outcomes, as you have seen how to handle the post-op pain. In addition, it is the rare OD who is going to refer glaucoma to a general oph, they are looking to send to fellowship trained docs.

 

[Eyefixer]

Yes, surgical glaucoma maybe be more painful than comprehensive at times but if you are doing pure glaucoma you can set up your practice to be able to see 50-60 pts per day and not even break a sweat. Remember, there are only 3 things you can do with glaucoma: treat, not treat, or change treatment. You CAN do very well. Also, if you are considering a desireable area- LA, NY, SF, SD, etc. YOUR JOB MARKET IS A LOT BETTER.