Lifestyle of VR ophthalmologists

[Ploppit]

I was wondering if the attendings could please comment on the lifestyle of an ophthalmologist who has completed a fellowship in Vitreoretinal surgery and is working in private practice.

I saw from looking through posts that Dr. Doan mentioned that the lifestyle is quite brutal (he mentioned that a colleague compared it to the life of a CT surgeon) while another private VR surgeon commented that this was not necessarily true. Is this simply a difference in academics vs. private practice?

All of my training has been in the academic community and so it is very difficult for me to assess the lifestyle/etc of a private ophthalmologist. I was thus hoping to get a better insight into that world by asking the private docs on this forum for any input they would be willing to share.

I think I would enjoy practicing as a VR surgeon, but do want to take lifestyle factors into consideration.

Thanks

P.S. Maybe it would be easier and more illuminating if we could compare this to different specialties? So, for example -- the lifestyle of a VR Ophthalmologist vs. ENT doc? Or Urologist? etc.

---

Members don't see this ad.

 

[Meibomian SxN]

I was wondering if the attendings could please comment on the lifestyle of an ophthalmologist who has completed a fellowship in Vitreoretinal surgery and is working in private practice.

I saw from looking through posts that Dr. Doan mentioned that the lifestyle is quite brutal (he mentioned that a colleague compared it to the life of a CT surgeon) while another private VR surgeon commented that this was not necessarily true. Is this simply a difference in academics vs. private practice?

All of my training has been in the academic community and so it is very difficult for me to assess the lifestyle/etc of a private ophthalmologist. I was thus hoping to get a better insight into that world by asking the private docs on this forum for any input they would be willing to share.

I think I would enjoy practicing as a VR surgeon, but do want to take lifestyle factors into consideration.

Thanks

P.S. Maybe it would be easier and more illuminating if we could compare this to different specialties? So, for example -- the lifestyle of a VR Ophthalmologist vs. ENT doc? Or Urologist? etc.

The retina practice I refer to has the hours of 8-4pm M-F; and my RD's are notorious for appointments after 4pm! So I'd take a wild guess and say private practice retina surgeons have a VERY nice lifestyle (as far as hours go).

 

[alesdu1]

On a slightly related note, how many days in the week are ophthalmologists in the OR? I am a third year planning on ophtho and I've discovered on my gen surg rotation that I actually really love operating and would love to align myself with research on the most surgical of the ophtho sub-specialties.

I would assume that say, neuro-ophtho, likely has the least amount of OR time, but what about others like comprehensive vs. oculoplastics vs. retina? I realize this depends on private vs. academic, part of the country, etc but I'd love some global thoughts as I basically have no clue (ophtho rotation is next summer...) thanks so much.

 

[MstaKing10]

as with any field, there is a lot of variability in terms of work hours and quality of life between one setting and the other. In general, VR specialist probably work a little harder than the comprehensive ophthalmologist in that their hours are a bit longer and there are more emergencies. That said, there is a general trend, particularly in private practice, to delay the treatment of certain emergencies to the following day or the MD's OR day. This is not out of laziness but because several studies, and VR specialist experience, have demonstrated superior outcomes.

The average clinic day probably runs from 8 to 6PM, and usually has One to two OR days week, typically half days. This will vary of course but gives a ballpark figure. Depending on the size of the group, call can be tough but if spread out over several retina specialist will likely not be too often.

 

[golfman]

How competitive is it to get into a retina Fellowship?

 

[Ploppit]

as with any field, there is a lot of variability in terms of work hours and quality of life between one setting and the other. In general, VR specialist probably work a little harder than the comprehensive ophthalmologist in that their hours are a bit longer and there are more emergencies. That said, there is a general trend, particularly in private practice, to delay the treatment of certain emergencies to the following day or the MD's OR day. This is not out of laziness but because several studies, and VR specialist experience, have demonstrated superior outcomes.

The average clinic day probably runs from 8 to 6PM, and usually has One to two OR days week, typically half days. This will vary of course but gives a ballpark figure. Depending on the size of the group, call can be tough but if spread out over several retina specialist will likely not be too often.

Thanks for your response. So, really, it sounds like the lifestyle of a VR specialist is not *that much* different from a general ophthalmologist (maybe not as few hours, but still a "lifestyle specialty") and certainly not nearly as busy as most other surgical specialties..am I interpreting this correctly?

So if we assume this is correct, then the notions I have heard from some about VR specialists being crazy busy are either: 1. anecdotal and not representative, 2. more representative of academics instead of private practice, 3. more specific to certain geographic areas or, 4. just false

Sorry - just trying to identify what the inconsistency stems from..thanks.

 

[BuckleExtrusion]

Thanks for your response. So, really, it sounds like the lifestyle of a VR specialist is not *that much* different from a general ophthalmologist (maybe not as few hours, but still a "lifestyle specialty") and certainly not nearly as busy as most other surgical specialties..am I interpreting this correctly?

So if we assume this is correct, then the notions I have heard from some about VR specialists being crazy busy are either: 1. anecdotal and not representative, 2. more representative of academics instead of private practice, 3. more specific to certain geographic areas or, 4. just false

Sorry - just trying to identify what the inconsistency stems from..thanks.

No no it's EASY being a VR guy! It is VERY easy to take care of late night mac on detachments/pick up the pieces of post cataract endophthalmitis because those cases are always PLANNED and ELECTIVE! Unlike the emergency cases of cataract extraction or Lasik which are always done on an EMERGENT basis. You can always assume to be able to close up shop at 430 PM on weekdays, never be on call and never need to take emergencies on weekends or before major holidays if you're a VR person.

 

[BuckleExtrusion]

How competitive is it to get into a retina Fellowship?

Not competitive at all. there's a bigger demand for pediatrics and glaucoma tis year. Usually the bottom of the class in a residency match in retina because they have no where else to go.

 

[JMK2005]

Not competitive at all. there's a bigger demand for pediatrics and glaucoma tis year. Usually the bottom of the class in a residency match in retina because they have no where else to go.

Don't listen to BuckleExtrusion.

 

[MR1]

buckle gets my vote for least helpful in a long while

My take. Retina used to be more busy because they would do mac on RD's as soon as they came in. Now I don't think this happens anywhere, will just add it on the next day. Granted weekend ones might require repair during the weekend but no middle of the night cases. Same thing with endophthalmitis, can always tap\inject and then take to OR next day. Only thing that really needs middle of night is IOFB and that may change with results from the iraqi war.

They are a little busier than general, similar to plastics. One study I saw, had avg hours for general at 45-50 and for retina 55ish.

Competitive, yes. Especially for the great programs. Plenty of good programs, few not so good.

I think the key is being in a group. There is always call and things come in on call needing things. You won't be in the OR in the middle of the night, but if you are solo then things probably could be busy. If you are in a group and share call and there is always someone in the OR everyday that can deal with the emergencies then it ain't that bad.

 

[BuckleExtrusion]

buckle gets my vote for least helpful in a long while

My take. Retina used to be more busy because they would do mac on RD's as soon as they came in. Now I don't think this happens anywhere, will just add it on the next day. Granted weekend ones might require repair during the weekend but no middle of the night cases. Same thing with endophthalmitis, can always tap\inject and then take to OR next day. Only thing that really needs middle of night is IOFB and that may change with results from the iraqi war.

They are a little busier than general, similar to plastics. One study I saw, had avg hours for general at 45-50 and for retina 55ish.

Competitive, yes. Especially for the great programs. Plenty of good programs, few not so good.

I think the key is being in a group. There is always call and things come in on call needing things. You won't be in the OR in the middle of the night, but if you are solo then things probably could be busy. If you are in a group and share call and there is always someone in the OR everyday that can deal with the emergencies then it ain't that bad.

Can only tap and inject if VA is HM or better. Even for cases that can go 'next day', folk don't necessarily have OR days/time at that time. At best it will be an 'add-on' case after you finish your busy clinic schedule and when the OR has 'time' and will still most likely start in the evening anyway.

If you're part of a crummy hospital system that has anesthesia run by monkeys who like to delay and delay (the majority out there and not minority unfortunately), then you'll be inconvenienced no matter what. Ideally a group setting with retina only will have access to an ASC and hired gun anesthesia services with a PA that can assist you. This would be even better when you DON'T have partners who won't mind taking cases on their OR days for the better of the group and the patient, those are also few and far between.

Summary: retina is subject to many emergencies either immediately or the next day, which is still often-times inconvenient, and mostly filled with partners who won't help you in a pinch.

 

[MstaKing10]

While it's true that VR specialist deal with most of the true ophthalmic emergencies, there is less and less need to do 2AM cases anymore. Many of us have seen how horrible it is to do the 2AM mac on RD case with the B crew who doesn't know the first thing about eye cases, this can be a total disaster and lead to poor outcomes. Part of the difference may be setting: in private practice, you can more easily add on a case at your ASC than at the University hospital where you are competing with trauma's etc. Also, if you are in a group with several retina specialist as opposed to solo retina practices, you can ask your colleague who has the OR day the next day to take care of a case for you. This has been my experience in a private practice, efficiently run, multi-specialty practice with 7 retina specialist, perhaps not the usual set up but clearly a good one!

Not sure where Buckle is getting his/her experience but adding on a case at a private ASC is not as messy as it sounds, and colleagues do indeed help each other out unless you are in a dysfunctional group. Most surgery can wait to the next day, and tap and inject for HM or better applies to post op cataract only, whereas most cases of endopthalmitis that I'm seeing are post intravitreal injection where the EVS does not apply, thus T and I in these cases is perfectly reasonable. IOFB's are indeed the rare exception to the rule and these must be done urgently.

 

[BuckleExtrusion]

While it's true that VR specialist deal with most of the true ophthalmic emergencies, there is less and less need to do 2AM cases anymore. Many of us have seen how horrible it is to do the 2AM mac on RD case with the B crew who doesn't know the first thing about eye cases, this can be a total disaster and lead to poor outcomes. Part of the difference may be setting: in private practice, you can more easily add on a case at your ASC than at the University hospital where you are competing with trauma's etc. Also, if you are in a group with several retina specialist as opposed to solo retina practices, you can ask your colleague who has the OR day the next day to take care of a case for you. This has been my experience in a private practice, efficiently run, multi-specialty practice with 7 retina specialist, perhaps not the usual set up but clearly a good one!

Essentially what I said. Goody for you that you're in a nice ASC with 7 others.

 

[MR1]

Summary: retina is subject to many emergencies either immediately or the next day, which is still often-times inconvenient, and mostly filled with partners who won't help you in a pinch.

Being a doctor is inconvenient by nature and I feel sorry for you if you have only been exposed to MD's like that. Everyone I know bends over backwards to help the others out. I know I would.

 

[BuckleExtrusion]

Being a doctor is inconvenient by nature and I feel sorry for you if you have only been exposed to MD's like that. Everyone I know bends over backwards to help the others out. I know I would.

One does not need to be inconvenienced all the time and no one works for free. Those are two rules even lawyers are quick to agree with. The Hippocratic Oath said do no harm, not live like an @sshole all your life.

 

[MstaKing10]

One does not need to be inconvenienced all the time and no one works for free. Those are two rules even lawyers are quick to agree with. The Hippocratic Oath said do no harm, not live like an @sshole all your life.

Who's working for free? You still get paid for these surgeries, unless you're in an academic/University setting, and even then there is some form of compensation.

I think inconvenient is the wrong word. When is it an inconvenience to take care of a patient really? What if it was your family member, or better yet, what if it was you?

But I will give you that if this happens every night you are on call, that would certainly wear you down. But I have not seen that to be the case as a VR specialist.

 

[BuckleExtrusion]

Who's working for free? You still get paid for these surgeries, unless you're in an academic/University setting, and even then there is some form of compensation.

I think inconvenient is the wrong word. When is it an inconvenience to take care of a patient really? What if it was your family member, or better yet, what if it was you?

But I will give you that if this happens every night you are on call, that would certainly wear you down. But I have not seen that to be the case as a VR specialist.

You must be in private. Do you dump (er...obtain a second opinion) to the local academic site when you're away or don't want to handle a particular case?

 

[JMK2005]

You must be in private. Do you dump (er...obtain a second opinion) to the local academic site when you're away or don't want to handle a particular case?

Troll.

 

[BuckleExtrusion]

Troll.

I'm having a conversation and it's regarding lifestyle of VR in private vs academics. And dumping off of cases does happen but it makes private life all that more appealing. So how am I troll, you @sshole?

 

[JMK2005]

I'm having a conversation and it's regarding lifestyle of VR in private vs academics. And dumping off of cases does happen but it makes private life all that more appealing. So how am I troll, you @sshole?

Because your arguments don't make sense.

 

[MstaKing10]

You must be in private. Do you dump (er...obtain a second opinion) to the local academic site when you're away or don't want to handle a particular case?

I actually have dual appointments in a private practice and academic setting, so essentially I would dump to myself!!

From time to time, some community docs do dump patients, but I take these as opportunities to teach and to learn myself. That is the attitude you need to be in an academic setting. If I was interested only in taking care of insured patients during regular business hours, I'm not sure I would even be a doctor!

Bottom line, VR specialist work hard but not as hard as other surgical sub-specialists, and we are reimbursed well and deal with fascinating surgical and medical cases. Nuff said!

 

[BuckleExtrusion]

I actually have dual appointments in a private practice and academic setting, so essentially I would dump to myself!!

From time to time, some community docs do dump patients, but I take these as opportunities to teach and to learn myself. That is the attitude you need to be in an academic setting. If I was interested only in taking care of insured patients during regular business hours, I'm not sure I would even be a doctor!

Bottom line, VR specialist work hard but not as hard as other surgical sub-specialists, and we are reimbursed well and deal with fascinating surgical and medical cases. Nuff said!

Thanks. That would make you a private guy with a token appointment at some nearby academic place. Does the title 'clinical assistant professor' ring a bell?