Future of Ophthalmology

[Pigmentosa]

I am a 3rd year medical student and I find the field of ophthalmology very interesting. I have done research during all my years at med school and had almost committed to being an ophthalmologist when all of a sudden I find myself doubting if ophthalmology is an economically stable field.

A couple of weeks ago I heard a senior ophthalmology resident say that there are to many ophthalmologist and that the market is crowded. He also told me that optometrists are a constant menace to the ophthalmologists.

There is obviously some truth to that, but how much importance should I give to this.

I like ophthalmology, but other fields like ENT are close behind in my list of top specialties.

Do you guys feel that ophthalmology will be economically stable for the next 30 years or do you guys feel that although it might not pay as much as it used to it is still very reasonably paid.

Any comments on my preoccupations are highly thanked before hand.

PS- Can ophthalmologic (cataracts,) surgeries become boring after a while???

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[salmonella]

-The private practice ophthalmology market is indeed quite saturated, especially in large cities and desirable locations like Los Angeles, San Francisco and New York. I have heard new grads taking jobs for $90,000 to $120,000 a year. Bonus/incentives are difficult to get because the market is competitive and it's hard to get enough patients. Some try to make extra on weekends by doing eye exams for optometrists for like $35 an hour.
-The start up cost for an ophthalmology practice tends to be very high due to high tech nature of this field. It will take years to establish a lucrative practice.
-Eye surgeries unfortunately does get boring after a while. Ophtho is a very specialized high volume specialty and you will be seeing/doing the same thing over and over again. But low stress, good lifestyle and patient satisfaction make this field attractive
-Optometrists are constantly pushing for surgical rights; in fact, they've already succeeded in Oklahoma. In a few years, they will probably gain surgical rights in more states after they've shown their operative safety data.
-If you want to do ophthalmology and be rich, practice in a small town.

 

[PDT4CNV]

-The private practice ophthalmology market is indeed quite saturated, especially in large cities and desirable locations like Los Angeles, San Francisco and New York. I have heard new grads taking jobs for $90,000 to $120,000 a year. Bonus/incentives are difficult to get because the market is competitive and it's hard to get enough patients. Some try to make extra on weekends by doing eye exams for optometrists for like $35 an hour.
-The start up cost for an ophthalmology practice tends to be very high due to high tech nature of this field. It will take years to establish a lucrative practice.
-Eye surgeries unfortunately does get boring after a while. Ophtho is a very specialized high volume specialty and you will be seeing/doing the same thing over and over again. But low stress, good lifestyle and patient satisfaction make this field attractive
-Optometrists are constantly pushing for surgical rights; in fact, they've already succeeded in Alabama. In a few years, they will probably gain surgical rights in more states after they've shown their operative safety data.
-If you want to do ophthalmology and be rich, practice in a small town.

I disagree with much of this. Starting salary in ophthalmology is highly dependent on the location, the type of job (academic vs private), and sub-specialty area. It can vary from $100,000-$300,000. Smaller cities do offer, in general, the potential for higher income. This is true for almost any specialty. I have never met nor heard of an ophthalmologist doing weekend eye exams for an optometrist. I highly doubt this is true at all.

I do not think that eye surgery gets boring. It is a little presumptious to say that unless you are in fact an ophthalmic surgeon whose been practicing for 20 years. Every surgery is different. There is some repetition but this is true in any field of medicine. Do tonsillectomies get boring? What about appendectomies or TURPS? Part of going into a surgical specialty is the repetition, so that you get good at the procedures you do.

Finally, it is completely FALSE that optometrists in Alabama have surgical rights. Optometrists do NOT have surgical rights. In oklahoma they were mistakenly allowed (via political maneuvering by their well funded lobby) to perform a few laser procedures and perform skin biopsies. Fixing that mistake is actively being pursued by many medical organizations, not just ophthalmology.

Basically, disregard much of what was said in the previous post. I am not sure who that person is, but I highly doubt he/she is a ophthalmologist or even a practicing physician.

 

[Wolverine98]

I would tend to agree with PDT. Much of the optometry damage in OK has already been undone. I've talked to a few friends who practice there as ophthalmologists, and they're happy with how things are going politically.

As for surgery getting boring, the potential for that is there in every field, not just eyes. I hated lap choles after I had seen about 3 of them. However, I haven't gotten sick of cataracts and trabs. And if you're aggressive about doing complicated cases, then you definitely don't have reason to get bored.

As for a saturation, there's predicted to be a major shortage of ophthalmologists in the next 15 years or so based on most of the studies I've seen. Southeastern Michigan, for example, is projected to be in the neighborhood of 200 short by the year 2020. Some areas are more saturated than others, but that by no means translates to the country as a whole.

Dave

 

[Andrew_Doan]

As for a saturation, there's predicted to be a major shortage of ophthalmologists in the next 15 years or so based on most of the studies I've seen. Southeastern Michigan, for example, is projected to be in the neighborhood of 200 short by the year 2020. Some areas are more saturated than others, but that by no means translates to the country as a whole.

I agree with the statements posted by PDT and Wolverine.

First, any surgical procedure requires repetition. If it didn't, few would pay you to do it. In the most recent issue of Ophthalmology, cataract surgeons who performed more than 1000 cataract surgeries per year had the lowest adverse event rate (0.1%) and with surgeons preforming more than 250 surgeries per year reducing their adverse event rate by half from 0.8% to 0.4%.[Reference] Thus, repetition in surgery is a good thing!

If you don't like repetition, then perhaps surgery is not for you.

Second, the problem is not having a shortage of eye surgeons. The real issue is attracting new surgeons to move to needed areas. How many on this board would consider moving to Oklahoma, New Mexico, or Western Iowa? General ophthalmologists in these areas can make $300K/year+ just doing cataract surgeries by working in practices with growing communities. The problem is that most young surgeons want to live in a major cities where the market is saturated with eye surgeons.

 

[PDT4CNV]

I agree with the statements posted by PDT and Wolverine.

First, any surgical procedure requires repetition. If it didn't, few would pay you to do it. In the most recent issue of Ophthalmology, cataract surgeons who performed more than 1000 cataract surgeries per year had the lowest adverse event rate (0.1%) and with surgeons preforming more than 250 surgeries per year reducing their adverse event rate by half from 0.8% to 0.4%.[Reference] Thus, repetition in surgery is a good thing!

If you don't like repetition, then perhaps surgery is not for you.

In the last American College of Surgeons bulletin, a similar type of study looked at complication rate and surgical volume as well as surgeon age for surgeons doing carotid endarterectomies. As expected, repetition (higher volume) was associated with better patient outcomes. I suspect this concept would hold true for any surgical procedure in virtually any surgical specialty.

 

[orangezero]

I'll throw out an opinion and see what everyone else thinks. (I'm an optometrist, btw)

It seems the need for ophthalmologists is going to be more and more in rural areas where people do not want to live, and also for further specialization. We have a lot of general ophthalmologists, but if I'm sending someone out with a serious retinal issue I'd prefer it be to a retinal specialist if possible. These general ophthalmologists are starting to hire ODs to do more routine care. My roommate from OD school sees almost all the new patients at his ophthalmologist employer's office. He refers all the surgical stuff to his boss. Both are happy because both get to focus on what they went to school so long to do.

So, you could still be a general ophthalmologist in a small rural town, but if you want to be all things to all people you'll be competing with several local private ODs, a walmart OD, and a privately owned optical that employs an OD. These are the places where patients go for what they perceive to be routine care, whether they have glaucoma, macular degeneration, cataracts, or myopia.

And while there still are problems and issues, I think a lot of this optometry/ophthalmology bickering will go away as the older generations retire and the newer grads continue to work more closely together. There is constant complaining among optometrists about how the OD educators are not in line with reality. From reading a lot of med student posts on here and elsewhere, I get the feeling that the ophthalmological academia is vehemently antiOD to a much higher magnitude than the average ophthalmologist currently in private practice. Thats a shame. I think you'll find that the average OD in your town could/should be one of your biggest practice builders.