Thanks for doing this!
1) Can you comment on job saturation in medium sized cities? Do you live in a big or small city?
2) What % of people in private practice end up becoming partners? Any stories of predatory docs just churning out associates?
3) What are the biggest downsides to the field?
4) How often do eye surgery complications occur due to surgery? How do you emotionally deal with bad outcomes?
5) To what degree do you attribute your salary to being business-savvy?
1) I am in Baton Rouge which is around 250K with a metro area of about 750K, so im not sure where your standards fall, but id consider that a medium sized city, with large being closer to the million+ range. There were no issues getting a job here, and there were several options that I ultimately had to choose from. Starting up a practice would be quite an uphill battle, with the larger established practices continuing to grow and expand. Going to the surrounding areas, like where my satellite clinic is, would be much more feasible as a start up location.
2) I honestly couldnt tell you that number, but that should definitely be on the table for whatever practice you decide to join. I have not heard those horror stories from anyone personally, and my practice treated me quite fairly, so that may be happening in the more saturated larger cutthroat areas where the older partners can get away with doing that because the prospective employees have less options and less bargaining ability.
3) Biggest downsides I may have mentioned previously, but other than paperwork and litigation (not specialty specific) its probably just dealing with certain patients. Ophtho has become a specialty that not only provides healthcare but lifestyle enhancement through specialized implants that people are paying a ton of money for. On the one hand its great, youre making more, and youre giving the patient unbelievable vision, but there are always going to be unhappy patients who are 20/20 and reading without glasses just because thats who they are. This kind of person can ruin your whole day in just a few minutes. Fortunately they are the minority. The other obvious downside being the encroachment of optometrists. I have commented in thread before that this is certainly something to consider and fight against, but I also dont think its as dire a situation as others who have also provided their opinion in this thread.
4) Complications are unfortunately a part of surgery, and will occur much more earlier in your career, and steadily decrease as you gain experience. The complication rate also depends on the difficulty of the cases you are performing. I do many more difficult cases like mature cataracts due to my satellite patient population than many people who do all "California cataracts" so my complication rate is going to be slightly higher. I used to be devastated when I had to send a patient to retina after a dropped nucleus but they can still turn out just fine - that is also something that comes with experience and learning the process of how to manage that patient. Other smaller complications like a tear in the capsule and anterior vitrectomy happen but become pretty routine to handle with enough experience and I dont worry about those at all anymore. Retrobulbar hemorrhage is another complication that can be devastating but this is pretty rare as surgery moves away from retrobulbar blocks and more towards all topical anesthesia.
5). I would not consider myself business-savvy at all, but this is where the partnership opportunity is a must. As long as youve got someone within the practice who IS business savvy, whether thats the doctors or the administrator, youre still going to reap the benefits once you reach partner status, which is really the key to the whole thing from the business/income end. Certainly though, the more you know, the better of you can probably make things if youre interested in being involved in those decisions.
