It might have been in the past. I know a retina specialist who switched to full-time refractive surgery maybe ~20 years ago when refractive surgery was booming and now wants try to get back into doing medical retina because he can no longer find enough refractive patients. Similarly, ~7 years ago my friends in radiology couldn't find jobs and now there's a severe shortage of radiologists. Times change and sometimes the job market seems cyclical.
How Much do Retina Specialists Make?
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Back then the Retina lifestyle was pretty bad, relatively, so I bet that was part of it as well.
Now it’s barely any worse than comprehensive.
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Resurrecting this thread after a few years, but is 300-350k still appropriate for an associate these days in non-PE retina only practices?
I'm a fellow looking into a mid-size city with surrounding rural areas, with 2-3 competing retina practices (3-4 partners each) and a multispecialty group with 3 retina docs. I guess salary for partners at these practices depend on number of patients per day? Think 500k is achievable as partner at these retina practices (let's say without ASC ownership)?
I'm a fellow looking into a mid-size city with surrounding rural areas, with 2-3 competing retina practices (3-4 partners each) and a multispecialty group with 3 retina docs. I guess salary for partners at these practices depend on number of patients per day? Think 500k is achievable as partner at these retina practices (let's say without ASC ownership)?
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Look at your future earnings, and not so much what you’ll make as an associate. Being an associate is only for 2-4 years. What you make as a partner will be for 20+ years and significantly more year to year and over time. A retina doc (partner) making $500k is either in academics or working part time
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That’s a pretty standard associate starting salary if you’re not on the coasts (meaning coastal metros will often be lower). Partners will generally eat what they kill, so what they make comes down to how busy they can/want to be. So yes, it comes down to patients per day for the most part, but there is usually some profit sharing agreement as well. I agree with the above that $500k as a partner would be part-time.
You need ~100k people to support one retina doc. If the catchment area for each practice is strong enough, competition shouldn’t be a problem as long as there are established referral patterns. If you don’t have a retiring or leaving doc ready to give you immediate volume (assuming your license and insurance credentialing are done), you will have to be patient as your practice builds.
Retina only versus multi-specialty is nuanced, but I prefer strictly retina. You have a built in referral system with the MS, but I don’t think I’ve ever heard of one in that kind of location that could support 4 retina folks. Also, comprehensive practices tend to have higher overhead, so you wind up subsidizing the non retina docs. It’s possible to balance that with ASC funds and some other bits, but you said no on that. Call can also be a little weird, including a higher likelihood of hospital coverage.
You need ~100k people to support one retina doc. If the catchment area for each practice is strong enough, competition shouldn’t be a problem as long as there are established referral patterns. If you don’t have a retiring or leaving doc ready to give you immediate volume (assuming your license and insurance credentialing are done), you will have to be patient as your practice builds.
Retina only versus multi-specialty is nuanced, but I prefer strictly retina. You have a built in referral system with the MS, but I don’t think I’ve ever heard of one in that kind of location that could support 4 retina folks. Also, comprehensive practices tend to have higher overhead, so you wind up subsidizing the non retina docs. It’s possible to balance that with ASC funds and some other bits, but you said no on that. Call can also be a little weird, including a higher likelihood of hospital coverage.
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Some disadvantages of being in a multi-specialty group that my colleagues have told me too - if your partners have complications and send to you to manage, you'll be treating this patients at a loss or even free since you'll be in the same tax ID. There's also the issue of profit-sharing, specifically when it comes to drug supply vs premium lenses. If a multi-specialty group can keep up with the drug float and reimbursements, you should usually net a profit from the drug supply. A point of contention some of my colleagues have brought up is how is that split - sometimes the partners may ask for a split since it's "overhead" - however, as retina you may not get a cut of the MFIOLs in the practice, so you have to negotiate that aspect.
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I'm in a multispecialty group with 3 ant and 3 retina. We all take home 40% of our collections (including drug profits, mfiol money) and the rest is distributed as profit after overhead. If done correctly, everyone wins between drug money and multifocal/lasik money. And it bolsters you in case of dropping drug profits
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This sounds like a fair way to work with your ant. seg. colleagues. I feel overall, this can be done correctly and it can be done very poorly. I'd point this out because this thread is about how much retina specialists make; the highest self-reported Ophtho income I've heard of came from a retina surgeon in a large multi-specialty group. Partner, surgery center, saw a lot of patients, went to rural areas, satellited more than typical - $3.1mil. I've heard there are others in that range or higher but I've not personally talked to them.
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Heard of 8 million net from a refractive/cataract person. Owns their own practice and asc and has a stable of optoms doing their preops/postops/dry eyes/medical stuff.
How lucrative has it been for some who do clinical trials? Lets not pretend many are doing it just for the science of it all.
If you’re a partner involved in LASIK, Premium IOLs, owning real estate, an ASC, and conducting clinical trials, you’re truly maximizing your potential. However, it seems that many recent graduates are content earning around $300,000 as associates throughout their careers, preferring to avoid administrative tasks. It’s as if they believe that partner doctors at larger practices are personally handling tasks like entering deposits into QuickBooks, rather than relying on a team to manage most of these responsibilities.
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Dang, I've heard upward of $2.5-3M net from refractive but that's crazy. My first thought was how do you sell that to realize the value being you're the only surgeon but I guess if you're making that much, it doesn't matter as much.
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I bet that’s a lot of 20/20 cataracts being removed for the volume of surgery required to reach that amount…..even if the surgeon also owns a few ASCs, does a lot of premium IOLs, and does refractive work
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Not a likely number unless he has a bunch of employed associates. Many refractive groups on the west coast never let you partner for example. You just take home 25 -29% or your collections
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"A stable of optoms" doing all the medical and preops and postops. To be fair, I do a good number of 20/20 cataracts too. Don't forgett, you can do cataract surgery when it causes patients problems with their activities of daily living. There's no specific numbers. All the autorefractor BATs will glare patients sufficiently to justify surgery. You just have to make sure you do a good job and don't mess up the most effective surgery known to man. From a technical standpoint, most high volume surgeons can do surgery. Just have to make sure surgery counselors don't oversell.
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They can be very lucrative if done properly and less headache long term than grinding out patients in clinic. Not going to dox anyone but I know of at least a few retina docs in a major metro area in the South (not southeast) clearing at least 2 million due to clinical trials. I've been involved in a few and the contracted rates are often a multiplier of what Medicare pays. But, you really have to keep a tight ship on it and not be stingy. The places with successful clinical trials teams have project managers and staff running the paperwork and backend stuff - many underappreciate how much effort is needed to keep up with the paperwork and compliance, it's not something you can really do yourself if you're full time. However, if you can get it to work, it's worth it. One of my friends tells me that he sees maybe 40ish a day, but 4-6 of of them may be in trials - financially it's on par compared to seeing 60-80 a day.
IDKIDIDK
I was in a similar situation 3 years ago.
3 year associateship. No Bonus. OK-ish city. 300,325,350. Retina Only. Monopoly for Miles. No interest in PE. I thought i could do it. because everyone told me, associateship is nothing just worry about partner salary and work life balance.
But my training was long. I had a family and 300 wasn't cutting it at all. Between private school, loans, one income. stark disparity in take home between partner/associate and taking twice as much call... i simply couldn't do it. I exited and joined multi-specialty with productivity bonus where i made 4 times that salary in 2 years.
You want no PE if your geographical preference will let you. You want ownership. Retina makes 500-2.5mill. The 2.5 mill doc that i personally know was similarly to the other poster in multispecislty group where retina keeps drug profits. There is no way to know these numbers for certain but most retina specialist expect 1 mill gross. There are only a few groups left where 1.5 and higher is the norm (most of them sold to PE)
The decision between retina only and muktispecialiry really comes down to the multispecialty structure and drug profit distribution. Some groups have more favorable retina-arrangement than others.
You will know based on the partner salaries. Other posters can elaborate on the pros and cons.
In short. 300 is terrible and puts you in the bottom 25 percent of 1st year retina associates working today. But if the partner salaries and lifestyle are to your liking and you can swing it, it shouldn't deter you. But you should know you are getting massively ripped off and hopefully when you are a partner you can think about providing more opportunity to your hard working associates
I was in a similar situation 3 years ago.
3 year associateship. No Bonus. OK-ish city. 300,325,350. Retina Only. Monopoly for Miles. No interest in PE. I thought i could do it. because everyone told me, associateship is nothing just worry about partner salary and work life balance.
But my training was long. I had a family and 300 wasn't cutting it at all. Between private school, loans, one income. stark disparity in take home between partner/associate and taking twice as much call... i simply couldn't do it. I exited and joined multi-specialty with productivity bonus where i made 4 times that salary in 2 years.
You want no PE if your geographical preference will let you. You want ownership. Retina makes 500-2.5mill. The 2.5 mill doc that i personally know was similarly to the other poster in multispecislty group where retina keeps drug profits. There is no way to know these numbers for certain but most retina specialist expect 1 mill gross. There are only a few groups left where 1.5 and higher is the norm (most of them sold to PE)
The decision between retina only and muktispecialiry really comes down to the multispecialty structure and drug profit distribution. Some groups have more favorable retina-arrangement than others.
You will know based on the partner salaries. Other posters can elaborate on the pros and cons.
In short. 300 is terrible and puts you in the bottom 25 percent of 1st year retina associates working today. But if the partner salaries and lifestyle are to your liking and you can swing it, it shouldn't deter you. But you should know you are getting massively ripped off and hopefully when you are a partner you can think about providing more opportunity to your hard working associates
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End game, let's see how "well" this turns out.
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I saw this too. @ 85% stake for $4.6B that turns into ~$5.4B total valuation. RCA has a little over 300 retina docs so just for conservative math let's say 325. That's about $16M per retina surgeon that works for them.
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Makes sense. Maybe they will pool and repackage the eyelea from 300+ retina specialists to resale.
Cencora - Wikipedia
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Hmm, selling to a drug distributor, that can’t possibly be a conflict of interest, right? I can’t get too mad at people for making money, we all need it, worked hard to get to this point, and work hard now to get it. Just lose the “practice efficiency” and “patient centered care” crap. We know it’s the numbers on the spreadsheet that matter here.
They’re going to need some folks to be ridden hard and put up wet to get their money back. I wonder if they’ll be continuing the $400/500/600k. If there are 325 docs making 600, that’s almost $200M of overhead they can try to trim, but then who’s going to get their product to the masses if they get fed up and quit? Looking at the ASRS job board since they’re always hiring, they’ve got a couple associated practices offering a $200k signing bonus as bait. I strongly suspect there’s some kind of repayment clause if you don’t stick around for however long they want.
They’re going to need some folks to be ridden hard and put up wet to get their money back. I wonder if they’ll be continuing the $400/500/600k. If there are 325 docs making 600, that’s almost $200M of overhead they can try to trim, but then who’s going to get their product to the masses if they get fed up and quit? Looking at the ASRS job board since they’re always hiring, they’ve got a couple associated practices offering a $200k signing bonus as bait. I strongly suspect there’s some kind of repayment clause if you don’t stick around for however long they want.
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If $600k is what the partners max out at, with these PE groups, then they are being terribly underpaid for private practice retina surgeons. But, if I was told I’d have $15M+ to put into my bank account, on top of the $600k yearly salary, I’d consider that deal.
At the same time, if I was a later stage retina surgeon (age 40s to 60s), and I had $15M to put into my investment account, then I’d be out the door as soon as my required contract time was up. I believe that’s part of the reason why there are so many open jobs with PE practices on ASRS. The senior docs have their golden egg so they jump ship as soon as their contracted time expires. That’s going to leave the younger docs to handle more patients without the potential payday of a second round PE acquisition nor the payday of being a partner in a private retina practice.
At the same time, if I was a later stage retina surgeon (age 40s to 60s), and I had $15M to put into my investment account, then I’d be out the door as soon as my required contract time was up. I believe that’s part of the reason why there are so many open jobs with PE practices on ASRS. The senior docs have their golden egg so they jump ship as soon as their contracted time expires. That’s going to leave the younger docs to handle more patients without the potential payday of a second round PE acquisition nor the payday of being a partner in a private retina practice.
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Everyone has a price, some less than $15M lol. If a company offered me $15M I'd very strongly consider the deal too; that's generational changing wealth.
One of my retina colleagues has mentioned that this same company is also running an oncology PE acquisition, and while the seniors are going to be retiring very comfortably, the junior associates are realizing they're making a fraction of their potential, and are unhappy/leaving. I can't see this not happening too. Before the second sale, a lot of revenue was made from drug rebates and clinical trials. With the vertical integration, that's no longer going to happen, and the physicians are going to be squeezed.
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Unfortunately Cencora, used to be known as AmerisourceBergen, owns Besse. No drug rebates are going to happen since Besse is a supplier and now they don't have any reason to give favorable rates because these practices will be forced to buy it from Besse. Any profits made from economic scaling and bulk purchasing will go to the parent company, not the practices.Makes sense. Maybe they will pool and repackage the eyelea from 300+ retina specialists to resale.
Cencora - Wikipedia
en.wikipedia.org
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Wow that’s HUGE! For the senior docs, who potentially just received $15M from the second PE purchase, not such a big deal. For the younger docs, and any fellows looking to join these practices, that loss of drug rebates is bad!
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While some of the docs did quite well, it’s not the whole story. I don’t remember what the breakdown was, but I’m pretty sure docs owned less than 50% of the shares, so they aren’t averaging $15M. There are also a decent number of them without shares - I think it was a 3 year minimum to buy in. I could be wrong as it’s obvious that I’m not in a PE practice, so no firsthand view from me, but the big picture isn’t quite as rosy as the first glance suggests.
I feel for anybody who has to join a PE practice. That strange sensation on their legs is corporate digging for more money out of their pockets.
I feel for anybody who has to join a PE practice. That strange sensation on their legs is corporate digging for more money out of their pockets.
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For some reason RCA selling to a company that owns Besse - reminds me of red lobster.
Remember how a shrimping company shareholder pushed for endless shrimp so they could offload all the shrimp they were catching? And red lobster almost went bankrupt 🤷♀️🤷♀️🤷♀️. Shrimp...drug rebates...potato potaato
Remember how a shrimping company shareholder pushed for endless shrimp so they could offload all the shrimp they were catching? And red lobster almost went bankrupt 🤷♀️🤷♀️🤷♀️. Shrimp...drug rebates...potato potaato
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This is almost the same scenario, but instead of restaurants it's healthcare. Instead of a chain restaurant with eh popularity being looted, it's now the US healthcare system. I can't think too much about it anymore to keep my mental wits about me.
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$600k is definitely NOT the partner max
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There will still be a lot of equity rollover into Cencora worth a pretty penny. Not certain how many senior docs will retire but I assume a fair amount will stick around until they are fully vested and allowed to withdraw that equity.
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Lot of assumptions being made here regarding the compensation structure post acquisition. My understanding is that drug revenue is credited to the individual practices and accounted for in the compensation model. This is unlikely to change as it is likely contractually obligated to be carried over post acquisition.
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The issue is going to be after the original compensation structure expires or is re-done after the sale finalizes. Webster/RCA will not be the ones setting terms, it will be Cencora. There is a comparison as well - the oncology practices owned by Cencora. The senior partners are happy but the junior ones are screwed.
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What I’m saying is there are guardrails to prevent a complete overhaul of the comp structure. The RCA compensation contract will remain in place going forward. I’m certain there will be negotiations to make some changes over time, but the contract is to be carried forward. Contracts can’t simply be nullified due to transition of ownership (unless this was agreed upon in writing beforehand, which of course no doctor would agree to). Not sure what the details are of the oncology purchase, can only speak to my knowledge of the retina space.
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I would like to share my situation and ask this treat about their opinion on this matter, relates to how much a retina docs make...
I work for a PE group, have very good personal and text etc relationships with referring docs, good rapport with patients and staff. Make around 700+ with potential to make more, likely cap at 1m when I am at my capacity. My question is this: is it worth opening up my own next to my old office and get some of my patients back (through referring docs recs), and preferably more over time with my network. Do you know anyone who has done this, would love to connect with them and ask their opinion. Truth to be told, the money I make is more than enough with my lifestyle, but seeing how technicians and front office people getting treated and seeing my collection report, and knowing that I bring these guys a lot of money makes my blood boil. Would love to hear opinions.
I work for a PE group, have very good personal and text etc relationships with referring docs, good rapport with patients and staff. Make around 700+ with potential to make more, likely cap at 1m when I am at my capacity. My question is this: is it worth opening up my own next to my old office and get some of my patients back (through referring docs recs), and preferably more over time with my network. Do you know anyone who has done this, would love to connect with them and ask their opinion. Truth to be told, the money I make is more than enough with my lifestyle, but seeing how technicians and front office people getting treated and seeing my collection report, and knowing that I bring these guys a lot of money makes my blood boil. Would love to hear opinions.
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You will hear a lot of opinions, especially from solo docs. I’m certain your hard work and effort up to this point will transfer to success in solo practice. If your truly as unhappy as you seem then may be worth the risk. Only you can answer that for yourself. Grass is always greener though. Good luck
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I'm not in private practice but talk to a lot of people in your exact same position. All I hear are dark storm clouds and "clauses" in the contracts that make the deal worse and worse the more I hear (e.g. shares requiring vesting, B share holders bagholding, contracts having to be re-done due to new ownership, etc.). Unless the PE group offers something that you are willing to pay for (lifestyle, part time, etc.), open up your own practice.
I've never understood how the KOLs can ethically justify PE being a good thing for medicine. Medicare capital and health care in general is a zero sum game. If the MBAs/wall street guys are making 7-8 figures, it's not out of nowhere. In other fields you read about how PE is decimating care and doctors' salaries.
BTW DM me if you're retina and need to hear the details firsthand.
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Having interviewed a lot of people and many in a similar situation I can tell you the answer to your question is the same answer to the following question:
Are you truly willing to give up a $700,000 and rising income for potentially less than $100,000 (assuming big capital outlay and no patients to start) next year to start your practice...and if the following year things are still ramping up maybe you get to $300-400K?
This is the classic concept of golden handcuffs. From my experience, most doctors in your situation need a dislocating event to make that jump. Because if you're married, your spouse is used to a lifestyle. If you have kids, do they go to private schools? Did you fly business/first class on your last vacation? How much is your mortgage? The one super thing you have going for you is you've not expanded your lifestyle to $700K - that's one of the most freeing things you can do.
Thanks for your reply, great question and I did ask the same question to myself, I suppose that is the main point, am I willing to get a huge pay cut for 3-4 years for high income and full autonomy in the future for 20+ years… to answer your questions, my wife and I are both docs and we live significantly below our means, so we would be fine with one salary … it’s not an easy question to answer though, regardless.
That is correct, for one year
