Ophtho private practice

[Primate]

I have a couple questions about private practice in ophtho, and it's difficult to find out much about it as I'm in a very academically oriented place (read as "if you don't stay at our big university you're a TOTAL failure"). So here' the littany...

1) In private practice (PP), does one need to be near a hospital and have OR priviledges?

2) Do ophthos perform operative procedures in their offices (and if so, which ones), or are all in a hospital OR (related to #1)?

3) Is it practical for PP ophthos to go into solo practice, or do they pretty much have to practice in a group to make it?

4) Do PP ophthos take call? If so, what's typical (I know this one is REALLY vague)?

5) The surgical aspect of ophtho seems the "safest" from competition. Any opinions on how the rest of ophtho will fare (have at it with this one )?

6) And here's perhaps the most annoying question - why are there more "dissatisfied" and fewer "satisfied" ophthos recently? I know there was a recent post on this, but thought I'd bring it back up to bother y'all (never saw an answer in that post).

Thanks for your thoughts.

PS - any dermies reading this, you must have me confused with a different Primate.

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[Andrew_Doan]

Originally posted by Primate
I have a couple questions about private practice in ophtho, and it's difficult to find out much about it as I'm in a very academically oriented place (read as "if you don't stay at our big university you're a TOTAL failure"). So here' the littany...

1) In private practice (PP), does one need to be near a hospital and have OR priviledges?

2) Do ophthos perform operative procedures in their offices (and if so, which ones), or are all in a hospital OR (related to #1)?

3) Is it practical for PP ophthos to go into solo practice, or do they pretty much have to practice in a group to make it?

4) Do PP ophthos take call? If so, what's typical (I know this one is REALLY vague)?

5) The surgical aspect of ophtho seems the "safest" from competition. Any opinions on how the rest of ophtho will fare (have at it with this one )?

6) And here's perhaps the most annoying question - why are there more "dissatisfied" and fewer "satisfied" ophthos recently? I know there was a recent post on this, but thought I'd bring it back up to bother y'all (never saw an answer in that post).

Thanks for your thoughts.

PS - any dermies reading this, you must have me confused with a different Primate.

1) In private practice (PP), does one need to be near a hospital and have OR priviledges?

If you plan to admit, then you need to be near a hospital. As for OR priviledges, if you have your own surgical center, then you don't need the hospital except for taking call at the ER and for admitting purposes. I know what you're thinking, "great... then I won't take call in the ER". Someone has to take call, and if you won't, then optometrists will gladly offer.

2) Do ophthos perform operative procedures in their offices (and if so, which ones), or are all in a hospital OR (related to #1)?

Yes.. Yes... Minor procedures can be done in the office. If you have a surgical center, then you can do PPVx in your practice.

3) Is it practical for PP ophthos to go into solo practice, or do they pretty much have to practice in a group to make it?

All of my colleagues have joined group practices. I think solo practice would be hard UNLESS you take over a retiring physician's practice.

4) Do PP ophthos take call? If so, what's typical (I know this one is REALLY vague)?

Yes, they take call for the local ER. In addition, they take call for the group and see call patients in the office as needed.

5) The surgical aspect of ophtho seems the "safest" from competition. Any opinions on how the rest of ophtho will fare (have at it with this one )?

I think I've exhausted this one in previous posts. I'll let new blood take it from here.

6) And here's perhaps the most annoying question - why are there more "dissatisfied" and fewer "satisfied" ophthos recently? I know there was a recent post on this, but thought I'd bring it back up to bother y'all (never saw an answer in that post).

Physicians are dissatisfied across the board, not just ophthalmologists. I'll let the practicing EyeMDs answer this one because I'm headed towards a Navy Career which is completely different than my private practice colleagues. First off, I know I won't make a ton and am willing to live with it. Second, my goal is academic medicine. What I find rewarding in this field is definitely different than most others. For instance, I enjoy call and love the excitement of seeing what comes in.

 

[north]

Ophtho Mudphud,

Thanks so much for all your input on this forum. Could you talk some about the private practices your colleagues have joined? Just wondering what size towns they were in, what size the groups were, if they joined as partners vs. employees, what kind of schedule they have, ballpark salary, etc. Just trying to get a feel for what it's really like out there. Thanks.

 

[Andrew_Doan]

Originally posted by north
Ophtho Mudphud,

Thanks so much for all your input on this forum. Could you talk some about the private practices your colleagues have joined? Just wondering what size towns they were in, what size the groups were, if they joined as partners vs. employees, what kind of schedule they have, ballpark salary, etc. Just trying to get a feel for what it's really like out there. Thanks.

In recent years, new grads (general ophthalmologists) have joined group practices varying from 1-10 physicians. Most were in medium sized cities, but located near larger city centers.

Most joined as employees with their salary guaranteed for the first 6-12 months, and then their income was based on how many patients they see/surgeries performed. Most have the option of buying into partnership after 2-3 years.

In regards to salaries, the average has been $130-$150K/year starting. Salaries after 3 years are projected to be around $250K/year. You can get another opinion about salaries from my FAQ.

 

[medstud721]

THE AVERAGE BASE SALARY FOR A BEGINNING GENERAL OPHTHALMOLOGIST IN PRIVATE PRACTICE IN 2002 WAS AROUND 160K. OPTHO IS A LITTLE DIFFERENT FROM OTHER FIELDS IN THIS REGARD, AS TOTAL SALARY EQUALS BASE + PRODUCTION.

THE AVERAGE FIRST YEAR OPHTHALMOLOGIST AUGMENTS THE BASE BY AROUND 33%, SO IN REALITY FIRST YEAR SALARIES ARE AT OR ABOVE 200K. HOWEVER, IF REALLY PROLIFIC, YOU CAN DOUBLE YOUR BASE WITH INCENTIVE. IF NON PROLIFIC, YOU MAKE YOUR BASE.

AFTER 2 YEARS, AVG. GENERAL OPHTHO SALARY IS OVER 300K.

RETINA IS AROUND 250K STARTING, 500K AFTER TWO YEARS(PRIVATE PRACTICE).

THIS DATA IS PUBLISHED BY MGMA

 

[edinOH]

I worked for a private Ophtho for a while before medical school and I became pretty familiar with how his system worked.

This guy was very business minded and had a pretty good system in place that allowed him to maximize revenue.

He was in a solo practice and he had myself and one other tech in his employ. We did all the slit lamp exams and refractions. Slit lamp was basically IOP and angles/gross deficits. Refraction was refraction if the pt was there for a comprehensive exam. We also did the fundal photos and VF with the Humphries (or was is Humphrey's?) Anyway, after our exam, he would come in, say a nice word, take a look through the slit lamp and send them out. Before they left he would do his best to sell them some "Thera-tears" lubricant or "vitamins" to prevent MD. He would also steer them through the optical shop he had in an attempt to get them to fill their new script there or buy some expensive sunglasses "because they would really help protect their vision". He would also try to sign them up for "lid hygeine" sessions where he would basically take soap and water and clean their lids and instill some saline into the eyes. For this service he would charge $40 cash. He was able to sell most pts (especially the elderly) on the lid hygeine, thera-tears, vitamins, and repeat visits as often as medicare would allow. This translated into serious cash flow.

He also had his own JACHO accredited surgi-center in the back. He would do cataracts/chalazion/pterygium surgeries there two days out of the week and the rest of the time he would have other docs doing their procedures there. He had a nice phaco machine back there but he would invariably convert to ECCE with/without vitrectomy in most of the cases. I don't know if this pays more but it wouldn't surprise me if it did.

The other docs would usually be plastics guys doing blephs and such. It was nice for him because when he operated he was able to keep the facility fee along with the surgeon's fee. Not to mention the other docs operating there and making him money.

He would also save money by reusing equipment. Do you realize that a pack of weck sponges has like 15-20 sponges when a really good surgeon only needs 2-3 per case? If you were to save the "unused" sponges and resterilize them you can save quite a bit of money. Not to mention keratomes. They are disposable of course but the plastic holds up really well to the autoclave. That is another great revenue source.

He also had a thriving refractive surgery practice. That is another great cash cow. Not to mention the new SRP procedure. (surgical reversal of presbyopia). Last I heard, he would fly his pts. down to Mexico for those since the FDA hadn't approved them here. They can be so obtuse.

All in all, he would "see" about 30 pts a day and operate on about 5-7 each week and pull in quite a load of cash. I expect any day now he will hire a chiropractor to cure those pesky subluxations of the spine. It will go well with all his IOL subluxations he sees!

I just thought I'd share what a great money-making practice my former boss had. I'm sure you all can't wait to emulate it out in practice!

Every word of the above is true. I was there man! lol

I know that 99.9% of the practicing Ophthalmologists out there have ethics beyond reproach and represent the best of what medicine has to offer. I have worked with many of them. This guy though was alittle too much used car salesman and not nearly enough pt. advocate. At the time I thought some of the things he did were fishy but now I realize they were fraud. Me and the other tech where the ones that filled out the exam form/note and he just signed it. We did the exam while he slept in his office (literally). I think he made over 600K the year I worked for him. Not too bad.

I'm an EM resident now. I must say though that I'm really glad for all the slit lamp experience I got working for him. I had completed formal training in the field in the navy a few years earlier, mainly in the surgical side, so it was nice to get good at looking at eyes. After a while, I really began to take my job very seriously since I realized that my exam was the only one they were going to get!

By the way, I'm SO tempted to put the link to his website in here. Just PM me if interested.

 

[soreed]

what were the fraud things he did?


i'm interested in visiting his website

 

[edinOH]

I think some of the things he tried to "sell" his pts on were fraudulent in many ways. I don't begrudge a guy for trying to make a buck, but I think they way he presented the artificial tears, vitamins, sunglasses and the like weren't on the level. He recommended these things with the goal of selling a product, not because he thought these things were in the pts best interests. He essentially told me as much.

He would bill for exams that he didn't do. His exam was very brief and superficial. Many times he wouldn't even examine the pt if I didn't point out anything unusual on my exam. Considering that I was an unlicenced tech with only technical and on the job training, I think medicare would consider that fraud.

I was kind of naive to these things at the time though I suspected that these practices weren't on the "up and up". I'm pretty sure now that most of these practices weren't ethical.