Ophthalmology Attending - AMA

[cubsrule4e]

How far into seniority can ophthalmologists practice? Do you think the senior ophthalmologist can transition to a mostly medical practice in their later years (65+)? At what age do most retire?

As long as you want. Fortunately I have the perfect example for you. The two senior doctors at my practice - 72 and 69. 72 does basically 1 lid surgery a week, and about 3 days of clinic. 69 is transitioning to basically only cataract and lasik evaluations in their clinic, and then doing the surgeries. And both of them will probably go at least another 5 years, with the 69 year old transitioning to LASIK only in the next 2-3 years. So 72 and still bringing in the income to buy a new car each month. Not too shabby.

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[Eye-eye]

As stated above, rheumatoid arthritis is probably the most common systemic non eye based disease that I deal with outside of diabetes. Chronic uveitis, uveitic cataract, scleritis/episcleritis that is in any way recalcitrant, pars planitis, retinal vasculitis - all automatic blood work for autoimmune conditions. Thats one of the great things that I really do enjoy about what I do. Someone may have been having problems for years because of an underlying autoimmune condition, whatever the symptoms (GI, neuro, MSK) and everyone treated acutely and hoped it would go away or punted to the other team. Then they present to me with an eye issue and its a fairly obvious situation, get them properly assessed, and referred to the appropriate specialist and all of the sudden things get much better for them. This is fairly routine. I would say 1-2 cases a month (which doesnt sound like a lot, but when your purpose is 99% vision/cataract/glaucoma/LASIK and then realize this patient had to come to the eye doctor to get their Crohn's disease diagnosed, its a very significant number).

Thank you for the info! Follow-up question: how does this apply for retina docs? Most of the systemic manifestations of multisystem disease that I'm thinking of are more anterior, but I know there are some that affect the retina more (excluding run of the mill things like HTN and DM that effect retinal vasculature as they do elsewhere); I'm curious how much they get to solve those multisystem mysteries patients have been having for years.

 

[cubsrule4e]

Thank you for the info! Follow-up question: how does this apply for retina docs? Most of the systemic manifestations of multisystem disease that I'm thinking of are more anterior, but I know there are some that affect the retina more (excluding run of the mill things like HTN and DM that effect retinal vasculature as they do elsewhere); I'm curious how much they get to solve those multisystem mysteries patients have been having for years.

Honestly, retina will handle a lot of the complex uveitis cases if general doesnt want to/cant quite figure out whats going on. There are a number of cases each year where I've treated what seemed to be a straightforward diagnosis only to find out what I was doing wasnt working and sent them to my retina friends. Its particularly helpful for me because when they end up needing an MRI they have better connections with the hospitals and can set up imaging way faster than I can (not sure if this is common or just specific to my area). Other times I'll just call them up and talk over the phone about a presentation that makes no sense whatsoever to me, send them over, and they pick up on the smallest of findings in the retina that I wasnt able to that will pinpoint an uncommon diagnosis.

 

[deleted600623]

So I've spent the greater part of 2 years working as a scribe for a general ophthalmologist and the only thing that has kept me from really considering the specialty is the fact that the attending I work for does all of her annuals which includes refractions and glasses/contacts management. This may be a consequence of us working in a very rural area (<20,000) so it may be significantly different than a bigger city. Or honestly it could just be a choice of theirs, which is fine too. Do you have any colleagues like this or are they strictly managing chronic medical issues like DM, retinopathy, ARMD, glaucoma etc. Also, from a business standpoint, how do you manage the costs of providing care to patients who need regular injections, particularly those who are on the more expensive drugs like Eylea and Lucentis?

 

[cubsrule4e]

So I've spent the greater part of 2 years working as a scribe for a general ophthalmologist and the only thing that has kept me from really considering the specialty is the fact that the attending I work for does all of her annuals which includes refractions and glasses/contacts management. This may be a consequence of us working in a very rural area (<20,000) so it may be significantly different than a bigger city. Or honestly it could just be a choice of theirs, which is fine too. Do you have any colleagues like this or are they strictly managing chronic medical issues like DM, retinopathy, ARMD, glaucoma etc. Also, from a business standpoint, how do you manage the costs of providing care to patients who need regular injections, particularly those who are on the more expensive drugs like Eylea and Lucentis?

@Lawper, we must fix this thread notification issue lol

Yes around here I'd say that's pretty uncommon. Even the solo doctors usually have an optometrist working with them to handle all of the refractions, and particularly contact lenses, but one could certainly do that if they wanted to. You would need to make sure you are signed up with the majority of vision plans in addition to medical in order to do this, or you'd be costing the patient way too much for a simple glasses check and theyd probably go elsewhere. In a multi-MD, multi-OD set up like I'm in, all refraction-only and contact lens appointments are made with the optometrists. I do medical annuals and give out glasses prescriptions all day every day, but the refractions are done by the technicians so I dont even fool with that unless I want to personally recheck it, or if there's a big change/something not adding up.

As to intravitreal injections, I cant speak much to that because I refer these cases out to local retina specialists. In rural areas many general ophthos will do this however, due to the lack of specialist availability and for increased revenue. Try the Ophtho thread in the subspecialties forum for an answer to this as there are several retina specialists who post in there.

 

[Lawpy]

@cubsrule4e bump!

So i recently came across a possible intersection of nsgy and ophtho. What are your thoughts on intra-arterial chemotherapy for retinoblastoma? Apparently this offers promising results compared to usual chemo or radiation or surgical eye removal but not sure if its commonly used?

 

[cubsrule4e]

@cubsrule4e bump!

So i recently came across a possible intersection of nsgy and ophtho. What are your thoughts on intra-arterial chemotherapy for retinoblastoma? Apparently this offers promising results compared to usual chemo or radiation or surgical eye removal but not sure if its commonly used?

Definitely still gaining popularity (its actually been performed for quite a while now, but the procedure itself and more direct delivery ability to the site of tumor has been what is advancing and making it more useful) and being performed more and more so that more data is available for evaluation. Id have to find some in depth articles to get specific stats but the gist is this:

The biggest advantage is that for early stage RB, it can be used as a primary first line treatment negating the need for systemic chemo/radiation which significantly increases the chances for formation of other tumors like osteosarcoma. If you have the defective RB gene from both parents, and get bilateral or trilateral RB, youre going to get other systemic tumors forming anyway and need systemic chemo, but it has shown to delay the onset of them.

For advanced cases and cases with vitreous seeding and local infiltration, youre likely still going to need chemoreduction/radiation but adding IAC has at least allowed for many more eyes to be salvaged and not require enucleation (keeping anatomy and appearance more normal despite the vision loss, less surgery/pain for the patient, preventing child psych issues due the aforementioned, etc).

Also, the side effect profile is very low, which is something you always look for in any kind of developing treatment.

 

[Matthew9Thirtyfive]

I just want to say that I did a successful fundoscopic exam and could see the optic disc and everything. I'm basically an ophthalmologist.

 

[cubsrule4e]

I just want to say that I did a successful fundoscopic exam and could see the optic disc and everything. I'm basically an ophthalmologist.

Direct (handheld magnifier) or indirect (headlamp while holding the magnifying lens) method? The first time I saw the fundus with the indirect was the moment I got hooked and decided I was going to do ophtho. Incidentally, it happened to be a patient who had an intraocular lymphoma and I could actually see the whitish-yellow lesion in a sea of surrounding orange normal retina. So fascinating!! You are well on your way!

 

[DrRedstone]

I just want to say that I did a successful fundoscopic exam and could see the optic disc and everything. I'm basically an ophthalmologist.

The first time I saw the it on slit lamp, I had to stare at it for a while before I realized that I was actually looking at the retina. Then I kicked myself for not realizing how easy it was. I just hadn't pulled back far enough.

 

[Matthew9Thirtyfive]

Direct (handheld magnifier) or indirect (headlamp while holding the magnifying lens) method? The first time I saw the fundus with the indirect was the moment I got hooked and decided I was going to do ophtho. Incidentally, it happened to be a patient who had an intraocular lymphoma and I could actually see the whitish-yellow lesion in a sea of surrounding orange normal retina. So fascinating!! You are well on your way!

It was direct. I had to focus a little to see it but as soon as it came into focus I could see everything. I was like woo hoo! My preceptor laughed haha.

The first time I saw the it on slit lamp, I had to stare at it for a while before I realized that I was actually looking at the retina. Then I kicked myself for not realizing how easy it was. I just hadn't pulled back far enough.

Yeah the first time I tried it, I could see the retina but I couldn’t make anything out. I hadn’t focused haha.

 

[Eye-eye]

Yeah the first time I tried it, I could see the retina but I couldn’t make anything out. I hadn’t focused haha.

You must try indirect again in focus. It's absolutely gorgeous.

 

[Matthew9Thirtyfive]

You must try indirect again in focus. It's absolutely gorgeous.

I haven’t done indirect yet. Only direct. It was super cool looking when I figured out how to do it. I want to try indirect now but I’ll probably have to go shadow an ophtho or do a rotation.

 

[Piglet2020]

Hello! I’m a MS2 at a upper/mid tier med school interested in ophtho. I worked in a few optometry places in college and dabbled a bit in eye health & research since then. However, I’m not the brightest student in my class. I’ve been getting B’s throughout my first yr and may end up with a C in a class this year (really bummed about that).

We dont have a huge support network for people interested in ophtho here, unfortunately. My question is can a mediocre student have any chance in ophtho? I’m just worried because I’m not at the top of my class (or anywhere near it). I plan to study hard for Step.

I think it would be a shame if I let go of my passion for eye health, but I understand if I’m not a good enough candidate.

Just wondering what are your thoughts - can a mediocre student end up in an ophtho residency (maybe in rural rural areas)?

Thanks.

 

[cubsrule4e]

Hello! I’m a MS2 at a upper/mid tier med school interested in ophtho. I worked in a few optometry places in college and dabbled a bit in eye health & research since then. However, I’m not the brightest student in my class. I’ve been getting B’s throughout my first yr and may end up with a C in a class this year (really bummed about that).

We dont have a huge support network for people interested in ophtho here, unfortunately. My question is can a mediocre student have any chance in ophtho? I’m just worried because I’m not at the top of my class (or anywhere near it). I plan to study hard for Step.

I think it would be a shame if I let go of my passion for eye health, but I understand if I’m not a good enough candidate.

Just wondering what are your thoughts - can a mediocre student end up in an ophtho residency (maybe in rural rural areas)?

Thanks.

Step 1 will be the great equalizer for you then. I was on the other end of the spectrum with high class rank, good grades (although not nearly all honors), but a just-above-average step 1 which got me by all the cutoffs - which is basically what your goal is. This actually could favor you, because the biggest screening tool for the thousands of apps is the Step score, not clinical grades unless youve just failed everything. And once youre granted an interview, anything can happen, and your history of clinical and research experience will help as well, but its not going to ensure you land a spot either. The poor support network sounds like a killer here as well because another thing you need is going to be a superb letter of rec, preferably by someone who has worked with you closely. If theres not much at your school then youre going to have to be pro-active and get into the community to find a mentor for more clinical and (hopefully) research experience. If you could manage to find some way to get heavier into research and get a good number of publications, this would also help offset an otherwise mediocre application.

So I would take it one Step (haha i crack myself up) at a time, and get a great score, do your best in class and then reevaluate once you hit third year. Nothing is ever impossible, but you are going to be on an uphill climb and will have to show you really want it.

 

[Ozilcr7]

@cubsrule4e

Hey Doc,
Looking for some advice, I've applied via SF match this year, step 1/2 scores are 244+, but didn't get as much ophthalmology exposure I had hoped for d/t lack of in-patient service at my home institution and scheduling issues. I have 3rd/4th author pubs in neuro and other fields, none in ophtho. How adversely should I anticipate this affecting my chances?

P.S. Thanks for doing this, I really appreciate you taking the time to provide honest insight as someone on the other side.

 

[Ms Procrastinator]

@cubsrule4e

So ophthalmology has never been one of the specialties that were on the table for me but it was also never one of the specialties that were completely off the table for me either. It was just simply never given much thought. This thread, along with a few ophthalmologists on social media, has given me a little more insight into the specialty but I still have a few questions.

today I did 22 cataracts

Does it ever feel repetitive to you? Do you ever get tired of doing the same procedures over and over? You mentioned that you weren't a fan of long hours in the OR so ophthalmology was a great choice for you. What's the longest procedure you've ever done?

The eye is a very small organ. How much do the procedures that you do vary? What kind of procedures do you do as a general ophthalmologist? I know you do a ton of cataract, glaucoma, and laser eye surgeries. Are there other procedures (might be a stupid question but I'm hella ignorant).

Do your patients ever freak out on you? Sure they're given local anesthetics but they can still see you do everything to them? Has a patient ever freaked out so bad during surgery that you had to stop to calm them down or something? I know that eye clamp thing prevents patients from closing their eyes, does it prevent them from moving their eyeballs too?

Does your clinic have a way of vetting patients before you see them or can anyone just walk in with random eye complaints? How often do you have to hand your patients over to other eye specialists (like retina), other specialties (like say neurosurgery), or simply say there's nothing that can be done? I know someone who was told that their daughter wasn't a candidate for surgery for her eye condition. Don't really know why though.

 

[cubsrule4e]

@cubsrule4e

Hey Doc,
Looking for some advice, I've applied via SF match this year, step 1/2 scores are 244+, but didn't get as much ophthalmology exposure I had hoped for d/t lack of in-patient service at my home institution and scheduling issues. I have 3rd/4th author pubs in neuro and other fields, none in ophtho. How adversely should I anticipate this affecting my chances?

P.S. Thanks for doing this, I really appreciate you taking the time to provide honest insight as someone on the other side.

Your scores will certainly get you in the door at least. How little ophtho exposure are we talking? Have you been able to set up any away electives? Thats usually a big key in getting more exposure and proving your interest, even if you may not have a chance at or interest in those particular schools. Having other research helps (I had a small amount in ortho, and a small amount in ophtho), but you will be asked about why it isnt at least integrated with an ophtho topic. Some people just decide late and I doubt it will "Hurt" you, but it may not help you either. Explaining that you had limited home program exposure is valid, but be prepared to answer: Why didnt you look for some exposure in the community? Why didnt you do any away rotations? Im not sure what you mean by scheduling issues, but if those arent valid in the interviewers' eyes you will be asked/told: if this residency is truly what you want, why didnt you find some way to make that happen, as experience in the clinic and OR is the backbone to understanding what youre truly getting into (and honestly, even then, you wont really know until youre doing it as a resident). The lack of away rotations and not being able to work with ophtho faculty and residents will hurt you. Where is your ophtho LOR coming from?

 

[cubsrule4e]

@cubsrule4e

So ophthalmology has never been one of the specialties that were on the table for me but it was also never one of the specialties that were completely off the table for me either. It was just simply never given much thought. This thread, along with a few ophthalmologists on social media, has given me a little more insight into the specialty but I still have a few questions.



Does it ever feel repetitive to you? Do you ever get tired of doing the same procedures over and over? You mentioned that you weren't a fan of long hours in the OR so ophthalmology was a great choice for you. What's the longest procedure you've ever done?

The eye is a very small organ. How much do the procedures that you do vary? What kind of procedures do you do as a general ophthalmologist? I know you do a ton of cataract, glaucoma, and laser eye surgeries. Are there other procedures (might be a stupid question but I'm hella ignorant).

Do your patients ever freak out on you? Sure they're given local anesthetics but they can still see you do everything to them? Has a patient ever freaked out so bad during surgery that you had to stop to calm them down or something? I know that eye clamp thing prevents patients from closing their eyes, does it prevent them from moving their eyeballs too?

Does your clinic have a way of vetting patients before you see them or can anyone just walk in with random eye complaints? How often do you have to hand your patients over to other eye specialists (like retina), other specialties (like say neurosurgery), or simply say there's nothing that can be done? I know someone who was told that their daughter wasn't a candidate for surgery for her eye condition. Don't really know why though.

Certainly some days fell repetitive, but we all have times we get in a rut. Honestly, the work itself doesnt ever bore me, just certain patients, or a string of seeing the same exact same thing all day that I dont really love to deal with (ie - dry eye). As far as procedures go, its quite the opposite. Every single cataract surgery is different in some little way. Whether its the type of cataract, patient anatomy, uncooperative patient, complex cataract, complication (certainly not wanted or fun, but definitely happens and its something different you have to deal with), every case makes you feel more and more like youre gaining skills and experience and getting closer to becoming the "best" you can be.

I started out doing a fair number of tube shunts out of residency for lack of cataract numbers, which took me about 45 minutes. Once my cataract numbers picked up I stopped doing them, and now with MIGS (minimally invasive glaucoma procedures), there is a multitude of options for glaucoma you can do without having to go towards a shunt right away. If those procedures fail I will refer to my partner to do a tube shunt. Currently my uncomplicated cataract cases take anywhere from 4-8 minutes, if its a combo procedure with MIGS youre looking at maybe 8-10 minutes on average.

Other procedures I do include LASIK, growth/cyst removal (most can be done in clinic, some require OR, YAG and SLT lasers, chalazion I&D/Kenalog injections.

All my OR procedures are done with topical anesthesia, but most all with also get a little IV sedative to relax them. They cant see anything Im doing as their face in draped, and the exposed eye is staring straight into the microscope light. There are definitely some that are very uncooperative, sometimes the anesthesia makes them worse because they arent fully with it and will start to move around a lot and will have to have nurses help hold them still. The speculum holds their lids open but doesnt touch the eye. The eye itself is under my control once I have instruments inside.

Anyone can walk in and be seen basically, and theres a call center that will "triage" basically and refer them to whichever doctor and schedule them an appointment depending on urgency.

Retinal referrals are a daily occurrence, strabismus (eye turning) and neuro are a good bit less common, but still happen a few times a month for me. What kind of surgery for that person? LASIK? There are definitely people who are not good candidates for that, but typically there are other solutions like an ICL (intraocular contact lens) or CLE (clear lens exchange - taking out the lens before it becomes a cataract and implanting an IOL in order to fix high amounts of refractive error).

 

[Ms Procrastinator]

growth/cyst removal

Cool (not for the patient of course)

All my OR procedures are done with topical anesthesia, but most all with also get a little IV sedative to relax them. They can see anything Im doing as their face in draped, and the exposed eye is staring straight into the microscope light. There are definitely some that are very uncooperative, sometimes the anesthesia makes them worse because they arent fully with it and will start to move around a lot and will have to have nurses help hold them still. The speculum holds their lids open but doesnt touch the eye. The eye itself is under my control once I have instruments inside.

That must suck sometimes

What kind of surgery for that person? LASIK? There are definitely people who are not good candidates for that, but typically there are other solutions like an ICL (intraocular contact lens) or CLE (clear lens exchange - taking out the lens before it becomes a cataract and implanting an IOL in order to fix high amounts of refractive error).

She's a toddler. She was less than a year around (6 months) when her parents took her to see an ophthalmologist for her strabismus. I'm not a neurologist or an ophthalmologist but I think that the reason she may not be a candidate is probably because it was caused by drugs that bio mom took during pregnancy and that's more neurological . Might edit this later.

 

[cubsrule4e]

Cool (not for the patient of course)



That must suck sometimes



She's a toddler. She was less than a year around (6 months) when her parents took her to see an ophthalmologist for her strabismus. I'm not a neurologist or an ophthalmologist but I think that the reason she may not be a candidate is probably because it was caused by drugs that bio mom took during pregnancy and that's more neurological . Might edit this later.

I meant they CANT see anything Im doing to them in previous post lol. Edited for clarity.

 

[cubsrule4e]

She's a toddler. She was less than a year around (6 months) when her parents took her to see an ophthalmologist for her strabismus. I'm not a neurologist or an ophthalmologist but I think that the reason she may not be a candidate is probably because it was caused by drugs that bio mom took during pregnancy and that's more neurological . Might edit this later.

Yeah, if someone has a severe misalignment and/or a bad nystagmus (involuntary eye movements back and forth or wandering around) that could actually be damage to the optic nerves which there is no treatment for, so would be pointless to do any surgery at that time.

 

[Ms Procrastinator]

I meant they CANT see anything Im doing to them in previous post lol. Edited for clarity.

Lol every time I think about laser eye surgery I think about that scene from final destination . Have patients ever brought up that scene to you? It's the one where the ophthalmologist leaves the patient on the table and the laser ends up taking her eye ball out. I would definitely bring that scene up to my optho as I get prepped

 

[cubsrule4e]

Lol every time I think about laser eye surgery I think about that scene from final destination . Have patients ever brought up that scene to you? It's the one where the ophthalmologist leaves the patient on the table and the laser ends up taking her eye ball out. I would definitely bring that scene up to my optho as I get prepped

Actually havent heard that one before. I think some of them are too nervous to joke about it lol. Then again they do get an oral sedative to take the edge off so theyre usually pretty chill when they get there for the procedure.

 

[Cornfed101]

I am a non-certified ophthalmic tech (not required in my state to do the work). Does this provide any advantage during residency apps, or is it fairly common?

Also, on a related note to the last post. There was a patient the other day that rubbed his eyes really hard as soon as he stood up from LASIK, and then he didn't show up for his 1-day post-op

 

[cubsrule4e]

Im sure it would definitely give you an "advantage" to have the experience and be able to communicate maybe on a little higher level if you truly have a broader/more in depth knowledge base, but like everything its not going to get you in just by itself. I know in clinic I definitely appreciate the techs that are knowledgeable and are wanting to learn more - so where this will help most is probably on away rotations where you can contribute a lot more than a less experienced applicant. Dont be a gunner about it, mention your prior experience maybe at the beginning, and then let them know you are there to help in any way. They will figure out your experience level whether in clinic or socially, even if you start out doing the most basic and menial of things and then start asking you to do more, no need to try to showcase it.

@Lawper Is it just this forum that my tags are broken in???

 

[cubsrule4e]

Anyone know any video editing programs? Got some surgery vids to share but Id like to crop the beginning and end and add in a voiceover to explain whats going on.

@Lawper @Ms Procrastinator

 

[dodolol21]

Anyone know any video editing programs? Got some surgery vids to share but Id like to crap the beginning and end and add in a voiceover to explain whats going on.

@Lawper @Ms Procrastinator

are you using Mac or Windows?

 

[cubsrule4e]

are you using Mac or Windows?

Windows. Think I found one through one of my technicians. Will look to post some vids soon.

 

[Ms Procrastinator]

Anyone know any video editing programs? Got some surgery vids to share but Id like to crop the beginning and end and add in a voiceover to explain whats going on.

@Lawper @Ms Procrastinator

Oho oho! @Lawper do you approve and am I doing it right?!

 

[cubsrule4e]

Oho oho! @Lawper do you approve and am I doing it right?!

Actually I think the tags to @Lawper are the ones that are broken lol

 

[Matthew9Thirtyfive]

Anyone know any video editing programs? Got some surgery vids to share but Id like to crop the beginning and end and add in a voiceover to explain whats going on.

@Lawper @Ms Procrastinator

I use adobe premier, which is a paid software that is awesome. But adobe also has a program called adobe spark that is a super basic editing program that is free. You can also add music/audio, so if you can record a voice over you can add that in.

 

[Fried Plantaris]

Hey there @cubsrule4e

I would like to know how many weeks of vacation you get a year? I find myself drawn to many interests outside of work, so it is important for me to find a specialty that would cater to a travel and adventure lifestyle. I have already started research in radiology, and it seems to fit my bill in what I'm looking for so far, as the radiologists I have spoken to brought up they receive ~10 vacation weeks per year. Having said that I'm also very interested in working with my hands, and that you don't get to experience in radiology as much. I was curious about ophtho as I have started to explore options more in depth and it is another choice that could fit my bill and allow me to work with my hands

Second question, do you ever find yourself regretful (for lack of a better work) that the eye is so specialized since you don't get to use as much of your medical knowledge you learned in school for the other body systems in general? For example if a family member or friend were to ask you a question about their kidneys, could you assist them?

Thanks for your response

 

[Ms Procrastinator]

Lol every time I think about laser eye surgery I think about that scene from final destination . Have patients ever brought up that scene to you? It's the one where the ophthalmologist leaves the patient on the table and the laser ends up taking her eye ball out. I would definitely bring that scene up to my optho as I get prepped

The eye surgery scene

@cubsrule4e Someone posted a gif of this scene and it reminded me of this convo. I was gonna post the gif, but then I realized I could just post the whole scene. I should have done this from the beginning . I knooooooow you guys wouldn't leave your patients hooked up like that and I know the lasers aren't that strong but it does strike fear in people.

 

[alissa14]

The eye surgery scene

@cubsrule4e Someone posted a gif of this scene and it reminded me of this convo. I was gonna post the gif, but then I realized I could just post the whole scene. I should have done this from the beginning . I knooooooow you guys wouldn't leave your patients hooked up like that and I know the lasers aren't that strong but it does strike fear in people.

Why did I just watch this

 

[Lawpy]

At this point i'm confused what forum i'm on

 

[rashmile]

The eye surgery scene

@cubsrule4e Someone posted a gif of this scene and it reminded me of this convo. I was gonna post the gif, but then I realized I could just post the whole scene. I should have done this from the beginning . I knooooooow you guys wouldn't leave your patients hooked up like that and I know the lasers aren't that strong but it does strike fear in people.

omg I remember this scene clearly and never wanted LASIK even though I saw my friends getting it. I still won't because of this scene.

 

[cubsrule4e]

The eye surgery scene

@cubsrule4e Someone posted a gif of this scene and it reminded me of this convo. I was gonna post the gif, but then I realized I could just post the whole scene. I should have done this from the beginning . I knooooooow you guys wouldn't leave your patients hooked up like that and I know the lasers aren't that strong but it does strike fear in people.

Thanks for scaring everyone away from my business services MsP

 

[cubsrule4e]

At this point i'm confused what forum i'm on

You are in the coolest forum ever. I also finally got notified on that last comment that was posted!

 

[Ms Procrastinator]

Thanks for scaring everyone away from my business services MsP

I didn't do anything, HOLLYWOOD did!

 

[Matthew9Thirtyfive]

The eye surgery scene

@cubsrule4e Someone posted a gif of this scene and it reminded me of this convo. I was gonna post the gif, but then I realized I could just post the whole scene. I should have done this from the beginning . I knooooooow you guys wouldn't leave your patients hooked up like that and I know the lasers aren't that strong but it does strike fear in people.

There were so many things about that scene that were completely ridiculous.

 

[deleted804295]

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.

Hiii cubs.

So this was all very great! I hope you didn't already answer this but since it's 2020 now are you seeing this optho shortage that you projected to see in 2017?

I'm hearing that residency match is still pretty competitive for optho but I haven't bothered to check.