Interesting Tidbits from Private Practice

[USFOptho]

Hey guys...

Just thought I would give you some info I came along after spending time with several private practice opthos' here in Florida.

1) Starting salaries for optho's are low. Really low. Try 80-100k. Why? Overhead. Overhead. Overhead.

2) These salaries stay low for a long time, because of Overhead. Additionally, it's very hard to get into the market of refractive surgeries because the big boys have the market share, PLUS they run retail business models, where they will accept 40% of medicare from different HMO's for cataract cases. This basically puts anyone that is by themselves or in a small group out of luck.

3) No one in Florida (and probably the south east) is allowing associate's to make partner within 3-5 years.

4) The best you can hope for is 40% profit margins, and that is the big boy lasik groups. More like 10-20% of gross will be your profits.


Still excited about optho? I am...But don't go into it thinking you'll be making the big bucks. The way things are with medicare right now combined with the tremendous overhead and market glut of refractive guys will make it very very hard on you. Oh, and another private guy told me that retina grads are asking 200k, but getting about 160-180k tops.

Something to think about.

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[OphthoBean]

Thanks so much for this post. All that you have posted makes my contract, starting salary, benefits, and partnership track sound awesome by comparison. I feel much better about signing on the dotted line now. Bless your heart.

 

[USFOptho]

Thanks so much for this post. All that you have posted makes my contract, starting salary, benefits, and partnership track sound awesome by comparison. I feel much better about signing on the dotted line now. Bless your heart.

I'm glad you got a good deal. What area of the country? (maybe florida just has a bad market?)

 

[Mirror Form]

I hope that florida just has a bad market since it's a very nice place to live. There might be much better ophtho job markets in other areas. Regardless though, as the population ages, there is going to be plenty of surgery (maybe not refractive) to go around. So ophthalmologists will still most likely do pretty well in the long run. But yeah, we're a far cry from Rads or Gas in terms of starting salaries.

 

[abcde]

I wish someone had a better explaination for the wide range of money talked about. 80000-120000 starting to Andrews #s of 225-275 after a few years. Seems like optho has bottomed out. Then there are those that say the money is great after a few years. Anyone else have some more light on the subject? Or maybe just add to the confusion.

 

[Andrew_Doan]

I wish someone had a better explaination for the wide range of money talked about. 80000-120000 starting to Andrews #s of 225-275 after a few years. Seems like optho has bottomed out. Then there are those that say the money is great after a few years. Anyone else have some more light on the subject? Or maybe just add to the confusion.

It's really about where you want to practice. In over-saturated areas, I've always said it's difficult. In places where communities are growing, then it's great. You take the averages of these two extremes, then you get ophthalmologists making the mid-200's after a few years. This number was obtained from salary surveys and from the AAO meeting last fall. I didn't make it up.

My advice is move to a growing area if money is important. If not, then learn to budget.

 

[CameronFrye]

I wish someone had a better explaination for the wide range of money talked about. 80000-120000 starting to Andrews #s of 225-275 after a few years. Seems like optho has bottomed out. Then there are those that say the money is great after a few years. Anyone else have some more light on the subject? Or maybe just add to the confusion.

I think the important question is why ophtho over derm?

 

[modemduck]

Hey guys...

Just thought I would give you some info I came along after spending time with several private practice opthos' here in Florida.

1) Starting salaries for optho's are low. Really low. Try 80-100k. Why? Overhead. Overhead. Overhead.

2) These salaries stay low for a long time, because of Overhead. Additionally, it's very hard to get into the market of refractive surgeries because the big boys have the market share, PLUS they run retail business models, where they will accept 40% of medicare from different HMO's for cataract cases. This basically puts anyone that is by themselves or in a small group out of luck.

3) No one in Florida (and probably the south east) is allowing associate's to make partner within 3-5 years.

4) The best you can hope for is 40% profit margins, and that is the big boy lasik groups. More like 10-20% of gross will be your profits.


Still excited about optho? I am...But don't go into it thinking you'll be making the big bucks. The way things are with medicare right now combined with the tremendous overhead and market glut of refractive guys will make it very very hard on you. Oh, and another private guy told me that retina grads are asking 200k, but getting about 160-180k tops.

Something to think about.

Hey USFOphtho, its great you are still interested in ophtho even after you found out you wouldn't make much in private practice. Unfortunately the info you are giving us is not generalizable. If you want to make money all you need is to go somewhere unsaturated... like the middle of nowwhere texas or kentucky. You are citing info from possibly one of the worst states to practice... check out this article:
http://www.ophthalmologytimes.com/ophthalmologytimes/article/articleDetail.jsp?id=144989

I live in manhattan, if I told you rent here was 1500 bux a month do you think that would be a fair estimate of what it would cost to live in an apartment in iowa city?

Here is some proof that there are plenty of great practices to start at well over 150k and at partner make over 275... it is about location and if you want to do academics:
=======================================================
IE:
Washington-Washington Lakefront Community ~ Join a large physician owned and operated multi-specialty group. Our well established and collegial group is seeking a board certified or board eligible General Ophthalmologist. The incoming physician will earn a first year income guarantee of $180,000. A full benefits package is provided, including health, life, dental, retirement plan, relocation assistance, and signing bonus.
Job # 29677 Call David Bik at (800) 829-7049 or Click here to contact via Email,
or Click here to enter your contact information online, or Fax your contact information to (812) 331-0659.
=======================================================

All in all, I do agree with you, if money is the key factor in determining your specialty you should do rads or anesthesia-pain.... they are really relaxed and you can really make a killing in interventional rads. Some of my classmates have found jobs for well over 600k annually. Just my 2 cents.

 

[eye3md]

If someone goes to the saturated markets, then they deserve whatever sucker amount of money the money grubbing older ophth. will give. I have learned there are really some sharks out there in our field who will more than willingly take advantage of the new guys. It happens in all fields but I believe ophth. probably has some of the worst slime balls.

As far as starting salaries and future salaries are concerned, you can still make a mint in ophth. That includes not having to be a refractive surgery ho as well. Yes, many of the salaries can be low but you have to look at bonus potential and future earnings (partner time). I had a friend who started at $105,000 in a small town in the south and by the end of his first year he had made about $220,000. His practice knew if he was a hard worker he would make money. My friend liked to work so he made the money. Now, he is partner and makes around $350,000 to $400,000/yr. He is not doing LASIK either and has a moderate volume practice. Also, only works four days per week. Retina guys demand higher salaries and usually get them, unless you want to practice somewhere like Miami or San Fran. Believe me, a retina guy may start out less than ortho or rads but in the end many retina guys are easily making just as much $$$$. On a per hour basis, retina and LASIK guys are probably the highest paid surgeons out there.

 

[hbs]

If someone goes to the saturated markets, then they deserve whatever sucker amount of money the money grubbing older ophth. will give. I have learned there are really some sharks out there in our field who will more than willingly take advantage of the new guys. It happens in all fields but I believe ophth. probably has some of the worst slime balls.

As far as starting salaries and future salaries are concerned, you can still make a mint in ophth. That includes not having to be a refractive surgery ho as well. Yes, many of the salaries can be low but you have to look at bonus potential and future earnings (partner time). I had a friend who started at $105,000 in a small town in the south and by the end of his first year he had made about $220,000. His practice knew if he was a hard worker he would make money. My friend liked to work so he made the money. Now, he is partner and makes around $350,000 to $400,000/yr. He is not doing LASIK either and has a moderate volume practice. Also, only works four days per week. Retina guys demand higher salaries and usually get them, unless you want to practice somewhere like Miami or San Fran. Believe me, a retina guy may start out less than ortho or rads but in the end many retina guys are easily making just as much $$$$. On a per hour basis, retina and LASIK guys are probably the highest paid surgeons out there.

From what I hear (I am not looking for a job so this is not first hand info), there seems to be a real steep hierarchy in the job market where the established guys are taking advantage of newcomers while they make the big money. I think it's fair to have to wait couple of years before becoming a partner, etc, but having "sharks" in this beautiful field is a shame. For everyone out there going to private practice, don't do this to the guys coming after you. Let's stop the cycle! Just remember your days when you were looking for a decent job and don't take advantage of people who come after you.

 

[OphthoBean]

I'm glad you got a good deal. What area of the country? (maybe florida just has a bad market?)

I am going out West!

Unless I am offered something in sunny So Cal relatively soon, I'll be in Sin City.

 

[gem777]

I am going out West!

Unless I am offered something in sunny So Cal relatively soon, I'll be in Sin City.

OpthoBean - I would really appreciate any advice you have to offer on looking for a job and getting offers. Specifically, I'd like advice about when to begin looking for a job (relative to finishing residency), how did you contact practices, did you have connections or did you have to "cold call" practices, how tight was the job market in which you were looking, etc. Answers to any or all of these questions would really be appreciated. Any other tips you have would be great too.

I'm beginning my job search in a small geographic area in the opposite end of the country of where I'm in residency. I'm finding this process to be really stressful. Thanks.

 

[samdo]

Just thought I would give you some info I came along after spending time with several private practice opthos' here in Florida.

1) Starting salaries for optho's are low. Really low. Try 80-100k. Why? Overhead. Overhead. Overhead.

I want to add my observations to these direct points so bear with my editing. Prices for salarys on a per hour worked and per liability basis are lower than optometry and para health professions.

2) These salaries stay low for a long time, because of Overhead. Additionally, it's very hard to get into the market of refractive surgeries because the big boys have the market share, PLUS they run retail business models, where they will accept 40% of medicare from different HMO's for cataract cases. This basically puts anyone that is by themselves or in a small group out of luck.

Simply untrue. Anyone can compete but you have to be willing and able to do so. That means business knowledge. SWOT analysis. Good advice. Luck. Hard work. A lean small organization doesnt need to stand toe to toe with a big giant. You just need to be able to hang long enough in the "fire fight" to know the competitions weakness, maneuver quickly, and exploit them.

3) No one in Florida (and probably the south east) is allowing associate's to make partner within 3-5 years.

Examine the partnership deal and add more salt. Spend 2,3,4,5, years adding your productivity to theirs. then buy in with a fair to flawed model based on your luck and persistence possibly risking alienating your partners and then buy your partners out when they leave. Do the math and it doesnt sound that apetizing unless they are average business people and you are above average.

4) The best you can hope for is 40% profit margins, and that is the big boy lasik groups. More like 10-20% of gross will be your profits.

This is so variable and depends on how thrifty and careful you are. Your profit margin can be all over the place but I would plan at least 70% overhead to start. That may or may not include your salary. Sharing office space is the best way to save money. Start reasonable and small, add as you succeed. The big LASIK practice which is usually not a group but a single mod to high volume doctor may have an overhead for this segment of his practice in the 80 to 90 percent range. Refractive surgery if implemented improperly is the SUV of opthalmic practices; cool, glitzy but.....


Samdo

 

[ReMD]

Private practice seems kind of scary. Can you tell us or warn us about anything else in the private sector? Specifically,

1) Is it feasible to start a practice straight out of residency?
2) How much does it cost?
3) How do you go about increasing your pt and surgical volume?
4) What is the progression of salary from year 1 to year 5?
5) Is private practice worth all the effort/headache or is academics becoming more appealing?

 

[Andrew_Doan]

How do you go about increasing your pt and surgical volume?

I am not experienced in running a private practice and will not pretend that I know more than the previous contributors. However, I do understand business and marketing, particularly Internet marketing, i.e., Search Engine Optimization (SEO).

I've been working with the American Academy of Ophthalmology to build http://www.eyeorbit.org

eyeOrbit offers private forums, blogging, and now a case archive of ophthalmic cases (http://www.eyeorbit.org/article.php?story=20050226074222236).

One way to attract patients and build surgical volume is to have a strong online presence. Even as a resident, I have received many emails from patients for evaluation and advice because of my exposure on the Internet. I send these patients to the U of Iowa as new evaluations. Some patients are willing to fly from the coastal states.

How can private practice physicians be noticed for their academic contributions?

Similar to how residents and faculty post case reports on EyeRounds (www.eyerounds.org), residents and private practice physicians can start their online reputation now. After posting case reports on your practice's web site, the case discussions can then be submitted to the eyeOrbit editors for listing. eyeOrbit provides a link to your website. The power of the eyeOrbit index is untapped and not realized by physicians who are not on the Internet. eyeOrbit provides you the ability to share your ophthalmic knowledge with the world as well as provide a way for patients to find your practice on the Internet. To understand the utility of eyeOrbit, search on Google "dorsal midbrain syndrome". The search result gives you: http://www.google.com/search?hl=en&q=dorsal+midbrain+syndrome

Out of 22,100 possibilities
Number #1 hit on Google! is U of Iowa (EyeRounds) - my site on U of Iowa
Number #2 hit on Google! is eyeOrbit (same case from U of Iowa's EyeRounds)

The above is one example of numerous examples of the power of the eyeOrbit and University Websites. By contributing cases, the Universities can increase their Internet presence. However, through eyeOrbit, private practice physicians can also contribute and "advertise" their knowledge via a peer-reviewed mechanism.

Over time, eyeOrbit will become the Yellow Pages for ophthalmology and the results will be placed on the first page of major search engines.

Thus, I've been encouraging my colleagues to contribute cases to EyeRounds and eyeOrbit because when patients search for an ophthalmologist or disease on Google!, you want your name, case, and practice on the first page.

With the above in mind, this is why my colleagues and I launched MedRounds Publications, Inc. (www.medrounds.org). One of our services is to build University and practice websites for physicians.

Good luck!

 

[samdo]

Private practice seems kind of scary. Can you tell us or warn us about anything else in the private sector? Specifically,

See the answers below:

1) Is it feasible to start a practice straight out of residency?
Yes but it depends on your ability and mindset. If you go through a process of apprenticing with a group improving your skills, learning more about business, coding, etc... then you will get a better running start. I came to the conclusion I wasnt going to have any major security in life with all the promises I heard when the first few promises fell through and I heard the statistic more than 50% of newly employed residents wind up leaving their first job within a a year or two.

2) How much does it cost? Variable based on your ability to set up an efficient business model and what type of practice you want to create and where you are creating it. I borrowed 250K to start and financed the rest from cash flow as I grew. You may not do it that way.

3) How do you go about increasing your pt and surgical volume?
Beat the drum. Advertise in the paper, radio, direct mailings, cable, yellow pages. Shake hands at the doctors lounge, carry cards with you at all times. Take ER call. Dont forget while in training, do NOT SHUN any subspeciality area of your field. In ophthalmology make sure you are as proficient in OPTICAL, plastics, glaucoma medical/surgical, retina medical, and refractive as possible. If you have more tools you can be more omnivorous.

4) What is the progression of salary from year 1 to year 5? I cant answer the question for you because in every case the answer may be completley different. Practice livinging frugally NOW and avoid accumulating more debt. Moonlight as a resident to pay your debt down or defer it and build an excellent credit rating. Still dont expect the banks to give a damn about what you want.
5) Is private practice worth all the effort/headache or is academics becoming more appealing?

Some academics positions looks sweet but many of these docs are nomadic moving from place to place every 3 to5 years. That really sucks if you want to settle down, put roots down, have a family. Arent you tired of all the moving around as a college, med student, intern, resident, fellow. during that time I lived in 5 states spanning the entire continental US. Many times i never took my stuff out of the boxes. The academic insititutes are hurting badly financially since most of the docs running these places have minimal business skills, ability, and knowledge. Ultimately who is "your daddy" when you work at the university? When will they tell you to jump and how high. Break it down to mindset what you can accept, howmuch of a "team player" are you, are you a chameleon or do you want to life free or die. Most medcial students and residents these days are rule followers extraordinare. Lets be honest they are competely domesticated cattle. They will go look for a "job" when they have the tool but not the know how to make it on their own . Yes it can be a royal pain but the knowledge you have completed has almost got you there now. Just take the time to stimulate your mind and learn some simple common sense business.
Remember the ceos, coos, business types are unethical and sometimes immoral. They dont give a damn about people but YOU do. You need to learn the business so that you wont fall prey to their contract "spell" and be financially forced/arm twisted to render care you do not want to. These business people for the most part lack a fraction of your brain power but make it up in business knowledge, group psychology, management, and interpersonal skills. They know that when teamed together they can domesticate most of the strong doctors. When this process is over, doctors will be like engineers, and pharmacists.

Remember the saying from medical school. The A students go into research at the university. The B student make the "best" doctors and the C students make the most money! While almost a myth, there is a kernel of truth in most myths. Many of the most successful doctors have only average clinical ability. They have managed to juggle all the challenges between clinical ability/skill and business ability. If you are a med student look around at the classmates with the "wild"look in their eye, they will be the ones most likely to go into private practice on their own.

You are not being taught this at all during med school and residency. At this point you have refined the ability to take massive amounts of information, digest, and wield 3 dimensionally to solve problems with little prior information, making lightning fast medical guesses. THIS IS A PERFECT skill set for business. Refine your business skills ala the karate kid paradigm, sand floor, wax on/off etc.. It is already there. Take that big brain and hit the afterburners to absorb basic business knowledge. Online, at borders, community college basic classes etc...

When that is all said and done you may be still scared to death. Do it, do anything. fall on your face, bust your head open, pick yourself up, apply a steri strip, adjust, modify and keep going. Keep at it and you will most likely succeed. look at the history of most successful people and many fail many times before succeeding. Odds are you will probably not fail.

Samdo

 

[plasticbuddy]

Samdo,
you are a little weird bro

- plastic buddy

 

[Andrew_Doan]

I think Samdo has good advice.

 

[samdo]

Samdo,
you are a little weird bro

- plastic buddy

explain?

Samdo

 

[maximuum]

I am an M3 trying to figure out what field to go into. I have done an Optho rotation, and absolutely loved it. However, an answer I can't seem to get from anybody is how saturated is the market in the Midwest. I went on AAO's website and only found about 15 jobs in the Midwest. I am willing to live in a smaller town (50,000-500,000 people). How do most of the new Optho residents get recruited, and what is the job market/salary like for a mid-sized Midwest town? I just really don't want to go through 4 years of residency and then have to move across the country for a job and go on the 30 year loan repayment. I really like the field, I just don't know if it is worth the hassle of moving and settling for relatively low salaries.

 

[Andrew_Doan]

I am an M3 trying to figure out what field to go into. I have done an Optho rotation, and absolutely loved it. However, an answer I can't seem to get from anybody is how saturated is the market in the Midwest. I went on AAO's website and only found about 15 jobs in the Midwest. I am willing to live in a smaller town (50,000-500,000 people). How do most of the new Optho residents get recruited, and what is the job market/salary like for a mid-sized Midwest town? I just really don't want to go through 4 years of residency and then have to move across the country for a job and go on the 30 year loan repayment. I really like the field, I just don't know if it is worth the hassle of moving and settling for relatively low salaries.

There are good jobs if you're interested in smaller towns. My theory is that as the US population grows via immigration and by other means, smaller towns will also grow. Physicians who are willing to work in growing towns will do VERY well. Good luck!

 

[Andrew_Doan]

I did an experiment by adding (Retina, Iowa City, IA) to a case I wrote with Ed Stone, MD, PhD. Search Google for "retina iowa" http://www.google.com/search?hl=en&lr=&rls=GGLD,GGLD:2005-07,GGLD:en&q=retina+iowa

Out of more than 80,000 possibilities, Ed Stone is now on the first page of Google!

Before I modified the eyeOrbit listing, "retina iowa" did not pull up Ed Stone.

Search engine placement is key. I can help you optimize your Google placement.

http://www.eyeorbit.org/article.php?story=20050402143319307