Deciding between glaucoma/cornea

[mmmmaaaaahhhhhh]

Hi everybody, I'm at something of a crossroads with regard to choosing a fellowship (cornea vs glaucoma), and hoping for advice / thoughts from those that have been through the process.

For context: I'm about halfway through residency right now. I'll be applying for fellowships in about a year.
I have a background in academic glaucoma, did a combined MD/PhD with my thesis on glaucoma, and have spent the better part of 7 years involved in high-impact glaucoma research, pubs, giving podium talks at AAO/ARVO/AGS, awards and grants... I've have built a strong CV and strong networks in this subspecialty. I am on very good terms with several fellowship directors at top 10 schools as a result. Everybody expects that I will go on to do a good glaucoma fellowship.
However, after much soul searching I have found that I am not interested in an academic career at all and will not pursue academia. I also -shocking to me and everybody else - don't love glaucoma clinic as much as I thought I would after several months of it. I don't enjoy the complex emergencies/dumping ground that it can be at times, and I don't especially enjoy the patient population. I CAN however see myself doing glaucoma for a career, and being quite OK with it overall. It is the path that is expected, and is the path of least resistance.

After starting actually doing cataract surgery, I am loving cataracts and cornea, and have seen the private practice, high-volume cataract surgery with a refractive component. The personalities and business-oriented mindset of cornea / high volume cataract surgeons seems to jive well with me, and I think that is how I'd like to orient my own practice one day. I love EKs, I find the very fascinating, and I love the patient population. Also, from my experience, cornea surgeons don't always do a ton of complex cornea all the time, and are largely comprehensive + occasional cornea, who just happen to get the lion's share of toric/multifocal cataract referrals.

I think in terms of coming in fresh to residency, I would do cornea. However, I am so far down the rabbit hole in glaucoma, I have the research and the connections. I would likely be able to do a great fellowship and get ahead in my career doing glaucoma a bit faster because of where I'm starting from. It feels like throwing away years of my life to suddenly switch to cornea. I also have no cornea research or connections and it is getting a bit late in the game I fear to realistically switch and nab a decent fellowship.

What would people do in my situation?

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[hello lady!]

I don't enjoy the complex emergencies/dumping ground that it can be at times, and I don't especially enjoy the patient population.

Unless you're going to go more exclusively cataract/refractive surgery I think you're going to get more of this than you're expecting. All of the corneal ulcers seem to flow to the cornea specialist on Friday afternoons.

Either way, if you have close mentors (glaucoma or not) who are willing to vouch for your work ethic I think they'll carry decent weight in the cornea realm. Do what you love, not what you think you need to do.

The personalities and business-oriented mindset of cornea / high volume cataract surgeons seems to jive well with me.......who just happen to get the lion's share of toric/multifocal cataract referrals.

It sounds like someone is smelling the dollar sign$. lol

 

[immunology89]

I would consider skipping the fellowship and doing comprehensive.

If you're not planning on pursuing academic cornea, I wouldn't be worried about the name recognition of your cornea fellowship.

Best of luck!

 

[i-doctor]

I would consider skipping the fellowship and doing comprehensive.

If you're not planning on pursuing academic cornea, I wouldn't be worried about the name recognition of your cornea fellowship.

Best of luck!

Exactly. Comprehensive, no fellowship. You can do some cornea if you want, some glaucoma, and a lot of cataracts
If you do a corneal fellowship, you will likely do little glaucoma. The referrals will go elsewhere. If you do a glaucoma fellowship, you will not be doing much cornea (unless you practice in a rural environment without specialists nearby). Plenty of non-corneal trained comprehensive docs do LASIK and many corneal procedures, but without the emergency headaches (ulcers, perforations,etc) that the fellowship-trained docs get.