Current Retina Job Market

[linevasel]

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Hi Ya'll.

I've noticed the only jobs being posted are mostly PE for surgical retina.
1. Does anyone have any sense of what percent of Retina jobs are PE vs Academic vs Private Practice (Multi-specialty and Retina-only) ?
2. Is this simply a timing thing, and its too early for job postings or is this a new reality for the current market ?

*I'm assuming that PE has had some turnover and so outgoing fellows are at a disadvantage in competing for Non-PE jobs as some of those have been swallowed up by folk exiting PE. I'm also assuming that PE has made competition tough in certain markets so non PE groups aren't as eager to expand.

*Disclosure- Working ophtho with a relative in VR fellowship who I'm having to console ... I myself am not looking for a job

 

[mjohnsonets]

Hi Ya'll.

I've noticed the only jobs being posted are mostly PE for surgical retina.
1. Does anyone have any sense of what percent of Retina jobs are PE vs Academic vs Private Practice (Multi-specialty and Retina-only) ?
2. Is this simply a timing thing, and its too early for job postings or is this a new reality for the current market ?

*I'm assuming that PE has had some turnover and so outgoing fellows are at a disadvantage in competing for Non-PE jobs as some of those have been swallowed up by folk exiting PE. I'm also assuming that PE has made competition tough in certain markets so non PE groups aren't as eager to expand.

*Disclosure- Working ophtho with a relative in VR fellowship who I'm having to console ... I myself am not looking for a job

I don't have specific numbers but from my best guess I'd say that over 50% of retina jobs openly posted are PE backed.

Again, not specific numbers but there are about 3000 retina surgeons in the US. Over 10% of the retina surgeons in the US are part of RCA alone. Hard to tell what the rest of them are, but I'd guess 20-25% are in PE groups or groups with outside investment.

PE offers are going up and some groups are more likely now to offer 4-day weeks or offers with the intent of a better work/life balance to recruit. This does make more competition for physician owned groups.

There are also a few major metro markets where more than half the retina surgeons work for a PE backed group.

 

[eyeeye_captain]

Do you have an idea of what the new offers look like? Everybody has heard of the 400/500/600 from RCA previously.

I think you’re right that some of the non-PE jobs have already been scooped up by people who bailed. You also have to keep in mind that these are desperate businesspeople trying to replace the losses of their golden parachute doctors. Of course they’re going to flood the postings. There’s a good size multispecialty PE group in my region that had ~25% of their docs retire in the last few years, had every associate during that period turn over, and have around half of the remaining MDs over the age of 60. I don’t think that’s an unusual story.

My group will almost certainly be hiring in the next 5 years and I wouldn’t be shocked if it’s in the next 2. I could probably hire 2 right now if I could find people willing to go to a couple smaller cities a little past our footprint.

The market unfortunately is what it is in some of the big metros. If you want to be in northern New Jersey, DC, Atlanta, Nashville, Minneapolis, etc., good luck finding a decent deal.

 

[mjohnsonets]

Do you have an idea of what the new offers look like? Everybody has heard of the 400/500/600 from RCA previously.

I think you’re right that some of the non-PE jobs have already been scooped up by people who bailed. You also have to keep in mind that these are desperate businesspeople trying to replace the losses of their golden parachute doctors. Of course they’re going to flood the postings. There’s a good size multispecialty PE group in my region that had ~25% of their docs retire in the last few years, had every associate during that period turn over, and have around half of the remaining MDs over the age of 60. I don’t think that’s an unusual story.

My group will almost certainly be hiring in the next 5 years and I wouldn’t be shocked if it’s in the next 2. I could probably hire 2 right now if I could find people willing to go to a couple smaller cities a little past our footprint.

The market unfortunately is what it is in some of the big metros. If you want to be in northern New Jersey, DC, Atlanta, Nashville, Minneapolis, etc., good luck finding a decent deal.

Offers for retina are getting all over the place at this point. For new grads, If you're asking PE it could run $400-650K. For physician owned, I've seen $350-$550K, but the high offers don't tend to be retina only groups. I'm sure there are outliers from these numbers too, these are 2025 offers.

There are some cities where private practice retina is almost entirely (save for a couple solo docs) PE: Minneapolis, Nashville, and Austin come to mind. M&A activity slowed down over the last 2 years so it's working from a low number anyways, but retina represented an outsized portion of the transactions in the last 2 years, and I'm not just saying that because of RCA.

 

[linevasel]

Offers for retina are getting all over the place at this point. For new grads, If you're asking PE it could run $400-650K. For physician owned, I've seen $350-$550K, but the high offers don't tend to be retina only groups. I'm sure there are outliers from these numbers too, these are 2025 offers.

There are some cities where private practice retina is almost entirely (save for a couple solo docs) PE: Minneapolis, Nashville, and Austin come to mind. M&A activity slowed down over the last 2 years so it's working from a low number anyways, but retina represented an outsized portion of the transactions in the last 2 years, and I'm not just saying that because of RCA.

MJOHNSONETs

Why are the higher offers in multispecialty practices. Is it because of the greater sharing in drug revenue that is expected from future collections (lower ceiling in your peak practice years?). Or is it because those groups have to work harder to appeal to retina specialists ? Or some other reason.

 

[mjohnsonets]

MJOHNSONETs

Why are the higher offers in multispecialty practices. Is it because of the greater sharing in drug revenue that is expected from future collections (lower ceiling in your peak practice years?). Or is it because those groups have to work harder to appeal to retina specialists ? Or some other reason.

I'm sure the drug profit sharing is some of it. It is harder to recruit retina to a multi-specialty group than retina only and
that's where I believe most of the price premium comes from. For instance, the $550K offer I know of is with a multi-specialty group that has a single retina surgeon right now. The numbers I quoted are numbers I've actually run into, there will be outliers.

 

[northeastgal95]

I'm sure the drug profit sharing is some of it. It is harder to recruit retina to a multi-specialty group than retina only and
that's where I believe most of the price premium comes from. For instance, the $550K offer I know of is with a multi-specialty group that has a single retina surgeon right now. The numbers I quoted are numbers I've actually run into, there will be outliers.

Why is it harder to recruit retina to a multi-specialty group?

 

[dantt]

Why is it harder to recruit retina to a multi-specialty group?

Biggest is probably retina call coverage and how drug money should be handled.

 

[wysdoc]

Why is it harder to recruit retina to a multi-specialty group?

Because other ophthalmologists who refer a patient to the Retina specialist think that the multi-group will "keep" that patient and not send them back to their referring ophthalmologist.

 

[mjohnsonets]

Why is it harder to recruit retina to a multi-specialty group?

Here's a non comprehensive list of pros and cons for multi-specialty practice for retina:

Pros: internal referrals, typically can avoid hospital call, potential practice owned surgery center buy-in, typically less challenging retina cases, likely higher base salary, lifestyle typically reported better to me

Cons: staff isn't all retina trained, higher overhead, less retina colleagues to share patients with, can be put in general call, tend to be less involved in clinical trials

On average, partner income is higher in a retina only group but the highest earning retina surgeon I've known was in a large multi-specialty group albeit with a large retina service. He was bought into the surgery center, the real estate, and basically everything the practice had to offer.

 

[eyeeye_captain]

Pros:
- internal referrals, true, but the group has to have the volume to support a hire. Outside referrals may be slow if others in the area worry the practice will keep the patients for general care
- typically can avoid hospital call, actually more likely as you’re more likely to have hospital coverage with bigger groups, so even if it’s general call only, your partners will send you some of what they get
- potential practice owned surgery center buy-in, true, generally more feasible than with retina only
- typically less challenging retina cases, unsure of what this implies, docs sending you a lot of softballs? Still get plenty of those with risk averse referral sources in retina only
- likely higher base salary, probably true, wouldn’t know
- lifestyle typically reported better to me, may be true but probably equivalent unless it’s from lower volume or maybe less commuting

Cons:
- staff isn't all retina trained, usually true but may have a dedicated team
- higher overhead, definitely true, you often wind up subsidizing the other docs
- less retina colleagues to share patients with, usually true
- can be put in general call, true, and even if you’re retina call only, you’re likely sharing it with fewer docs
- tend to be less involved in clinical trials, true
- partner income is higher in a retina only group, true
- potential questions about profit sharing with drugs and premium lenses
- may have less of a say on equipment/capital expenditures

 

[Slide]

Another slight con to multispecialty groups - some of the internal "referrals" you'll get may be essentially unpaid work. Any complications or issues from your partners will either fall under the 90 day global period (if surgical) or will be considered established so you can't bill for new patient visits. So that dropped lens or endophthalmitis case you have to deal with? Free or heavily discounted care, unless you have a revenue structure in your contract to account for this - not to mention the lost opportunity cost of seeing other patients and performing other surgeries due to the chair time and additional potential surgeries needed.

 

[eyeeye_captain]

Another slight con to multispecialty groups - some of the internal "referrals" you'll get may be essentially unpaid work. Any complications or issues from your partners will either fall under the 90 day global period (if surgical) or will be considered established so you can't bill for new patient visits. So that dropped lens or endophthalmitis case you have to deal with? Free or heavily discounted care, unless you have a revenue structure in your contract to account for this - not to mention the lost opportunity cost of seeing other patients and performing other surgeries due to the chair time and additional potential surgeries needed.

Solid point. You should have it spelled out contractually that if there’s any same day referral, or some surgical cleanup, you’re the only one billing, bar none. Hopefully not super common, but if anyone on the same tax ID beats you to the punch on these visits? Freebie. That 4+ brunescent cataract the cataract surgeon dunked in 2 minutes and didn’t put in a lens? Long annoying freebie case. Absolutely reasonable to help out, but you don’t want to be a dumping ground.

 

[Slide]

Solid point. You should have it spelled out contractually that if there’s any same day referral, or some surgical cleanup, you’re the only one billing, bar none. Hopefully not super common, but if anyone on the same tax ID beats you to the punch on these visits? Freebie. That 4+ brunescent cataract the cataract surgeon dunked in 2 minutes and didn’t put in a lens? Long annoying freebie case. Absolutely reasonable to help out, but you don’t want to be a dumping ground.

Yeah exactly. All that care managing a dropped lens or endophthalmitis that came from one of your partners is basically free. If you have to take them to surgery, it's a 30% reduction in payment. Plus, potentially 5-15 post op visits in that time frame that is not billed for, which could be going to procedures or new patients. Whereas if you're retina-only, you'll at least be compensated for your efforts. I'm in this situation in an academic department but it works out because they also help me out in kind as well for other stuff. But if I were in private practice, I'd definitely want some sort of consolation prize for this.

 

[eyeeye_captain]

Last point on managing someone else’s surgical stuff and making nothing - it can still happen in retina only groups if you have any nonsurgical docs. I also advocate for the surgeon getting to bill there.

The collaboration is a small plus. It’s a lot easier to get your NVG patient a tube quickly or set up a combo phaco/vitrectomy in a MSG. If you’re retina only, your referral groups want everything seen same or next day but are less likely to return the favor.

 

[ophthoswap2]

Last point on managing someone else’s surgical stuff and making nothing - it can still happen in retina only groups if you have any nonsurgical docs. I also advocate for the surgeon getting to bill there.

The collaboration is a small plus. It’s a lot easier to get your NVG patient a tube quickly or set up a combo phaco/vitrectomy in a MSG. If you’re retina only, your referral groups want everything seen same or next day but are less likely to return the favor.

Non-surgical person usually sees plenty of unpaid post-ops for the surgical docs, so it's probably a wash.
Agree that referral groups want everything seen urgently and are less likely to return the favor with for tubes.

 

[eyeeye_captain]

Non-surgical person usually sees plenty of unpaid post-ops for the surgical docs, so it's probably a wash.

A few 2 minute POD1s a week doesn’t match up to losing a clinic day to operate. The surgeon is almost certainly seeing them at least twice more during the global even if the nonsurgical sees them once as well.

 

[Slide]

Mind you I'm on a wRVU system, but I did the math and most of my clinic days come out at worst equal to normal surgical day. My busiest clinical days are at least 33% more RVUs than my OR days. For a normal clinic day, I'd have to perform 4 TRDs/complex RDs, or perform 5-6 vitrectomies to come out equal to a clinic day. So yeah I can definitely see how people "lose" money being in the OR. Guess the saying is true - injection for dough, cutting for show.

 

[MstaKing10]

Doing a good job surgically increases referring doctors confidence in your skills and will increase referrals for both surgical and non surgical patients. Though this wouldn’t show up in a revenue spreadsheet, there would likely be a significant cut to the practices revenue if surgical services were not offered.

 

[eyeeye_captain]

Bumping as it sounds like PE is getting worse.

Got the rare recruiter email for an actually desirable area (if fairly saturated tmk), so I looked out of curiosity. Same usual junk, but now the advertised pay is $350k capping at $450k for an “associate” for up to 3 years. Guess they’ve squeezed almost all the blood from the stone.

 

[northeastgal95]

Bumping as it sounds like PE is getting worse.

Got the rare recruiter email for an actually desirable area (if fairly saturated tmk), so I looked out of curiosity. Same usual junk, but now the advertised pay is $350k capping at $450k for an “associate” for up to 3 years. Guess they’ve squeezed almost all the blood from the stone.

Is your impression that the PE situation in retina is significantly worse than the rest of Ophtho? I’m interested in retina but with not wanting to work for PE and also wanting to be in a major city, wondering if that’s a pipe dream if I go into retina haha

 

[percyeye]

If someone opens up and are even somewhat successful will others jump ship and go work for a non-PE practice? Or would the non-competes hit too hard? PE doesn't work if they can't get anyone to work for them. As an Optometrist who regularly refers patients I'm almost always choosing a non-PE place over a PE office if I have the choice and I know many others think the same way.

 

[RetinaDude]

If you are interested in retina in a large city, it appears the majority of big groups are already affiliated with PE. Even many of the retina groups, in medium towns, are affiliated with PE. PE pays well, to start, but you are limited on the top end. I’ve heard $350k-$450k starting and up to a million once a “partner”. From talking with friends who are part of various PE groups, most don’t tell you how to practice or force you to do anything you are not comfortable with. My sources are limited but it seems the PE that owns both general ophthalmology, as well as retina groups, are more “pushy” about seeing more patients and pushing premium lenses. PE that includes only retina (such as RCA) are very hands off with your practice because they are mainly interested in the highly profitable drug money. But, with that being said, there are still a lot of really good non-PE retina positions available. You may have to be more open with your search.

 

[eyeeye_captain]

Is your impression that the PE situation in retina is significantly worse than the rest of Ophtho? I’m interested in retina but with not wanting to work for PE and also wanting to be in a major city, wondering if that’s a pipe dream if I go into retina haha

I don’t know the penetration into general, but the retina footprint in major cities is relatively high even though the overall percentage of doctors/practices is still a distinct minority. The buy ups have slowed but not ended. Myself and most of the people I keep in touch with are non-PE, but we’re not old enough to have sold and are not coming out of training looking to be in a market that already sold. There are still a lot of good spots if you’re willing to look around.

From talking with friends who are part of various PE groups, most don’t tell you how to practice or force you to do anything you are not comfortable with. My sources are limited but it seems the PE that owns both general ophthalmology, as well as retina groups, are more “pushy” about seeing more patients and pushing premium lenses. PE that includes only retina (such as RCA) are very hands off with your practice because they are mainly interested in the highly profitable drug money.

I’ve kinda heard the same with the few PE folks I speak with, but who knows with the non-disparagement clauses. I had a conversation with a RCA executive who post-Good Days’ demise told me flat out they aggressively push branded drugs to patients who may not be able to pay and why wouldn’t I? Doesn’t sound all that hands off.

I texted my coresident in the above mentioned practice’s market and apparently they’re in a big multispecialty PE conglomerate. Sketchy reputation that’s publicly available (can DM me for the public stuff).

 

[sloh]

If you are interested in retina in a large city, it appears the majority of big groups are already affiliated with PE. Even many of the retina groups, in medium towns, are affiliated with PE. PE pays well, to start, but you are limited on the top end. I’ve heard $350k-$450k starting and up to a million once a “partner”. From talking with friends who are part of various PE groups, most don’t tell you how to practice or force you to do anything you are not comfortable with. My sources are limited but it seems the PE that owns both general ophthalmology, as well as retina groups, are more “pushy” about seeing more patients and pushing premium lenses. PE that includes only retina (such as RCA) are very hands off with your practice because they are mainly interested in the highly profitable drug money. But, with that being said, there are still a lot of really good non-PE retina positions available. You may have to be more open with your search.

1M as partner is pretty good, no?

 

[eyeeye_captain]

1M as partner is pretty good, no?

Sure, but not ideal when corporate is taking 20% of what you brought in.

 

[RetinaDude]

1M as partner is pretty good, no?

Don’t get me wrong, $1M is an outstanding salary no matter what, but I’m just comparing to what I know of my income over the years, my partners, and other close friends in private retina practice. For most of us, $1M income would be taking a 50% or more pay cut