How Much do Retina Specialists Make?

[percyeye]

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I'm worried about the last part next year - the 10% across the board cuts are probably going to be what finally tips things over for private practices. Some of my friends/colleagues that are comprehensive have begun to weigh whether to opt out of Medicare or only perform premium IOL surgery. The proposed 5% injection bump may help us out a lot in clinic but I can see this being what makes older surgeons switch to medical retina.

It will be very interesting to see what happens after the cuts. In our area Medicaid is now overtaking Medicare as far as reimbursement goes. If you can do 5 premium IOL surgeries in a morning that equals ~25 non-premium surgeries some might have to start thinking hard about that.

 

[RetinaDude]

To make it all even worse, one of the medical journals (maybe NEJM) did an analysis of physician shortages in the coming years and found ophthalmology to be the third highest shortage area by the year 2035. I believe it was based on average age of current physicians, number retiring each year vs number finishing residency/fellowship, and projected growth in patient population for that particular specialty.
I can see this to be true. Even though we have recruited new physicians on a regular basis, most of the docs in my group are closer to 60+ than 35. Several are considering retiring or slowing down to med retina only. Our local population is aging and growing, so we are busier. None of the local cataract groups can recruit quick enough to fill the demand for cataract surgery volume. Most have a few months wait time

 

[eyeeye_captain]

I wonder if some of the comp docs are going to start doing more injections with the cataract drop.

I’ve got a number of them out in our most rural footprint, and they’re fiercely protective of keeping that volume. They’ll send a patient over occasionally for a second opinion but already have them scheduled for their next shot. As far as I can tell they’ve been ramping up that volume despite being in an underserved cataract area.

 

[percyeye]

To make it all even worse, one of the medical journals (maybe NEJM) did an analysis of physician shortages in the coming years and found ophthalmology to be the third highest shortage area by the year 2035. I believe it was based on average age of current physicians, number retiring each year vs number finishing residency/fellowship, and projected growth in patient population for that particular specialty.
I can see this to be true. Even though we have recruited new physicians on a regular basis, most of the docs in my group are closer to 60+ than 35. Several are considering retiring or slowing down to med retina only. Our local population is aging and growing, so we are busier. None of the local cataract groups can recruit quick enough to fill the demand for cataract surgery volume. Most have a few months wait time

Worse for patients, but more leverage for eye care providers?

The analysis from NEJM highlights that primary care (family medicine and internal medicine) will experience the largest absolute shortfall, followed by cardiology and obstetrics-gynecology. Additional literature projects severe shortages in ophthalmology (with only 70% workforce adequacy by 2035) and urology (with a 46% shortage by 2035), both of which will be especially acute in nonmetropolitan areas.

Will this provide enough leverage where you can start dropping certain plans, or turn more towards office based surgery if the safety standards keep up where you can charge patients a cash fee to have surgery in your office suite. And if they don't want to pay cash for your surgery suite you could offer to have them schedule at the nearest academic center that is booked out 1-2 years.

This will hurt patient care the most, but surgeons may have no choice but to make decisions that will ultimately benefit themselves. And with all of this going on more new grads are going to PE, when it could be the best time ever to own your practice or start one.

 

[Slide]

I wonder if some of the comp docs are going to start doing more injections with the cataract drop.

I’ve got a number of them out in our most rural footprint, and they’re fiercely protective of keeping that volume. They’ll send a patient over occasionally for a second opinion but already have them scheduled for their next shot. As far as I can tell they’ve been ramping up that volume despite being in an underserved cataract area.

Same - I'm less and less inclined to bail these guys out when a complication occurs. If you can do an injection, you can also do a tap and inject and follow it.

 

[Slide]

Agreed. I’m pretty busy surgically, and with established practices I don’t think anyone in our group tops 10% of their pro fee collections via surgery. It’s doable if you’re starting out, slow, and getting sent cases because you have the free time.

The obvious answer is to just send all surgical retina to the academics like yourself 😉 I think one of the Hopkins guys did an article a little while back raging against that.

Ironically, the way the hospital fees are set up and the way our collections are in clinic, surgery surprisingly helps our bottom line a lot lol.

 

[MstaKing10]

Worse for patients, but more leverage for eye care providers?

The analysis from NEJM highlights that primary care (family medicine and internal medicine) will experience the largest absolute shortfall, followed by cardiology and obstetrics-gynecology. Additional literature projects severe shortages in ophthalmology (with only 70% workforce adequacy by 2035) and urology (with a 46% shortage by 2035), both of which will be especially acute in nonmetropolitan areas.

Will this provide enough leverage where you can start dropping certain plans, or turn more towards office based surgery if the safety standards keep up where you can charge patients a cash fee to have surgery in your office suite. And if they don't want to pay cash for your surgery suite you could offer to have them schedule at the nearest academic center that is booked out 1-2 years.

This will hurt patient care the most, but surgeons may have no choice but to make decisions that will ultimately benefit themselves. And with all of this going on more new grads are going to PE, when it could be the best time ever to own your practice or start one.

Maybe. Or do other specialties use this to further reinforce their “access to care” argument to expand their scope?

 

[MstaKing10]

Ironically, the way the hospital fees are set up and the way our collections are in clinic, surgery surprisingly helps our bottom line a lot lol.

Agree. And if you have ownership in an ASC you can amplify the benefit a bit. I still think surgery has to be offered to continue to get referrals, at least in our area. If we sent out all surgeries we would stop getting the bread and butter stuff. We are all retina group, this is less of an issue for you multi specialty docs