Current job market/pay from fresh out of general ophtho residents and vitreoretina fellows

[freakonomics]

Hi all,
I have heard many things about relatively low pay and tough job market of starting ophtho doctors/vitretoretina fellows right out of residency.
Could any ophtho residents as well as vitreoretina fellows who are currently seeking jobs could comment on current job market and starting pay with their desired geographic location?

I know that it may change drastically but it will help some of us to have an idea of the current job market/pay seen from those who are seeking jobs right now.

Thank you for any input!

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[happymedicalman]

Also, if anyone could weigh in from cornea fellowship - are you able to get jobs that include a portion of corneal surgeries (transplants, refractive, etc.) or do the majority end up practicing mostly general? Are there many openings where you can do a decent bit of the corneal practice (and general)?

Thanks!

 

[VikingFavre]

Hi all,
I have heard many things about relatively low pay and tough job market of starting ophtho doctors/vitretoretina fellows right out of residency.
Could any ophtho residents as well as vitreoretina fellows who are currently seeking jobs could comment on current job market and starting pay with their desired geographic location?

I know that it may change drastically but it will help some of us to have an idea of the current job market/pay seen from those who are seeking jobs right now.

Thank you for any input!

Vitreoretinal jobs are available although obviously depends on demand and varies from urban to rural areas. Starting salaries vary geographically but typically 200-250 was what I heard when I was looking. Starting not as important as finishing though.

 

[hello lady!]

This is something that I can answer because I just went through this process within the last year. I cannot attest to retina or oculoplastic starting salaries, but Comprehensive, Cornea, Glaucoma and Peds were roughly the same. You might be able to convince someone to give you $10,000-$25,000 more per year if you're fellowship trained but most places didn't offer any extra compensation.

The starting salary really depends on what type of setting you pursue:

1. Private practice (with intent to become partner)
The average starting base salary was $175,000-$225,000. There was usually an end of year bonus thrown in (25-35% of your annual collections once they exceeded 2.5-3.5x your base). Starting off for the first year or two you probably won't hit the threshold so you want your base salary to be as high as possible.
Most places offered $5,000 moving/relocation allotment. $2,000 educational stipend was normal. Malpractice insurance was standard. Some places even offered a car+car insurance+gas, computers, etc.

Obviously in this situation you want to make a livable wage while you are an employee, but these numbers shouldn't be your biggest focus. Partnership details are more important. For partnership I saw various deals:
1. Time track to partnership - I've seen 1.5 years all the way to 4 years. 2-3 was average.
2. What you can be partner in (and are there multiple ones?) - Many split up ASC vs Optical vs real estate vs medical practice. You want to make sure you're being offered ALL of the areas and not just the least profitable ones (real estate and optical are probably the most profitable two, the medical and ASC are often designed to "break even" with expenses (such as paying the real estate owners rent)). At once place I interviewed they didn't offer real estate partnership and the owners were paying themselves $40,000-$50,000 per month in rent (for a 4 doc practice). Guess how much profit there was from the medical clinic to share at the end of the year? Barely any.
3. What percentage partner you will be (equal to the others?)
4. Is there a good-will to buy in - This means that you will have to pay a percentage over and above the value of the practice (pretty much a hey thanks for letting me in, here's an extra $100,000 or two). In rural areas this should not exist; in big cities you probably will have to pay it.
5. How does this buy in happen - do you have to go fishing for a $500,000 loan to buy into the practice? Will your partners finance it and just do salary reallocation?
6. What is the partner salary breakdown? Do all partners draw equal salaries? Do all partners split profits equally even if there is a discrepency between two people? If the money isn't split equally, how are all new patients/surgery referrals handled? You want to make sure that the partners don't keep all of the referrals for themselves and leave you struggling to pull income.
7. Is partnership included in the contract you sign or will it be considered down the road? They might use you for cheap labor for three years until you figure out they were never going to offer you partnership.

When you're starting out you have no patients. You're going to want to fill your schedules with as much as possible, so you'll start off doing comprehensive work. After you get a large patient base and referral sources you can then start to trim down your scope of practice and focus solely on your subspecialty. The amount of time (and if you're able to do this entirely) depends largely on where you work.

2. Employee of a hospital or health organization
This could range from a small hospital or a large system like Kaiser. The salaries here started off much higher than private practice but also had a lower ceiling (because you'll never be a business owner and won't get profits from ASCs or real estate or glasses sales). Base salaries that I saw ranged from $275,000 to $350,000. Most places included a productivity bonus based on RVUs ($49 per RVU over 8,500 is one that I saw). Malpractice was included. Signing bonuses around $10,000 were standard too.

Your practice definitely was dependent on what system you were joining. For a small hospital you would probably see everything they threw your way. In a large system (like Kaiser) that is set up, you probably could jump right in and get a decent caseload of subspecialty patients.

3. Academia
Personally I was so burned out from the academic world that I didn't look into this option too heavily. The few places that I looked at required both letters of recommendation and oral recommendations and a petition to the dean just to get an interview. After the interview there were more hoops to jump through if you actually wanted the job.
The salaries I was quoted were around the $200,000 mark. There wasn't a whole lot of room for increase.



The final thing to mention is that there are a lot, (and I mean a lot) of scumbag "physician recruiters/placement specialists" or whatever else they want to call themselves. They are just like car salesmen and insurance salesmen. If you can avoid using them your life will be better. If you have a location you'd like to practice, I would just contact the practices in the area if they are interested. If you're really desperate you could contact the agencies to see if they have any vacancies, but they will come after the practices for $25,000-$30,000.

I had one guy trying to "help me" and he contacted a place on my behalf. I hadn't heard back for 2 weeks from this place and it turned out it was because he was making them sign contracts before he would present me as a candidate. It is so much easier to do it yourself.


I hope that helps. Let me know if you have any other questions I can answer.

 

[ojoseco]

thank you so much for the detailed post hello lady! for the private practice jobs, were these primarily in urban, desirable areas? Can you comment on differences in salary/parternership you came across in rural vs urban areas or were you mainly targeting a specific location?


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[hello lady!]

thank you so much for the detailed post hello lady! for the private practice jobs, were these primarily in urban, desirable areas? Can you comment on differences in salary/parternership you came across in rural vs urban areas or were you mainly targeting a specific location?


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I was mainly targeting less populated suburban areas. I wasn't looking to go into the middle of Montana yet I had no desire to be in the middle of NYC.

In large cities (or densely suburban areas directly outside of the city) the difference was that some places required fellowships or else you would doing just cataracts and routine checks. They still offered the same base salaries (maybe on the lower side; $150,000-$200,000), but they wanted you to be fellowship trained. The competition will be fierce enough that if you aren't subspecialized then the referrals are going to go to other docs in the area. I had people tell me that if I tried to come to the area and do a PKP or Trab then I would "piss off the community" and lose patients (despite whatever adequate training and countless procedures I had already done). The optoms in these areas think they can manage everything and end up directly referring to subspecialists which bypass the comprehensive guys.

Also in the city practices typically have partnership tracks that are longer and require a good-will buy in (I've heard 22% - 50% of 1-2 years of accounts receivable)

I was interested in practicing in an area without a lot of subspecialists. Where I am now it's much more common to just do the trab yourself rather than refer it next door.

 

[happymedicalman]

I was mainly targeting less populated suburban areas. I wasn't looking to go into the middle of Montana yet I had no desire to be in the middle of NYC.

In large cities (or densely suburban areas directly outside of the city) the difference was that some places required fellowships or else you would doing just cataracts and routine checks. They still offered the same base salaries (maybe on the lower side; $150,000-$200,000), but they wanted you to be fellowship trained. The competition will be fierce enough that if you aren't subspecialized then the referrals are going to go to other docs in the area. I had people tell me that if I tried to come to the area and do a PKP or Trab then I would "piss off the community" and lose patients (despite whatever adequate training and countless procedures I had already done). The optoms in these areas think they can manage everything and end up directly referring to subspecialists which bypass the comprehensive guys.

Also in the city practices typically have partnership tracks that are longer and require a good-will buy in (I've heard 22% - 50% of 1-2 years of accounts receivable)

I was interested in practicing in an area without a lot of subspecialists. Where I am now it's much more common to just do the trab yourself rather than refer it next door.

I'm curious - what do you consider to be less densely populated suburban areas? I know everyone interprets different size places very differently... Thank you for all of your information/experience - it is much appreciated as it is hard to gather this information !

 

[hello lady!]

I'm curious - what do you consider to be less densely populated suburban areas? I know everyone interprets different size places very differently... Thank you for all of your information/experience - it is much appreciated as it is hard to gather this information !

I would consider 1-2 hours outside a major city to be less populated.

A few examples of more populated suburban areas that were near big cities that I considered included
Outside of NYC - Westchester County and Western Long Island and Northern NJ
Boston - Worcester County, Massachusetts and Portsmouth NH
Philadelphia - The main line area outside of Philadelphia
Chicago - Oak Park area
Baltimore/DC - Annapolis, Towson, etc

I didn't look in California but I'd imagine anywhere remotely desirable would require a fellowship just to be competitive because of the saturation.

If you're interested in a specific area, do a Google search for all of the ophthalmology providers in that area. If everyone has a fellowship and all subspecialties are represented multiple times, then that is telling of what will be required of you to make it into that area and what type of practice you probably will have.

 

[Bronze Medal]

This was so helpful. Thank you!

This is something that I can answer because I just went through this process within the last year. I cannot attest to retina or oculoplastic starting salaries, but Comprehensive, Cornea, Glaucoma and Peds were roughly the same. You might be able to convince someone to give you $10,000-$25,000 more per year if you're fellowship trained but most places didn't offer any extra compensation.

The starting salary really depends on what type of setting you pursue:

1. Private practice (with intent to become partner)
The average starting base salary was $175,000-$225,000. There was usually an end of year bonus thrown in (25-35% of your annual collections once they exceeded 2.5-3.5x your base). Starting off for the first year or two you probably won't hit the threshold so you want your base salary to be as high as possible.
Most places offered $5,000 moving/relocation allotment. $2,000 educational stipend was normal. Malpractice insurance was standard. Some places even offered a car+car insurance+gas, computers, etc.

Obviously in this situation you want to make a livable wage while you are an employee, but these numbers shouldn't be your biggest focus. Partnership details are more important. For partnership I saw various deals:
1. Time track to partnership - I've seen 1.5 years all the way to 4 years. 2-3 was average.
2. What you can be partner in (and are there multiple ones?) - Many split up ASC vs Optical vs real estate vs medical practice. You want to make sure you're being offered ALL of the areas and not just the least profitable ones (real estate and optical are probably the most profitable two, the medical and ASC are often designed to "break even" with expenses (such as paying the real estate owners rent)). At once place I interviewed they didn't offer real estate partnership and the owners were paying themselves $40,000-$50,000 per month in rent (for a 4 doc practice). Guess how much profit there was from the medical clinic to share at the end of the year? Barely any.
3. What percentage partner you will be (equal to the others?)
4. Is there a good-will to buy in - This means that you will have to pay a percentage over and above the value of the practice (pretty much a hey thanks for letting me in, here's an extra $100,000 or two). In rural areas this should not exist; in big cities you probably will have to pay it.
5. How does this buy in happen - do you have to go fishing for a $500,000 loan to buy into the practice? Will your partners finance it and just do salary reallocation?
6. What is the partner salary breakdown? Do all partners draw equal salaries? Do all partners split profits equally even if there is a discrepency between two people? If the money isn't split equally, how are all new patients/surgery referrals handled? You want to make sure that the partners don't keep all of the referrals for themselves and leave you struggling to pull income.
7. Is partnership included in the contract you sign or will it be considered down the road? They might use you for cheap labor for three years until you figure out they were never going to offer you partnership.

When you're starting out you have no patients. You're going to want to fill your schedules with as much as possible, so you'll start off doing comprehensive work. After you get a large patient base and referral sources you can then start to trim down your scope of practice and focus solely on your subspecialty. The amount of time (and if you're able to do this entirely) depends largely on where you work.

2. Employee of a hospital or health organization
This could range from a small hospital or a large system like Kaiser. The salaries here started off much higher than private practice but also had a lower ceiling (because you'll never be a business owner and won't get profits from ASCs or real estate or glasses sales). Base salaries that I saw ranged from $275,000 to $350,000. Most places included a productivity bonus based on RVUs ($49 per RVU over 8,500 is one that I saw). Malpractice was included. Signing bonuses around $10,000 were standard too.

Your practice definitely was dependent on what system you were joining. For a small hospital you would probably see everything they threw your way. In a large system (like Kaiser) that is set up, you probably could jump right in and get a decent caseload of subspecialty patients.

3. Academia
Personally I was so burned out from the academic world that I didn't look into this option too heavily. The few places that I looked at required both letters of recommendation and oral recommendations and a petition to the dean just to get an interview. After the interview there were more hoops to jump through if you actually wanted the job.
The salaries I was quoted were around the $200,000 mark. There wasn't a whole lot of room for increase.



The final thing to mention is that there are a lot, (and I mean a lot) of scumbag "physician recruiters/placement specialists" or whatever else they want to call themselves. They are just like car salesmen and insurance salesmen. If you can avoid using them your life will be better. If you have a location you'd like to practice, I would just contact the practices in the area if they are interested. If you're really desperate you could contact the agencies to see if they have any vacancies, but they will come after the practices for $25,000-$30,000.

I had one guy trying to "help me" and he contacted a place on my behalf. I hadn't heard back for 2 weeks from this place and it turned out it was because he was making them sign contracts before he would present me as a candidate. It is so much easier to do it yourself.


I hope that helps. Let me know if you have any other questions I can answer.

 

[outdoorfanatic]

What is the timeline for all this? when to start reaching out to contacts as a resident?

 

[hello lady!]

What is the timeline for all this? when to start reaching out to contacts as a resident?

There is no official timeline. Ideally you should secure a position 6-9 months before you want to work. Getting state licenses, medicare/dea/etc #s, hospital and insurance credentials takes FOREVER. If you're dead set on a certain state you can often get a license after passing step 3 and having your internship completed.

I know of some people who contacted practices directly in their second year of residency to see if there was any interest. This allows the applicant and the practice to have an ongoing "feeling out" process. Also if the practice has a specific need (like cornea) it could point you into a fellowship direction if you're not sure.

 

[hello lady!]

@hello lady!

Firstly, I wanted to thank you for such an amazing reply.

Just out of curiosity, were you fellowship trained or were these offers straight out of general ophthalmology residency?

How much were the buy ins to become a partner and how much does your salary theoretically jump up from an associate position?

Thanks again!

I was straight out of residency. If you're doing Gen/Peds/Cornea/Glaucoma I think your mileage will be similar. I think the retina and plastics folks are in a different league.

Buy in to become partner can vary A LOT. Same with your theoretical salary. The higher your salary, the higher the buyin. My current position I expect to go from $200k to $350-400k. I was offered a position where I was guaranteed $1 million in my first year as partner that I didn't take.

 

[hello lady!]

wow that is a quite a big jump! Any reason why you didnt take the job with $ 1 million as a partner? Also are the buy ins even affordable from the salary you made in the first couple of years in practice or do most people take loans?

Thanks again for your very informative responses.

I'd imagine most people take out loans, or some practices will give you the loan and redistribute your salary (like if the partners all pull $400k, you'll get $250k until your portion is paid off). You're looking at buying in $500k-$1 mil

Money is not everything! This practice was a huge cataract shop; each provider was doing 50-75 cases per week. Unless it was a cataract or a laser it got referred out. I also hated hated hated the area.

 

[LightBox]

I would be careful about asking for everything under the sun when negotiating for your first job out of training. Many practice owners (myself included) get kind of put-off when a newbie comes into the interview, guns-a-blazing, asking for equity in every piece of the pie. Yes, you should try to get a fair package, but at the same time, don't be so aggressive that the owners get turned off by you. Remember: you are an unproven product until you work with the new practice for awhile to see if the owners (and staff) can actually work with you. Partnership is like marriage -- no one wants to be with someone annoying for the rest of their lives!

 

[hello lady!]

I would be careful about asking for everything under the sun when negotiating for your first job out of training. Many practice owners (myself included) get kind of put-off when a newbie comes into the interview, guns-a-blazing, asking for equity in every piece of the pie. Yes, you should try to get a fair package, but at the same time, don't be so aggressive that the owners get turned off by you. Remember: you are an unproven product until you work with the new practice for awhile to see if the owners (and staff) can actually work with you. Partnership is like marriage -- no one wants to be with someone annoying for the rest of their lives!

Well if you're not offering equal partnership to incoming docs clearly the newbie won't have much to negotiate on. There are a lot of places that advertise equal partnership but hide that they're cooking the books a little bit and not making you truly equal in terms of profit sharing.

...and of course we're unproven - thats why we have to work 2-4 years before partnership is even considered.

 

[soonmd1]

Well if you're not offering equal partnership to incoming docs clearly the newbie won't have much to negotiate on. There are a lot of places that advertise equal partnership but hide that they're cooking the books a little bit and not making you truly equal in terms of profit sharing.

...and of course we're unproven - thats why we have to work 2-4 years before partnership is even considered.

It's things like this (referring to LighBox's post) that make new associates feel uneasy. Like hello lady! said, of course the practice we are joining does not know us, nor do we know the practice. The associate period is in a sense a testing period for both parties.
Why is it wrong for someone interviewing for a job to know what the terms of partnership might be when that associate period ends? If the books are clean and the practice is ethical then this shouldn't be an issue. Wanting to know if you will be an equity partner provided that all criteria are satisfied is a valid question before you work your tail off for 3 years taking home only a percentage of the income you are generating?
It just seems like if it is a good practice with no intentions of screwing you over, this information should be very open. Obviously if an associate is too demanding with the contract or demands a guaranteed partnership, that is unreasonable. But I feel there is an uneasiness cultivated in our profession when it comes to asking financial questions of your potential employer, as if it's somehow wrong or you will create a bad impression, and the associate ends up having to tease it out a lot of the times. It can be like pulling teeth

 

[dantt]

Pity the fool who joins a practice as a "partnership track" associate without even knowing what being a partner would look like.

 

[LightBox]

Partnership is never guaranteed. So better play nice and work extremely hard and pray your Employer sees the value of you having equity. Otherwise, giving someone equity can be an unnecessary hassle. If an associate does not like the terms, there is always the option of starting one's own practice. In many cases, starting new can be much cheaper than buying into a practice.

 

[JMK2005]

Thats the problem with our profession. Too many owners have this take it or leave it mentality. In the end, new associates gets screwed.

 

[Eyefixer]

Partnership is never guaranteed. So better play nice and work extremely hard and pray your Employer sees the value of you having equity. Otherwise, giving someone equity can be an unnecessary hassle. If an associate does not like the terms, there is always the option of starting one's own practice. In many cases, starting new can be much cheaper than buying into a practice.

Very glad he posted this for all the graduating residents and fellows to see. I work with many private practice physicians of all specialities and I can tell you that, for the most part, this type of thinking mostly exist in ophthalmology. I routinely talk with urology, ortho, neurosurgery, etc. colleagues whose practices go out of their way to make associates productive and thriving, so they actually STAY and enhance the practice both as an asset and financially. This is a typical ophtho predatory practice owner BS type of thinking (and Lightbox is not even in a desirable area). In desirable areas, they churn associates every 2 years and never even consider partnership behind closed doors. "...work extremely hard and better pray..." What a crock of s***t.

 

[ojoseco]

Very glad he posted this for all the graduating residents and fellows to see. I work with many private practice physicians of all specialities and I can tell you that, for the most part, this type of thinking mostly exist in ophthalmology. I routinely talk with urology, ortho, neurosurgery, etc. colleagues whose practices go out of their way to make associates productive and thriving, so they actually STAY and enhance the practice both as an asset and financially. This is a typical ophtho predatory practice owner BS type of thinking (and Lightbox is not even in a desirable area). In desirable areas, they churn associates every 2 years and never even consider partnership behind closed doors. "...work extremely hard and better pray..." What a crock of s***t.

Any tips to help new grads avoid these types of "predatory" practices since some of these things aren't all that easily discerned in a job interview?



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[Eyefixer]

If you don't hear any partnership details, it's a bad sign. Try to find out how many associates have left the practice and for what reason. Best thing to do is to actually talk to an associate/partner who recently left. That person hopefully will give you a less biased opinion of the practice's dynamic. Talk to local device/drug reps, they can usually give you very good low down on a practice. Oh, never EVER join ANY practice where practice manager is a spouse of a partner. Or if it's a wife/husband/cousin/son/daughter partner combination. Good luck.


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[hello lady!]

Any tips to help new grads avoid these types of "predatory" practices since some of these things aren't all that easily discerned in a job interview?



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I agree with Eyefixer.

You have to get a good feel for who the partners are as people. Are they family-oriented? Do they seem like a slick businessperson? Do many of the partners come from the same family? That is a red flag. Is every partner from the same alma mater and you're going to be the odd one out?

Look at the deal: is it fair? Too good to be true? Trust your gut.

I took one of the lowest offered salaries because I trusted to practice and partners so much.

You definitely want to know 1) how many and 2) why any prior physicians left without partnership. Get close to your Alcon rep - they will make phone calls for you and get you some details. It turned out that some of the practices actually had their reps contact MY local rep to ask how I was as a surgeon/physician. It's a huge game.

 

[hello lady!]

Partnership is never guaranteed. So better play nice and work extremely hard and pray your Employer sees the value of you having equity. Otherwise, giving someone equity can be an unnecessary hassle. If an associate does not like the terms, there is always the option of starting one's own practice. In many cases, starting new can be much cheaper than buying into a practice.

Well I guess you can have this mentality if you're in a highly desirable area and you have ophthalmologists knocking on your door every day to come work for you. Many of the practices I interviewed at didn't have this luxury (it's currently an employee's market) and were giving fair, attractive offers to try to entice young physicians with the end-goal of expanding the practice.

 

[DrZeke]

Can anyone comment on how the job search in academics works? Do people usually pick you up and offer you a job? I always heard rumours that people stay in the place they trained, but this doesn't seem that common. Any advice ?


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[LightBox]

Very glad he posted this for all the graduating residents and fellows to see. I work with many private practice physicians of all specialities and I can tell you that, for the most part, this type of thinking mostly exist in ophthalmology. I routinely talk with urology, ortho, neurosurgery, etc. colleagues whose practices go out of their way to make associates productive and thriving, so they actually STAY and enhance the practice both as an asset and financially. This is a typical ophtho predatory practice owner BS type of thinking (and Lightbox is not even in a desirable area). In desirable areas, they churn associates every 2 years and never even consider partnership behind closed doors. "...work extremely hard and better pray..." What a crock of s***t.

Eyefixer has some kind of weird infatuation with me since he always twists my words and makes me look like the "bad guy" He also thinks I live in Fargo, ND (It's South Dakota -- get it right! )

Anyways, my comments are just meant to give the perspective of someone who owns a practice. Of course, any practice owner would love to bring on an equity partner if some conditions are met:

(1) The existing patient volume is overwhelming the current partners such that the practice cannot expand or thrive without someone new coming onboard.
(2) The proposed practice buy-in amount gives some type of incentive for the existing partners. Why would someone just give away equity (and thus future revenue) without gaining some type of incentive him/herself?
(3) The proposed new partner is easy to get along with for the next 20 years.
(4) The proposed new partner is a good surgeon/clinician and is ethical.
(5) The proposed new partner has some business acumen or at least has the aptitude and desire to run a business and do some administrative work outside of office hours. (aka I don't want to do all of the admin work if I now have less equity).

My point in my post above is that many new associates come in thinking that they "deserve" everything under-the-sun just because they finished training...even if they suck as a surgeon, are abrasive to patients and staff, cannot make business decisions to save their lives, and don't want to deal with any admin work after clinic. I just feel like people are being told to "...ask to have a piece of everything! Get clinic revenue, ASC buy-in, optical buy-in, dry eye product revenue, real estate buy-in...and make sure you only pay 50k for that 50% stake too!" Things don't always have to be "all-or-none" and there are many good jobs out there they don't include everything.

Due to the vagueness of most associates' job situations, I frequently advise people to save as much money as possible during their associate years if things really don't go their way. Instead, most newbies go on a spending spree and buy a new car (or worse a house) with their newfound 200-250k salary. Again, starting a new practice is a viable option for anyone who worries that partnership may not happen.

Lastly, I find it interesting that people who work for Kaiser (and get paid roughly the same amount as a busy associate does) do not describe Kaiser as "predatory" and "abusive" like a private practice. I guess the bigger an organization gets, the less "personal" and thus accepted some of their decisions are (e.g. the decision of non-partnership) even if they lead to the same net effect (e.g. salary of 200-400k).

 

[DrZeke]

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[dantt]

My point in my post above is that many new associates come in thinking that they "deserve" everything under-the-sun just because they finished training...even if they suck as a surgeon, are abrasive to patients and staff, cannot make business decisions to save their lives, and don't want to deal with any admin work after clinic. I just feel like people are being told to "...ask to have a piece of everything! Get clinic revenue, ASC buy-in, optical buy-in, dry eye product revenue, real estate buy-in...and make sure you only pay 50k for that 50% stake too!" Things don't always have to be "all-or-none" and there are many good jobs out there they don't include everything.

In retrospect, do you not wish you had asked those questions when you were considering your first job? If you had received those same vague answers back then, would you have still accepted it?

 

[taehong81]

Eyefixer has some kind of weird infatuation with me since he always twists my words and makes me look like the "bad guy" He also thinks I live in Fargo, ND (It's South Dakota -- get it right! )

Anyways, my comments are just meant to give the perspective of someone who owns a practice. Of course, any practice owner would love to bring on an equity partner if some conditions are met:

(1) The existing patient volume is overwhelming the current partners such that the practice cannot expand or thrive without someone new coming onboard.
(2) The proposed practice buy-in amount gives some type of incentive for the existing partners. Why would someone just give away equity (and thus future revenue) without gaining some type of incentive him/herself?
(3) The proposed new partner is easy to get along with for the next 20 years.
(4) The proposed new partner is a good surgeon/clinician and is ethical.
(5) The proposed new partner has some business acumen or at least has the aptitude and desire to run a business and do some administrative work outside of office hours. (aka I don't want to do all of the admin work if I now have less equity).

My point in my post above is that many new associates come in thinking that they "deserve" everything under-the-sun just because they finished training...even if they suck as a surgeon, are abrasive to patients and staff, cannot make business decisions to save their lives, and don't want to deal with any admin work after clinic. I just feel like people are being told to "...ask to have a piece of everything! Get clinic revenue, ASC buy-in, optical buy-in, dry eye product revenue, real estate buy-in...and make sure you only pay 50k for that 50% stake too!" Things don't always have to be "all-or-none" and there are many good jobs out there they don't include everything.

Due to the vagueness of most associates' job situations, I frequently advise people to save as much money as possible during their associate years if things really don't go their way. Instead, most newbies go on a spending spree and buy a new car (or worse a house) with their newfound 200-250k salary. Again, starting a new practice is a viable option for anyone who worries that partnership may not happen.

Lastly, I find it interesting that people who work for Kaiser (and get paid roughly the same amount as a busy associate does) do not describe Kaiser as "predatory" and "abusive" like a private practice. I guess the bigger an organization gets, the less "personal" and thus accepted some of their decisions are (e.g. the decision of non-partnership) even if they lead to the same net effect (e.g. salary of 200-400k).

I think there is difference between Kaiser and private practice in terms of what they offer. Some private practice lure associates to job with possibility of partnership but in truth may never offer partnership or the terms of partnership may not be fair to the associates. When you apply for Kaiser you know exact terms and how to obtain partnership and know what you are getting yourself into.

 

[hello lady!]

Eyefixer has some kind of weird infatuation with me since he always twists my words and makes me look like the "bad guy" He also thinks I live in Fargo, ND (It's South Dakota -- get it right! )

Anyways, my comments are just meant to give the perspective of someone who owns a practice. Of course, any practice owner would love to bring on an equity partner if some conditions are met:

(1) The existing patient volume is overwhelming the current partners such that the practice cannot expand or thrive without someone new coming onboard.
(2) The proposed practice buy-in amount gives some type of incentive for the existing partners. Why would someone just give away equity (and thus future revenue) without gaining some type of incentive him/herself?
(3) The proposed new partner is easy to get along with for the next 20 years.
(4) The proposed new partner is a good surgeon/clinician and is ethical.
(5) The proposed new partner has some business acumen or at least has the aptitude and desire to run a business and do some administrative work outside of office hours. (aka I don't want to do all of the admin work if I now have less equity).

My point in my post above is that many new associates come in thinking that they "deserve" everything under-the-sun just because they finished training...even if they suck as a surgeon, are abrasive to patients and staff, cannot make business decisions to save their lives, and don't want to deal with any admin work after clinic. I just feel like people are being told to "...ask to have a piece of everything! Get clinic revenue, ASC buy-in, optical buy-in, dry eye product revenue, real estate buy-in...and make sure you only pay 50k for that 50% stake too!" Things don't always have to be "all-or-none" and there are many good jobs out there they don't include everything.

Due to the vagueness of most associates' job situations, I frequently advise people to save as much money as possible during their associate years if things really don't go their way. Instead, most newbies go on a spending spree and buy a new car (or worse a house) with their newfound 200-250k salary. Again, starting a new practice is a viable option for anyone who worries that partnership may not happen.

Lastly, I find it interesting that people who work for Kaiser (and get paid roughly the same amount as a busy associate does) do not describe Kaiser as "predatory" and "abusive" like a private practice. I guess the bigger an organization gets, the less "personal" and thus accepted some of their decisions are (e.g. the decision of non-partnership) even if they lead to the same net effect (e.g. salary of 200-400k).

I feel like I've been bombarded with so many recruiters and seen so many journal advertisements for jobs in Fargo. You make it seem like there is a plethora of ophthalmologists in the area.

Your 5 conditions are also exactly what I would look for in a practice - I want the volume to be overwhelming and for there to be a need for a new provider, I want there to be an incentive to the partners to give them an interest in my own success. They should also be ethical and good ophthalmologists.

Starting a practice de novo is really not as easy as you make it out to be. If you're working as an employee it's almost a guarantee that you've signed a non-compete. So you're going to work in 1 area and then go start a new practice 30-50 miles away? Does one do this slowly, like 1 day per week new practice vs 4 days per week employed practice? Are they going to allow that? Will they still provide your health insurance? Are you going to be able to make the payments on your student loans?

....or do you save up for 4-5 years and just move and start a new practice full time? How are you going to pay yourself while you wait for a patient base to accrue?

 

[Eye-eye]

Multiple questions, so I apologize in advance for the length of this. Does anyone know what the job market looks like for a general ophtho a bit farther out in the country (middle of Montana or something)? I would assume there's less competition, but if it's also less populated, can that also make it difficult to generate good patient volume? Is there a way to easily judge what may be too far in the country, if that's a thing?

Also curious what the retina job market looks like, if anyone may happen to know. I've heard a little about salary (more than most gen ophthos, less than a cataract mill partner), but less about availability, becoming a partner, etc. Also curious about lifestyle. People say you're giving up the 9-5 because of call, but if you're at a practice that has its own ASC for its patients, and thus no association with a hospital or bigger health system, is there still much call? Of course, this wouldn't be an issue at all with medical retina, but I have heard that if you wanted to do full time retina, you'd have a hard time getting in at a retina practice without a surgical retina fellowship. If anyone could clarify any of this, I would be very appreciative.

Thanks!

 

[Slide]

Multiple questions, so I apologize in advance for the length of this. Does anyone know what the job market looks like for a general ophtho a bit farther out in the country (middle of Montana or something)? I would assume there's less competition, but if it's also less populated, can that also make it difficult to generate good patient volume? Is there a way to easily judge what may be too far in the country, if that's a thing?

Also curious what the retina job market looks like, if anyone may happen to know. I've heard a little about salary (more than most gen ophthos, less than a cataract mill partner), but less about availability, becoming a partner, etc. Also curious about lifestyle. People say you're giving up the 9-5 because of call, but if you're at a practice that has its own ASC for its patients, and thus no association with a hospital or bigger health system, is there still much call? Of course, this wouldn't be an issue at all with medical retina, but I have heard that if you wanted to do full time retina, you'd have a hard time getting in at a retina practice without a surgical retina fellowship. If anyone could clarify any of this, I would be very appreciative.

Thanks!

If you're out in the country, you can basically write your own check. It's not just in places like Montana; plenty of states in the Midwest and Southeast need comprehensive ophthalmologists due to a plethora of aging ophthalmologists retiring. Cities and towns 1-2 hours away from major hubs are in need for comprehensive ophthalmologists. There's actually good volume in these areas because many rural folks don't like traveling to major cities.

The retina job market is still thriving, but some rules still apply just like comprehensive. Private practices are looking for partners who are willing to join them in suburban or semi-rural areas. In highly populated metro areas, it will be saturated, but the further you go down in population list, the more opportunities there will be. I currently live in my state's capital and there is plenty of need for more retina specialists.

The lifestyle varies and depends on where you are at and how you want to practice. Some practices have the ability to add on cases in the evening, but some other places don't. There are fewer indications nowadays to take a patient in the middle of the night anyway so the after-hours lifestyle is better than it was 20 years ago.