ophtho vacancies recently

[wildholdy]

Advertisement - Members don't see this ad

it seems like there have been a few vacancies lately on the sfmatch website (some pgy3 spots currently and a few pgy2s that are now gone). Some say that they got funding for extra spots, but some say people left for personal reasons or switched specialties. I was talking with a graduating fellow who was job searching and lamenting the difficult time he was having getting a decent starting salary. He suggested I go into anesthesia to make some real money. Are people leaving ophhto because of the poor compensation?

 

[Tiburon]

it seems like there have been a few vacancies lately on the sfmatch website (some pgy3 spots currently and a few pgy2s that are now gone). Some say that they got funding for extra spots, but some say people left for personal reasons or switched specialties. I was talking with a graduating fellow who was job searching and lamenting the difficult time he was having getting a decent starting salary. He suggested I go into anesthesia to make some real money. Are people leaving ophhto because of the poor compensation?

People that expect a large starting salary in Ophtho in a large city may be extremely disappointed with low starting salaries and leave for a more lucrative field. Low starting salaries should be expected in most cases, as you're starting out with basically no patients and in Ophtho you need a large volume of patients to make money. Anesthesia/Radiology starting salaries are higher because they generally step into something more established that doesn't need the ramp up time.

In short, starting salaries often suck. Especially in big cities. But, they can ramp up quickly depending on your situation.

 

[mydodger]

In short, starting salaries often suck. Especially in big cities. But, they can ramp up quickly depending on your situation.

I still see most starting positions around $150 - except maybe in saturated urban centers. Am I wrong about that? Because I can definitely make that work with my debt. Much lower and becomes a tighter issue.

 

[parzone]

This kind of stuff is really terrifying to read for those thinking about or entering the application process

 

[Tiburon]

I still see most starting positions around $150 - except maybe in saturated urban centers. Am I wrong about that? Because I can definitely make that work with my debt. Much lower and becomes a tighter issue.

I should clarify, I believe they suck in comparison to similarly competitive medical specialties. 150k seems pretty normal (although I have seen around 80-90k posted on this forum) but that pales in comparison to what radiologists start out with. And 150k is a lot of money, just feels like less when you are looking at what your med school friends in other specialties are starting out with.

 

[mydodger]

I should clarify, I believe they suck in comparison to similarly competitive medical specialties. 150k seems pretty normal (although I have seen around 80-90k posted on this forum) but that pales in comparison to what radiologists start out with. And 150k is a lot of money, just feels like less when you are looking at what your med school friends in other specialties are starting out with.

Oh I completely agree - looking at what other competitive specialties are making makes it seem paltry. Heck EM is a hot field right now and they seem to be making more than that doing 3 days on 3 days off type schedules. I just worry that if it falls much lower then I'm in the realm of "it would have been a better financial decision to stay in your previous line of work and you'd have a lot more time with your family to boot." I'd rather medicine be a win-win for me.

 

[xanthomondo]

Here is a super official-looking pdf of starting salaries: http://www.google.com/url?sa=t&rct=j&q=physician%20starting%20salary%20by%20specialty%20ophthalmology&source=web&cd=1&ved=0CFAQFjAA&url=https%3A%2F%2Fwww.thehealthcaregroup.com%2FProductdownloads%2F2009PSSSreport.pdf&ei=LfrxT6SdO6Ou6AHIsZifBg&usg=AFQjCNF_WqkdIqqD0L1kwyHTikh2Z310AA

It's pretty much what you'd expect: Urban places generally are low, suburban a little better and rural the best. Every offer listed involves some sort of incentive bonus.

How hard is it to collect $450,000? If the salary says $150,000 base + 20% of >$450,000 collected should you just be expecting 150k?

 

[Eyefixer]

I don't know how accurate this PDF is (probably not very), but for a SURGICAL speciality this is f***n pathetic. Ophthalmology had taken a huge compensation hit since late '80 where we used to make to the tune of $3800/cataract. Do not kid yourself, only go into ophthalmology if you really love it. And you will envy your EM friends woring 2 weeks out each month and making x1.5-x2 of what you are making. Of course, if you are willing to practice in a super rural environement, things may be slightly different.

Here is a super official-looking pdf of starting salaries: http://www.google.com/url?sa=t&rct=j&q=physician%20starting%20salary%20by%20specialty%20ophthalmology&source=web&cd=1&ved=0CFAQFjAA&url=https%3A%2F%2Fwww.thehealthcaregroup.com%2FProductdownloads%2F2009PSSSreport.pdf&ei=LfrxT6SdO6Ou6AHIsZifBg&usg=AFQjCNF_WqkdIqqD0L1kwyHTikh2Z310AA

It's pretty much what you'd expect: Urban places generally are low, suburban a little better and rural the best. Every offer listed involves some sort of incentive bonus.

How hard is it to collect $450,000? If the salary says $150,000 base + 20% of >$450,000 collected should you just be expecting 150k?

 

[Shnurek]

I don't know how accurate this PDF is (probably not very), but for a SURGICAL speciality this is f***n pathetic. Ophthalmology had taken a huge compensation hit since late '80 where we used to make to the tune of $3800/cataract. Do not kid yourself, only go into ophthalmology if you really love it. And you will envy your EM friends woring 2 weeks out each month and making x1.5-x2 of what you are making. Of course, if you are willing to practice in a super rural environement, things may be slightly different.

Heh, not as pathetic as optometry. I've seen numbers as low as $50k and $65k being thrown around on the optometry forums.

 

[mydodger]

I don't know how accurate this PDF is (probably not very), but for a SURGICAL speciality this is f***n pathetic. Ophthalmology had taken a huge compensation hit since late '80 where we used to make to the tune of $3800/cataract. Do not kid yourself, only go into ophthalmology if you really love it. And you will envy your EM friends woring 2 weeks out each month and making x1.5-x2 of what you are making. Of course, if you are willing to practice in a super rural environement, things may be slightly different.

I really love it as much as one can really love any type of work. I think if I did anything else I'd ultimately regret not being able to do ophthalmology. I see a lot more older Ophthos than I see old ER docs. Those guys get burned out so quick even with their good schedules. Derm pays well but it's so boring and there's no surgery. All of the other surgical specialties have too much and too long surgeries for my tastes. Hopefully reimbursement will still be decent and I'll be able to have a fairly good work schedule. I still see quite a few 4 days/wk opthos. That's a pretty good lifestyle.

 

[parzone]

I don't know how accurate this PDF is (probably not very), but for a SURGICAL speciality this is f***n pathetic. Ophthalmology had taken a huge compensation hit since late '80 where we used to make to the tune of $3800/cataract. Do not kid yourself, only go into ophthalmology if you really love it. And you will envy your EM friends woring 2 weeks out each month and making x1.5-x2 of what you are making. Of course, if you are willing to practice in a super rural environement, things may be slightly different.

Geez. Are we talking only comprehensive here? I know retina makes a lot but how do the other fellowships compare to comprehensive?

 

[parzone]

Also look at ENT. They are only 20,000 more than ophthalmology and their residency process is, I believe, a bit more demanding and they see their kids less.

 

[mydodger]

Also look at ENT. They are only 20,000 more than ophthalmology and their residency process is, I believe, a bit more demanding and they see their kids less.

Residency is a lot more hours intensive than ophtho and your schedule as an attending involves a lot worse call. Plus if I never have to sit through another neck dissection it will be too soon. I do see the similarities however.

 

[Visionary]

Here is a super official-looking pdf of starting salaries: http://www.google.com/url?sa=t&rct=j&q=physician%20starting%20salary%20by%20specialty%20ophthalmology&source=web&cd=1&ved=0CFAQFjAA&url=https%3A%2F%2Fwww.thehealthcaregroup.com%2FProductdownloads%2F2009PSSSreport.pdf&ei=LfrxT6SdO6Ou6AHIsZifBg&usg=AFQjCNF_WqkdIqqD0L1kwyHTikh2Z310AA

It's pretty much what you'd expect: Urban places generally are low, suburban a little better and rural the best. Every offer listed involves some sort of incentive bonus.

How hard is it to collect $450,000? If the salary says $150,000 base + 20% of >$450,000 collected should you just be expecting 150k?

You can collect $450,000 seeing about 25-30 patients per day as a generalist. 50-60 per day, and you should be over $1 mil. For retina, 30-40 patients per day nets about $1.2-1.6 mil in annual collections. You can make good money in ophthalmology.

 

[mydodger]

You can collect $450,000 seeing about 25-30 patients per day as a generalist. 50-60 per day, and you should be over $1 mil. For retina, 30-40 patients per day nets about $1.2-1.6 mil in annual collections. You can make good money in ophthalmology.

I see numbers ranging from this ballpark to saying that you can barely clear $120,000 or that you'll have to work horrible hours to get near $200,000. My neurotic personality won't allow me to just ignore all of the conflicting numbers. I think that for now I will assume everyone is lying to me, but that said I always like your lies best Visionary.

 

[xanthomondo]

I see numbers ranging from this ballpark to saying that you can barely clear $120,000 or that you'll have to work horrible hours to get near $200,000. My neurotic personality won't allow me to just ignore all of the conflicting numbers. I think that for now I will assume everyone is lying to me, but that said I always like your lies best Visionary.

He was talking about the office collecting money (I think). You're talking about take-home pay. Those two numbers agree with each other.

If you're making $150k base + 20%>$450,000 to bring home an extra $50k you would have to collect $700,000 overall, which I imagine would not be an easy task.

 

[Visionary]

I see numbers ranging from this ballpark to saying that you can barely clear $120,000 or that you'll have to work horrible hours to get near $200,000. My neurotic personality won't allow me to just ignore all of the conflicting numbers. I think that for now I will assume everyone is lying to me, but that said I always like your lies best Visionary.

Yes, let's clarify terms. The numbers I provided are true and from my actual group. As xanthomondo stated, they represent collections, not take-home pay.

First, there is what you bill the patient and insurance. That's your billing. Then, there's what you actually receive. That's collections. Your take-home, as a partner, is collections, less overhead, which is your bills (lease, staff payroll, materials, etc.). If you're in a competitive market, you'll likely have high advertising costs. If you're in a very desirable area, you'll likely have higher lease, payroll, etc. These increase your overhead and decrease your take-home pay.

As an associate, these numbers still hold. However, your take-home pay can vary considerably, depending on your contact structure.

Hope that clears it up.

Sent from my Droid Incredible on SDN Mobile

 

[mydodger]

Yes, let's clarify terms. The numbers I provided are true and from my actual group. As xanthomondo stated, they represent collections, not take-home pay.

First, there is what you bill the patient and insurance. That's your billing. Then, there's what you actually receive. That's collections. Your take-home, as a partner, is collections, less overhead, which is your bills (lease, staff payroll, materials, etc.). If you're in a competitive market, you'll likely have high advertising costs. If you're in a very desirable area, you'll likely have higher lease, payroll, etc. These increase your overhead and decrease your take-home pay.

As an associate, these numbers still hold. However, your take-home pay can vary considerably, depending on your contact structure.

Hope that clears it up.

Sent from my Droid Incredible on SDN Mobile

Okay I was reading that wrong then. So I assume this part of the reason why everyone says "starting salaries are lower but after a few years you'll be making a lot more?" Since you would be a partner in most places after a few years of working with the group and getting collections less overhead is significantly more than base pay + 20-30% of collections over a certain relatively high amount?

So what on average IS the starting income? It looks like on the average salary calculations the reported value is just average base pay. Will most starting ophthalmologists not make more than base pay? I understand that building the practice will take some time since patients don't just immediately know you're there and that this is all highly variable so it makes these figures hard to "average" but does anyone have a new ophthalmologist in their practice so you could just say "our new guy made $X his first year?"

And what kind of income are you looking at after becoming a partner assuming you're seeing a good 30 patients per day 4 days per week and spending one day in the OR per week? Closer to other competitive specialty pay or not? And is 4 days clinic 1 day OR a decent estimate of the average workweek or am I way off here?

 

[RestoreSight]

You can collect $450,000 seeing about 25-30 patients per day as a generalist. 50-60 per day, and you should be over $1 mil. For retina, 30-40 patients per day nets about $1.2-1.6 mil in annual collections. You can make good money in ophthalmology.

These are great numbers, but a few questions!

50-60 pts a day? Is this possible? Even on the busiest services I have been on nobody ever saw that many patients. How do OR days fit in these estimations? 2 OR days per week is about average for most in comprehensive. How does the breakdown in collections work using your calculations? As a comprehensive ophthalmologist is the majority of your income from OR days or from office visits?

Thanks Visionary!

 

[Visionary]

Okay I was reading that wrong then. So I assume this part of the reason why everyone says "starting salaries are lower but after a few years you'll be making a lot more?" Since you would be a partner in most places after a few years of working with the group and getting collections less overhead is significantly more than base pay + 20-30% of collections over a certain relatively high amount?

So what on average IS the starting income? It looks like on the average salary calculations the reported value is just average base pay. Will most starting ophthalmologists not make more than base pay? I understand that building the practice will take some time since patients don't just immediately know you're there and that this is all highly variable so it makes these figures hard to "average" but does anyone have a new ophthalmologist in their practice so you could just say "our new guy made $X his first year?"

And what kind of income are you looking at after becoming a partner assuming you're seeing a good 30 patients per day 4 days per week and spending one day in the OR per week? Closer to other competitive specialty pay or not? And is 4 days clinic 1 day OR a decent estimate of the average workweek or am I way off here?

To your first point, yes, that is what I'm talking about. People get all up in arms about starting salaries. It's gets especially ludicrous when you compare to a field like radiology. They are apples and oranges. I ophthalmology, you typically have to build a patient base, which takes time. In radiology, you are typically fed imaging from a hospital, so you don't really "build" a practice (there are exceptions, I know). Also, radiologists have a greater likelihood of being employees, rather than employers. Therefore, in radiology you start out with higher pay, but peak early. Ophthalmology tends to start out low and build over time. Most will start around $125-150k plus bonus. Depending on how your contract is set up and how productive you are, you could get close to $200k in year one. You could also just make your base. A lot of variables make giving you a solid number impossible.

It's hard to give you a solid number for partner pay. Based on my group and location, if you are seeing 30 patients per day as a generalist partner, you will probably have about $500-600k in collections (other revenue sources, such as optical, ASC, notwithstanding). If your overhead is reasonable, say 50-60%, you're looking at $250-300k annual income. That matches most averages you'll find for generalists.

 

[Visionary]

These are great numbers, but a few questions!

50-60 pts a day? Is this possible? Even on the busiest services I have been on nobody ever saw that many patients. How do OR days fit in these estimations? 2 OR days per week is about average for most in comprehensive. How does the breakdown in collections work using your calculations? As a comprehensive ophthalmologist is the majority of your income from OR days or from office visits?

Thanks Visionary!

50-60 is definitely possible, with the right clinic support and flow. Now, I don't see that many as a med ret doc, because most of my patients have serious pathology. The generalists in my group manage that many, because they each have about 4 technicians, usually including a scribe, and the patients are typically not that complicated.

The OR days vary. Most docs won't do a full day in the OR. They will operate in the AM, with clinic in the PM. We have a couple docs who hold later hours once a week, so they can have a short day elsewhere. There's a lot of flexibility. I have Thursday mornings off. Currently, I use that time for errands, golf, etc. Soon, I'll be staffing a VA retina clinic a couple times per month with that time.

For generalists, the OR is typically more lucrative, assuming efficient management and good volume. There are some docs who spend the majority of time in the OR and co-manage with optometrists. They can make a killing. For other specialties, particularly retina, the OR is currently less lucrative. You can make more doing in-office procedures, such as injections and lasers.

 

[LightBox]

These are great numbers, but a few questions!

50-60 pts a day? Is this possible? Even on the busiest services I have been on nobody ever saw that many patients. How do OR days fit in these estimations? 2 OR days per week is about average for most in comprehensive. How does the breakdown in collections work using your calculations? As a comprehensive ophthalmologist is the majority of your income from OR days or from office visits?

Thanks Visionary!

2 OR days is NOT average for most comprehensive docs...even in a relatively busy practice. Two *full* OR days is more typical of a very busy practice that co-manages with optometrists. In other words, the OMD can fill up the surgery slots because his surgery case-per-encounter ratio is very high (e.g. <10:1).

Another thing to think about: you will lose money going to the OR (vs. just seeing patients in clinic) if you are not doing a decent case volume that day. I think you need to do at least 5-6 cases in a day just to break even (i.e. pay your office staff who may be twiddling their thumbs while you operate). It's interesting that in academic practices, the surgeons rarely can do more than 6-8 cases in a day due to how inefficient academic hospitals are with turnaround. In private practice, when you first start out, it is often better (financially) to just operate every other week. That way, you can fill in your OR slots more efficiently, and also fill in your empty office visit time slots.

Much more lucrative practices will have their surgeons in the OR on average for 12-25 cases in a day. Of course, we are talking about an ASC!

 

[mydodger]

Also, radiologists have a greater likelihood of being employees, rather than employers.

And to that point, it seems that a lot of other specialties are trending towards being hospital employees or hospital-owned clinic employees. I know that I would never bring it up on the interview trail at an academic center, but this is a big benefit to being an ophthalmologist. I know it comes with plenty of stresses, and I often think that it would be tempting to just be a shift working hospital employee, but you lose a lot of freedom of practice when you become an employee. Doctors in general have given up that freedom for security over the years, but for those of us who are less willing to make that sacrifice Ophthalmology becomes an even more tempting career choice even with relatively low salaries compared to say radiology or anesthesiology. Medicare, Medicaid, and the insurance companies already have us by the scrotum, no reason to add another bureaucrat between myself and my patients if I can avoid it.

 

[dantt]

These are great numbers, but a few questions!

50-60 pts a day? Is this possible? Even on the busiest services I have been on nobody ever saw that many patients. How do OR days fit in these estimations? 2 OR days per week is about average for most in comprehensive. How does the breakdown in collections work using your calculations? As a comprehensive ophthalmologist is the majority of your income from OR days or from office visits?

Thanks Visionary!

I know many who see 70-80 pts/day in comprehensive, cornea, and retina. 3-4 days of clinic + 1 OR day / week.

 

[Visionary]

And to that point, it seems that a lot of other specialties are trending towards being hospital employees or hospital-owned clinic employees. I know that I would never bring it up on the interview trail at an academic center, but this is a big benefit to being an ophthalmologist. I know it comes with plenty of stresses, and I often think that it would be tempting to just be a shift working hospital employee, but you lose a lot of freedom of practice when you become an employee. Doctors in general have given up that freedom for security over the years, but for those of us who are less willing to make that sacrifice Ophthalmology becomes an even more tempting career choice even with relatively low salaries compared to say radiology or anesthesiology. Medicare, Medicaid, and the insurance companies already have us by the scrotum, no reason to add another bureaucrat between myself and my patients if I can avoid it.

There are definitely trade-offs for both. Our local medical society recently conducted a survey of physician satisfaction. Overall, employed physicians were "happier." However, when you drilled down into the data, the "happy" ones had only been employed a few years. Those employed more than a few years stated they were less "happy." May be a grass is always greener scenario. With employed status, you give up a lot of the stressors of self-employment, but you also give up a lot of the autonomy. Personally, I'll take autonomy. Ophthalmology is fairly insulated from large-scale employment, because we don't have a lot to offer hospitals. We rarely admit, and most of our procedures are short and can be performed in ASCs. The greatest number of employed ophthalmologists are in the military/VA system.

 

[Visionary]

I know many who see 70-80 pts/day in comprehensive, cornea, and retina. 3-4 days of clinic + 1 OR day / week.

There's one retina doc down the street from me who sees over 100 patients per day. Don't know how he keeps from burning out, but he does it. Has 7 techs with him at all times. I've seen quite a few of his patients, actually, and one of his former techs now works for me. While they've said that they think he's a fine physician, they felt rushed and somewhat neglected. I prefer to see fewer patients and spend more time with them. I'm often dealing with bad pathology, and patients tend to have a lot of questions and concerns. I plan to cap my days at 40. Personal preference.

 

[MstaKing10]

Back to the OP question, don't really think spots opening up are due to poor compensation and resident's "jumping ship" to make more money doing something else. That would seem rather ridiculous. Most likely personal reasons or the like.

Starting salaries are just that, starting. Coming out of fellowship, starting salary is important but not the most important factor in choosing a job in my opinion. The practice, the partners, and what the potential salary will be in 3-5 years once you are partner should be much more important. The overall structure of the partnership and how funds are distributed is also important. Basically, you sometimes need to take a bit of a hit starting out to be doing well a few years from starting. Need to have a good long term outlook.

There's a lot more to it than that, but I remember getting into these kind of debates with co-fellows, those with short term goals and those of us with more long term goals. Ultimately, I feel starting salary needs to be fair based on region and specialty, but compensation once you are partner is much more important.

 

[MstaKing10]

And to that point, it seems that a lot of other specialties are trending towards being hospital employees or hospital-owned clinic employees. I know that I would never bring it up on the interview trail at an academic center, but this is a big benefit to being an ophthalmologist. I know it comes with plenty of stresses, and I often think that it would be tempting to just be a shift working hospital employee, but you lose a lot of freedom of practice when you become an employee. Doctors in general have given up that freedom for security over the years, but for those of us who are less willing to make that sacrifice Ophthalmology becomes an even more tempting career choice even with relatively low salaries compared to say radiology or anesthesiology. Medicare, Medicaid, and the insurance companies already have us by the scrotum, no reason to add another bureaucrat between myself and my patients if I can avoid it.

Some private practices are set up so that a new hire may be hired as an employee, without partnership potential. This is akin to working for a hospital, except the hospital is a private practice. Upside is you have no risk, your salary is fixed and consistent, and if the practice goes under who cares since you didn't pay in to become partner. Big downside is your salary will remain stable (unlikely to increase) and at the mercy of the managing partners. Also you will have little say in the way the practice is run or on equipment purchases etc.

Let's not kid ourselves though, Obamacare may eventually make us all employees...but that's a different topic completely!