glaucoma job market? why isn't it more competitive?

[docdoc2012]

Hey Guys,
when i first started residency i was sure i would be doing retina and thought glaucoma was boring...but the more i read about it and see patients the more intrigued i am...

i was just wondering if i could get some insights on the glaucoma job market.

why is the fellowship not very competitive?

how is compensation compared to other fields? i know retina and high volume cataract practices are probably more lucrative...but do glaucoma specialists do well?

for those of you in glaucoma practice..are the post-op complications that everyone dreads really that bad and ubiquitous?

thanks!

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[dantt]

Probably most people do not find glaucoma interesting. You did ophtho so you would not be hounding patients about their blood (eye) pressure all day, right?

 

[Andrew_Doan]

Post-operative care for glaucoma surgery is tedious and requires patience too.

 

[DrZeke]

Post-operative care for glaucoma surgery is tedious and requires patience too.

The pre and post op can be frustrating. You take patients that have 20/20 vision and put them through a surgery to lower pressure. Then they have inflammation and edema so in the immediate post-op period they are seeing worse than they did. Or sometimes you take an island of vision to surgery and then they go blind anyways. Compare that to cataracts...

There is no cure for glaucoma and it is progressive. There are plenty of patients who progress despite drop therapy. For those that can't afford combo meds or who can't tolerate certain drops, regimens can be time consuming and exhausting and require a lot of work for the patient. And, glaucoma is a silent taker of vision, people don't notice the VFD until it's quite significant, so compliance can be a problem.

Many people went into ophthalmology for immediate gratification, appreciative patients, the ability to return sight... Many of us hate uphill battles like regimens for primary management of diabetes or high blood pressure. Compliance issues and different drop combination regimens in glaucoma are quite someone akin to that type of management.

I think those are most of the reasons it's not more competitive. I have always liked glaucoma because of its research potential and interesting theories and academics. I'm not sure I could see myself doing it in private practice though...

 

[ophthope]

Conversely the surgeries themselves seem pretty fun. And for the business minded, you have a base of patients who, depending on their stage and progression, will be returning to your clinic every 1-6 months for IOP checks and possibly to get a visual field or OCT. And you don't have to feel scummy about it because real glaucoma patients require close follow up. I don't think most glaucoma specialists have clinics full of 'glaucoma suspects' with 0.5 cups and normal IOPs without VF damage.

And you still get cataract referrals, routine refractions, AMD, diabetes, etc - the usual comprehensive bread and butter stuff. Research in the field is hot right now too.

Honestly I think if the post-ops weren't so horrible it would be more competitive. As mentioned above it isn't fun taking a 20/25 patient to the OR and have them be 20/200 the next day and require months to get back down to 20/30, even when you've informed them thoroughly and you know it's the right thing to do to ultimately save their vision. It's just not fun. Putting in an Ahmed shunt is fun. Seeing them the next day isn't.

 

[orbitsurgMD]

Hey Guys,
when i first started residency i was sure i would be doing retina and thought glaucoma was boring...but the more i read about it and see patients the more intrigued i am...

i was just wondering if i could get some insights on the glaucoma job market.

why is the fellowship not very competitive?

how is compensation compared to other fields? i know retina and high volume cataract practices are probably more lucrative...but do glaucoma specialists do well?

for those of you in glaucoma practice..are the post-op complications that everyone dreads really that bad and ubiquitous?

thanks!

There is the old joke, said in black humor, that your glaucoma patient's best vision was what they had the first day they walked in your office.

Glaucoma is interesting, but then, so is neuro. The problem is usually one of temperament, of the doctor. If you need the praise and elation from your patients on a regular basis, glaucoma practice probably won't make you satisfied. Glaucoma patients are usually long-term, are older, more frail, have multiple medical problems, have more fragile eyes and have in many cases difficulty maintaining treatment regimens due to debility and sometimes poor personal resources. One of my professors once said that your job in glaucoma management is to keep your patients seeing until they die, which due to their advanced age they regularly do.

Most glaucoma is managed by generalists; typically only the sickest and most refractory get referred, and the surgeries sometimes require bleb needling or revisions, or tubes and other interventions that carry higher risk of endophthalmitis, which stalks glaucoma doctors' practices probably more than any other subspecialty. While the surgery procedures usually pay well compared to other eye surgeries--except LASIK and custom IOLs--the followup is more intensive.

 

[Eyefixer]

To answer OPs original question, glaucoma job market is fabulous. Even in competitive parts of the country, including So Cal, there are multiple positions currently open in private practice, Kaiser and academics. Starting salaries tend to higher and sometimes much higher then comp.

 

[DopaDO]

To bump an older thread, what's reimbursement like especially when compared to more lucrative fields such as high volume cataract or surgical retina? Is it reasonable to achieve an income that rivals the others? I understand that money isn't everything but it is a factor especially when I could see myself in practicing a few different subspecialties and having a tough time deciding. Thanks for any advice! Feel free to PM me if that's better. Any insight is appreciated.

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[LightBox]

To bump an older thread, what's reimbursement like especially when compared to more lucrative fields such as high volume cataract or surgical retina? Is it reasonable to achieve an income that rivals the others? I understand that money isn't everything but it is a factor especially when I could see myself in practicing a few different subspecialties and having a tough time deciding. Thanks for any advice! Feel free to PM me if that's better. Any insight is appreciated.

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One thing that you have to realize is that you don't have to pigeon-hole yourself as "only" the glaucoma specialist if you do a glaucoma fellowship. You are still allowed to do high volume cataract surgery. I do everything possible that involves the anterior segment (cataracts, MIGS, tubes/filters, LASIK, corneal transplants, AC reconstructions, etc), so you don't have to constrain yourself in just seeing glaucoma patients. The one benefit of doing a glaucoma fellowship is that you can build a busy clinic volume since these patients will forever come for follow-ups. I would estimate that at least 60% of my clinic volume are glaucoma patients. I do about 30 cases a week (90% cataracts; 10% everything else). Lastly, doing MIGS procedures is fun and very profitable especially if you own your ASC.