Med student curious about careers in ophtho

[Eye-eye]

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Hello all,

I'm in the summer between MS 1 & 2 and have had the chance to re-explore the specialties I could see myself in a little more. I've been interested both in ophtho and neurosurg for quite a while now based on a lot of shadowing, and both are very intriguing.

I love the OR, and I like being busy and productive, and thus I've been leaning toward neurosurgery just based on that and on my experiences with my (very benign) home program. At the same time, I wouldn't mind a more relaxed schedule and happier patients with better prognoses. The main reason I am concerned with ophtho is that every attending I have talked to only operates a half day to a day per week. Personally, I can't imagine being in the OR so little, and while people have told me you can do more surgery, I've never seen anyone do it in practice. I'd probably rather have more surgery than clinic if it were possible. But I can't see how one could provide enough patient volume to even get more than maybe a day and a half of surgery a week since the procedures are so short, at least based on what I've seen with the doctors I've worked with.

What do you all think? What's realistically feasible? Does this change by subspecialty? I'm interested in a non-academic career not particularly close to any major city, if that makes a difference.

Thank you all in advance! Sorry for the long post.

 

[MstaKing10]

Both completely different fields. Yes with ophtho you will spend more time in the clinic. That said there are a long list of in office procedures we perform, though not major surgeries, this breaks up the day nicely and adds a procedural component to you clinic days. Not sure neurosurgery provides that. My NS best friend does mostly back cases and is quite happy with lifestyle and patients are grateful with good prognosis. Most of his time is spent in the OR with few clinic days generating cases. However his call is horrible and he spends plenty of time in the hospital rounding and so on. I haven’t stepped foot on an inpatient hospital floor in 7 years! Your decision will become easier when you do the rotations during your 3rd year. Do surgery first and take NS and ophtho electives early on.

 

[WhatNEyeTem]

I know people that operate 4 days of week doing about 100-150 cataracts a week. They are pure co-managers with optometrists as there is almost no way you can generate that volume on your own (unless you employ a farm of optometrists as well).

 

[Eye-eye]

Both completely different fields. Yes with ophtho you will spend more time in the clinic. That said there are a long list of in office procedures we perform, though not major surgeries, this breaks up the day nicely and adds a procedural component to you clinic days. Not sure neurosurgery provides that. My NS best friend does mostly back cases and is quite happy with lifestyle and patients are grateful with good prognosis. Most of his time is spent in the OR with few clinic days generating cases. However his call is horrible and he spends plenty of time in the hospital rounding and so on. I haven’t stepped foot on an inpatient hospital floor in 7 years! Your decision will become easier when you do the rotations during your 3rd year. Do surgery first and take NS and ophtho electives early on.

Thank you for the insight. One thing I was thinking with neurosurg would just be to work fewer hours than many do, since as I understand it, the amount of clinic time you do (and thus OR time outside call) is negotiable. What still worries me, though, is call. Is this something you can negotiate less of in your contract?

 

[Eye-eye]

I know people that operate 4 days of week doing about 100-150 cataracts a week. They are pure co-managers with optometrists as there is almost no way you can generate that volume on your own (unless you employ a farm of optometrists as well).

Thank you; it's good to hear that it is feasible and it is done. Do you know how feasible it is outside the city? And would you end up doing pretty much all 1 type of surgery (cataract, lasik, etc), or can you still keep some variety doing that?

 

[cubsrule4e]

Thank you; it's good to hear that it is feasible and it is done. Do you know how feasible it is outside the city? And would you end up doing pretty much all 1 type of surgery (cataract, lasik, etc), or can you still keep some variety doing that?

One of my partners operates 2 days a week doing 20-25 cataract/migs/pterygiums/etc per day. Lasers after OR the first day and a short clinic after the second OR day. We all do Lasik on the same day 2 fridays a month. We have 7 employed ODs at 3 different clinics, and they also take primary call for us. Even without them though (I took call by myself for the first few years) call still isnt bad if you are just covering your own group and not a hospital or other large group situation.

 

[Eye-eye]

One of my partners operates 2 days a week doing 20-25 cataract/migs/pterygiums/etc per day. Lasers after OR the first day and a short clinic after the second OR day. We all do Lasik on the same day 2 fridays a month. We have 7 employed ODs at 3 different clinics, and they also take primary call for us. Even without them though (I took call by myself for the first few years) call still isnt bad if you are just covering your own group and not a hospital or other large group situation.

Thank you for sharing; it's good to know what is actually done in the field.

 

[Slide]

Hello all,

I'm in the summer between MS 1 & 2 and have had the chance to re-explore the specialties I could see myself in a little more. I've been interested both in ophtho and neurosurg for quite a while now based on a lot of shadowing, and both are very intriguing.

I love the OR, and I like being busy and productive, and thus I've been leaning toward neurosurgery just based on that and on my experiences with my (very benign) home program. At the same time, I wouldn't mind a more relaxed schedule and happier patients with better prognoses. The main reason I am concerned with ophtho is that every attending I have talked to only operates a half day to a day per week. Personally, I can't imagine being in the OR so little, and while people have told me you can do more surgery, I've never seen anyone do it in practice. I'd probably rather have more surgery than clinic if it were possible. But I can't see how one could provide enough patient volume to even get more than maybe a day and a half of surgery a week since the procedures are so short, at least based on what I've seen with the doctors I've worked with.

What do you all think? What's realistically feasible? Does this change by subspecialty? I'm interested in a non-academic career not particularly close to any major city, if that makes a difference.

Thank you all in advance! Sorry for the long post.

If you subspecialize in more surgical heavy specialty (plastics, retina), you can be in the OR quite a bit. I know retina specialists who generate enough volume to operate at least twice a week

 

[Eye-eye]

If you subspecialize in more surgical heavy specialty (plastics, retina), you can be in the OR quite a bit. I know retina specialists who generate enough volume to operate at least twice a week

I've heard that in retina (and other subspecialties) more revenue actually comes from office visits than surgeries. Is this true? It doesn't make much sense to me. If true, does this mean that ophtho is pushing more and more away from surgery and more toward management of conditions in clinic? These may be dumb/basic questions, but I've heard a lot of competing info and it's a bit confusing to me still.

Thank you!

 

[Slide]

I've heard that in retina (and other subspecialties) more revenue actually comes from office visits than surgeries. Is this true? It doesn't make much sense to me. If true, does this mean that ophtho is pushing more and more away from surgery and more toward management of conditions in clinic? These may be dumb/basic questions, but I've heard a lot of competing info and it's a bit confusing to me still.

Thank you!

For the most part, yes. Retina is procedure and imaging heavy in the clinic, and we see a lot of patients. Some things that were done surgically can be done in the office at first now. There are more things that can be managed in the clinic but there's still a lot of things that require surgery. How much you operate depends on how you tailor your clinic preferences, and what kind of practice you're in. When you start out you'll likely be operating only one day a week, but it can pick up pretty fast, especially if you're the only game in town. The questions you are asking are by no means dumb, it's an ever evolving field and what we're doing now may not be the same in 5 years.

 

[Eye-eye]

One last question, which is typically a very taboo one, but which I'm very confused by throughout these posts. How is reimbursement, realistically? I've seen lots of 200-600 numbers, some >1M numbers, and most concerning, a lot of close to 100 numbers. I realize that a lot of this must be from variations in location, type of practice, where they are in their careers, and subspecialty, but still that variation seems huge. What could someone expect living out in the country and doing, say, general ophtho? I have a HUGE amount of debt, and am very debt-averse (read: easily stressed by thinking about it), and the lower end of those numbers does quite scare me.

 

[Slide]

The variation is huge because the location plays a massive difference in your salary. If you want to do general in a big metropolitan area that is saturated, you're going to be paid less than the average salary unless you have some sort of "in" at the practice (family/friend, long pre-arranged agreement, etc.). In the country or even suburbs, your salary will be much higher. For comparison points where I am, general ophthalmology starts out 150-200K, and doubles within 2-3 years if you can maintain good volume. 1-2 hours outside of town, your salary can easily 600k after several years, and if you are really ambitious, you can hit 1 mil. For subspecialists, the number can be much higher.

The other reason why the variation is huge and you can't get a straight answer is that payment schematics vary in academics and private practice. You have to factor things in like bonuses, a buy-in, revenue from other associates and ancillary facilities (optical shops, ownership and equity in equipment/buildings/ASCs). In private practice, especially in general, your business acumen becomes more important in your potential salary.

 

[Eye-eye]

The variation is huge because the location plays a massive difference in your salary. If you want to do general in a big metropolitan area that is saturated, you're going to be paid less than the average salary unless you have some sort of "in" at the practice (family/friend, long pre-arranged agreement, etc.). In the country or even suburbs, your salary will be much higher. For comparison points where I am, general ophthalmology starts out 150-200K, and doubles within 2-3 years if you can maintain good volume. 1-2 hours outside of town, your salary can easily 600k after several years, and if you are really ambitious, you can hit 1 mil. For subspecialists, the number can be much higher.

The other reason why the variation is huge and you can't get a straight answer is that payment schematics vary in academics and private practice. You have to factor things in like bonuses, a buy-in, revenue from other associates and ancillary facilities (optical shops, ownership and equity in equipment/buildings/ASCs). In private practice, especially in general, your business acumen becomes more important in your potential salary.

Thank you for the detailed reply! I greatly appreciate it. Another question: is it feasible to start a new private practice anymore? I've been interested in being a business owner for a while now, and it seems like ophtho is one of the few fields where that's still common. But it seems like everywhere I may want to live (PNW, but not by a major city) has at least a couple ophthos and I don't want to start some big competition. Or are their options at existing practices to get on some sort of ownership tract? (And how exactly does that differ from partnership?)

Thank you so much!

 

[ball123]

Solobuildingblogs (type it in google since for some reason I can't post the link) is a superb forum on building a solo practice in ophthalmology (by Dr. Ho Sun Choi, who is a great advocate of going solo)

[It may or may not help but thought I'd share anyway 🙂 ]

 

[Eye-eye]

Solobuildingblogs (type it in google since for some reason I can't post the link) is a superb forum on building a solo practice in ophthalmology (by Dr. Ho Sun Choi, who is a great advocate of going solo)

[It may or may not help but thought I'd share anyway 🙂 ]

I'll take a look; thank you!