Medical retina?

[JR]

Hello everyone.

As the first year ophthalmology residency winds down, I need to start thinking what I am going to do fellowship-wise. What do you guys think about medical retina? Pros/cons? Can you still do general ophthalmology with medical retina slant? There are very few medical retina fellowships out there- is it just not popular or is there any other reason? Any info would be greatly appreciated.

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[GuP]

I am only a med student so here is what I know so far about it. I went to a meeting a while ago and got there early. Somehow, I started chit-chatting with an old school OD. I told him I was a med student and wanted to do ophtho. He took an interest and started explaining what he knew about the field as he had been an OD for the past 30 years. He told me that ophtho followed by retina is the way to go. His logic was that as the baby-boomers get older there will be many retina problems in the future. He also said that people will be living longer in the future and diabetes is very prominent. Basically, his whole thing was that retina specialists will have tons of clients as time progresses. Retina guys also make a killing.

The only cons I can see is that the fellowship can be 2 years. You also work more than your average ophtho guy b/c there is a potential for more emergencies in retina.

The rest of the questions I am not qualified to answer. Hope this helps!

BTW, if I do get into ophtho, I am either going to do retina or refractive surgery/cornea fellowship.

 

[JR]

Thanks for your input. Medical retina is usually a 1 year fellowship as opposed to 2 year VR fellowships; you concentrate on the medical aspect of retinal disease: ARMD, DR, vascular dz, etc., etc. You don't do retinal surgery hence you have much fewer emergencies as compared to VR surgeons.

Anyone else?

 

[4424]

The only cons I can see is that the fellowship can be 2 years. You also work more than your average ophtho guy b/c there is a potential for more emergencies in retina.



medical retina is only 1 year and there aren't many medical retina emergencies. as far as i know you don't do vitrectomies (those require the full 2 yrs). i think u're pretty limited to laser only but i think would be a good way to go as a gen ophtho or in an academic program

 

[ckyuen]

You're probably better off spending the two years in fellowship, vitrectomy just increased to over 23 rvu for physician work, and prp almost 14 rvu a lot more than a cataract, or trab. It's hard to just do medical retina, b/c everyone wants to do that at somepoint in their career so its usually the senior retina guy. Practices hiring want someone who can do vits b/c why pay for a retina guy if he can't do vits. A general guy can do the prp/focals/avastin/ivk it's when you have a complication and get a rd or endophthalmitis that you need retina and usually surgical at that point. Unfortunately to make yourself most marketable, you probably have to do surgical fellowship. Otherwise you may get a job, but you will not be paid as retina. Everyone wants to do focals and prps b/c they are low stress and pay well. My friend at Bascom who just did a 1 year medical retina fellowship is now doing a 2 year surgical retina fellowship. She says avastin is taking over pdt and the first year residents do them.

 

[JR]

As usual, great points. However, in the area where I want to practice, general guys don't do PRPs, intravits, etc., etc. I talked to several of them and it seems it's not a "standard of care" for that particular area; there is a retina guy on every block . So, if you were to get sued for a complication, you'd loose.

 

[7ontheline]

General guys don't do any lasers where you are? I can sort of see not donig IVK or avastin because of IOP or endophthalmotis concerns, which could really cause problems with malpractice if something goes wrong. Still, I would think that general ophthos are certainly competent enough to do most PRP and focal if they want to.

Anyway, one of my attendings does medical retina in private practice and he is part of a group. If you're in a group they can send you all the lasers and intravitreal stuff and you pretty much just do that. He gets referrals from other docs too but you have to send any cataracts back for sure. No one is going to send you anything if you start stealing all the reimburseable procedures. Thus, he doesn't do any cataracts anymore.

 

[magicsurg]

Medical retina is good only if you are convinced and sure that you can like it regardless what procedures you will do within.

If you proved successful you will find your path through real career.

Most of the people of course like surgery but it's good for classic ones.

Check if you are better in fine surgery skills vs clinical skills.

Magicsurg
A new member

 

[f_w]

The problem with doing anything 'subspecialty+general' is your referral base. You want to have general ophthos send their cases to you. If they are not very certain that you don't infringe on their turf they won't do this.

The main reason why most surgical retina specialists won't do routine cataracts is not that they couldn't do it, but rather that they don't want to p### off their referral base. The general model is that the retina guy takes care of the diabetic troubles but sends the patient back to the referrer once significant cataracts develop (even if the patient who now has developed a closer relationship with the retina doc begs them).

Based on your little logo you are at Wilmer. Don't confuse the 'W' or even Baltimore with the real world. There are some referral patterns at work there that wouldn't survive in the real world.

 

[JR]

Thanks for all your opinions!

f_w, believe me, I am not confusing academia with the real world; I just wanted to hear some opinions/input on this issue. Keep 'em coming

 

[GuP]

May be a bit off topic here but I was wondering if someone could point me to a site or provide a guesstimate of the yearly income of each of the ophtho subspecialties.

 

[ckyuen]

What you make is so dependent on where you practice, and your volume. There are lasik guys making 150,000 and guys making 2-3 million like Dr. Boothe in Texas. depends on your volume. Overhead with refractive is very high. I've heard 90% is not unrealistic especially given the evil advertising. Evil b/c it cost so damned much and may not do a darn thing for you. Only thing to remember with advertising is you have to be persistent with it. It takes someone 5 encounters with that particular media before they take note and consider using you. That's a hell of a lot of commercials. Plastic guys have to have a lot of volume surgically to do well, but often 50-75 % of their referrals lead to a surgery. Which means you get a lot of cases, some recent increase medicare work rvu's for plastics. You are probably looking at 150 to start. Successful plastics guys doing very little cosmetics I know can make quite a bite. Let's say much more than you need live. Retina start around 200 closer to 300 at kaiser, about 2-3x that when you are established, if you have enough business. A lot of retina guys in private practice don't have enough volume so they may see 15-20 patients a day and do 1-2 vits a week. Big cities are over saturated. Glaucoma and Cornea will start a little higher than comprehensive. 140-160 in private practice. Their high end potential is very similar to comprehensive. Comprehensive is all over the map a lot make low 100's starting. Many peak at mid 200's. Many can do a lot more than that without refractive, seeing your typical patients medicare, medicaid, not many rich patients. For ophtho volume is key and controlling overhead is just as important. Main thing is stop getting caught up on money, Do what you love and you will do well. If you chose based on finances, you'll be the sucker that takes that great job paying tons of money, next to major universities, the beach, skiing, nightlife, major airports, 390 days of sun, no rain, if you like skiing it's next the slopes, but you never have to put snow tires on. There's a lake. Housing is cheap. If you're single beautiful women and men are everywhere. If you can't tell I'm being sarcastic. That type of thing doesn't exist, and if it really did why are they having such a hard time filling a spot paying more money than you could ever imagine.

 

[f_w]

For ophtho volume is key and controlling overhead is just as important.

I think controlling overhead is almost more important than volume. I have seen practices where one ophtho sees 60+ patients/day with 4 lanes and refracting techs going at the same time. But when you looked at the bottom line of the practice, you realized that the partners pay is not much different from what other people in the same market make on half the number of patients.

Ophtho groups love to grow. That nice office building accross the street from the local hospital, plenty of toys and different function areas. Sometimes this leads to a situation where the growth is necessary just to be able to pay the overhead and fixed liabilities incurred.

Main thing is stop getting caught up on money,

You will make good money, but not outrageous (there is no medical or surgical specialty left where you can make that anyway). When you look at different subspecialties, also keep in mind the lifestyle and opportunity cost that come with it. Yes, I know VR surgeons who make very good money, but they travel hospitals in a 200mi radius and in order to keep their referrers happy, they will come in on a sunday morning to see a consult. At the same time, many of the general ophthos will just take their 1:10 call, run their 9-5 shop out of one office and manage to go home for lunch with their kids every day.

Ophthos tend to be happy people. They will complain on how it is not like it used to be, but I have yet to meet one who regretted his choice of specialty.

 

[ckyuen]

I agree it's very important to control overhead, come visit my no frills office and you'll see what I mean. We are not in a ritzy area of town, but guess what we see blue collar people who have insurance and their insurance pays just as well as the insurance for white collar people most of the time with a lot less headaches. Of course controlling overhead is critical. I will see up to 30 patients a half day with two techs. During which time I also do laser surgeries etc. It's very rare I see that many patients but I will not staff my clinic like its the norm. Like I tell my boss, suck it up and be short handed every now and then rather than be overstaffed. Optho's are happy in general compensation is good, I don't work harder than residency, so I am very happy. My practice has been booming and I have been very lucky, I keep my referring docs very happy by seeing all their referrals on the same day if they request no matter what.

 

[GuP]

ckyuen - Are you a general ophthalmologist? or a subspecialist?

 

[ckyuen]

I do general oph, I did some extra subspecialty training in plastics but by no means am i a plastics guy. I do the plastics for the practice, blephs, ptosis, moh's repair, entropion, ectropion, lid lesions, dcrs, and optic nerve sheath decompressions though I haven't had one in private practice yet after doing about a dozen in residency. I don't do orbital stuff, there is strictly a eye plastics guy i send that stuff to. I only have 2 half days of surgery a week, so I can't book cases that take a long time for a small return, b/c I'm still paying overhead about 200.00 an hour while I'm in surgery. My boss is retina so I end up doing a lot of diabetic lasers. I have a lot of asian female hyperopes in my practice so I do a lot of lpi's. Where I'm at, the people who have subspecialty training rarely only do that. They all do general also b/c it's too competitive. There are about 3 retina only guys and one plastics only guy. If I were to choose a fellowship based on wanting to be in the best geographic location I would go with glaucoma most demand. But often times the glaucoma partner earns less than the general guy based on a survey I saw at the academy. My reasoning less surgeries a week and more unpaid post op visits based on trabs and tube shunts. If I were to chose purely on my interest I would pick retina, I enjoyed the surgeries the most. So why did I choose my current course? I was super heavily recruited in a very desireable area of the country. The opportunities would not have been available a year later. And there was a need for someone to do minor plastics in most of the practices I looked at. I got offers from almost every practice I interviewed with. Those offers were not available the following year, and if I came out a year later it would have been horrible. Also there were way way too many retina guys in the area I practice. They say about 250000 people per full time retina guy. We have about 10 retina guys for almost a million people. We also have a lot of ophtho guys but a lot don't operate, or operate very little. In the end there is nothing I enjoy more than cataract surgery. I have been very fortunate that I am not even a year out, but my patients have been very happy and spreading my name like wild fire. The result is a busy week can now mean I do more cases than about 90 % of the other ophthalmologist in my area. I am always thankful for being busy and never turn anyone away.

 

[PDT4CNV]

Hello everyone.

As the first year ophthalmology residency winds down, I need to start thinking what I am going to do fellowship-wise. What do you guys think about medical retina? Pros/cons? Can you still do general ophthalmology with medical retina slant? There are very few medical retina fellowships out there- is it just not popular or is there any other reason? Any info would be greatly appreciated.

Medical retina has sort of fallen by the wayside. There is certainly much for a medical retina specialist to do considering all that has come out in the last few years. But, since performing retina surgery has become much more routine and can be done safely, most fellowships are combined medical+surgical retina. Most practices want somebody with surgical retina skills although you would probably be able to find a job still in medical retina. I know two medical retina specialists and they do almost no surgery other than laser procedures. As mentioned previously, it would be difficult to pursue a general practice and a medical retina practice although it certainly could be done. I think it would have to be mostly a general practice and then you could take care of your own patients medical retina issues unless you were with a multispecialty group and you could get medical retina referals from within your group.

JR if it is the extra time that bothers you, there are actually still quite a few 1 year med/surg retina fellowships in the US. But the vast majority are two year fellowships and this is sorta the standard of training of now.

Besides, why would you want to miss out on doing retina surg, its awesome!

 

[theeyeboy]

I am in a fellowship that has medical retina fellows. Believe me, I personally am, and forever will be, a surgeon. But the medical fellows from our program go out a get great jobs. Most doing a mix of general and retina, but some exclusively retina. There are a few advantages to doing just medical:
1) Your call is a lot better. In our program the medical people (including attendings) don't take call
2) You can make a ton of money. Most money in retina is made in the clinic and going to the OR is actually a waste of money.
3) You can still send all of your problem patients away
4) You have quite a bit to offer a group that is looking to add retina expertise and keep the retina business in house.

Bottom line if you are interested in retina the medical route might be the way to go. If you decide after a year that you want to do surgery, you can always tack on another year at a good one year surgical fellowship

 

[CatSurg13]

Can you tell me what program are you in? I am doing general now but I'm considering doing a fellowship in medical retina. Thanks a lot for your input.

I am in a fellowship that has medical retina fellows. Believe me, I personally am, and forever will be, a surgeon. But the medical fellows from our program go out a get great jobs. Most doing a mix of general and retina, but some exclusively retina. There are a few advantages to doing just medical:
1) Your call is a lot better. In our program the medical people (including attendings) don't take call
2) You can make a ton of money. Most money in retina is made in the clinic and going to the OR is actually a waste of money.
3) You can still send all of your problem patients away
4) You have quite a bit to offer a group that is looking to add retina expertise and keep the retina business in house.

Bottom line if you are interested in retina the medical route might be the way to go. If you decide after a year that you want to do surgery, you can always tack on another year at a good one year surgical fellowship

 

[theeyeboy]

Can you tell me what program are you in? I am doing general now but I'm considering doing a fellowship in medical retina. Thanks a lot for your input.

Northwestern

 

[pianist]

Any new updates on the market/field of medical retina?

I'm a pgy2 trying to grind through the end of this first year.

I like retina the best, but I'm not sure if I have the energy/interest to do things like buckles, TRD repairs, membrane peels, especially if they don't improve vision and you just get anatomical repairs.

Are there jobs out there for medical retina trained people? Either in private or academic?

Thanks

 

[Visionary]

Any new updates on the market/field of medical retina?

I'm a pgy2 trying to grind through the end of this first year.

I like retina the best, but I'm not sure if I have the energy/interest to do things like buckles, TRD repairs, membrane peels, especially if they don't improve vision and you just get anatomical repairs.

Are there jobs out there for medical retina trained people? Either in private or academic?

Thanks

I'm a medical retina specialist. Have posted some info in other threads about this. To avoid repeating myself, just do a thread search looking for my name and medical retina. Also, feel free to PM me about it. The short answer is: I also wasn't that into surgery; and there are jobs, but they aren't as easy to find as surgical.