Neuro-ophthalmology compensation

Discussion in 'Young Ophthalmologists' started by PCR, Jul 29, 2007.

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  1. PCR

    PCR 5+ Year Member

    Jul 28, 2007
    What is the average salary/compensation for neuro-ophthalmologist.
    I really find this sub-speciality interesting and exciting.
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  3. NR117

    NR117 Member 7+ Year Member

    Jan 9, 2005
    The subspecialty is interesting and exciting, but as far as compensation goes it is probably one of the least lucrative subspecialties in ophthalmology. The starting salary could be 120 to 150 K in academic institutions, and maybe 165 to 180 K in private practice but the problem is that this amount is only guaranteed for the first one or two years. After that, it usually becomes "you eat what you kill". Since neuro patients are usually complicated cases that take up a lot of time, you can only see so many patients. In the current system that rewards quantity over quality and procedures over clinical assessment, this means that most people have a hard time making their salary and covering their expenses. What many neuro-ophthalmologists will do is, realize this fact early on, and go on to do a second fellowship, typically in oculoplastics/orbit, peds &strabismus, or glaucoma. After these dual fellowship-trained ophthalmologists have been in practice for a short while they figure it makes much more financial sense to ditch neuro-opht and just concentrate on the other subspecialty. And most do just that...(I personally know quite a few people who did).

    The end result of all of this could be summarized as:

    -Not enough people training in neuro-ophthalmology (and more importantly, sticking to doing neuro-ophthalmology even if they have received training in it), which means that the few practitioners out there are in demand, especially in academic institutions.
    -Even though starting salaries are decent, after the guarantee period is up, the institution usually ends up having to subsidize the neuro-opht person's salary.

    I think this subspecialty is for those who are either independently wealthy and do not need to work for a living, or those who are truly passionate about neuro-ophthalmology and who do not mind making (sometimes substantially) less than their peers.

    I am interested in what other people think...
  4. GuP

    GuP Senior Member 7+ Year Member

    Oct 28, 2005

    Very true post. A friend of mine who graduated this year really wanted to go into oculoplastics but he didn't get a spot. He now instead is going into neuro-ophth and will re-apply again next year after making connections and doing more research, etc. He echoed the same points as NR117 - money is low, you do not operate much, etc. etc.

    Funny how you mentioned about wealthy people and neuro-ophth - this is exactly the scenario which I came across. An individual with a wealthy family was the lone neuro-ophth guy in the dept. I also spoke with him a few times inquiring about the field and he said the same things as above. He added that one should only do neuro-ophth if you like it - i mean really really like it!!
  5. PCR

    PCR 5+ Year Member

    Jul 28, 2007
    Thanks for the replies.

    Do you think combining a neuro-op fellowship with medical retina fellowship would be more lucrative and give a decent compensation.
  6. orbitsurgMD

    orbitsurgMD Senior Member 10+ Year Member

    Dec 27, 2005
    I do neuro along with plastics as well as some general/comprehensive ophthalmology. I have fellowship training in both neuro and oculoplastics. The observations above are generally true. Neuro patients are time-intensive, high-risk and generally unhappy, unfortunately. By the time they get to you, they have generally seen one or two other doctors already and they are often worried and frustrated. If you do neuro practice, you have to understand that going in, and recognize that your duty is to be vigilant for things that can really harm your patients. That is going to involve extended workups, and sometimes a lot of time hand holding and occasionally arm twisting patients who are having one form or another of difficulty dealing with their disease. There isn't the kind of "wow" factor giving you gratifying feedback from patients in most neuro practice as there can often be in cataract and refractive surgery. You need to become comfortable with this too.

    If you even mention doing neuro in your practice community, you will have no trouble building a referral practice. There are very few ophthalmologists with this training beyond residency and most general ophthalmologists want to refer suspected neurological disease out as soon as possible.

    There is a surgical practice, but generally not a high-volume one. You will do lots of temporal artery biopsies, a few nerve sheath procedures and occasionally tarsorraphies. You could do strabismus cases as well. What others have mentioned is true as concerns combining specialties. Oculoplastics and orbit and pediatrics/strabismus tend to be the most common associated subspecialties. I have found plastics to be the most useful. In many areas, glaucoma subspecialists are too busy to be working up other optic neuropathies, and although from a pathological perspective, the two fields would seem to intersect well, they rarely do in practice. Peds practices are generally swamped, and the high risk, high time demands of neuro are not terribly attractive to them. I trained at a program where there was a specialist with a peds/neuro research background, but on the whole, it is not common, especially in private practice.

    I would not discourage you from the training, especially as you find it interesting. Even if you do choose a second area for fellowship, your ability to provide consultation in neuro will almost certainly make you a valuable asset wherever you choose to go.

    I would suggest that if you do not go to work for a department, consider a mixed practice, and try to develop a working relationship with the neurologists in your community and with the radiologists. You will get to know one another well. Also, it is important to have a relationship with a lab that can do electrophysiology studies for your patients.
    RockDoc7 and Spica like this.
  7. KHE

    KHE Senior Member SDN Advisor 10+ Year Member

    Jun 14, 2005
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    I can't speak for the compensation of neuro-ophthalmology with any great percision but I have worked with a couple of neuro ophthalmologists. They all enjoyed their work very much but the problem with neuro-ophthalmology is that it tends to be a vast "dumping ground" of problem patients that no one can figure out what the heck is going on. There seem to be very few billable procedures in that sub specialty. Most of the revenue is generated through what are essentially billed as extended office visits.

    If you like detective work on complex cases, it's an interesting field.

    If you want to make a boat load, I don't think it's the way to go.
  8. GuP

    GuP Senior Member 7+ Year Member

    Oct 28, 2005
    Great post with good info!

    I was wondering if you would talk about oculoplastics a little bit. What kind of practice do most oculoplastics guys opt for - many have mentioned that most guys go into academics and work alongside ENT and neurosurgeons. Is this the norm? Or is there demand for a strictly oculoplastic surgeon? Do most market themselves to the cosmetic crowd? What is job market like - any turf wars with facial plastics guys? Moreover, is ASOPRs fellowship the way to go or would you be just as good in a non-ASOPRs fellowship? Feel free to add anything you'd like to share!

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