I was wondering how much money a retina specialist (surgical) would make in an academic setting? I am sure the 600K average applies more to private practice folks and reimbursement in academics can vary greatly depending on location, but still.. just trying to get an idea.
How much do retina specialists make on average in an academic setting?
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I’m not sure, but wouldn’t be surprised if the figure was less than the average. However, there’s a lot of wiggle room there. While there salary may be less, there are other advantages. Call is taken by residents and fellows, liability insurance and other benefits are usually very good and covered by employer. All these speaking engagments, lectures etc can be quite lucrative, thus while salary may be lower, overall income may be just as good if not better than private practice.
I believe that being an academic retinal specialist can be lucrative as long as you are "known" and thus get lots of consulting gigs, or have the chance to be on the scientific board of device/drug companies. I see some people start off in academia to establish their name/reputuation first, and then jump over to the private/industry world.
I think the biggest pitfall economically of academia is that you don't own any equity in the academic practice. Thus, you won't get a big payout at the end of your tenure (someone correct me if I am wrong) or when private equity comes knocking on your door.
I think the biggest pitfall economically of academia is that you don't own any equity in the academic practice. Thus, you won't get a big payout at the end of your tenure (someone correct me if I am wrong) or when private equity comes knocking on your door.
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The buy out at retirement can be quite large indeed. And private equity will definitely not knock on academic door. All good points. On the other hand, these types of business decisions are associated with some inherent risk that academics don’t have to worry about. Building a practice, wooing referring docs, running a practice from a business standpoint etc is not something they need to be concerned with. Some may view this as a big plus.
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I work at an academic center so hopefully I can shed some useful insight without giving up my anonymity.
There's a saying about academic centers - "When you see one academic practice, you've seen ...only one academic practice". There's a lot of variability among academic practices. Some are hybrid practices or private practices attached to the overall department, while others are 100% academic and fully employed by the university. Payment structures and salaries depend on the center; some places keep it very competitive, while others grossly underpay you (but hey, you get to eat Ivy). Most places work on a work-RVU system. You negotiate a contract anywhere from 2 to 5 years, and you are paid a base salary. Sometimes you have incentive measures where you can take home part of what you bring in, but the stipulations vary - some places let you take home a certain amount after you hit a certain number of charges/RVUs, while other places will only let you take home bonuses if the department is not in the red.
Though academic, our practice is still constrained with economic realities (as well as many other departments without huge endowments or research/charity funds) so we still have market pressures to bring in more patients and increase revenue. However, I can say starting out that I am very, very happy with my current salary, and I know a few attendings in academia that have made more than the average salary for retina. My general feeling after going through the job search is that academic centers in highly desirable locations (major metropolitan cities like NY, SF, LA, Boston, Philadelphia, etc.) will pay you much less than the average rate, while other centers in less populous or less attractive areas (at least to millennials like me) will pay you more.
There's a saying about academic centers - "When you see one academic practice, you've seen ...only one academic practice". There's a lot of variability among academic practices. Some are hybrid practices or private practices attached to the overall department, while others are 100% academic and fully employed by the university. Payment structures and salaries depend on the center; some places keep it very competitive, while others grossly underpay you (but hey, you get to eat Ivy). Most places work on a work-RVU system. You negotiate a contract anywhere from 2 to 5 years, and you are paid a base salary. Sometimes you have incentive measures where you can take home part of what you bring in, but the stipulations vary - some places let you take home a certain amount after you hit a certain number of charges/RVUs, while other places will only let you take home bonuses if the department is not in the red.
Though academic, our practice is still constrained with economic realities (as well as many other departments without huge endowments or research/charity funds) so we still have market pressures to bring in more patients and increase revenue. However, I can say starting out that I am very, very happy with my current salary, and I know a few attendings in academia that have made more than the average salary for retina. My general feeling after going through the job search is that academic centers in highly desirable locations (major metropolitan cities like NY, SF, LA, Boston, Philadelphia, etc.) will pay you much less than the average rate, while other centers in less populous or less attractive areas (at least to millennials like me) will pay you more.
I think the bottom line is: "to each his or her own." I think that the most important thing one should consider is to do whatever is truly right for you. Whether this is academia, private practice, Kaiser, the VA...or even non-clinical work, you should pursue what will truly make you happy. Many studies have shown that happiness does not significantly increase after a certain threshold, and I personally agree with this. I don't feel that much "happier" making 7 figures compared to when I made low 6-figures. What I'm definitely more happy about is having autonomy compared to the past.
I think the hardest part of deciding, is that when you are in training, you are primarily surrounded by the academic practice model. At least when I trained, there was constant pressure from our attendings to pursue an academic career. And there was this unsaid sentiment that private practice was a waste of one's intellect or not as ethical as academic medicine. There was a lot of self-righteousness, even though when I reflect now, there were/are many bad surgeons in academia. I know I would have been miserable in an academic practice. Though I liked research, the number of hours I put in to publish each manuscript did not seem worth it to me. I also despise bureaucracy and love that I can change the way I practice (e.g. equipment, staff) in a heartbeat. I didn't want to sit through committees to improve things for my patients. Anyways, that's my 2 cents. Just make sure that whatever you choose aligns with your heart.
I think the hardest part of deciding, is that when you are in training, you are primarily surrounded by the academic practice model. At least when I trained, there was constant pressure from our attendings to pursue an academic career. And there was this unsaid sentiment that private practice was a waste of one's intellect or not as ethical as academic medicine. There was a lot of self-righteousness, even though when I reflect now, there were/are many bad surgeons in academia. I know I would have been miserable in an academic practice. Though I liked research, the number of hours I put in to publish each manuscript did not seem worth it to me. I also despise bureaucracy and love that I can change the way I practice (e.g. equipment, staff) in a heartbeat. I didn't want to sit through committees to improve things for my patients. Anyways, that's my 2 cents. Just make sure that whatever you choose aligns with your heart.
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All very true. Where I did my fellowship, one of the attendings disparaged the graduating residents during their graduation dinner for all going into general and private practice rather than pursuing fellowships or joining academic programs. The self-righteousness is real.
I've learned in my very young career that while pay is important, happiness and autonomy is paramount to continuing your career without burnout or having a career crisis. Young attendings leave academia more for the chance to have more autonomy and to be in charge of themselves rather than the pay. Ironically, it can sometimes be much easier to do research and clinical trials in private practice because there is much less bureaucratic BS and administrators dictating how you spend your time. Luckily my situation is nowhere like this but it is true to see this in many academic institutions.
Lots of good replies, but I am always disheartened by the unwillingness/reluctance of physicians to talk real numbers. Even in a fairly anonymous venue such as this, there is no mention of an actual salary figure in this thread. I understand the notion of extreme variability. However, concrete numbers help those up and comers like myself better understand the market, make better life decisions, better negotiations, realistic expectations, etc. I long for the day of transparency in finances in the medical (and ophtho) world. It can only make things better, not worse.
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I'm not retina, so I can't speak of "concrete" numbers. But if my local retinal specialists are not all making at least 7 figures (or close to it), then I'd be really surprised. There is definitely a potential to get to the 2-4M range in retina.
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I'm surgical retina, and 4M would be a pretty insane number. 2M is very doable after several years of practice with other passive revenue streams. But I am practicing in a relatively desirable coastal area. Kudos to those getting those larger numbers.
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Specific numbers vary as someone commented above.
Generally starting Retina salaries when I graduated a couple of years ago were 200-250k both academic and private. Higher than that for Kaiser type jobs with less growth over time. Academic salaries can top off anywhere from 300 to close to 7 figures (rare) depending on your productivity model and how you grind. Private compensation for retina only groups once you make partners is close to 7 figures and above.
Generally starting Retina salaries when I graduated a couple of years ago were 200-250k both academic and private. Higher than that for Kaiser type jobs with less growth over time. Academic salaries can top off anywhere from 300 to close to 7 figures (rare) depending on your productivity model and how you grind. Private compensation for retina only groups once you make partners is close to 7 figures and above.
Using public documents available on the internet I could quickly come up with one academic example. A retinal surgeon with impeccable residency and fellowship training working in his second year at a top ten eye department in a public institution is making $260K.
Above 2 posts are accurate. 200's starting in both academia and private practice. How that increases and levels off depends on the academic department and private practice, but obviously higher for private practice. Definitely NOT 4M though. Don't want the students and residents to get the wrong idea here. Don't do it for the money. Those making close to 2M are few in number, limited to very few practices, you need to see literally 100 patients a day, sacrifice family time, etc. Find a balance that works for you. Speaking/consulting engagements pay a bit, but you usually lose more money by cancelling a day of clinic to go speak, so it's not for the money. Retina is an awesome field, and there is so much excitement over what we can now offer patients. The science, surgery, research, has so much momentum in our field now. Enjoy all aspects of this, and other aspects of life, not just doing injection after injection and having no time for anything else. The happiest retina surgeons are those who find a good balance, whether it's a healthy balance of clinical work and investigation, or lower volume but more family time, etc., and the most unhappy seem to be those making the close-to or at 2M mark, but again, that is not the norm, and students should not be expecting those figures by the time they are attendings also, because compensation is only going down, and there's a limit to how much you can increase volume without becoming insane or compromising patient care.
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My take on this is a little bit different from what many residents and first year attending think, which is "which job pays the most?" Rather, it should be "which job makes me the happiest?" Of course you want to be paid fairly, and more is better than less- this blog post is more for private practice than academics:
Why a $300,000 junior associate salary may not be as good as it seems
Do you guys and gals know that there's NO correlation between income and happiness (once you're over about $100,000?) Read John Pinto's green book- he did a study which interestingly enough shows that there is no correlation between number of surgeries, practice revenue, income etc with happiness. But there was a strong correlation with percent of income saved with happiness! The happiest folks are ones that live under their means. If you make $1.2 million per year but spend $1.25 million guess what, you're broke!
If you like the academic environment, and are simulated by teaching residents, tough cases, and research then go for it and don't keep on comparing your salary to those in private practice. It'll just make you unhappy to keep on comparing (but, make sure you are at least getting paid fairly; I hate seeing other docs getting ripped off, as you can tell from my link above). And the reason why there are no specific numbers is because the harder you work (more patients you see) and the harder it is for the department to find some (more rural areas), the higher your salary will be. It's all over the map. And if you don't like your salary or academic practice, then find something else to do.
Indeed, for me the best thing about being solo is the flexibility in my schedule. I value that WAY more than income (don't get me wrong though I do just fine). If you want to take an afternoon off for your kids piano recital, or to get ready for Duke playing in the NCAA championship game, no one is stopping you.
Why a $300,000 junior associate salary may not be as good as it seems
Do you guys and gals know that there's NO correlation between income and happiness (once you're over about $100,000?) Read John Pinto's green book- he did a study which interestingly enough shows that there is no correlation between number of surgeries, practice revenue, income etc with happiness. But there was a strong correlation with percent of income saved with happiness! The happiest folks are ones that live under their means. If you make $1.2 million per year but spend $1.25 million guess what, you're broke!
If you like the academic environment, and are simulated by teaching residents, tough cases, and research then go for it and don't keep on comparing your salary to those in private practice. It'll just make you unhappy to keep on comparing (but, make sure you are at least getting paid fairly; I hate seeing other docs getting ripped off, as you can tell from my link above). And the reason why there are no specific numbers is because the harder you work (more patients you see) and the harder it is for the department to find some (more rural areas), the higher your salary will be. It's all over the map. And if you don't like your salary or academic practice, then find something else to do.
Indeed, for me the best thing about being solo is the flexibility in my schedule. I value that WAY more than income (don't get me wrong though I do just fine). If you want to take an afternoon off for your kids piano recital, or to get ready for Duke playing in the NCAA championship game, no one is stopping you.
All things else being equal, 2MM is better than 200k 
But I agree -- you should always try to live way under your means, so that you have the leeway to do whatever you want should the sh** hit the fan. The biggest advantage of making 2MM /year versus 200k, is that you can save a ton very quickly, and then basically know in the back of your mind that working is "optional" (as long as you have a reasonable lifestyle) since you have a big nest egg that appreciates on its own.
The bad situation that some people get into is that they can accrue very high fixed living costs (e.g. high association fees living in a Manhattan apartment, car payments on the Ferrari, property taxes on the 4MM mansion, etc). And then when their comp dips from 2MM to "only" 800k, they suddenly find themselves with a cashflow problem.
But I agree -- you should always try to live way under your means, so that you have the leeway to do whatever you want should the sh** hit the fan. The biggest advantage of making 2MM /year versus 200k, is that you can save a ton very quickly, and then basically know in the back of your mind that working is "optional" (as long as you have a reasonable lifestyle) since you have a big nest egg that appreciates on its own. The bad situation that some people get into is that they can accrue very high fixed living costs (e.g. high association fees living in a Manhattan apartment, car payments on the Ferrari, property taxes on the 4MM mansion, etc). And then when their comp dips from 2MM to "only" 800k, they suddenly find themselves with a cashflow problem.
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All great points above. I had a practical perspective when I landed my first job. My initial salary wasn’t as important as what my income trajectory would be over the coming years. Now as full partner in my group I am very happy with my decision. While I completely agree with going for the job that makes you happy, understand that NO job is perfect. There will be compromises along he way no matter which path you choose. Also, unlike other careers, switching from one job to the next is a real opportunity cost as it delays buy ins (private practice partnership track) and delays ramping up and building a practice. Thus, it’s important to choose wisely and think ahead.
Living below your means, investing intelligently, paying down debt and so on are really personal finance issues that apply no matter which path you choose and regardless of income. Higher incomes don’t necessarily correlate with smarter financial decisions.
Living below your means, investing intelligently, paying down debt and so on are really personal finance issues that apply no matter which path you choose and regardless of income. Higher incomes don’t necessarily correlate with smarter financial decisions.
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My argument "against" making $2 million is that there's no such thing as "passive" income. You gotta hustle/ work hard to achieve this. And if you live beneath your means, making even "just" one million over five years, let's say take home is $670,000 after taxes. If you can live on "only" $170,000 of post tax money (which would require about a $230,000 pretax salary), then you can save $500,000 per year, or $2.5 million over just five years. Invested properly, 24 years later at typical stock market 8% returns this $2.5 million after compounding is about $20 million; even just 16 years later it's $10 million.
Most folks I know that have this much would rather not deal with headaches because their time is worth more than money- so many of them would rather slow down and enjoy practicing ophthalmology, perhaps by running a micro practice. (I'm not saying EVERYONE would do this of course; some folks just like being busy, all the power to them- but I know many busy folks who wish they could do this).
The problem with having a big practice is if you want to cut down, it's a lot harder than having a small practice and ramping up. Don't get me wrong, money is important and I'm interested in making lots of it, but so is enjoying practicing rather than feeling like you're on a assembly line (if you see 80 patients a day and don't think it's a treadmill, your personality is different from mine), being able to take lots of vacation, and spending time with family.
Most folks I know that have this much would rather not deal with headaches because their time is worth more than money- so many of them would rather slow down and enjoy practicing ophthalmology, perhaps by running a micro practice. (I'm not saying EVERYONE would do this of course; some folks just like being busy, all the power to them- but I know many busy folks who wish they could do this).
The problem with having a big practice is if you want to cut down, it's a lot harder than having a small practice and ramping up. Don't get me wrong, money is important and I'm interested in making lots of it, but so is enjoying practicing rather than feeling like you're on a assembly line (if you see 80 patients a day and don't think it's a treadmill, your personality is different from mine), being able to take lots of vacation, and spending time with family.
Thank you Schistosomiasis.
I see far fewer patients than the average ophthalmologist but I'm doing fine because we keep our spending low. The key is don't spend money on things that don't bring you long-term happiness. The rest gets saved in investments. I would much rather be able to spend time on each patient and have more time to spend with my family.
Of course I'd love to get paid more for doing the same thing. But unfortunately it's rare to make more money without more work or compromising on the quality of care. I've seen too many Ophtho practices where the ophthalmologist is running in and out of patient rooms like a chicken with his head cut off. I'm a retina specialist and every single day I get sent patients with "flashes and floaters" when they weren't really having a PVD or retinal tear; they were just having a migraine. It's clear the referring doctor didn't even talk to the patient; they just looked at the tech note. I've seen people miss an active occipital lobe stroke because they looked in the patient's eye and didn't see anything wrong so assumed there was no real problem to explain the vision change.
Unfortunately the general public's reaction to being treated like they're on an assembly line is to think that doctors get paid too much. And yet if they do cut reimbursements, the doctors that actually spend time with each patient will have to start spending 5 minutes with each patient to survive, and that's when I plan to quit clinical medicine.
I see far fewer patients than the average ophthalmologist but I'm doing fine because we keep our spending low. The key is don't spend money on things that don't bring you long-term happiness. The rest gets saved in investments. I would much rather be able to spend time on each patient and have more time to spend with my family.
Of course I'd love to get paid more for doing the same thing. But unfortunately it's rare to make more money without more work or compromising on the quality of care. I've seen too many Ophtho practices where the ophthalmologist is running in and out of patient rooms like a chicken with his head cut off. I'm a retina specialist and every single day I get sent patients with "flashes and floaters" when they weren't really having a PVD or retinal tear; they were just having a migraine. It's clear the referring doctor didn't even talk to the patient; they just looked at the tech note. I've seen people miss an active occipital lobe stroke because they looked in the patient's eye and didn't see anything wrong so assumed there was no real problem to explain the vision change.
Unfortunately the general public's reaction to being treated like they're on an assembly line is to think that doctors get paid too much. And yet if they do cut reimbursements, the doctors that actually spend time with each patient will have to start spending 5 minutes with each patient to survive, and that's when I plan to quit clinical medicine.
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I know of an academic retina position that started ~350-400, decently sized midwest city.
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I’m going to try to answer the question to why salaries in academics vary and there’s a wide range.
1. How much time do you spend in your own clinic (seeing own patients rather than precepting residents). This is probably what generates most revenue to justify your income. Are there a ton of patients or are you fighting with community docs for patients? What’s the payer mix lots of Medicaid or commercials and Medicare?
2. How often are you in trauma call (or have to come in to back up residents). Someone who is on the pager twice a week should be paid more than someone once every two weeks for obvious reasons. If you have to come in every fifth night on average vs every night....same can be said for inpatient consults. If you’re doing a ton you need to be paid more than if you aren’t.
3. Deans tax. Chairman’s tax. Different fields- If you’re retina your salary subsidized the peds and neuro Ophtho in your department.
4. How much time do you spend doing research. If you’re being paid some type of bonus based on RVU or collections, the more time doing research is less time doing clinical stuff. But if you like research and can get grants go for it.
5. There’s nothing wrong for trying academics and leaving for a different academic job or private practice. My first job was with the government and then with a group before I went solo. The government job wasn’t exactly the highest paying but it was a good experience and I’m glad I had that opportunity although after two years I couldn’t wait to leave.
7. For more information about how bonuses are calculated for private practice I cross posted this in young ophthalmologists thread: Bonus structures on physician associate employment contracts: pearls and pitfalls
Same principles apply for academic jobs in addition to above. Bottom line is precepting residents and surgery won’t pay as much as seeing patients and payor mix in academic center might have more Medicaid, but you’re not gonna be broke and go for it if you truly enjoy academics.
1. How much time do you spend in your own clinic (seeing own patients rather than precepting residents). This is probably what generates most revenue to justify your income. Are there a ton of patients or are you fighting with community docs for patients? What’s the payer mix lots of Medicaid or commercials and Medicare?
2. How often are you in trauma call (or have to come in to back up residents). Someone who is on the pager twice a week should be paid more than someone once every two weeks for obvious reasons. If you have to come in every fifth night on average vs every night....same can be said for inpatient consults. If you’re doing a ton you need to be paid more than if you aren’t.
3. Deans tax. Chairman’s tax. Different fields- If you’re retina your salary subsidized the peds and neuro Ophtho in your department.
4. How much time do you spend doing research. If you’re being paid some type of bonus based on RVU or collections, the more time doing research is less time doing clinical stuff. But if you like research and can get grants go for it.
5. There’s nothing wrong for trying academics and leaving for a different academic job or private practice. My first job was with the government and then with a group before I went solo. The government job wasn’t exactly the highest paying but it was a good experience and I’m glad I had that opportunity although after two years I couldn’t wait to leave.
7. For more information about how bonuses are calculated for private practice I cross posted this in young ophthalmologists thread: Bonus structures on physician associate employment contracts: pearls and pitfalls
Same principles apply for academic jobs in addition to above. Bottom line is precepting residents and surgery won’t pay as much as seeing patients and payor mix in academic center might have more Medicaid, but you’re not gonna be broke and go for it if you truly enjoy academics.
