Ophthalmology procedures - requires fellowship?

[rocketbooster]

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If you want to do procedural work in ophthalmology, does it require a fellowship? Just based on experience with my own eye appointments, it seems only doing residency basically leaves you as an optometrist. Obviously you have much more clinical training and education, but for all practical purposes, you don't do much more than an optometrist haha. You basically do checkups all day, which makes me think optometry takes a lot of the business from general ophthalmologists.

I'm hoping I'm mistaken, but it seems you need to do a fellowship in order to specific procedures. Is this true?

Also, how competitive is it to get into a fellowship program? Thanks!

 

[OPPforlife]

Comprehensive docs routinely do the bulk of eye surgery from my understanding...but I'm just a med student. There is a trend towards fellowship training in ophtho, but this trend is also evident in the rest of medicine. Although, I do not think people pursue fellowship entirely because of inadequacy of residency training considering at most programs residency training is and should be adequate for a career as a comprehensive doc.

 

[Shnurek]

If you want to do procedural work in ophthalmology, does it require a fellowship?

No. You get your unlimited medical/surgical license when you graduate with an M.D. or D.O. before residency. However, to get insured you need to have a residency done in almost all cases. And you do not get an increase in your scope of practice by law when you do a fellowship. I worked for a comprehensive ophthalmologist that did intravitreal injections at the slit lamp (done a lot by a fellowship trained retinologists), LASIK surgery, cataract surgery, laser glaucoma surgeries (LPI, SLT), fluorescein angiographies, lacrimal procedures, and more.

 

[rocketbooster]

No. You get your unlimited medical/surgical license when you graduate with an M.D. or D.O. before residency. However, to get insured you need to have a residency done in almost all cases. And you do not get an increase in your scope of practice by law when you do a fellowship. I worked for a comprehensive ophthalmologist that did intravitreal injections at the slit lamp (done a lot by a fellowship trained retinologists), LASIK surgery, cataract surgery, laser glaucoma surgeries (LPI, SLT), fluorescein angiographies, lacrimal procedures, and more.

I see. Where would you get trained to do all that, excluding something like cataract surgery? I thought those more specialized procedures are taught in fellowships?

 

[Shnurek]

I see. Where would you get trained to do all that, excluding something like cataract surgery? I thought those more specialized procedures are taught in fellowships?

Here is a list of surgeries that every ophthalmology resident has to complete:

Current minimums. How long to master depends on the person.

Cataract - 86
Laser Surgery - YAG Capsulotomy - 5
Laser Surgery - Laser trabeculoplasty - 5
Laser Surgery - Laser iridotomy - 4
Laser Surgery - Panretinal laser photcoagulation - 20
Laser Surgery - Focal laser photocoagulation - 5
Corneal Surgery - 3
Keratorefractive Surgery - 6
Strabismus - 10
Glaucoma - Filtering/shunting procedures - 5
Retinal Vitreous - 10
Oculoplastic and Orbit - 28
Oculoplastic and Orbit - Eyelid laceration - 3
Oculoplastic and Orbit - Chalazia Excision - 3
Oculoplastic and Orbit - Ptosis/blepharoplasty - 3
Globe Trauma - 4

So as you can see, you are taught minimum competency in residency or more depending on the residency program. Does that mean when you become an attending you will be doing all of these procedures? No. The point of fellowship is to specialize you to one part of eyecare. So you get really really good at doing a few things. I think the figure is 50% of ophthalmology residents end up doing fellowships?

 

[rocketbooster]

Here is a list of surgeries that every ophthalmology resident has to complete:

Current minimums. How long to master depends on the person.

Cataract - 86
Laser Surgery - YAG Capsulotomy - 5
Laser Surgery - Laser trabeculoplasty - 5
Laser Surgery - Laser iridotomy - 4
Laser Surgery - Panretinal laser photcoagulation - 20
Laser Surgery - Focal laser photocoagulation - 5
Corneal Surgery - 3
Keratorefractive Surgery - 6
Strabismus - 10
Glaucoma - Filtering/shunting procedures - 5
Retinal Vitreous - 10
Oculoplastic and Orbit - 28
Oculoplastic and Orbit - Eyelid laceration - 3
Oculoplastic and Orbit - Chalazia Excision - 3
Oculoplastic and Orbit - Ptosis/blepharoplasty - 3
Globe Trauma - 4

So as you can see, you are taught minimum competency in residency or more depending on the residency program. Does that mean when you become an attending you will be doing all of these procedures? No. The point of fellowship is to specialize you to one part of eyecare. So you get really really good at doing a few things. I think the figure is 50% of ophthalmology residents end up doing fellowships?

Right. I just was wondering if realistically most comprehensive ophthos actually do a lot of procedures, though. Wouldn't most patients go to the subspecialized doc? Do most comprehensive opthos do like 3-4 days of clinic and 1-2 days of procedures, or is that more of the schedule for someone who did a fellowship? I just don't want to end up doing ophtho, stop at residency, and then end up doing 5 days of clinic because the ones with fellowships take all the procedures. I find the procedures the most exciting part, but also want some clinic. I don't know how competitive it is to get a fellowship, though. Therefore, I want to know if most comp. opthos actually do procedures or not. My biggest fear is doing all this training and then ending up an optometrist haha.

 

[Shnurek]

Right. I just was wondering if realistically most comprehensive ophthos actually do a lot of procedures, though. Wouldn't most patients go to the subspecialized doc? Do most comprehensive opthos do like 3-4 days of clinic and 1-2 days of procedures, or is that more of the schedule for someone who did a fellowship? I just don't want to end up doing ophtho, stop at residency, and then end up doing 5 days of clinic because the ones with fellowships take all the procedures. I find the procedures the most exciting part, but also want some clinic. I don't know how competitive it is to get a fellowship, though. Therefore, I want to know if most comp. opthos actually do procedures or not. My biggest fear is doing all this training and then ending up an optometrist haha.

I really can't tell you much more you have to wait for the ophthos here to reply for I am not experienced enough to tell you. I just know that I worked for a comprehensive ophtho and he did surgery 1-2 days a month and I worked for a fellowship trained retina ophthalmologist and she did surgery 1-2 days every 2 weeks. So yes, I'd assume procedure frequency goes up in relation to years of training (except for like neuro-ophthalmology). Most comprehensive ophthos do procedures, yes.

 

[rocketbooster]

I really can't tell you much more you have to wait for the ophthos here to reply for I am not experienced enough to tell you. I just know that I worked for a comprehensive ophtho and he did surgery 1-2 days a month and I worked for a fellowship trained retina ophthalmologist and she did surgery 1-2 days every 2 weeks. So yes, I'd assume procedure frequency goes up in relation to years of training (except for like neuro-ophthalmology). Most comprehensive ophthos do procedures, yes.

Oh sorry, I didn't realize you were an optometry student lol. Didn't mean anything by saying I don't want to be like an optometrist...hehe

Anyways, can anyone else answer my questions? Thanks.

 

[Shnurek]

Oh sorry, I didn't realize you were an optometry student lol. Didn't mean anything by saying I don't want to be like an optometrist...hehe

Anyways, can anyone else answer my questions? Thanks.

Its OK not everyone wants to be an optometrist and not everyone wants to go into medicine either. 🙂 And when you said that sentence it actually makes us feel good. Because comprehensive ophthalmologists compete with optometrists as they are almost the same sans the surgery. (/waiting for political storm)

 

[MR1]

Yeah no, there is a ton more to comprehensive ophtho vs optometry. A massive ton more.

Anyway to answer your question. Comprehensive ophtho's mainly do cataracts, but they also do glaucoma lasers, YAGs, simple plastics (brow, bleph). Some also do retinal lasers or injections. Lesser few do corneal transplants or glaucoma surgery or strabismus. Also some do refractive. All what you do depends on your training. Some residencies better prepare you for the other stuff, everyone gets good at cataracts.

Fellowship training is when you want to do most or all cornea, glaucoma, or peds surgery. A lot of cornea and glaucoma still do cataracts. For retina and plastics those are for those that only want to do that kind of surgery.

Most ophtho do surgery about 1 time per week, busier ones up to 2\week.

 

[rocketbooster]

Yeah no, there is a ton more to comprehensive ophtho vs optometry. A massive ton more.

Anyway to answer your question. Comprehensive ophtho's mainly do cataracts, but they also do glaucoma lasers, YAGs, simple plastics (brow, bleph). Some also do retinal lasers or injections. Lesser few do corneal transplants or glaucoma surgery or strabismus. Also some do refractive. All what you do depends on your training. Some residencies better prepare you for the other stuff, everyone gets good at cataracts.

Fellowship training is when you want to do most or all cornea, glaucoma, or peds surgery. A lot of cornea and glaucoma still do cataracts. For retina and plastics those are for those that only want to do that kind of surgery.

Most ophtho do surgery about 1 time per week, busier ones up to 2\week.

Just curious...how does ophth look in the long term? A growing field? Enough business for everyone? Any big foreseeable changes in the future?

 

[Shnurek]

Just curious...how does ophth look in the long term? A growing field? Enough business for everyone? Any big foreseeable changes in the future?

Good, yes, yes, no.

 

[LightBox]

Its OK not everyone wants to be an optometrist and not everyone wants to go into medicine either. 🙂 And when you said that sentence it actually makes us feel good. Because comprehensive ophthalmologists compete with optometrists as they are almost the same sans the surgery. (/waiting for political storm)

I love all of the advice coming from an optometry student who has almost zero real-world experience. To the OP: please take Shnurek's comments with a grain of salt 🙂

 

[Shnurek]

I love all of the advice coming from an optometry student who has almost zero real-world experience. To the OP: please take Shnurek's comments with a grain of salt 🙂

I love how you enjoy discrediting another person more than helping somebody out. Thanks for contributing.

 

[rocketbooster]

Lol, okay guys, calm down. All responses are helpful. Shnurek actually did a good job answering my earlier questions, so he/she has definitely been helpful. I suppose for my last question it would be better for a resident/fellow/physician to respond if possible, but I'll still take any advice. So anyways...

Just curious...how does ophtho look in the long term? A growing field? Enough business for everyone? Any big foreseeable changes in the future? And if possible, please compare the clinical aspect vs procedural, i.e. enough clinical business for everyone? enough procedural work for everyone?

I mentioned earlier that my biggest fear into choosing ophtho is having no procedural work and ending up an optometrist haha. That (unrealistic?) scenario thus makes me subconsciously tell myself that maybe I should go into a medical field that does not have another type of medical professional encroaching on your business haha (ENT, ortho). I hope this isn't a realistic fear, though...just thought I should ask it since I have heard some ophthalmologists complain about it. Thanks for your help.

 

[JMK2005]

Lol, okay guys, calm down. All responses are helpful. Shnurek actually did a good job answering my earlier questions, so he/she has definitely been helpful. I suppose for my last question it would be better for a resident/fellow/physician to respond if possible, but I'll still take any advice. So anyways...

Just curious...how does ophtho look in the long term? A growing field? Enough business for everyone? Any big foreseeable changes in the future? And if possible, please compare the clinical aspect vs procedural, i.e. enough clinical business for everyone? enough procedural work for everyone?

I mentioned earlier that my biggest fear into choosing ophtho is having no procedural work and ending up an optometrist haha. That (unrealistic?) scenario thus makes me subconsciously tell myself that maybe I should go into a medical field that does not have another type of medical professional encroaching on your business haha (ENT, ortho). I hope this isn't a realistic fear, though...just thought I should ask it since I have heard some ophthalmologists complain about it. Thanks for your help.

Ophthalmology is a surgical specialty. From your questions, you sound as if you are not yet into clinicals. Shadow some doctors to get a feel for the type of work we do with mix of clinic, office procedures, and operating room.

 

[Shnurek]

That (unrealistic?) scenario thus makes me subconsciously tell myself that maybe I should go into a medical field that does not have another type of medical professional encroaching on your business haha (ENT, ortho).

ENT ---> Audiologists (not yet a lot), oral and maxillofacial surgeons (dentists) and some ophthalmologists encroach on this field.

Orthopaedic surgery ---> Doctors of physical therapy want to see their own patients without referrals, chiropractors and of course podiatrists are raising their scope of practice literally as they continue up the leg and in some states podiatrists also do hand procedures.

Scope of practice overlap is normal in almost every medical field. Best to get used to it 😛

 

[rocketbooster]

Ophthalmology is a surgical specialty. From your questions, you sound as if you are not yet into clinicals. Shadow some doctors to get a feel for the type of work we do with mix of clinic, office procedures, and operating room.

I just started Clinicals but at no point can we rotate in ophtho during 3rd yr. I'm gonna contact my school's ophtho department and see if I can schedule some shadowing times.

 

[rocketbooster]

Can any residents/physicians comment on any issues on encroachment of their fields by ODs or even by other ophthalmologists?

I understand that comprehensive ophthos can do many surgeries and specialized ophthos can do their specialized procedures and the general ones, but based on your personal experience, which procedures do you actually do on a regular basis? Also, how often do you do procedures? 1-2 days per week?

Thanks

 

[Visionary]

I do not feel at all threatened by comprehensive ophthalmologists or optometrists. Sure, there are comprehensive docs doing retina lasers and intravitreal injections, but they tend to be in rural areas where retina is hours away. An informed patient will usually seek out a retina specialist, if available, for such procedures over a comprehensive doc.

I do upwards of 20 injections per day and usually a few lasers per week--all in clinic.