Ophthalmology Attending - AMA

[cubsrule4e]

Hey guys! As a long time SDNer, it was suggested that I start one of these threads since apparently eyeballs isnt very well represented over here. In addition, the ophtho forum itself isnt quite as active as it once was, although if you're willing to search it does have plenty of valuable information.

Some basics about myself: I am a partner in a 4 surgeon private practice in southern Louisiana. I was originally interested in orthopedics up until my second year of med school. I began to research ophthalmology on this very website and discovered it had many more of the qualities I was interested in for a medical specialty - surgical field, but clinic based with continuity of care. Multiple short surgeries vs few multiple hour long surgeries. Many in office procedures. Good "lifestyle" specialty in terms of hours and call once in private practice, as well as good compensation. And above all, the subject matter was intriguing to me. Ophthalmology encompasses multiple organ systems, not just eyes. Primary care (diabetics, hypertensives), neurology (stroke patients, MS patients, patients on psych medications), Rheumatology (autoimmune disorders), Pediatrics (strabismus, amblyopia... and while I have no interest whatsoever in peds and dont see kids on a routine basis, I have actually diagnosed a case of Retinoblastoma and saved a life. Pretty awesome!).

Ophtho is a 3+1 residency, with a prelim med/Transitional year followed by 3 years of ophtho. There are a few 4 year incorporated programs that have sprung up over the last several years. The first year is generally all clinic. There is a very steep learning curve, and you will be working harder than you ever have to keep up. By the middle-end of your first year you begin to learn basic laser procedures and in-office procedures like chalazion I&D, which is kind of your "reward" for all your clinic grunt work . Second year is much better and you begin to work in subject-based rotations like cornea, retina, etc., and begin your venture into cataract surgery! Third year is all about honing surgical skills and preparing for the real world. There are multiple 1-2 year fellowships available after residency which include cornea/refractive, glaucoma, retina, plastics, and uveitis.
Residency is pretty competitive, and has only gotten moreso in the last several years. I matched in 2009 from a low-middle tier state school with a 233 Step 1 and basically no research. Strong LORs from a well known Chairman and PD, plus one away rotation. At that time my step 1 score was right at the average for matched applicants, these days probably closer to 240.

My typical weekly schedule is as follows:

4.5 day work week

Monday: Main office. Start cases at 8 (average 18-20 cases; cataracts, glaucoma, pterygiums), finish around 1130-12, lasers immediately following (anywhere from 5-15). Start a short clinic around 1 and try to get out of there by 3-330.

Tuesday: Satellite clinic. Busiest day, average 40-50 pts which includes some 1 day and 1 week post ops, my optometrist (we employ 8 optometrists across 4 locations) sees a fair number of them for me also. 9-4:30 typically.

Wednesday: Main office. Off AM, See about 20 pts from 1-4:30

Thursday: Satellite clinic. Average 30-40 pts, 9-4:30

Friday: Main office. Average 25-35 pts. 9-3:30, Lasik every other Friday afternoon (do about 5 cases a month, the older partners still garner the majority of these cases)

All considered an average 34-36 hour work week. I take secondary call every Tuesday night (optometrist takes first call in front of me) and one weekend a month (usually an optometrist covering here as well), so "in office" time on call is practically nothing. I would say I go into the office one weekend every 3-4 months to handle 1 or 2 patients.

Salary: I wont give you my exact details but I am slightly above the overall average, mainly because I carry a higher surgery load. I would estimate the average OMD after 3 years in practice is bringing in around $300-350k. Obviously this is going to depend on where you practice, as well as demographics. A saturated market in a big city with lots of medicaid patients is going to pay significantly less than a rural area with surrounding well-to-do communities. I see quite a bit of medicaid patients, but also my fair share of good insurance, well-off patients who are able to afford upgrades on their cataract surgeries, which will obviously boost your take home numbers.

Lastly, the big MD vs OD debate. You'll hear all over this site in every specialty forum how mid levels are taking over everything, etc. Go back through the ophtho forums almost 15 years and youll see the same debates happening that there are today. Ophthalmologists aren't going extinct, and we are actually looking at a shortage of them by 2020. In fact, with the baby boomer population and the advent of femtosecond laser cataract surgery (LACS) and premium IOL implants, the future couldnt be brighter for patient volume and reimbursement, despite actual insurance reimbursements slowly being cut (and across all fields of medicine, mind you). Sure, there are rogue optometrists with a big ego out there wanting to be surgeons without doing all the work necessary but these are the exceptions, not the rule. Not a single OD ive ever met or talked to has any desire to perform even laser procedures, must less surgical ones.

Finally, a link to the FAQ in the ophtho forum which has great info and addresses a timeline for med students and the application process for residency. Many of the external links are outdated, but you can easily find the updated data with a simple google search.

Ophthalmology Forum FAQ & Applying to Ophthalmology Residency Programs

I hope this helps, and good luck to everyone in their search for their chosen specialty!


Mark 8:25
Then Jesus laid his hands on his eyes again; and he opened his eyes, his sight was restored, and he saw everything clearly.

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[Lawpy]

Awesome stuff, thanks for this

 

[spartan25]

Great post, thanks! Ophtho is one of the specialties that we get the least amount of exposure to in med school, so what can I do as an MS3 to figure out if this is what I want to do? My school does not offer ophtho as an elective during the surgery clerkship unfortunately...

 

[Foot Fetish]

Thank you for doing this!

- What is your least favorite part of your job?

- What is considered the most desirable / competitive ophtho sub-specialty?

 

[ItsAMeMario007]

What do you think about ReLEx SMILE vs. LASIK?
With its recent premarket approval, would you recommend this newer procedure over LASIK to patients that can afford it?
Do you plan to do this procedure in the future (or are already doing)?

FDA approves ReLEx SMILE for myopia with astigmatism

 

[Dwight Snoot]

What is your least favorite part of ophtho?/ are there any things that you feel you are missing out on that other specialties have?

 

[cubsrule4e]

Great post, thanks! Ophtho is one of the specialties that we get the least amount of exposure to in med school, so what can I do as an MS3 to figure out if this is what I want to do? My school does not offer ophtho as an elective during the surgery clerkship unfortunately...

But they do have an ophtho program? I recently addressed this in another thread about the unfortunate lack of ophtho exposure for med students. I only got 1 week of it at the end of my 3rd year, and then obviously took a home elective to start 4th year. So your situation would be similar to mine in the sense that I had to get going long before I could ever get "Scheduled" exposure. The best way to approach it at this point is to just show the initiative. If you or a friend knows one of the ophtho residents, this is an easy way to go. Ask them to show you around the clinic and meet the other residents. Otherwise just walk in cold turkey, introduce yourself and politely ask to do some shadowing. As an MS3, youre in a little bit of a time crunch for getting some exposure since ophtho is an early match specialty, so the sooner the better. Ophtho residents are typically pretty accepting of med students and will let you shadow them in clinic when you have time. I was on a psych rotation at the time I first developed some interest and had a fair amount of extra time to hang out in the resident clinic. You obviously will know nothing, and it might even seem boring at first, but if you show up more than once and prove your true level of interest, or at least the intent of wanting to get a better idea of the specialty, the residents will take you in and start showing you things, let you use the slit lamp, etc. If you already have a significant interest or develop one along the way, I'd also get them to introduce you to the PD and some of the attendings as a med student interested in the field. Ask to hang out in the OR for a few cases as well, as this is obviously a huge part of the specialty.

 

[cubsrule4e]

Thank you for doing this!

- What is your least favorite part of your job?

- What is considered the most desirable / competitive ophtho sub-specialty?

@Foot Fetish @Dwight Snoot

Least favorite part of my job is most likely everyone else's in any field - dealing with insurance, pharmacy, etc. But I assume youre speaking ophtho specific.

On one end of the spectrum, you have end stage glaucoma patients, who are endlessly thankful for anything you can do to maintain their 20/400 vision. Even after continuous drop therapy and multiple surgeries, these patients are typically going to continue to progress and ultimately go blind. This is pretty taxing, at least for me, to see them every 4 months and realize I'm basically just babysitting them until they pass away, and youre just hoping they maintain vision until that time. It comes with the territory, and in a way you get "used to it," but it's always difficult to have nothing to say to these patients except "see you in 4 months."

On the other side, you have patients who you perform flawless cataract surgery on with a multifocal implant. They see 20/20 at distance, intermediate, and near. Yet its "just not what I thought it would be." These are expensive implants as well, so setting expectations from the beginning is important, but you will still get this type of patient here and there. These patients are typically engineers . You will see them every week as they "track their progress" and "wait to get a little better" until they finally decide it is what it is and disappear happy enough once their post op period is up and the co-payments kick in again. But babysitting this type of patient for 3 months after an outcome that 99.9% of people would be ecstatic with is easily my least favorite thing.

I guess those are both "patient-based" issues. Otherwise there's really not much I dislike about my job itself as far as performing duties.

The most desirable sub specialty depends on what you're referring to. From a compensation standpoint, retina is going to be your biggest cash maker, and is also fairly competitive, but youre also going to work longer hours with more call and more trauma than anyone else. Oculoplastics is also pretty competitive. Cornea, glaucoma, and uveitis are much lower competitiveness and also have many more fellowship openings. These also pay at about the average general ophthalmologist salary, so unless youre truly interested in doing it, you're not gaining much in the way of compensation/lifestyle/job acquisition to do one of these fellowships just for the heck of it.

I really dont feel like I'm "missing out" on anything from another specialty standpoint. In fact, it's almost a daily occurrence that I'll walk out of a room after seeing a patient with serious co-morbidities and say to myself "So thankful I'm not this person's PCP/Endocrinologist/Cardiologist, etc." I love being the consultant, address their issue, and have their comprehensive medical care handled by someone else. The one thing I guess you could say I wish I did more of, is seeing/evaluating these patients' CT/MRIs when I have to order one for some reason. Radiology was the last thing I eliminated from my possible specialty list. I could never see myself reading film after film in a room by myself, but on the wards I always loved researching the imagining on my specific patients for whom I was looking for a specific finding or non-finding. Unfortunately I dont have access to the multiple hospitals and imagining centers to see the scans for myself, but still enjoy reading the interpretations.

 

[THaramura]

Thank you for the amazing thread!!
I have a question about applying to ophtho as lowly a med student. I wonder what do you think the reputation of the home program impacts on the chance. I often hear that the most possible place to match into is the home program but when it's so high up there might it hurt the chances? On the contrary the letters from the attendings might carry more weight as they might be better recognized especially in a small field like ophtho?
Please excuse me for my bad expression but I am very excited about having a strong home program and all the opportunities while worrying a little in the meantime.

 

[DrRedstone]

Thanks for setting this up for us! I have a couple questions if you don't mind:

1) What rotations do you really wish you had done during your 3rd and 4th year to give you a better base of understanding for clinical practice in ophtho? For example, I have been considering scheduling rotations in Rheumatology, Endocrinology, Infectious Disease, and Cardiology since they are strongly related to diseases that affect the eye.
2) Have you gotten involved in any missions work since completing residency? I'm assuming based on your reference from Mark you might be somewhat involved in them.

 

[cubsrule4e]

What do you think about ReLEx SMILE vs. LASIK?
With its recent premarket approval, would you recommend this newer procedure over LASIK to patients that can afford it?
Do you plan to do this procedure in the future (or are already doing)?

FDA approves ReLEx SMILE for myopia with astigmatism

I dont have any experience with SMILE or intend to use it at this time. The two big things about SMILE everyone is touting is that 1) Its a flapless procedure, so its less prone to traumatic disruption, and maintains more of the original corneal stability and 2) because theres no need for the flap there is less risk for dry eye.

The big issue with it is that treatment is pretty limited. Only myopic (nearsighted patients) without astigmatism are candidates whereas LASIK treats myopia, hyperopia, and astigmatism. I know people are having success with it but I dont know that it will be what surpasses LASIK which is still the gold standard for corneal refractive procedures.

 

[cubsrule4e]

Thank you for the amazing thread!!
I have a question about applying to ophtho as lowly a med student. I wonder what do you think the reputation of the home program impacts on the chance. I often hear that the most possible place to match into is the home program but when it's so high up there might it hurt the chances? On the contrary the letters from the attendings might carry more weight as they might be better recognized especially in a small field like ophtho?
Please excuse me for my bad expression but I am very excited about having a strong home program and all the opportunities while worrying a little in the meantime.

True, definitely your best chance at matching is at your home program (which I did). But obviously that program wont only take residents from within that school. I think school reputation will help you or hurt you depending on the level of field youre playing. If youre at a lesser known program with few research ties and not many big names in the department, this will hurt your chances for the big name top programs, but it probably wont with most of the other programs. On the other side, if youre at a big name research driven institution, unless youve got a good reason to want to go to a lower-middle tier program, some of these residencies will likely ignore you for the most part because they know youre not going to go there and may view you as using them as a "Safety" school versus someone who has a true interest in attending there. If youre a good candidate at a top school you will easily have enough interviews to match somewhere, it might just not be exactly where you hoped, and also depends on how many in your class are also applying (which would obviously help or hurt your chances of matching at home).
As far as letters go, these are definitely impactful. If a PD somewhere recognizes your PDs name or other faculty and has history with them, they may give you an interview simply out of courtesy to get your foot in the door. Other attendings with connections tend to feed their own med students/residents into residency/fellowship positions to a handful of specific locations because they trust that program and have always gotten solid performances out of those students.

 

[cubsrule4e]

Thanks for setting this up for us! I have a couple questions if you don't mind:

1) What rotations do you really wish you had done during your 3rd and 4th year to give you a better base of understanding for clinical practice in ophtho? For example, I have been considering scheduling rotations in Rheumatology, Endocrinology, Infectious Disease, and Cardiology since they are strongly related to diseases that affect the eye.
2) Have you gotten involved in any missions work since completing residency? I'm assuming based on your reference from Mark you might be somewhat involved in them.

1. I took rheumatology as an elective intern year and would definitely recommend that. Comprehensively, it is probably the most relevant. Did not have exposure to I/D or endo but those would likely be helpful as well. I/D most likely more clinically relevant for cases youre actually seeing (HIV retinopathy/CMV retinitis) because theyre usually carrying some immunocompromised patients. Endo would be good for "book" knowledge, learning what ocular findings you can get with abnormal blood glucose levels, thyroid levels, etc. Neurology is another one where you will see a fair amount of findings like nystagmus, visual field defects, diagnoses like pseudotumor (IIH) (most people get at least a small block of this in 3rd year).

I wouldnt think cardio would add too much other than basic things you could read about on your own that youd much less likely have exposure to in a rotation.

Of course all of these being electives, you may see a few interesting cases with ophtho findings, but its going to be on you to read up on the clinical relevance. A typical I/D case on rounds for instance may involve an immunocompromised patient being treated for x problem who then has new onset blurry vision. They may not even discuss what theyre looking for and just say "ophtho consult!" and you would need to then go learn about fungal endophthalmitis, cmv retinitis, etc based on what the patient is being treated for, cd4 count, history of candida infection, etc.

If I think of any other good ones ill make an edit.

2. Have not done any true missionary work, though I do some charity just through my own clinic. Spend a few years getting practice up to speed and very busy these days, so not really any time to set aside for that sort of thing, but definitely a possibility in the future. There are many people doing this though, and very easy to find the connections you need if interested in doing it.

 

[acslater99]

Just a lowly pre-med here, thanks for doing this.

Do you have any advice for pre-meds interested in ophthalmology? I understand I should be concerned with getting into medical school first but like you said building relationships is important. Is there anything I can do to increase my chances in the future?

Also I’m applying to MD/DO programs, have you seen any bias towards osteopathic medical students trying to get an ophthalmology residency position?

 

[Cuongoff]

I know this has been asked ad nauseam but kinda off topic but would you yourself get lasik?

 

[salmonellaisafish]

would you say fellowship is de-facto required these days to get a job in big cities?

 

[cubsrule4e]

Just a lowly pre-med here, thanks for doing this.

Do you have any advice for pre-meds interested in ophthalmology? I understand I should be concerned with getting into medical school first but like you said building relationships is important. Is there anything I can do to increase my chances in the future?

Also I’m applying to MD/DO programs, have you seen any bias towards osteopathic medical students trying to get an ophthalmology residency position?

Basically just get exposure as early as you can and try to build on it. The majority of your "worthwhile" exposure will come in med school, but it can never hurt to build some relationships even beforehand. The one thing you may be able to do to help bolster your application even as a premed would be to get involved in or at least show some interest in research. May be more difficult though unless you can find the right connections. But showing your interest and devotion to the specialty as early as possible would help, even though a majority of the people accepted dont have any of this experience beforehand. I dont think MD/DO is going to matter nearly as much as your other stats and whole application. As with many things, MD is inherently subconsciously preferred, but once youve gotten through med school in a competitive spot youve already leveled your playing field essentially and the MD/DO comparison will be lower on the list of pertinents.

 

[cubsrule4e]

I know this has been asked ad nauseam but kinda off topic but would you yourself get lasik?

I am very slightly myopic (nearsighted) and dont really need vision correction but I would certainly consider it if I needed it. Just this year one of our associated optometrists had LASIK, and one of my partners will be getting it done in the near future. Here is a helpful article involving some of the myths and hearsay surrounding LASIK.

 

[cubsrule4e]

would you say fellowship is de-facto required these days to get a job in big cities?

Depends on your definition of a big city (I assume youre referring to NYC/DC/SF and the like. To be honest, outside of retina, many specialty trained ophthos are still practicing general but with a concentration in the area of their specialty, or may be carrying out research related to that field. I certainly dont think its required to find A job; if youre looking at a specific job in a certain location that is actually looking for a certain specialty trained physician then obviously that is going to greatly help you. So I guess my answer is, depending on your situation, its not going to hurt you, but in some instances could help you.

 

[tammyp]

Your hours seem amazing, is this pretty typical for new attendings? What were your hours like in residency? Also I'm a first year and interested in ophtho but from the very little I know about it, it seemed like you couldn't really build long term patient relationships in a surgical speciality which was a con for me. Could you go into detail about the type of continuous care you do?

 

[esob]

Do you know or have you heard of any/many non-traditional med students matching to Optho ?

 

[acslater99]

I’ve been having a hard time trying to shadow an ophthalmologist. I’ve cold called offices, left voicemails and even emails. No luck so far.

Do you have any tips? Should I just be persistent and continue to call physician offices?

 

[panda16]

Thanks so much for doing this.

I am supremely interested in ophtho. It's awesome, but something that has provided me some anxiety is that I don't have the best vision myself (corrected to 20/20, with some retina issues). Wasn't sure on your take of someone with "bad vision" entering a "visual field" from the long-term perspective.

 

[Lawpy]

Bump!

What are your thoughts on neuro-ophtho? I saw there are a few different pathways to get there (neuro residency -> neuro-ophtho fellowship or ophtho residency -> neuro-ophtho fellowship). Not too familiar with the process other than ophtho and neuro are linked, and you had mentioned the importance of neuro rotations.

 

[cubsrule4e]

Bump!

What are your thoughts on neuro-ophtho? I saw there are a few different pathways to get there (neuro residency -> neuro-ophtho fellowship or ophtho residency -> neuro-ophtho fellowship). Not too familiar with the process other than ophtho and neuro are linked, and you had mentioned the importance of neuro rotations.

Sorry about missing those earlier posts, I must have had a notifications glitch or something. Ill answer this and get back to the past few I missed tomorrow.

Neuro-ophth is pretty highly specialized and a takes a lot of patience and critical thinking. I think of it as the nephrology of IM. Sometimes people will combine this into a neuro/plastics specialty so they can still do a fair amount of operating. Neuro alone would be good for someone who loves ophtho but doesnt like to operate and/or who like taking lots of time on fewer patients. Its generally considered on the lower end of the pay spectrum. Theres a lot of testing to bill for, but the exam times per patient can run really long so youre really not seeing many patients per day, and is not ideal for the typical surgeon who likes to go go go. The key to taking the neuro rotations is that even as a comprehensive doc you still have to know a lot of this stuff for daily practice and certainly for the boards. Nerve palsies (3rd, 4th, 6th, even 7th) and visual field defects are probably the most common thing youll see day to day neuro related. Most people specializing solely in neuro are going to be found in academics. I really dont know anyone who has gone neurology residency and then specialized in neuro-ophth; Ophtho with a neuro-ophth specialty is probably the way you need to go.

Edit: Another thing to mention, there's not a lot of "treating" you can do in neuro as compared to ophtho in general. A lot of these cases are referrals for people who are already having problems for which no one else could find a diagnosis or cure. This is a turn off to many people who chose ophthalmology because of all the positive impacts you can have on the patients by improving and restoring vision.

 

[cubsrule4e]

Your hours seem amazing, is this pretty typical for new attendings? What were your hours like in residency? Also I'm a first year and interested in ophtho but from the very little I know about it, it seemed like you couldn't really build long term patient relationships in a surgical speciality which was a con for me. Could you go into detail about the type of continuous care you do?

Again, sorry for delayed response, see above re: notifications.

Many ophthalmologists can routinely fit a full weeks worth of work into 4.5 days. This usually includes a full day for surgery and lasers with the rest being clinic. Even coming straight out of residency this is pretty standard. Some people would rather work 5 full days but keep their patient load a little lower so they have more time to spend with each patient. Generally you can set your clinic and surgery hours within reason. I am not a morning person so my clinics start at 9am, with patients starting to arrive at 830. This allows time for the patients to get worked up (vision checked, etc; dont mean getting angry!) and become appropriately dilated so that I at least have a few patients ready to go by the time I get there; thus, my first 2-3 patients of the day are always complete exams as opposed to rechecks or shorter exams. Some of my colleagues have their patients start as early as 7 and anywhere in between. I generally don't take a "lunch break," however there is sufficient time between morning and afternoon clinic to stop for a half hour or so as my technicians and scribe go to lunch (they are staggered so I will have one leave early so they can be back in time for me to start again despite the break being less than an hour). I am now a partner, but my group was very fair from the moment I stepped in the door. I would caution, however, as is seen in any field of medicine, that some practices are going to treat the new additions a bit harsher, have them take extra call, see the patients with lower paying insurance plans, and maybe not have as flexible as a schedule as I did.

In contrast, residency hours are much more taxing (but still not terrible compared to other residencies). So if you can make it through residency as a competent doctor and surgeon, the rest is all downhill. My hours in residency ranged from 730 to anywhere from 430-630 in first year, and 730-430/5 second year. 3rd year is mainly for operating so you generally have to get to the OR around 630-7 on those days, but usually go no later than 430. Call can be brutal as well, taking a week at a time q-however many residents are in your class as primary the first two years (we had 3 residents per year, so I was q6), and as back up as a 3rd year. This obviously varies between programs. 3rd years also have to operate at all hours for certain emergency cases. My call share now is one night a week and roughly one weekend a month, and there is usually an optometrist taking first call in front of me. Im sure this varies widely based on the type and number of employees in a specific practice, but is generally 100% better than residency call.

Ophthalmology is much closer to a primary care role than you would think. If you break a bone or need to have sinus surgery, you will see the orthopedist or ENT for as long as that treatment process dictates and then really have no reason to go back to them. This is true in ophtho for acute things like abrasions, ulcers, styes, etc., but very rarely does a person leave my clinic with a "prn" follow up date. This is because any younger person wearing glasses or contacts or who has any eye-related diagnosis needs a yearly exam at minimum. Anyone over 50 should be getting yearly eye exams regardless of their need for vision correction. All diabetics need a yearly eye exam at minimum which is typically requested by their PCP, and glaucoma patients are seen routinely every 3-6 months basically for life, so continuity of care is plentiful is this field.

As far as the surgery patient aspect, unlike that ortho or ENT doc, even if someone is coming to me strictly for cataract surgery, unless they were referred by a co-managing optometrist (their original "primary" doctor for eye care), they basically become my patient and are seen at least yearly for their routine exam and prn for any problems that may arise. Many of my surgery patients are people that I've already been seeing for years who finally need a surgical intervention for vision improvement. In this case, that doctor-patient relationship has already been established which adds a level of trust and care that is impossible to develop on a first time meeting before surgery.

 

[puahate]

Why not any other surgical subspecialty ? Why Ophth?

 

[cubsrule4e]

Do you know or have you heard of any/many non-traditional med students matching to Optho ?

Absolutely. One of my med school classmates was in her mid 40s with no real medical background prior and matched without a hitch. Its all about what you put into it. That being said, you may be starting a little behind in some peoples' eyes, but that just means you have to put in a little bit more work to meet the current applicant standards. Some PDs may look at your different background as a positive, not a negative, depending on what your circumstances are. Bottom line, being non traditional in and of itself will never disqualify you from any residency.

 

[cubsrule4e]

I’ve been having a hard time trying to shadow an ophthalmologist. I’ve cold called offices, left voicemails and even emails. No luck so far.

Do you have any tips? Should I just be persistent and continue to call physician offices?

Any luck yet? Do you have any physician in any field that you could shadow or know personally? The next step would be to try to network through other physicians you or family/friends know. Its much easier for another physician to make a call to a colleague than it is for you to cold call as a nobody. I see a PCP yearly, but he's called me more times to ask about students shadowing me than I've probably ever seen him for my own health checks. Also, you could contact local optometrists in the area and see if they would be accepting of a shadow. State your intentions and follow them a bit and surely they could find you an ophthalmologist to get started with.

 

[cubsrule4e]

Thanks so much for doing this.

I am supremely interested in ophtho. It's awesome, but something that has provided me some anxiety is that I don't have the best vision myself (corrected to 20/20, with some retina issues). Wasn't sure on your take of someone with "bad vision" entering a "visual field" from the long-term perspective.

If your vision is correctable to 20/20 then you shouldnt have any issues. Dont know what your retina problems are obviously, but unless you have serious depth perception (stereopsis) issues (which I would highly doubt with 20/20 acuity) then I dont think you'd be disadvantaged in any way. The microscope can give people problems when trying to learn surgery but there are even monocular surgeons out there who do just fine. Also, even if you are unable to adapt and learn surgery because of your vision or other reason, you can always still do medical ophtho which still can include lasers and minor procedures.

 

[Ninefingers]

How many of your patients have diabetes/come in due to diabetes complications?

 

[esob]

Absolutely. One of my med school classmates was in her mid 40s with no real medical background prior and matched without a hitch. Its all about what you put into it. That being said, you may be starting a little behind in some peoples' eyes, but that just means you have to put in a little bit more work to meet the current applicant standards. Some PDs may look at your different background as a positive, not a negative, depending on what your circumstances are. Bottom line, being non traditional in and of itself will never disqualify you from any residency.

Thanks, my background was first in medicine in the military, and then later in tech (mostly computer hardware/software). I had Lasik and it was one of those big game changers for me. I know that's not all Ophthalmology does, but, like Anesthesia, it is one of those fields I have had personal good experiences with and so I am naturally curious about it and wanted to know if it would be worth my time to investigate further or if being an older non-trad was going to be a barrier to the field.

 

[cubsrule4e]

Thanks, my background was first in medicine in the military, and then later in tech (mostly computer hardware/software). I had Lasik and it was one of those big game changers for me. I know that's not all Ophthalmology does, but, like Anesthesia, it is one of those fields I have had personal good experiences with and so I am naturally curious about it and wanted to know if it would be worth my time to investigate further or if being an older non-trad was going to be a barrier to the field.

Military will usually always be a positive on your resume as a non trad and the fact that you have medical experience won’t hurt either.

 

[tammyp]

Again, sorry for delayed response, see above re: notifications.

Many ophthalmologists can routinely fit a full weeks worth of work into 4.5 days. This usually includes a full day for surgery and lasers with the rest being clinic. Even coming straight out of residency this is pretty standard. Some people would rather work 5 full days but keep their patient load a little lower so they have more time to spend with each patient. Generally you can set your clinic and surgery hours within reason. I am not a morning person so my clinics start at 9am, with patients starting to arrive at 830. This allows time for the patients to get worked up (vision checked, etc; dont mean getting angry!) and become appropriately dilated so that I at least have a few patients ready to go by the time I get there; thus, my first 2-3 patients of the day are always complete exams as opposed to rechecks or shorter exams. Some of my colleagues have their patients start as early as 7 and anywhere in between. I generally don't take a "lunch break," however there is sufficient time between morning and afternoon clinic to stop for a half hour or so as my technicians and scribe go to lunch (they are staggered so I will have one leave early so they can be back in time for me to start again despite the break being less than an hour). I am now a partner, but my group was very fair from the moment I stepped in the door. I would caution, however, as is seen in any field of medicine, that some practices are going to treat the new additions a bit harsher, have them take extra call, see the patients with lower paying insurance plans, and maybe not have as flexible as a schedule as I did.

In contrast, residency hours are much more taxing (but still not terrible compared to other residencies). So if you can make it through residency as a competent doctor and surgeon, the rest is all downhill. My hours in residency ranged from 730 to anywhere from 430-630 in first year, and 730-430/5 second year. 3rd year is mainly for operating so you generally have to get to the OR around 630-7 on those days, but usually go no later than 430. Call can be brutal as well, taking a week at a time q-however many residents are in your class as primary the first two years (we had 3 residents per year, so I was q6), and as back up as a 3rd year. This obviously varies between programs. 3rd years also have to operate at all hours for certain emergency cases. My call share now is one night a week and roughly one weekend a month, and there is usually an optometrist taking first call in front of me. Im sure this varies widely based on the type and number of employees in a specific practice, but is generally 100% better than residency call.

Ophthalmology is much closer to a primary care role than you would think. If you break a bone or need to have sinus surgery, you will see the orthopedist or ENT for as long as that treatment process dictates and then really have no reason to go back to them. This is true in ophtho for acute things like abrasions, ulcers, styes, etc., but very rarely does a person leave my clinic with a "prn" follow up date. This is because any younger person wearing glasses or contacts or who has any eye-related diagnosis needs a yearly exam at minimum. Anyone over 50 should be getting yearly eye exams regardless of their need for vision correction. All diabetics need a yearly eye exam at minimum which is typically requested by their PCP, and glaucoma patients are seen routinely every 3-6 months basically for life, so continuity of care is plentiful is this field.

As far as the surgery patient aspect, unlike that ortho or ENT doc, even if someone is coming to me strictly for cataract surgery, unless they were referred by a co-managing optometrist (their original "primary" doctor for eye care), they basically become my patient and are seen at least yearly for their routine exam and prn for any problems that may arise. Many of my surgery patients are people that I've already been seeing for years who finally need a surgical intervention for vision improvement. In this case, that doctor-patient relationship has already been established which adds a level of trust and care that is impossible to develop on a first time meeting before surgery.

Thank you so much for this detailed response! I was able to shadow last month and found the clinical aspects really interesting. I also was able to use a slit lamp and see the RBCs moving in the vessels in the eye and it was the coolest thing I had ever seen. I'm excited to keep learning more about it!

 

[cubsrule4e]

Why not any other surgical subspecialty ? Why Ophth?

I was originally gung-ho orthopedics until I finally got into med school and was able to get much more involved, and I realized I didnt like being in the OR for 1-4 hours at a time, nor did I enjoy getting paged at 2am to go in and operate. I'd much prefer doing 20 five-minute surgeries over and over than I would doing a couple of 2-3 hours cases per day and/or in the middle of the night. The specialty also contains numerous other minor procedures I could do in clinic to break up the monotony. I also was attracted to the continuity of care aspect (see earlier post from today) which is pretty unique for a surgical subspecialty.

 

[cubsrule4e]

Thank you so much for this detailed response! I was able to shadow last month and found the clinical aspects really interesting. I also was able to use a slit lamp and see the RBCs moving in the vessels in the eye and it was the coolest thing I had ever seen. I'm excited to keep learning more about it!

Isnt it?? Once I was able to use the indirect (head lamp) to see the fundus (back of the eye), thats the moment I became totally hooked and committed myself to ophtho!

 

[Matthew9Thirtyfive]

I'd much prefer doing 20 five-minute surgeries over and over than I would doing a couple of 2-3 hours cases per day and/or in the middle of the night.

That’s how I feel as well. I love doing procedures, but I like them short and technical. My only exposure to ophtho cases was cataracts in the OR. Those seemed to take about 6-8 mins. What’s the range on procedure time? Like how long is your longest procedure and how often do you do it?

Oh, also: when you start to get older and not feel super comfortable handling sharp things near people’s eyes anymore, can you switch to non-surgical ophtho and still make okay money? Like I know you’ll make less, but can you keep the doors open with that? I’m guessing having a partner to refer the surgical stuff to makes it easier.

 

[cubsrule4e]

That’s how I feel as well. I love doing procedures, but I like them short and technical. My only exposure to ophtho cases was cataracts in the OR. Those seemed to take about 6-8 mins. What’s the range on procedure time? Like how long is your longest procedure and how often do you do it?

Oh, also: when you start to get older and not feel super comfortable handling sharp things near people’s eyes anymore, can you switch to non-surgical ophtho and still make okay money? Like I know you’ll make less, but can you keep the doors open with that? I’m guessing having a partner to refer the surgical stuff to makes it easier.

In residency starting out a cataract could take a half hour. Highly refined surgeons range from 4-10 minutes I’d say. I go about 5-6 minutes for a standard case. Adding in a combination glaucoma procedure will add another 5 minutes or so. About 10-20% of my case load will involve a combo case like this with a cataract plus MIGS procedure.

Our oldest doctor only does 1-2 cases a week and only does lid procedures which don’t require quite as much precision as the intraocular procedures. You can also continue to do a ton of lasers and in office procedures. Your take home will surely drop but if you’re still doing plenty of clinic you won’t be in bad shape by any means. And yes, having partners for in house cataract referral is key here.

 

[Matthew9Thirtyfive]

In residency starting out a cataract could take a half hour. Highly refined surgeons range from 4-10 minutes I’d say. I go about 5-6 minutes for a standard case. Adding in a combination glaucoma procedure will add another 5 minutes or so. About 10-20% of my case load will involve a combo case like this with a cataract plus MIGS procedure.

Our oldest doctor only does 1-2 cases a week and only does lid procedures which don’t require quite as much precision as the intraocular procedures. You can also continue to do a ton of lasers and in office procedures. Your take home will surely drop but if you’re still doing plenty of clinic you won’t be in bad shape by any means. And yes, having partners for in house cataract referral is key here.

Sweet thanks.

 

[acslater99]

Any luck yet? Do you have any physician in any field that you could shadow or know personally? The next step would be to try to network through other physicians you or family/friends know. Its much easier for another physician to make a call to a colleague than it is for you to cold call as a nobody. I see a PCP yearly, but he's called me more times to ask about students shadowing me than I've probably ever seen him for my own health checks. Also, you could contact local optometrists in the area and see if they would be accepting of a shadow. State your intentions and follow them a bit and surely they could find you an ophthalmologist to get started with.

Hey, so I'm not sure if you can call it luck but I did manage to get in contact with one of the ophthalmologist's secretary before the new year started. She told me that he said I wasn't able to shadow him yet due to his schedule being full with students shadowing. She told me to contact him later to set up session.

I'm looking to start in March during spring break. Hopefully I get the opportunity! Thanks

 

[Psai]

In residency starting out a cataract could take a half hour. Highly refined surgeons range from 4-10 minutes I’d say. I go about 5-6 minutes for a standard case. Adding in a combination glaucoma procedure will add another 5 minutes or so. About 10-20% of my case load will involve a combo case like this with a cataract plus MIGS procedure.

Our oldest doctor only does 1-2 cases a week and only does lid procedures which don’t require quite as much precision as the intraocular procedures. You can also continue to do a ton of lasers and in office procedures. Your take home will surely drop but if you’re still doing plenty of clinic you won’t be in bad shape by any means. And yes, having partners for in house cataract referral is key here.

????
Ours take 2 hours?

 

[Matthew9Thirtyfive]

????
Ours take 2 hours?

What takes 2 hours? A cataract?

 

[nimbus]

I’ve worked with a large number of cataract surgeons. 5-6min is the faster end. 10-12 min is typical. A few outliers average 45-60min even with decades of experience.

 

[cubsrule4e]

????
Ours take 2 hours?

Well I was going with minimums. My first few cases were closer to 45 minutes, and if you've got a complication then you're looking at switching out the bottle multiple times.

 

[cubsrule4e]

I’ve worked with a large number of cataract surgeons. 5-6min is the faster end. 10-12 min is typical. A few outliers average 45-60min even with decades of experience.

Again, quoting more mainstream/high volume which is what I'm involved in. Experienced cataract surgeons who still take 40 minutes for a cataract surgery are usually called glaucoma specialists

 

[cubsrule4e]

Hey, so I'm not sure if you can call it luck but I did manage to get in contact with one of the ophthalmologist's secretary before the new year started. She told me that he said I wasn't able to shadow him yet due to his schedule being full with students shadowing. She told me to contact him later to set up session.

I'm looking to start in March during spring break. Hopefully I get the opportunity! Thanks

Thats awesome! I wouldnt just stop there though. Like I said, you could even try the local optometrists. You wont see any surgeries there but a solid base to build some basic knowledge and experience clinic flow, testing, etc.

 

[acslater99]

Thats awesome! I wouldnt just stop there though. Like I said, you could even try the local optometrists. You wont see any surgeries there but a solid base to build some basic knowledge and experience clinic flow, testing, etc.

Will do! Even though I’m shadowing optometrists, do you think I can add that towards my AMCAS application? Or should I just use them as a gateway to get shadowing opportunities with an ophthalmologist as you stated?

 

[spartan25]

This has been discussed a lot elsewhere in this forum, but what are your thoughts on the growing popularity of private equity takeover in ophthalmology? Do you foresee any major reversal in this trend in the next 5-10 years?

 

[cubsrule4e]

Will do! Even though I’m shadowing optometrists, do you think I can add that towards my AMCAS application? Or should I just use them as a gateway to get shadowing opportunities with an ophthalmologist as you stated?

Absolutely include that! Despite what politics will tell you, ODs and OMDs are symbiotic. For a majority of practices that include ODs, they dont want anything to do with surgery and happily refer internally to the surgeons. Even most stand alone ODs have an MD practice they co-manage with. There are definitely ODs who want to do it all and are the spearheads for legislative bills, etc to gain more rights but this is definitely not the norm. So even shadowing an OD when you "didnt have any OMD opportunities" shows you were still doing what you could to get involved.

 

[Matthew9Thirtyfive]

There are definitely ODs who want to do it all and are the spearheads for legislative bills,

Does this concern you? Sort of like the mid-level encroachment in other fields?