Ophthalmology versus anaesthesiology

[monsoon]

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I'm not too sure whether I'm on right forum to be posting this topic here, but I'm giving it a try. Firstly I'm neither an American citizen nor my queries relate to US residency programmes. But I believe questions I face are more generic and universal in nature. So if moderators believe this thread doesn't belong here they have the right to move it somewhere else.

I'm an Indian medical graduate (MBBS) waiting for what you guys call a "match". At the moment I have really very good prospects of matching in top notch anesthesia and what I call second tier ophthal programmes here in India. To be honest my first choice for specialisation was neither of these to specialities. I always wanted to do derm but my "scores" are not top notch. So ophthal and anaesthesia are really my fall backs and i need to choose one of them.
So getting to the point, I have got few questions which are really troubling me a lot and I believe you can help me with these -

1) here in India we have uniform 3 year residency programmes with plenty of hands on surgical experience (we call it "cutting" here) but phacoemulsification and LASERs remain relatively the preserve of attendings. I believe these procedures require high level of manual dexterity with little margin for error. My question is whether 3 years is sufficient time to master these skills if I get to do at least 4 procedures a month PGY-2 onwards?

2) once you finish with your residency how difficult it is to shut down your practice for a while to go somewhere to master newer surgical techniques and modalities. I have an impression that ophthalmology procedures are more technology intensive, complicated and difficult to master. Is it true that skill upgradation is an issue?

3) i'm a non traditional student, so I started out a bit late in my medical career. I fear I may not be able to physically remain at the top of my game for too long. Should my age be a valid concern?

Thank you

 

[orbitsurgMD]

I'm not too sure whether I'm on right forum to be posting this topic here, but I'm giving it a try. Firstly I'm neither an American citizen nor my queries relate to US residency programmes. But I believe questions I face are more generic and universal in nature. So if moderators believe this thread doesn't belong here they have the right to move it somewhere else.

I'm an Indian medical graduate (MBBS) waiting for what you guys call a "match". At the moment I have really very good prospects of matching in top notch anesthesia and what I call second tier ophthal programmes here in India. To be honest my first choice for specialisation was neither of these to specialities. I always wanted to do derm but my "scores" are not top notch. So ophthal and anaesthesia are really my fall backs and i need to choose one of them.
So getting to the point, I have got few questions which are really troubling me a lot and I believe you can help me with these -

1) here in India we have uniform 3 year residency programmes with plenty of hands on surgical experience (we call it "cutting" here) but phacoemulsification and LASERs remain relatively the preserve of attendings. I believe these procedures require high level of manual dexterity with little margin for error. My question is whether 3 years is sufficient time to master these skills if I get to do at least 4 procedures a month PGY-2 onwards?

2) once you finish with your residency how difficult it is to shut down your practice for a while to go somewhere to master newer surgical techniques and modalities. I have an impression that ophthalmology procedures are more technology intensive, complicated and difficult to master. Is it true that skill upgradation is an issue?

3) i'm a non traditional student, so I started out a bit late in my medical career. I fear I may not be able to physically remain at the top of my game for too long. Should my age be a valid concern?

Thank you

For a moment, I thought this was about cage fighting.🙂

Let's set aside the issues of your basis for choosing one or the other.

A residency that did not train you well in phacoemulsification technique and clear-corneal incisional technique would be considered a severely-deficient program in the USA or Canada, as in not worthy of certification.

That said, there is a learning curve which depends largely on case volume. If you can do 200 phaco cases in three months, you can probably learn phaco in three months, at least well enough to be doing the surgery with confidence on your own. In the UK, where ophthalmologists seem to be scarcer relative to the whole medical profession, they will say, in that typically understated British way, that one can think oneself experienced after about 5000 cases. The typical UK ophthalmologist has a large referral volume and a theater list booked months in advance.

So what you really need is a chance to do about 200 phaco cases if not during your residency, then shortly afterward. I can't think of a better place to go to do that than India.

Skills upgrading is a continuous process. Many ophthalmologists learn new techniques at their work or through short courses that typically do not require more than a few days absence from your practice.

 

[monsoon]

@orbitsurgeryMD-
Thank for the reply.
Here in India ophthal is not as competitive as say radiology or internal medicine because we have lots of ophthalmology programmes compared to takers. This is partly because government initiative to reduce preventable blindness through more human resource development to tackle the issue. Phacoemulsifications and other advance techniques have just started to be offered at ophthal departments in non-metro cities. SICS still constitute the bulk of cataract surgeries performed here in India but clearly there is shift towards phaco. I don't want to be halfbaked in a technique which is clearly going to be procedure of choice in future. It almost looks inevitable that i'll have to continue in same or similar other programme for few more years after certification to gain necessary experience.