Doesn't this mean it's relatively difficult compared to other specialties? I mean, I'm not naive enough to think that jobs fall out of the sky once you're done with residency, but on the opposite side of the spectrum, if, as you say, most jobs are filled before they ever reach the public side, then that seems to imply that market saturation is the case. It sounds just as difficult to find a job as an ophthalmologist as just being, say, a businessman/woman in this economy we're going through (even despite the more advanced degree), while other specialties seem to always have job openings at hospitals and the like.
I'm asking these questions not to denigrate ophthalmology, but rather because I'm interested in it but want to see what I'd be getting myself into in terms of job prospects and choice of geography/location.
I am not sure of the usefulness of these comparisons. Are you trying to choose to apply to an ophthalmology residency versus something else? If so, I hope that jobs availability (a snapshot impression that can change year to year) is only a small part of your calculation.
There are roughly 420 residency slots open in a given year. They always fill, so there are just as many graduates of residency and/or fellowships hitting the market in any given year. Add to those people changing jobs.
You will not find piles of job offers in your residency mailbox as you would say in general surgery or cardiology. But people find work. Some have to compromise because many areas are saturated and the combination of high living or practice costs and relatively slow practice growth make hiring and startup a risky business proposition. But in other places, it is much easier. In some towns, hospitals recruit new ophthalmologists, but in many others they don't.
Usually hospitals have a motivation to hire if they are losing a sole ophthalmologist on staff and need to find a replacement or, doctors on staff are exercising rights in the staff bylaws and are leaving the ED call schedule unfilled. Other than that, I really haven't seen much interest from hospitals. Even when the hospital has interests in surgery centers in the community, that alone is not enough to trigger job searches. Losing hospital accreditation for state funding for trauma service is a sufficient trigger. And just because a hospital wants to recruit does not mean you will be able to make a viable and satisfying practice in that community. You need to look carefully at a community and find out how many referring doctors there are, where they presently refer patients, what the community employment picture is like, how many patients have conventional insurance (more is better) versus Medicaid (more is definitely worse.)
If you want SFO, good luck; you'll need it. Ditto JFK/LAX/DCA and ORD. But you could land somewhere else and not have so much difficulty.
My general impression is that ophthalmologists have a harder time getting established than do many internal medicine subspecialists. Hospitals take much less interest in helping ophthalmologists than they do in helping general surgeons, anesthesiologists, cardiologists, gastroenterologists, internists and others whose practices are core essentials for a viable inpatient facility. That is just the way it is. We may not be seen as extraneous as dermatology, but we are not far from that. Even psychiatrists excite more interest from hospitals.
There is also the still widely-subscribed misperception that ophthalmology is a license to print money, which has not been true for quite some time. You will need to build a practice and tend to it very carefully for probably much longer than you expect before you will be able to generate an income that both covers your operations costs--they are significant--and generates you an income that would seem to reflect what you think you should be earning for a reasonable return on your time and investment. Ophthalmologists definitely have to work a lot harder than they used to to generate even less than what took only modest effort in years past. Our ability to do procedures is really the only thing that distinguishes us from other office-based outpatient specialties, and the reimbursement for our procedures has been cut very heavily over the past few years. As an example, Medicare's payment for a cataract surgery in actual dollars today is less than it paid in 1967 when the Part B plan was started; that represents about an 83% reduction in constant dollars. Believe me, none of your costs will be paid at 1967 levels.
Ophthalmology is still a pleasant and interesting specialty, but getting established is probably going to be more challenging and expensive that it would be for many other specialties, and that is really not likely to change very much.
