- Joined
- Nov 26, 2007
- Messages
- 383
- Reaction score
- 100
Does anyone have any information on working as an ophthalmologist at Kaiser Permanente? I do know a few people that do and they seem extremely happy. Any info? Pluses? Minuses?
Does anyone have any information on working as an ophthalmologist at Kaiser Permanente? I do know a few people that do and they seem extremely happy. Any info? Pluses? Minuses?
sorry no one has replied yet. i work in private practice so this is not insider information.
pros
1. built-in referral network
2. higher starting salary
3. better health/pension/retirement benefits
4. do not have to worry about billing/insurance (but probably true for most large groups)
5. less busy clinic schedule
cons
1. lower potential income
2. larger organization - dealing with the bureaucracy (esp with hiring/firing of techs)
3. perhaps less flexibility with vacation scheduling (?)
4. no ownership of the practice
Yes, it can be disheartening. I didn't realize how undervalued my services were until recently - it is unfortunate that we do not get more business/billing teaching in residency. You get contracted with insurance companies and have to write off 30-60% of billable fees. Medicare is looking to cut back on reimbursement even more - it is easy for them to slash another 5-10% off cataract reimbursement and 'save' billions. It is incredible how 'cheap' cataract surgery has become, just because it is perceived as a easy, fast surgery - perpetuated by some cataract cowboys who do not even see their own post-ops (or pre-ops for that matter). The surgery would be worth a lot more in the free market when you consider the quality of life improvement.
The market is definitely competitive for desirable areas which drives compensation and benefits down. It is not unheard of to have offers below 100 in these areas. Frustrating. Most senior guys will make money off of you during the buy-in period - which may last 3-5 years.
But, the honest guys are still out there. You just have to do your due diligence before signing a contract. Word gets around about predatory senior guys. Ask the local Alcon, Allergan reps - they know a lot more than most local docs about who has joined/left practices recently.
You may also consider going solo, but need to start in your last year of residency. It took me 7-8 months to get my state license and medicare number. Many insurance companies desire a medicare number before you can get put on their plans. You need to good year to write a business model, secure a loan, buy/lease equipment, read about billing/insurance, and get your licensure. Going solo is a huge pain in the butt and will be rough for a few years (few vacation, being on call all the time, building up a practice), but you get to do everything your way. It can be very rewarding. It is not for everyone - it wasn't for me - at least not right now.
I appreciate your input. I like to keep this discussion going; I am just curious what other people think out there.
Without going into too much detail, I have spent about 6 months working per diem in a few places in a very competitive area. I thought about solo, associate, etc. positions. I did start early in residency and was able to get everything squared away by July 1st of my senior year (license, dea, most insurance panels, medicaid, etc.,etc.). I understand that the economy plays a huge part in this and that I probably graduated during the worst possible time (well, residents graduating this year are doing so during the worst possible time ), and here is what I have observed: I witnessed refractive volume drop about 80% in just a few months (evidenced by the volume numbers in the refrective ASC where I had priviliges). That led a lot of local guys who were >50% refractive for the past 15 years pick up more general stuff, lay off some staff, shorten working weeks, etc. That in turn is hurting everyone else. I know a few guys retirement age taking extra clinic days and a few closing up shop. Can a young guy consider buying a practice being closed? Sure, but what are you buying? There is a trend nowdays where practices are way overvalued and everyone knows that including the buyers. How does one calsulate "good will" nowdays?
Moreover, a lot of guys I have spoken with won't even give you a salary. "Well, you come in and I'll just give you precentage of your collections and then we'll see...". B*****t, that's no way to start someone out even though this is the easiest for the practice owner.
All in all, I agree with you. It's amazing how our services are undervalued. Cataract surgery pays around $650 now. According to chats on ASCRS and other forums, $500 is a break point for most people. If it gets less than that, people would stop operating because they can make more money in clinics. And ophthalmology services is projected to have the highest demand jump by 2020 only second to cardiology services.
What I have seen in the last 6 months made me very unsure about private practices nowdays. Don't get me wrong, I think you can still do pretty well if you are willing to skip New York, LA, SF, etc. But if you are not willing to do that, you will find job market tougher than you expect.
Having said all that, Kaiser is starting to look better and better. Even with all the negatives you've listed.
Not to derail this thread, BUT reading this advice from experienced/practicing ophthalmologists on here is making me a bit worried...
I'll be starting my residency this July and at this point will most likely be pursuing a retina fellowship in a few years. I'm doing this for a few reasons:
1) retina makes serious money (b/c they're in higher demand).
2) I enjoy the pathology and procedures.
3) It allows me to be "in-training" during these volatile times. I think we'll all have a better feel for the market climate once the dust of Obama-nation settles.
These are MY reasons and not necessarily in order of importance..
So my question to you guys is -- does your advice mainly apply to general ophthalmologists? Would a retina specialist face these same issues and to the same extent?
This forum and you guys are indispensable!
Yes, it can be disheartening. I didn't realize how undervalued my services were until recently - it is unfortunate that we do not get more business/billing teaching in residency. You get contracted with insurance companies and have to write off 30-60% of billable fees. Medicare is looking to cut back on reimbursement even more - it is easy for them to slash another 5-10% off cataract reimbursement and 'save' billions. It is incredible how 'cheap' cataract surgery has become, just because it is perceived as a easy, fast surgery - perpetuated by some cataract cowboys who do not even see their own post-ops (or pre-ops for that matter). The surgery would be worth a lot more in the free market when you consider the quality of life improvement.
The market is definitely competitive for desirable areas which drives compensation and benefits down. It is not unheard of to have offers below 100 in these areas. Frustrating. Most senior guys will make money off of you during the buy-in period - which may last 3-5 years.
But, the honest guys are still out there. You just have to do your due diligence before signing a contract. Word gets around about predatory senior guys. Ask the local Alcon, Allergan reps - they know a lot more than most local docs about who has joined/left practices recently.
You may also consider going solo, but need to start in your last year of residency. It took me 7-8 months to get my state license and medicare number. Many insurance companies desire a medicare number before you can get put on their plans. You need to good year to write a business model, secure a loan, buy/lease equipment, read about billing/insurance, and get your licensure. Going solo is a huge pain in the butt and will be rough for a few years (few vacation, being on call all the time, building up a practice), but you get to do everything your way. It can be very rewarding. It is not for everyone - it wasn't for me - at least not right now.
There is an ophtho in the town I grew up in who specializes in cataract surgery. Granted he is probably mid-late career at this point but the guy owns a plane and drives around in a new Maserati. He always seemed a bit out of touch in a small midwestern town populated by middle class blue collar families like mine. I always assumed his wealth was from with ophtho practice but now I'm suspicious that he has some other shady stuff going on (knowing the guy, it wouldn't surprise me).
Ophthalmologists used to make a killing -- back when reimbursement for cataract surgery was ~$2000 an eye. Plus he may have investments elsewhere. Not everyone relies on ONE source of income. So don't go calling the FBI on him yet just yet..
What floors me about ophtho is that it's such a competitive field. You constantly bust your ass in med school (Step 1, AOA, research, etc, etc) to hopefully get a spot. And yet what do you have to look forward to when you're done -- a crappy job market with starting salaries below $100K. That's just ridiculous.
Every competitive field in medicine (Rads, Anesthesia, Derm, etc) at least allows you to reap the rewards of your hardwork with solid salaries and good lifestyles once you're done with residency.
I guess the name of the game in ophtho is fellowship and location. Subspecialize then move to the midwest or down south (Texas is on my radar)...
Sounds like a plan. Work your butt off for 4-5 years and then set up shop in Waco. Sweet...
Anyway, sorry to derail the thread. I was just curious. The grass always seems greener on the other side.
Oh come on man (woman?), Texas can't be THAT bad?
Plus I'm talking about places like Houston, Austin, etc. It's a great state overall for a doc to start practicing and for so many reasons. Look into it..
I appreciate your input. I like to keep this discussion going; I am just curious what other people think out there.
Without going into too much detail, I have spent about 6 months working per diem in a few places in a very competitive area. I thought about solo, associate, etc. positions. I did start early in residency and was able to get everything squared away by July 1st of my senior year (license, dea, most insurance panels, medicaid, etc.,etc.). I understand that the economy plays a huge part in this and that I probably graduated during the worst possible time (well, residents graduating this year are doing so during the worst possible time ), and here is what I have observed: I witnessed refractive volume drop about 80% in just a few months (evidenced by the volume numbers in the refrective ASC where I had priviliges). That led a lot of local guys who were >50% refractive for the past 15 years pick up more general stuff, lay off some staff, shorten working weeks, etc. That in turn is hurting everyone else. I know a few guys retirement age taking extra clinic days and a few closing up shop. Can a young guy consider buying a practice being closed? Sure, but what are you buying? There is a trend nowdays where practices are way overvalued and everyone knows that including the buyers. How does one calsulate "good will" nowdays?
Moreover, a lot of guys I have spoken with won't even give you a salary. "Well, you come in and I'll just give you precentage of your collections and then we'll see...". B*****t, that's no way to start someone out even though this is the easiest for the practice owner.
All in all, I agree with you. It's amazing how our services are undervalued. Cataract surgery pays around $650 now. According to chats on ASCRS and other forums, $500 is a break point for most people. If it gets less than that, people would stop operating because they can make more money in clinics. And ophthalmology services is projected to have the highest demand jump by 2020 only second to cardiology services.
What I have seen in the last 6 months made me very unsure about private practices nowdays. Don't get me wrong, I think you can still do pretty well if you are willing to skip New York, LA, SF, etc. But if you are not willing to do that, you will find job market tougher than you expect.
Having said all that, Kaiser is starting to look better and better. Even with all the negatives you've listed.
I'm starting to work with my second ophthalmologist getting him set up in private practice. He reported a similar scenario to what others on here have posted which is why he's going out on his own. I would like to pose some questions to this forum:
1) What percentages are you normally being offered with respect to your collections? 20,30,40,50% of collected?
2) For those offered a flat salary and/or bonus structures, what are the general nature of these? In other words, if you are offered $150000 as a salary, how much in billings are you expected to generate for that.
3) Where do your patients come from? Are you mostly taking on overflow from other practitioners or are you expected to pound the pavement to bring new patients to the practice?
I would not shy away from starting or buying your own practice. Truth be told, the last young ophthalmologist that I helped get started is in his 3rd year and is on pace to make $230k this year after making $195 last year after a cold start up. This is in Connecticut, not exactly known as the land of cheap anything.
In my case, this guys has pulled the same crap in the past. Yes, I did ask around before I joined. What I find, is because Ophthalmology is such a small community, people tend to keep their mouth shut, and really do not want to talk bad about another older doc. Now that I am leaving, everyone is speaking up. Too bad they didn't speak up a year ago!
No, actually what I think their plans were is to string me along on my salary for a couple years, while growing their practice base, and run me off by putting off partnership etc.,....bring a new guy on and do the same while all along building up the practice and having the practice O.D.'s assume those patients once I am gone, sending the surgeries back to the senior docs. I was going to hit bonus way before any of the previous associates, and with the economy hitting their overall business, it was better to cut ties now. Probably better for me in the long run, but in the short term, really sucks!
So again, you believe that that was the plan before they even hired you, or was it just that that was how it worked out?
If you thought it was their plan right from the start, was there a reason you took the position in the first place? Not trying to be nosy, but I'm getting into a bit more consulting and it's helpful to be able to draw on other people's experience.
On some level it's also good to know that it isn't just something that happens in optometry.
That is a common story.
Hire a new guy. Everyone in the practice takes less call, and less holiday call. The net cost is generally manageable: startup salary, malpractice, maybe a new tech (but usually not, just a shifting of responsibilities), perhaps a small capital equipment investment (but again, often not), and hospital application and society membership fees. Usually the new associate has met his net added cost--i.e. "covered" himself before the end of the first year, sometimes well before then. Once done, all that is necessary is to get him to do some more work, and the earnings go straight to the partners. Keep him interested with a little taste of a production bonus, maybe even promises of a buy-in plan, perhaps promise a share of a surgery center, and pretty soon, he has developed a full, busy and profitable practice.
Then you screw him. Do things to him and his practice that would make anyone unhappy. Renege on the partnership deal. Cancel his contract.
Now you go and hire a new associate. Only this time, you don't have to wait for him to build up a practice; his predecessor did that for him. He becomes profitable right away. And guess what, he is motivated by promises of a bonus and partnership just like the first "associate" was. Good deal.
Serial hiring can be very profitable. And you know, those expressions of pained regret when someone interviewing asks about the guy who left.
"Oh, he just never seemed happy." "We tried to help him, but it just didn't work out." "He wanted to live somewhere else in the country." (Good thing if he had a non-compete locking him out.)
There are plenty of these kinds of guys around the country. Their practices are always advertising for new people on the AAO Professional Choices webpage, and in the throwaway journals. Yes, local docs are often reluctant to say what they think of other doctors, even ones that really have bad reputations. They want to avoid trouble.
Here is a hint: if they don't say great things about that doctor, if there is even the slightest hesitation, take that as a bad sign.
And call the former associate doctors. Try to track them down and get them to talk with you. That is probably the most helpful thing to do. Be persistent but polite. Keep what you hear in confidence; you are trying to make a personal decision, for yourself, not others. If there is reluctance to endorse the practice, that is a sign the practice was not a good opportunity. If they say they have agreed not to discuss the practice as a condition of some settlement, you can draw the obvious conclusions.
There are a lot of predatory older docs that do crappy things to new hires and have all sorts of sociopathic rationalizations for why things don't work out. It is really a shame more of them aren't outed for what they are and what they do.
Hey everyone, thank you for posting your experiences. Like a few other posters on here, I am a medical student with a deep interest in ophtho. This thread is certainly concerning, but I hope that there is another side of the coin we haven't heard yet. I feel that if Ophthalmologists made killer salaries in the 300K+ range, along with all the other perks (lifestyle, etc.) this would be too perfect a specialty.
How do you guys think specialization helps job prospects? I know Retina docs do well, but how would Glaucoma/Cornea guys-- does it make it easier to find a position in a private practice?
Also, how are average ophtho salaries in the low-mid 200's if people are starting so low? (150K for example).. who are the people making over 250K? I would think Academic docs make less, so the private practice guys would do even better than the mid 200's average..
Buying . . . depends. Most sellers tend to wildly overvalue their practices, commonly with the support of estimates provided by practice valuation "experts" who are paid by the practice owners and who tend to stroke the egos of their clients by providing inflated valuations. There is no penalty to a valuation consultant for over-valuing a practice that subsequently doesn't sell (by contrast, under-valuation leaves clients feeling they were poorly-served.) These estimates of value are commonly based on historical models which in ophthalmology result in skew toward over-valuation, given downward trends in per-procedure payment, offset mostly by volume which ultimately becomes finite.
If you thought it was their plan right from the start, was there a reason you took the position in the first place?
sorry no one has replied yet. i work in private practice so this is not insider information.
pros
1. built-in referral network
2. higher starting salary
3. better health/pension/retirement benefits
4. do not have to worry about billing/insurance (but probably true for most large groups)
5. less busy clinic schedule
cons
1. lower potential income
2. larger organization - dealing with the bureaucracy (esp with hiring/firing of techs)
3. perhaps less flexibility with vacation scheduling (?)
4. no ownership of the practice
Hello ,
... I will never change the field cause I just love it and I will never change it or have financial issues change my mind.