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I am curious as to the potential ceiling for ophthalmology.

A. I am willing to work wherever.
B. I am willing to work 80+ hours a week.
C. I want to do LASIK.

Is 750K-1 million a realistic net income?

Thanks!
 

90 diopter

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The two ophthalmologists that I know that probably pull in this level of income have a few things in common:

- Both are high volume cataract surgeons
- Neither does any other surgery, including LASIK
- They do 40 to 60 cases per week
- They don't do anything other than surgery. Anyone with any eye complaint other than cataract gets referred elsewhere.
- They live in relatively small towns
- They co-manage with optometrists
- 95% to 99% of the local optometrists send all patients requiring surgery to that one ophthalmologist
- Neither works anything remotely close to 80 hours a week

For a person to make that much money as an ophthalmologist, business skills are far, far more important than clinical competence. And it takes time and some degree of luck to build up the referral base needed to achieve that level of volume.
 

LightBox

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750k to 1 M is more common than you might think among Ophthalmologists :) Much more common than these discussion boards filled with residents and fellows might imply. And no, you do not have to work 80 hours to achieve that level of income. You obviously have to be a practice owner to achieve that level of income. Factors that help:

1) Decent volume of LASIK
2) Owning a surgical center.
3) Owning the real estate.
4) High percentage of "premium" IOLs being implanted.
5) Good insurance mix (aka no Medicaid).
6) Minimize waste, improve efficiency, improved billing "capture rate" (aka coding correctly).
7) Employing providers (especially optometrists) where you earn from their collections.
8) For non-retina: doing "high-yield" surgical cases (i.e. doing cataracts and avoiding long cases like PKPs) as much as possible; for retina: staying in the clinic pumping out as many "high-yield" diagnostic tests (e.g. FA/ICG) and lasers as possible.
9) Owning ancillary cash business (e.g. optical shop)

Those are some of the big factors off the top of my head. And probably the taboo ones that are not allowed to be spoken in the hallowed halls of academia :)
 
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Probably not, especially if you want to do Lasik. It's competitive area and there aren't many places where you can get busy enough to make anywhere near 750k (or even enough to justify performing it at all). Only 5% of ophthalmologists make 700k or more. Most of those have been in business for awhile and have become the "referral guy" for cataracts in a local area. Or they're very busy retina specialists. Or they're entrepreneurs who make money via their associates, optical shops, ASC ownership, etc.

Ophthalmology is a very competitive field, and the will to work long hours won't guarantee a high salary unless you're a retina specialist who doesn't mind living anywhere. And who knows if that will still be true in 10 years.
 

ophthope

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So what sort of income is a 9am-5pm, 4 days/wk in clinic, 0.5 day/wk in OR, comprehensive Ophthalmologist in a medium town (for example's sake lets say population 60,000-100,000 maybe catchment area pulls it up to 250-300,000) with a small optical, either solo practice or one partner, looking at these days? I assume that's a sort of an 'average' practice setting?
 

Dusn

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If you're not already well-established and own a large practice, you'll never make that amount, unless you switch into business or something non-medical. Reimbursements are getting cut enormously and the overhead continues to go up due to increasing regulations. All of the averages reflect established 60 year old practice owners. Starting ophthalmologists make much less, especially because it is much harder and too expensive to start your own practice these days and your employer wants to make money off you. With declining reimbursements, it's now much more of a debate whether it's even worth it to spend the 500K+ to buy into a practice even when given the opportunity.

LASIK follows the economy, so right now when the economy sucks, LASIK is down. No one is going to pay out of pocket to get LASIK from you when you're 30 when there's a 55 year old refractive surgeon down the street who looks more experienced. It's not much of a money-maker right now.

The willingness to work anywhere will help increase your income and decrease your expenses more than anything else. The key is that you and your family have to be perfectly willing to walk away from a contract or from any particular location if you're not being offered a fair salary.

But you still won't make 750k to 1 M unless you own the hospital. And if that's your goal, going into business is the more straightforward path.
 
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On the other side of the equation, what is the floor? What is the lowest and average you would expect an ophthalmologist to make 4-5 years out of training, in both general and all of the subspecialties?
 

LightBox

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Again, I personally know of several Ophthalmologists that make 7-digits. Some of these guys are in their late-30's. And no, they don't own entire hospitals or whatever. So it is possible; but yes, you will have to own a large practice and make money off of your associates, do tons of surgery, own the ASC, own some opticals, make lots of business deals, etc. Obviously, I don't know of any associates/employees making that much money. Money should not be the prime driving force in any career, but it definitely is possible to make a salary in the 750k-1M range with some hard work, business acumen, and luck.

The "floor" of salaries is obviously ZERO -- i.e. if you don''t work. Again, "averages" are just that. There is a HUGE range of salaries for Ophthalmologists out there. From the part-timer associate who wants to spend more time with his/her kids...to the person that owns a refractive surgery franchise. No one is going to just give you money. You have to go out there and work hard, watch your expenses, make business deals to earn income passively, etc. There is no "set" salary, so try to get out of that mentality.
 
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Silent Cool

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Again, I personally know of several Ophthalmologists that make 7-digits. Some of these guys are in their late-30's. And no, they don't own entire hospitals or whatever. So it is possible; but yes, you will have to own a large practice and make money off of your associates, do tons of surgery, own the ASC, own some opticals, make lots of business deals, etc. Obviously, I don't know of any associates/employees making that much money. Money should not be the prime driving force in any career, but it definitely is possible to make a salary in the 750k-1M range with some hard work, business acumen, and luck.

The "floor" of salaries is obviously ZERO -- i.e. if you don''t work. Again, "averages" are just that. There is a HUGE range of salaries for Ophthalmologists out there. From the part-timer associate who wants to spend more time with his/her kids...to the person that owns a refractive surgery franchise. No one is going to just give you money. You have to go out there and work hard, watch your expenses, make business deals to earn income passively, etc. There is no "set" salary, so try to get out of that mentality.

I'll summarize the question: what is reasonable for a practice-owner who is partnered with, say, 3 other ophthos? I'm not talking about some mega practice, etc...--but someone who is now a partner in a decent practice in a place like Seattle or Orlando or Austin. Emphasis on "reasonable." Assume general practice ophtho. My guess is they are probably taking home 250K.
thanx
 

ophthope

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I'll summarize the question: what is reasonable for a practice-owner who is partnered with, say, 3 other ophthos? I'm not talking about some mega practice, etc...--but someone who is now a partner in a decent practice in a place like Seattle or Orlando or Austin. Emphasis on "reasonable." Assume general practice ophtho. My guess is they are probably taking home 250K.
thanx

I don't think anyone is ever going to answer this, because it seems to be some sort of secret in Ophthalmology. If we were Anesthesia residents we could go to gaswork.com and see a bunch of job offers with min-max ranges. In Ophtho I suppose since we're all headed into working in smaller offices, the information isn't widely available. It is frustrating not to have a good idea about your income potential when dedicating another 4 + 1-2 years of your life to training.
 

Silent Cool

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I don't think anyone is ever going to answer this, because it seems to be some sort of secret in Ophthalmology. If we were Anesthesia residents we could go to gaswork.com and see a bunch of job offers with min-max ranges. In Ophtho I suppose since we're all headed into working in smaller offices, the information isn't widely available. It is frustrating not to have a good idea about your income potential when dedicating another 4 + 1-2 years of your life to training.

I agree. I'm waiting for someone to come along and say, "Well, as long as you are biz-savvy, the sky is the limit!!"
 

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I don't think anyone is ever going to answer this, because it seems to be some sort of secret in Ophthalmology. If we were Anesthesia residents we could go to gaswork.com and see a bunch of job offers with min-max ranges. In Ophtho I suppose since we're all headed into working in smaller offices, the information isn't widely available. It is frustrating not to have a good idea about your income potential when dedicating another 4 + 1-2 years of your life to training.
If you want to see the average salaries, just look up the Medscape "Ophthalmologist Compensation Report" for 2013.

However, you'll never get a straight answer about income is because it's extremely variable and highly dependant on things like optical shop revenue, ASC revenue, premium IOL's, location, type of practice etc. You could look at two 38 year old comprehensive ophthalmologists who are "partners" and working the exact same hours in the same town. One might be making 1 million per year b/c they're the local optometrist's cataract "referral guy," whereas the other is a new partner who's seeing lots of patients with bad insurance and only taking home 175k after his buy in costs.
 
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LightBox

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Ugh. I wrote a nice-sized post, but SDN was down. Anyways, I would say the average is around 400-600k for the situation that you described. Again, as alluded to above, many factors involved: ASC ownership, cash-business %, # of associates profiting from, optical sales, etc. I wouldn't say the "sky is the limit," but you can definitely get in the 7 digits with lots of business acumen. But what really is the difference in happiness level between 1.2M and 600k?
 
Apr 27, 2014
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I am curious as to the potential ceiling for ophthalmology.

A. I am willing to work wherever.
B. I am willing to work 80+ hours a week.
C. I want to do LASIK.

Is 750K-1 million a realistic net income?

Thanks!
Hi We are currently seeking to partner with an ophthalmologist. Starting salary $750k. We concentrate more on cataract surgey and we are fully booked for a year.

Please let me know if you would be interested.

Thanks
 
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Ar2

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$750 K to a million?.. And they say physician incomes are declining. ;)
 

OJOJobsGuy

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I posted this reply in another thread on SDN, but it looks like it might be useful here too. I'm an Ophthalmology Recruiter, so I thought I'd throw some real world experience and numbers out there. Following applies for young ophthalmologists straight out of training- not subspecialists or experienced Ophths.

Salary year 1: $175 plus or minus 15%

Salary year 2: Usually a 10% increase over year 1 salary

Production Bonus: Generally 25% to 30% after a threshold of 2.5 times salary is met.

Vacation: 3 or 4 weeks

CME: 1 week reimbursed at $2500

Malpractice is usually paid by the employer.

Tail coverage is hit and miss. Sometimes the employee covers this, sometimes the employer covers this and sometimes it's shared. Sorry- Wish I could be more helpful on Tail but that's what I see- kind of a mixed bag.

Partnership: Usually offered after 2 years.

Getting back to salary again for a moment. The figures I'm quoting are for new general ophthalmology grads- fresh out of school doctors. And there are certainly exceptions to my figures just as there are exceptions to many rules. Several times a year I will hear of salaries in the mid 300's for a general ophthalmologist. When this happens- when a large figure like this is given it is usually because an older solo practice owner wants to get rid of his practice immediately. I also hear of unusually high figures thrown out there by hospitals. The one thing you'll need to keep in mind with hospital agreements, you will likely have to renegotiate your salary after the first contract term- probably 1 or 2 years in and there is no guarantee you’ll be paid at the same high rate.

If anyone would like to ask me more about this you may email me at [email protected]

Thanks
 

RestoreSight

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A related question for those with some work experience, what are the start up costs related to either starting a new practice including an ASC, optical shop, etc versus buying an existing practice? How much in total is needed and how common is it?
 
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I am a resident of ophthalmology in México and I´m about to finish my residency program. The reason i write this email is because i was wondering if you could help me with information about places where to buy slit lamps or the whole unit in SAN ANTONIO, TEXAS. Or maybe you could help me get in touch with someone who knows about this. Thank you very much.
 

Dave89

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I've been browsing a bunch of threads on the lifestyle/salary of Ophtho, and I can't help but wonder: are ophthalmologists, on average, actually making essentially as much as a very successful FP doc? Almost everyone who goes into Ophtho has the numbers to get into Derm, top Anesthesia programs, Rad-Onc (although, research is more of a factor there), etc... so, are there any of you who think that Ophtho is now so much trouble that it's not worth pursuing?
 

LightBox

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I've been browsing a bunch of threads on the lifestyle/salary of Ophtho, and I can't help but wonder: are ophthalmologists, on average, actually making essentially as much as a very successful FP doc? Almost everyone who goes into Ophtho has the numbers to get into Derm, top Anesthesia programs, Rad-Onc (although, research is more of a factor there), etc... so, are there any of you who think that Ophtho is now so much trouble that it's not worth pursuing?
Didn't I answer this question a year ago?

Here's some hope for you if you are worried about money: a personal friend of mine pulled down 3M last year. How did he do it? Well, we aren't going to share the recipe to that secret sauce! :p
 

Dave89

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Didn't I answer this question a year ago?

Here's some hope for you if you are worried about money: a personal friend of mine pulled down 3M last year. How did he do it? Well, we aren't going to share the recipe to that secret sauce! :p
Haha, that's reassuring! :)

I have no expectations of making 450-500,000. That said, it's a field that does require a fair amount of sacrifice, especially with the relatively low starting salaries. Is a mid-career salary of ~350K realistic for someone who isn't exactly a "borrow $5 million and build a practice from the ground up" type?
 

Xclusiv

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I've been browsing a bunch of threads on the lifestyle/salary of Ophtho, and I can't help but wonder: are ophthalmologists, on average, actually making essentially as much as a very successful FP doc? Almost everyone who goes into Ophtho has the numbers to get into Derm, top Anesthesia programs, Rad-Onc (although, research is more of a factor there), etc... so, are there any of you who think that Ophtho is now so much trouble that it's not worth pursuing?
I am also curious about this.
 

LightBox

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I am also curious about this.
Ophthos definitely make more than family practice doctors. This is a no-brainer. You guys are obsessed with looking at crappy starting salaries that are advertised on job boards. These figures do NOT reflect the norm of what most Ophthalmology partners make. As I wrote 1 year ago -- no one is going to hand you over 7 figures. You will have to work to earn it. But I'm not talking about 60 hours a week working. More like 40 hours in clinic/OR and a bunch of time doing admin/business work on nights/weekends.
 
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bronx43

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I am also curious about this.
Now more than ever, business acumen > specialty choice for the most part.

I know a guy in Cleveland doing primary care pulling $1 million a year and his partner pulls $800k. They have a high volume practice and multiple different alternative revenue streams. He has sold his practice multiple times to the CCF for 7 figures, and bought it back pennies on the dollar because they couldn't run the practice as well as he can.

I know another guy doing allergy/immunology in Columbus making $2 million a year. He's got 6 different clinics, and 5-6 midlevels working for him. He pays another allergist like $180k. You see his advertisements everywhere on the streets, malls, and internet.

People really need to realize that in this day and age, the income potential depends on your ability to hustle. I rather be a FP with keen business acumen than a plastic surgeon without...
 
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LightBox

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. I rather be a FP with keen business acumen than a plastic surgeon without...
I respectfully disagree. Though I thoroughly respect my PCP colleagues, there is no way I could do what they do, no matter how much someone paid me. Ophtho is perfect for me because I get to operate and receive lots of instant gratification.

After a certain threshold, additional $$ does not increase one's happiness proportionately.
 

airplanes

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Now more than ever, business acumen > specialty choice for the most part.

I know a guy in Cleveland doing primary care pulling $1 million a year and his partner pulls $800k. They have a high volume practice and multiple different alternative revenue streams. He has sold his practice multiple times to the CCF for 7 figures, and bought it back pennies on the dollar because they couldn't run the practice as well as he can.

I know another guy doing allergy/immunology in Columbus making $2 million a year. He's got 6 different clinics, and 5-6 midlevels working for him. He pays another allergist like $180k. You see his advertisements everywhere on the streets, malls, and internet.

People really need to realize that in this day and age, the income potential depends on your ability to hustle. I rather be a FP with keen business acumen than a plastic surgeon without...
Do you have a point here? There are millionaires in every specialty. If you dream of running our own large practice and making the big bucks, being a sharp businessman is going to be important no matter what field you decide on. So is a willingness to oversee and administrate.
 

Dave89

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Do you have a point here? If you want to make the big bucks, being a sharp businessman is going to be important no matter what field you decide on. There are millionaires in every specialty.
Pretty sure that was his (her?) point.
 

Silent Cool

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Good lawd, have mercy!

@bronx43 is fiscally conservative (like me). In other words, we think in terms of dollars and cents--that IS what makes us happy: the ROI of our education. The point is (to those of us who care about the ROI) that you shouldn't feel boxed financially because of your field. For the past 20 or so years, there has existed a (growing) discrepancy in compensation between various areas of medicine--namely, primary care and specialties. That gap is now slowly vanishing and, as such, you should realize that if you want to make the 'dolla dolla bills, ya'll' that have been characteristic of the ROADEECUG (or WTF ever) to success, well....you don't necessarily need a 258 on the Step 1.