How much does a comprehensive ophthalmologist make?

[robellis]

I marked your question as inappropriate not because of your question, but because of how you are phrasing it. Your words imply that it's some cardinal sin or inappropriate to make a lot of money. And your previous post acted like it's not fair that someone in medicine is able to earn a lot of money. If @LightBox is able to work 35 hours a week and make $1.5M a year then good for him! Why is this bad? There are Neurosurgeons who earn $5M a year.

I am unable to tell what your role is in medicine, as your status does not indicate anything, but if you are premed or a medical student, what will this information do for you? If you are a resident or an attending in Ophthalmology, I would recommend PMing LightBox to maybe get some suggestions on earning more money. I am unsure if @LightBox will share anything, but I imagine approaching in a more friendly manner with less accusatory tone would certainly help.

i asked what it means to be a partner and what the business model is, if one is doing surgery only and making that much then yes objectively it’s too much, if you’re implementing business practices then it becomes more reasonable

---

Members don't see this ad.

 

[LightBox]

i asked what it means to be a partner and what the business model is, if one is doing surgery only and making that much then yes objectively it’s too much, if you’re implementing business practices then it becomes more reasonable

Good luck with anyone helping you in life. Bye.

 

[hello lady!]

I marked your question as inappropriate

I didn't even know this was a thing. Fun stuff. But I agree with you.

 

[docdoc2012]

i asked what it means to be a partner and what the business model is, if one is doing surgery only and making that much then yes objectively it’s too much, if you’re implementing business practices then it becomes more reasonable

So you have an issue with us being paid that amount for surgery only? Its just too much money? The microsurgical skills we painstakingly acquired, honed and perfected over years and years don't deserve it? But you don't have an issue if the money was from 'implementing business practices?'?

You are the reason why beaurocrats have taken over medicine. Way to drink the kool-aid and undervalue your own skills and profession.

 

[Openglobetrotters]

i asked what it means to be a partner and what the business model is, if one is doing surgery only and making that much then yes objectively it’s too much, if you’re implementing business practices then it becomes more reasonable

How can you determine what is too much? And why business practices make it more reasonable and not the surgery? I feel like it’s the other way around.

There’s physicians in every speciality that have that potential.

There are Beverly hill doctors that charge 20x because there’s the clientele for it.

 

[dantt]

i asked what it means to be a partner and what the business model is, if one is doing surgery only and making that much then yes objectively it’s too much, if you’re implementing business practices then it becomes more reasonable

Nothing wrong with making that much doing surgeries only. Realistically speaking though, it would be hard to make that much practicing medicine even if you're just doing the most profitable surgeries. How much would your collections have to be to keep 1.5 million? Anybody who is in practice and understands the numbers (nobody who is employed by the VA or Kaiser or similar) knows the amount of work that's actually involved with generating those kinds of numbers. For those who have not or will not get the opportunity due to being in saturated markets: sitting in the OR doing 50 cataracts in a day is not actually that fun or satisfying.

 

[Dr.K124]

Nothing wrong with making that much doing surgeries only. Realistically speaking though, it would be hard to make that much practicing medicine even if you're just doing the most profitable surgeries. How much would your collections have to be to keep 1.5 million? Anybody who is in practice and understands the numbers (nobody who is employed by the VA or Kaiser or similar) knows the amount of work that's actually involved with generating those kinds of numbers. For those who have not or will not get the opportunity due to being in saturated markets: sitting in the OR doing 50 cataracts in a day is not actually that fun or satisfying.

Hence why I said a more reasonable target is $400,000-$600,000 as a comprehensive, and $500,000-$1M in retina.

 

[robellis]

Nothing wrong with making that much doing surgeries only. Realistically speaking though, it would be hard to make that much practicing medicine even if you're just doing the most profitable surgeries. How much would your collections have to be to keep 1.5 million? Anybody who is in practice and understands the numbers (nobody who is employed by the VA or Kaiser or similar) knows the amount of work that's actually involved with generating those kinds of numbers. For those who have not or will not get the opportunity due to being in saturated markets: sitting in the OR doing 50 cataracts in a day is not actually that fun or satisfying.

how much does a cataract surgery pay you and how long does it take to do

 

[docdoc2012]

how much does a cataract surgery pay you and how long does it take to do

What is your background? Are you an ophthalmology resident? Medstudent?

Once again, your question sounds like its coming from someone non-medical. Because I see no mention of complexity in that question.

There are doctors in India doing 30 knee replacements in a day. Because they have developed the ability to do so due to rigorous training and just plain talent. If someone is doing 50 cataracts a day, those are some talented hands- the ability to handle volume like that doesn't just happen. If you are doing refractive cataracts, no need to even explain here how complex it is to get pts to 20/20 every time.

 

[Dusn]

The problem is not that reimbursement is too high.

I would agree that it may very well be that some doctors should spend more time talking to and examining their patients so that they inject fewer patients with macular schisis, put fewer multifocal lenses in patients with AMD, etc. There are also probably way too many patients in the typical optometry and ophthalmology clinic that don’t really need to be there — does every patient with a cataract really need to be seen yearly or can they just come back when they want surgery?
I unfortunately do think that a lot of the healthcare I see around me is unnecessary or sub-optimal — across all fields (maybe the worst are the urgent care centers). Many doctors should probably spend more time with each patient and make a little less so that they can provide better care. But cutting reimbursement will only drive out the doctors who actually spend the time to give their patients good care.

 

[Dr.K124]

The problem is not that reimbursement is too high.

I would agree that it may very well be that some doctors should spend more time talking to and examining their patients so that they inject fewer patients with macular schisis, put fewer multifocal lenses in patients with AMD, etc. There are also probably way too many patients in the typical optometry and ophthalmology clinic that don’t really need to be there — does every patient with a cataract really need to be seen yearly or can they just come back when they want surgery?
I unfortunately do think that a lot of the healthcare I see around me is unnecessary or sub-optimal — across all fields (maybe the worst are the urgent care centers). Many doctors should probably spend more time with each patient and make a little less so that they can provide better care. But cutting reimbursement will only drive out the doctors who actually spend the time to give their patients good care.

Doctors could spend more time with patients and make the same amount of $. All that needs to happen is cutting out all of the useless administration stuff.

Every time I hear about some of this, it reminds me how lucky I am to be in a specialty where it isn’t nearly as prevalent.

 

[dantt]

There are different types of lenses you can place in the eye during a cataract surgery. There are lenses that are "premium" that pay 5-8x than a traditional cataract surgery since they are considered cosmetic/out of pocket costs. You also have to keep in mind that there is also a fee that is reimbursed to the ASC (for supplies + profit etc). So if you partially own an ASC or own an optical shop you are multiplying your income.

Good general answer. Along the theme that it's not so easy to make over 7 figures, in general markets that support 50 surgeries a day do not support that type of premium charge. Conversely, markets that support a 5-8x reimbursement have ophthalmologists on every corner. In order to get any kind of volume in the saturated market, one typically either has to have a closed capitated contract (patients are forced to come to you because insurance pays you almost nothing), or you have to have a large comanagement network (optometrist gets paid extra to send to you). Optometrists don't want to send to ophthalmologists who own optical shops. ASC ownership may not even be a good deal or available unless you founded it (you would have to have the volume first) or require a certificate of need where applicable. Point is it's not easy money. People end up making it work for themselves in whatever market but geographic arbitrage is very real.

To answer the question of whether compensation is appropriate for surgery, average cataract surgery length is 18 minutes according to the last nationwide survey. It is impossible to do 50 cataract surgeries a day at 18 minutes a case (plus turnover). Only the most exceptional surgeons are able to operate at a pace to do 50 cases a day and again, not so easy to even generate those cases. Reimbursement is around $500/case and also includes ~3 postop visits on average. Do the math.

 

[Dr.K124]

Good general answer. Along the theme that it's not so easy to make over 7 figures, in general markets that support 50 surgeries a day do not support that type of premium charge. Conversely, markets that support a 5-8x reimbursement have ophthalmologists on every corner. In order to get any kind of volume in the saturated market, one typically either has to have a closed capitated contract (patients are forced to come to you because insurance pays you almost nothing), or you have to have a large comanagement network (optometrist gets paid extra to send to you). Optometrists don't want to send to ophthalmologists who own optical shops. ASC ownership may not even be a good deal or available unless you founded it (you would have to have the volume first) or require a certificate of need where applicable. Point is it's not easy money. People end up making it work for themselves in whatever market but geographic arbitrage is very real.

To answer the question of whether compensation is appropriate for surgery, average cataract surgery length is 18 minutes according to the last nationwide survey. It is impossible to do 50 cataract surgeries a day at 18 minutes a case (plus turnover). Only the most exceptional surgeons are able to operate at a pace to do 50 cases a day and again, not so easy to even generate those cases. Reimbursement is around $500/case and also includes ~3 postop visits on average. Do the math.

You most certainly don't need 50 cataracts a day to generate 7 figures. You need less than 30, assuming a 50% overhead and 3 days in the OR. While this is still very challenging, it most certainly is not impossible. Many skilled cataract surgeons are able to get them done in around 10 minutes. I do agree that it is not easy money, but such positions do exist.

But 7 figures is an extreme outside of retina, as we already established. Most private practice Ophthalmologists will make $500k give or take $100k.

 

[robellis]

You most certainly don't need 50 cataracts a day to generate 7 figures. You need less than 30, assuming a 50% overhead and 3 days in the OR. While this is still very challenging, it most certainly is not impossible. Many skilled cataract surgeons are able to get them done in around 10 minutes. I do agree that it is not easy money, but such positions do exist.

But 7 figures is an extreme outside of retina, as we already established. Most private practice Ophthalmologists will make $500k give or take $100k.

why does retina make so much more

 

[Dr.K124]

why does retina make so much more

Arguably the same reason Orthopedic Surgeons and Neurosurgeons make so much. More training. Retina takes an extra 2 year fellowship. It's sub-specializing on an area that requires a lot of time and skill. Their lifestyles are also a bit worse than a comprehensive.

 

[Dr.K124]

I expect this to change. The retina field has declining # of surgeries with intravitreal injections or lasers taking over. Injections reimburse a ton at the moment...it is a matter of time before medicare cuts them. Common theme in all of medicine (cardiology, GI), when a new procedure/surgery comes out, it reimburses really highly. The surgeons/physicians then make a ton of money but doing them in a short amount of time. Medicare catches on... rinse and repeat.

Ophthalmologists were really dumb for flaunting how quickly they can do phacos in and how much money they make/made. Cardiology/GI are experiencing similar cuts with stents/scopes. Right now a simple heart vessel stent reimburses $500 and takes minimum 15-20 minutes (just to compare #s).

Perhaps reimbursements will change, but Retina has almost always made more and I don’t see that changing. People have been saying it will for years.

 

[Slide]

why does retina make so much more

Retina is more procedural and sees issues that have higher visual morbidity/mortality. In clinic, the bulk of visits include injections and lasers, which CMS tends to reimburse more (aka procedures) compared to clinic visits. In addition to 2 more years of fellowship, there are lots of situations where retina is needed to evaluate and treat a patient quickly, often same day. The surgeries are also higher stakes and are more complex. For cataract surgery, many cases are fairly routine and can be done quickly; the same is not necessarily true for retina.

Already our field is getting cut - 67036 and 67040 are likely on the chopping blocks (injections thankfully were spared for 2021). People may say retina specialists make too much money, but my argument against that for a high intensity field where what we do can literally determine whether you have useful vision or not, there has to be a good value for it to attract good physicians and reward good work.

Not too long ago, I had some estate/living will documents taken care of by a lawyer, and the rate he charged worked out to at least $600 an hour (which is more if not the same amount I make). My financial situation wasn't even all that complex - most of the contract was created from a template and only a few words were changed out. Hell, he even charged us 15 minutes for making copies and making small talk. Though what he did required specialized training in the field of law, there's not a good argument that what he does is more valuable than the service retina specialists provide to society.

 

[percyeye]

i asked what it means to be a partner and what the business model is, if one is doing surgery only and making that much then yes objectively it’s too much, if you’re implementing business practices then it becomes more reasonable

This person has never worked a day in their life. Self righteousness usually leaves after they see their first paycheck and all the taxes taken out

 

[Dr.K124]

Retina is more procedural and sees issues that have higher visual morbidity/mortality. In clinic, the bulk of visits include injections and lasers, which CMS tends to reimburse more (aka procedures) compared to clinic visits. In addition to 2 more years of fellowship, there are lots of situations where retina is needed to evaluate and treat a patient quickly, often same day. The surgeries are also higher stakes and are more complex. For cataract surgery, many cases are fairly routine and can be done quickly; the same is not necessarily true for retina.

Already our field is getting cut - 67036 and 67040 are likely on the chopping blocks (injections thankfully were spared for 2021). People may say retina specialists make too much money, but my argument against that for a high intensity field where what we do can literally determine whether you have useful vision or not, there has to be a good value for it to attract good physicians and reward good work.

Not too long ago, I had some estate/living will documents taken care of by a lawyer, and the rate he charged worked out to at least $600 an hour (which is more if not the same amount I make). My financial situation wasn't even all that complex - most of the contract was created from a template and only a few words were changed out. Hell, he even charged us 15 minutes for making copies and making small talk. Though what he did required specialized training in the field of law, there's not a good argument that what he does is more valuable than the service retina specialists provide to society.

Don’t be so pessimistic. People have been saying Derm and Retina will be on the chopping blocks for a decade now. And while some procedures have been cut, overall compensation has kept up with inflation.

 

[Slide]

Don’t be so pessimistic. People have been saying Derm and Retina will be on the chopping blocks for a decade now. And while some procedures have been cut, overall compensation has kept up with inflation.

I'm not pessimistic, just realistic. Retina will never be cut to the point where people leave the field en masse, but based on the previous trajectory of proposed changes as well as sneaky ways insurance is trying to limit payments or reimbursements, something is already going to get cut. Retina lucked out this year because of strong lobbying (which is why injections actually going up 2% next year), but just like cataract surgery, vitrectomies are likely going to get cut. Since the CMS proposals are budget neutral, someone has to lose and it will likely be the procedures that suffer. Of note, please don't misunderstand that I disagree with all of what CMS is doing - I do agree that primary care and more "cognitive" fields need to be reimbursed properly by CMS.

The main reason why compensation has stayed intact is because of a) newer procedures and improvements in technology, and b) increasing clinic load (hence why you hear of retina seeing 60-80+ patients a day). Barring any new breakthrough treatment changes or modalities, it's hard to see more than 60-80 patients a day (I don't see that many and nor would I want to). Diagnostic testing is likely getting cut too due to overuse and supply costs for fluorescein are also going up, so ancillary imaging really doesn't help either.

 

[Dr.K124]

I'm not pessimistic, just realistic. Retina will never be cut to the point where people leave the field en masse, but based on the previous trajectory of proposed changes as well as sneaky ways insurance is trying to limit payments or reimbursements, something is already going to get cut. Retina lucked out this year because of strong lobbying (which is why injections actually going up 2% next year), but just like cataract surgery, vitrectomies are likely going to get cut. Since the CMS proposals are budget neutral, someone has to lose and it will likely be the procedures that suffer. Of note, please don't misunderstand that I disagree with all of what CMS is doing - I do agree that primary care and more "cognitive" fields need to be reimbursed properly by CMS.

The main reason why compensation has stayed intact is because of a) newer procedures and improvements in technology, and b) increasing clinic load (hence why you hear of retina seeing 60-80+ patients a day). Barring any new breakthrough treatment changes or modalities, it's hard to see more than 60-80 patients a day (I don't see that many and nor would I want to). Diagnostic testing is likely getting cut too due to overuse and supply costs for fluorescein are also going up, so ancillary imaging really doesn't help either.

Despite this increasing clinic load, Retina lifestyle has gotten much better in the last decade. Barely any worse than comprehensive.

I tend to be optimistic, but you do make good points. Here's to hoping things don't get worse. Things like this More than One-Third of House Members Ask CMS To Back Off Proposed Medicare Cut give me some hope.

 

[Slide]

Despite this increasing clinic load, Retina lifestyle has gotten much better in the last decade. Barely any worse than comprehensive.

I tend to be optimistic, but you do make good points. Here's to hoping things don't get worse.

Fair points. I do prefer the better lifestyle than increased compensation. To me, money is nothing if you don't have the time to utilize it for you of your family. Personally the only reasons I care as much as I do about reimbursement is for one, I don't feel pressured by external sources to not practice in a way best for my patients care and finances, and two, to be sure my work is valued appropriately (same reason why sports athletes care about their contracts - it's not necessarily the money, but to show how much their talents are prized).

 

[Dr.K124]

Fair points. I do prefer the better lifestyle than increased compensation. To me, money is nothing if you don't have the time to utilize it for you of your family. Personally the only reasons I care as much as I do about reimbursement is for one, I don't feel pressured by external sources to not practice in a way best for my patients care and finances, and two, to be sure my work is valued appropriately (same reason why sports athletes care about their contracts - it's not necessarily the money, but to show how much their talents are prized).

I agree entirely. Above a certain pay threshold, lifestyle is much more important. It's one of the main reasons I chose Ophthalmology aside from astonishment at the intricacy of the eyes. A field caring for such an incredible organ, that also allows me sufficient time off, the ability to cut back later, AND a solid mid-6-figure paycheck... I'm just sad I couldn't have signed up quicker!

We're very fortunate that we don't have to choose between adequate compensation and lifestyle. We can have both

 

[dantt]

why does retina make so much more

They see around 80 patients a day and are always on call. Does that sound like fun to you?

 

[robellis]

They see around 80 patients a day and are always on call. Does that sound like fun to you?

nope now that that has been explained I completely understand lol..80 patients a day..wow they are definitely earning their money..

 

[Dr.K124]

They see around 80 patients a day and are always on call. Does that sound like fun to you?

This is a very false statement. Well, the always on call is, at least. Seeing 80 patients a day is also very much on the high end. 60 patients a day is a much more accurate benchmark average.

It’s very fun.

 

[linevasel]

ro

 

[Dr.K124]

Robellis - your questions are borderline annoying. I suspect you are a med student or perhaps even worse pre-med. I say that because they seem divorced from any appropriate context. Still, I will try to answer your questions in a straightforward manner. Without a residency under your belt, these numbers won't mean much to you as far as communicating the effort, time, and opportunity cost of your training and the "appropriateness" of the compensation received at the end. But here goes:

How you make 1.5 million.

• See 50-60 patients daily
• Use 70/30 or higher Branded::Non-branded antivegf therapy
• Buy Antivegf therapy in bulk so you capture wholesale discounts
• Buy with Credit Card so you capture revenue in cashback
• Operate out of an ASC that you own jointly with really fast ant-segment surgeons or Operate out of a friendly but not too busy hospital so that you don’t loose money on cases and have surgical access when needed
• Keep your overhead low:
• Maximize your billing (as in make sure you have a competent coding billing department)

Next steps – Pathway 1

• Have a a really long associateship 4-7 years; Give your associates an increasing amount of salary every year to keep them hungry. An average retina specialist fresh out should be able to provide at least 1-1.5 mill of revenue (minus drug costs) per year (more with time and efficiency). So first order of business is make sure you present on starting salaries for new trainees at AAO, and make sure you give numbers like 250K is average for retina so that every retina fellow thinks they are getting a good deal at 250K. Encourage a wall of silence so that it becomes impolite to discuss salary. That way retina fellows will remain ignorant of the Retina business and accept anything. Start them at 250K(because of course they have been trained to take it…), increase by 50K every year., so you seem generous You should be able to squeeze out a good 4-5 million by the time they approach their buy-in. Then ask them for a 1-2 million buy in, and tell them its standard… If you, the partner work at an average rate – you should be able to bill 2-3million minus drug costs yourself. Incorporate the extra 1 million/year you receive for each associate. Pay the overhead. If multi-specialty (50-70%), if retina only (30-55%). If you do the math – you can see how a partner walks away with 1.5 mill.

Pathway 2

• Be reasonable with the associateship; keep the overhead low ( I find this is basically impossible in a multispecialty….) Hire smart young people fresh out of college, who don’t need a ton of money or benefits as staff/scribes/techs. Be okay with staff turnover. Make sure you don’t have ridiculous admin positions like executive VP or Director of HR in your organization to suck up salary. If you do this and are averagely busy, you can net 2-3 million. Subtract the overhead percentage and voila!!! 1.5 million

Main point – to make 1.5 you need special circumstances…. As in any combination of the following

• Monopoly without lots of capitated plans
• Patient population that live forever, make all their appointments, have lots of wet AMD and need antivegf therapy
• Location with Low cost of labor
• Unique clinic flow: (Nurses vs PA do subconj injection; “advanced optometric care” to see all the chronic patients/ post-ops who don’t need an intervention; captive optometric referrals; contract with VA/Feds; etc etc)
• Slamming Clinical Trial Department - pharm pays well for those patients

If you don’t have one or more of those situations; 1.5 mill will be difficult to make. You could also try seeing 80+ a day and opening on the weekends. Those models also seem to work, but obviously not for everyone.

I don’t have an axe to grind. This is just the business of medicine. Every field has its peculiarities. Why should Dermpath folks be millionaires? Why do we pay spine surgeons for every joint that gets fused in a case ? Why does your local ped infectious disease specialist who trained for 6 years post med school get paid 300s max ? This is just the business of medicine.

Was this helpful? Probably not particularly if you don't have the context. Nonetheless, everyone who makes the aboe literally follows some iteration of this formula. Essentially, the American system evolved, for a myriad of complex reasons, to reward procedures. Its just much easier to assign value to stuff you do with your hands than stuff you do with your brains. There is massive institutional inertia to continue in this vein. Docs are also altruistic. The more altruistic ones (who happen to be less aggressive) end up in less-procedural specialties, so they are less likely to agitate for a bigger portion of the dwindling pie that is medical reimbursement. Its turtles all the way down.

Remember, money doesn't create happiness. I would gladly give up dollars for freedom and agency when it comes to my practice/lifestyle. And... the above formula isn't sustainable. At some point, the compensation will "right" itself. The reason to do ophtho is not for the money, its rather to control lifestyle. The money is the cherry on the cake.

Looking through their post history, they also asked monetary related questions in Emergency Medicine, Psychiatry, and Anesthesia.

You are correct. Ophthalmology is about the lifestyle. If you can't be happy working 45 hours a week making $500,000... you should have gone into investment banking

 

[mjohnsonets]

Them cutting cataract surgery is not-so-much leading to a loss of income as preventing incomes from rising. The average duration of Cataract surgeries has been dropping, so reimbursement has been dropping to reflect this.

Comparing reimbursements in the past to modern reimbursements is a fool's game, in my opinion. If a cataract surgery took over an hour in 1980 and takes 8 minutes today, they obviously should not be reimbursed as they used to be. Now, I don't agree with the extent to which they've been cut, but the reason for cutting makes sense. Similarly, procedures that required extremely expensive equipment and were quite long in duration are often shorter and less expensive now, so they've seen a drop in reimbursement. Lastly, new procedures usually start out with a relatively high reimbursement until evening out and eventually dropping as time goes on.

When you see older physicians citing average incomes in the 7 figures for Ophthalmology, this was only in that short period of time where duration of Cataract surgery had dropped but reimbursements hadn't yet. The average income for an Ophthalmologist has mostly keep constant and kept up with inflation with some fluctuations. Same with most specialties.

I do agree that it's likely a guard against potential loss for income, and that Ophthalmology being more established in private practice than most other specialties likely plays a role in the lower starting salaries.

Edit: and if you can find the volume, a modern cataract surgeon can still earn 7 figures without much difficulty, so long as you focus entirely on cataracts.

Agreed it is keeping them from rising much.

I didn't mean to compare reimbursement from times past, I was asking what was the comparison to other specialties starting salaries? Was Optho paid closer to other specialties starting salaries when reimbursements were higher?

what does it mean to be a partner? I don’t understand how a doctor can work 35 hours a week and make 1.5 million dollars as you do..is optho making too much? Are you guys too highly reimbursed for your surgeries? Doesn’t seem right when others are working 50 hours a week to make 400k

By partner, LightBox likely means being paid for the revenue he/she produces, surgery center income(passive), and the real estate income. One of the best wealth builders out there is owner-occupied commercial property.



Wow, overall, didn't read the last page just jumped to my notification. Haha, this has been a funny swing in the central question of the thread. Overall, as an even averagely paid ophthalmologist, your income will be in the top 3-4% of incomes in the US...you can buy a tesla, go on vacation, and probably afford to not make your own coffee in the morning depending on what you get.

 

[RetinaDude]

what does it mean to be a partner? I don’t understand how a doctor can work 35 hours a week and make 1.5 million dollars as you do..is optho making too much? Are you guys too highly reimbursed for your surgeries? Doesn’t seem right when others are working 50 hours a week to make 400k

As a partner, you not only earn money from your productivity but also from ancillary streams of income (real estate, ASC, having ODs work for you, etc...). I'm part owner of an ASC that pays me $200k/year.....and all I do is show up and operate. Trust me, you can work that few hours (listed previously) and make more than $1.5M. Yeah reimbursement has been cut in ophthalmology but we still get paid very well for our exams and procedures. The rest of the medical world laughs at ophthalmologists as not being "real doctors", until they have an ocular problem. Ask yourself, what one body part/sense would you be most scared to lose and I can guarantee you most would say they are scared to ever go blind. There is A LOT of value in that and people are willing to pay handsomely for it.

 

[ER BlueBlood]

I think this phenomenon is because residents/fellows are paid so poorly, that they think that 200k is a "huge" salary relative to how they were living. So earning 200k/year and living in Santa Monica seems like a dream compared to starving like a resident. Also obviously, it is hard to be far away from family. But it's very unlikely that anyone making 7 figures could ever "go back" to making a paltry salary, no matter which geographic locale it is.

Wow you must be a big baller

 

[ER BlueBlood]

im just trying to understand what it means to be a partner, what is generating you so much revenue that you can make 1.5 million working 35 hours a week? Is it the surgeries themselves or do you hire a bunch of mid levels and skim off of them or do u hire a bunch of other surgeons or where is that crazy revenue coming from

light box is the big baller on SDN show some respect

 

[LightBox]

Funny how the talk of $$ brings about all of the non-ophthos into this forum

 

[Dr.K124]

As a partner, you not only earn money from your productivity but also from ancillary streams of income (real estate, ASC, having ODs work for you, etc...). I'm part owner of an ASC that pays me $200k/year.....and all I do is show up and operate. Trust me, you can work that few hours (listed previously) and make more than $1.5M. Yeah reimbursement has been cut in ophthalmology but we still get paid very well for our exams and procedures. The rest of the medical world laughs at ophthalmologists as not being "real doctors", until they have an ocular problem. Ask yourself, what one body part/sense would you be most scared to lose and I can guarantee you most would say they are scared to ever go blind. There is A LOT of value in that and people are willing to pay handsomely for it.

I always laugh when people cite Medscape and think the average mid-career Ophthalmologist only makes $350,000.

 

[ER BlueBlood]

Answer: I go into the hospital once or twice per year and thus don't have to deal with that mess of an organization. I work ~35 hours a week (I will be taking off every other Friday soon to boot). I'm home by 4 pm on most days so I can spend time doing homework with my kids. I don't deal with anything messy -- I'm not cutting through fat and miscellaneous tissue to get to the area of interest. My patients see an immediate improvement. I have autonomy. I make 7 figures. Ophtho gives me free time to pursue 10 other entrepreneurial activities and to stay in shape.

Pre-partnership salaries are lower because owners like me can offer that rate and get 20 CVs to fill the spot. And why are applicants beating down the gates? Because they want the partner's financial situation and lifestyle.

Wow man you are so badass, just amazing

 

[LightBox]

Wow man you are so badass, just amazing

Oh the grapes...

 

[Trefoil]

what does it mean to be a partner? I don’t understand how a doctor can work 35 hours a week and make 1.5 million dollars as you do..is optho making too much? Are you guys too highly reimbursed for your surgeries? Doesn’t seem right when others are working 50 hours a week to make 400k

I think the discrepancy lies in that ophthalmology has a lot of potential for business minded individuals. My first rotation in ophthalmology was at a high throughput cataract practice.I was honestly shocked by the change in scenery and atmosphere. I went from a medicine rotation where everyone was exhausted and angry into this practice where everyone had a smile on their face. It’s because everyone was treated well. The docs bought food for the entire practice including me every day. The mentality is that if you work hard and do a good job we will reward you for your loyalty. That type of mentality doesn’t exist in a lot of other types of medicine.

In ophthalmology, you need to be comfortable identifying patients who are good candidates for premium lenses and surgery. It’s true that a small number of practices will upsell everyone (unethically) on premium lenses, but in the right market this will increase your revenue quite a bit and be a perfectly ethical standard of care for the right patient.

The type of work we do has an immediate benefit to the patient, so they are often willing to invest some of their own money into that result. Is a toric lens for everyone, no, but in a patient with high cyl, it’s the difference between great uncorrected vision and wearing glasses after surgery. What would you be willing to pay for? That also adds stress on the surgeon. When someone is investing to optimize their vision, they have high expectations. This is true of cataract and refractive surgery.

I think that environmental shock makes sense to some degree. In other fields of medicine, the hospital is running the show most of the time, and or the patient experiences no immediate quality of life benefit. In primary care, you have to convince someone to make large lifestyle choices with no obvious immediate benefit from the patients perspective. Is it beneficial? Of course, but the patient doesn’t experience it. In ophthalmology, the patient is generally aware of the benefit the day after surgery, and it can be life changing. Having a patient scream or cry immediately after surgery (in joy) happens not infrequently, and it feels great. That’s why we love our jobs, and it’s why our practice is able to ethically make large sums of money. I’ve seen elderly wheelchair bound patients start walking again without assistance after my surgery...that is a wonderful feeling, and I don’t think it’s easy to put a price tag on that type of change. The price tag is different for everyone. Mixing business and medicine is not something people are taught in medical school. Remember the cadre of academics does not see value in business, but the reality is that the efficiency of these centers is what prevents the shortage from worsening. Academic centers and hospitals are just not an efficient place for ophthalmologists to practice unfortunately. They are still good places for complicated cases, but the average patient doesn’t require that level of care. We function best outside of those types of environments.

The trauma/ call situation is tricky. Hospitals in many areas often aren’t willing to invest in the equipment we need to take call. Taking call for us means seeing patients without insurance, and since we aren’t hospital employees, the practice usually has to eat the cost of those patients. I think ethically, it would be far better for patients if ophthalmologists could negotiate better with local hospitals, but unfortunately they don’t seem to have a lot of incentive to invest the resources needed for us to provide care in their environment. Generally, patients end up transferred to the nearest tertiary care center, and that’s just the way it is now.

I should add the caveat that I’m writing all of this while working in a hospital environment, so the views expressed might be slightly off, but I’ve tried to gather the opinions of many different people, and this post is me trying to summarize them as best I can. Anyone with more experience, feel free to correct me on my misconceptions as I’m not currently part of a private practice.

 

[RetinaDude]

ER Blueblood, why are you here on this discussion? I know it’s to be nosy, and a troll, but I didn’t know if you had anything useful to add or not???

 

[Splenda88]

1.5 million is an outlier. Ophthalmology is a specialty mostly in private practice. Private practice pays better than other types of practice.

An anesthesiologist working in a hospital makes less than they do in private practice. But in other specialties, most of the doctors don’t work in private practice.

We are not over compensated. The average Ophthalmologist makes $500,000, not 1.5M.

It also depends on your business skills. The more profitable your practice is, the more profitable you are.

Why do you think we are overpaid when Dermatology and Orthopedics can make the same and work the same hours (depending on subspecialty within Ortho)? Radiation Oncology too, if you’re able to actually find a job.

It seems like they are well compensated for working only 35-40 hrs/wk...

Most physicians would dream making that kind of $$$ working these hours. I can't even find a 250k+/yr hospitalist job offer that is in a semi desirable location. I am not even taking about California or the Northeast. IM sucks!

 

[ball123]

It seems like they are well compensated for working only 35-40 hrs/wk...

Most physicians would dream making that kind of $$$ working these hours. I can't even find a 250k+/yr hospitalist job offer that is in a semi desirable location. I am not even taking about California or the Northeast. IM sucks!

Really?! I had no idea! I was under the impression that most hospitalist/IM gigs can easily find a 250/300k job that’s generally one week on/one week off in a pretty decent city! At least I thought I remembered hearing this when I did my prelim year.

 

[Splenda88]

Really?! I had no idea! I was under the impression that most hospitalist/IM gigs can easily find a 250/300k job that’s generally one week on/one week off in a pretty decent city! At least I thought I remembered hearing this when I did my prelim year.

I am graduating next June; I have been looking for 2 months now and I have not found anything in a desirable city in the south yet.

 

[Splenda88]

@Splenda88

Tbh I think most of the jobs in medicine right now are not hiring due to the covid pandemic. A lot of hospitals/practices are on a hiring freeze.

On a separate note, I would be wary of a life long 7/0/7/0 schedule as a hospitalist. The truth of the matter is 26 weeks of the year you will not have weekends off and the Monday-Friday of the weeks you are off, typically no one is free to hang out with. I have many friends in IM, and most people still feel happier living a normal Monday-Friday work week. WEEKENDS OFF ARE ESSENTIAL or even better 3 day weekends lol.

I will do it for a couple of years so I can make enough $$$ to put a big dent on my student loan. Then I will go into academia.

 

[Openglobetrotters]

I am graduating next June; I have been looking for 2 months now and I have not found anything in a desirable city in the south yet.

May be covid effect?

I have a couple of friends graduated 1-2 year ago in IM. Got 300K+ hospitalists in a mid sized city in the Carolinas and Florida. Schedule is 1 week on and 1 week off.

 

[Trefoil]

I am graduating next June; I have been looking for 2 months now and I have not found anything in a desirable city in the south yet.

Dude, do an allergy fellowship. Those people have a great lifestyle. Also, their fellowship is probably easier than a week as a hospitalist. I admitted a patient last week, and it reminded me of how hard inpatient medicine is. Everything conspires against success.

 

[bronx43]

I will do it for a couple of years so I can make enough $$$ to put a big dent on my student loan. Then I will go into academia.

Academic Hospitalist? That’s more or less same thing as normal hospitalist... I used to be one.

 

[sloh]

Dude, do an allergy fellowship. Those people have a great lifestyle. Also, their fellowship is probably easier than a week as a hospitalist. I admitted a patient last week, and it reminded me of how hard inpatient medicine is. Everything conspires against success.

What about the actual job market for allergy though?

 

[Trefoil]

What about the actual job market for allergy though?

That’s fair! I have no idea what that might be like. Maybe rheumatology? Here is a trick, do a rheum fellowship followed by a uveitis fellowship. The back door to ophthalmology.

 

[schistosomiasis]

Good discussion and I generally agree that most folks are poorly paid right out of training, and the income potential goes up as a partner/ owner especially in areas that aren't as saturated, but often even in areas that are.

But one very important point- if you have to earn over $1 million vs $500,000 to be happy, then I feel real sorry for you. My life wouldn't be one iota better if I earned that much. I live way more comfortably than when I was making $180K right out of training but to tell you the truth I'm not that much happier.

Even as a practice owner, I earn way less than $500k. Guess I must be a *****. Funny thing is, when I see the folks that earn in the seven figures at our society meetings/ pharma dinners, they always look stressed and wonder how I manage to walk around with a big smile and take so much vacation. You gotta work to earn. There are no shortcuts in life. I've quoted on this thread before- Pinto did a study, no correlation between number of cases/ volume/ revenue and happiness. High correlation between income saved and happiness. I pretty much beat everyone in that number.

Frequently, but by no means always and not referring to anyone on this thread, the folks that earn seven figures are the ones that push femto/ multifocal IOLs unnecessarily on patients, or get a lot of Optometry referrals and don't even examine the patients before surgery. And frequently, but not always, the folks who make $1.2 million aren't happy because the next guy is making $1.25 mil.

I didn't go into medicine to work nonstop, nor take shortcuts or hawk stuff to patients to make more money than I need. Perfectly content here with my sub-$500K salary here. Sometimes it's fun to be "poor". Just saying.

Ophtho is a terrific field that is fun to do and pays reasonably well, but if you're a med student reading this and wants to earn the most, please find something else to do.

 

[Splenda88]

Good discussion and I generally agree that most folks are poorly paid right out of training, and the income potential goes up as a partner/ owner especially in areas that aren't as saturated, but often even in areas that are.

But one very important point- if you have to earn over $1 million vs $500,000 to be happy, then I feel real sorry for you. My life wouldn't be one iota better if I earned that much. I live way more comfortably than when I was making $180K right out of training but to tell you the truth I'm not that much happier.

Even as a practice owner, I earn way less than $500k. Guess I must be a *****. Funny thing is, when I see the folks that earn in the seven figures at our society meetings/ pharma dinners, they always look stressed and wonder how I manage to walk around with a big smile and take so much vacation. You gotta work to earn. There are no shortcuts in life. I've quoted on this thread before- Pinto did a study, no correlation between number of cases/ volume/ revenue and happiness. High correlation between income saved and happiness. I pretty much beat everyone in that number.

Frequently, but by no means always and not referring to anyone on this thread, the folks that earn seven figures are the ones that push femto/ multifocal IOLs unnecessarily on patients, or get a lot of Optometry referrals and don't even examine the patients before surgery. And frequently, but not always, the folks who make $1.2 million aren't happy because the next guy is making $1.25 mil.

I didn't go into medicine to work nonstop, nor take shortcuts or hawk stuff to patients to make more money than I need. Perfectly content here with my sub-$500K salary here. Sometimes it's fun to be "poor". Just saying.

Ophtho is a terrific field that is fun to do and pays reasonably well, but if you're a med student reading this and wants to earn the most, please find something else to do.

I agree, but $1 mil will allow you to be FI(RE) quicker than 500k+...

 

[schistosomiasis]

I agree, but $1 mil will allow you to be FI(RE) quicker than 500k+...

Three years vs eight or nine years? While I totally agree that it's best to get financially independent ASAP so you don't have to worry about declining reimbursements, loss of volume/ patients or anything else, if you're one of those people who can't wait to get independently wealthy so they can stop practicing medicine (not implying Splenda88 is one of those folks), then I feel sorry for you and you sure picked the wrong field/ career.

The joy of getting rich/ financially independent is in the pathway and process, not the destination.