Opthamology Saturation?

[patriots0000000]

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well is there? and what do you think the outlook will be in about 5-6 years?

 

[orbitsurgMD]

well is there? and what do you think the outlook will be in about 5-6 years?

It depends on where you want to go and what you plan to practice. Is the whole country saturated? No. Not even close. Are there cities where the costs of practice and costs of living would make a startup a risky business venture? Yes. Is there saturation of specific subspecialties in many places? Yes. Lasik-only in LA might be tough right now.

In 5-6 years? There will be people with eye diseases who will need doctors to care for them. But the economy changing as it is--not necessarily in reassuring ways--might have something to do with how a practice will have to act to be viable. I don't think anyone can give you a realistic prediction of the average after-expenses income of an ophthalmologist five years from now.

I can say that the trend is toward costs-containment in ever more serious ways, reducing waste, optimizing use of space and staffing, scrutinizing insurer performance, utilizing automated processes wherever advantageous and examining the feasibility of offering certain services that are net practice income losers. This is wise business practice for anyone, but is especially necessary where there is an annual threat of rising expenses and fixed or falling third party payment.

Is it beyond imagining for doctors to become more highly selective in dealing with insurers? Not at all. Is it likely that many ophthalmologists will opt out of Medicare? Probably not; the large numbers of medicare age patients in most general ophthalmology practices might make that impossible. Is it possible that practices might restrict the numbers of new Medicare patients accepted? Yes.

 

[Andrew_Doan]

I think the outlook is good. Compared to other jobs, medicine (including ophthalmology) provides incredible stability and is not affected even in economic downturns like the one we're seeing now. The demand for ophthalmology will remain high as the baby boomers retire and develop eye diseases associated with age.

 

[Icareforeyecare]

I love John Pinto's comments on the industry. I think he summaraizes it well. You can find some of his articles on OSN supersite

http://osnsupersite.com/view.asp?rID=27881

We are struggling to find MD's. We have numerous postings and we network constantly to help practices, and usually private practices, find the available MD's.

http://www.localeyesite.com

The online networking tool for all eye care professionals...
Let's network!

 

[orbitsurgMD]

I love John Pinto's comments on the industry. I think he summaraizes it well. You can find some of his articles on OSN supersite

http://osnsupersite.com/view.asp?rID=27881

We are struggling to find MD's. We have numerous postings and we network constantly to help practices, and usually private practices, find the available MD's.

http://www.localeyesite.com

The online networking tool for all eye care professionals...
Let's network!

John Pinto is an interesting observer. He always gets lots of column inches in the throwaways. I agree with many of his observations, but find him occasionally grating as well. He has clearly made his reputation in the service of high-volume, high-revenue-generating practices whose doctors he fawningly admires in many of his articles. Here and elsewhere, he takes a less admiring stand on younger ophthalmologists. A less sanguine view would be that like his high-dollar clientele, he rode the wave of great third-party payment, cataracts paying $3,000 apiece, that brought wealth and early retirement and some of those high-dollar buyouts he refers to. Now the wave is in the beach and the following seas are flat. No more big paydays, no more big buyouts, no more early fat retirement. Were these older docs just a generation of geniuses and giants (doing extracaps) or just the lucky beneficiaries of the accidents of fortune? Should we judge negatively the younger doctors who see more fatigue than wealth coming from being "hard-working" (the unstated comparison is rich, here, no?) And as for difficulty in finding suitable buyers for these practices these days, perhaps that is because the price is too high? One doesn't buy the mine after it has payed out.

Facts are, Medicare payment for the central surgical procedure in ophthalmology, cataract extraction with intraocular lens implant, is less than the same number of dollars as was paid in 1967, the year Part B was initiated. That amounts to a 83% decline in constant-dollar fees. Even with improvement in techniques and equipment, that is still a huge reduction in the payment for labor and cognitive skill. Had the payment value kept constant, a cataract would pay around $4,000 today. (And it would be worth it as it is a much safer, faster-healing and more predictable procedure.) Who would have thought an activity involving highly-developed manual skill and cognitive effort would so closely parallel Moore's "law"?

Unlike a robotized assembly line, however, there is a limit to what the medical field will produce, at least on terms of the present notion of doctor-patient interaction. Americans expect to spend time with their doctor and many take offense when they receive the time allotment their ever-reducing payments actually afford them. I am seeing some of the side effects of this among my colleagues, who are ever more quick to dump troublesome patients and payors. Some have even quit the field, at the prime of their careers. That isn't good. We rationalize an assembly-line experience to buy LASIK for $799 an eye; we may soon do the same for cataract, and no whining please.

I am grateful for many of John Pinto's insights, but his suggestion that the following generation of ophthalmologists is less industrious just sticks in my craw. It's wrong. They aren't lazy, or stupid. But they know futility and are quicker to make the call that happiness may come more with control of one's time than with the illusion of a bigger paycheck.

 

[Icareforeyecare]

I am grateful for many of John Pinto's insights, but his suggestion that the following generation of ophthalmologists is less industrious just sticks in my craw. It's wrong. They aren't lazy, or stupid. But they know futility and are quicker to make the call that happiness may come more with control of one's time than with the illusion of a bigger paycheck.

I agree with you on this one. My craw doesn't like this part of his commentary either.

Thank you for your feedback to the John Pinto article. I think you have valid points on the Medicare situation. Quite the hot topic around our SE private practices!

 

[Andrew_Doan]

I am grateful for many of John Pinto's insights, but his suggestion that the following generation of ophthalmologists is less industrious just sticks in my craw. It's wrong. They aren't lazy, or stupid. But they know futility and are quicker to make the call that happiness may come more with control of one's time than with the illusion of a bigger paycheck.

I agree!

 

[Incandescent]

just a quick question. i understand that medicare payments for cataract surgery has relatively decreased over the past several decades. however, we all know that the surgery is much shorter than it used to be and is not as high-risk as it once was.

(i am asking for knowledge here, not to make any point). do you think the relative decrease might be appropriate for the decrease in time spent/risk of the surgery?

please don't flame me, i'm sincerely asking this question for educational purposes. i'm going to be an ophthalmologist myself with a billion loans, and i want to be fairly paid too. i promise!

 

[Andrew_Doan]

(i am asking for knowledge here, not to make any point). do you think the relative decrease might be appropriate for the decrease in time spent/risk of the surgery?

Yes, and also because Medicare is broke.

 

[orbitsurgMD]

Yes, and also because Medicare is broke.

That is the real reason. Cataract surgery is the most commonly done surgery in the USA, by a huge margin. So it makes a ripe target for cost cutting just by the power of numbers.

Yes, the surgery is simpler, and shorter and generally less risky than just a few years ago. That is due to significant technological improvements that were paid for not by doctor's fees but by OR fees. Better phaco machine design with better "fluidics" and chamber volume stability, better nuclear sectioning technique, better phacoemulsification design (pulsed duty cycles), made possible by smaller foldable implants that made smaller and more anterior incisions possible that reduced the need for injectable anaesthetics (and their complications) and reduced the need for sutured closure, all of which shortened the surgery time. And made outcomes better.

 

[200UL]

One final comment about Medicare reimbursement... In the 1980s cataracts paid well over $2000. You could also have a surgical assistant collect an “assistants fee” of a couple of hundred dollars (for keeping that cornea moist). When adjusting for inflation, cataract surgeons have enjoyed about a 90% paycut per cataract. Now that is what I call doing our part to control medical spending!!!!!!!!!!!!!

Unfortunately society now sees it as the physicians role to keep the medical industrial complex moving and everyone wants a piece of the pie(insurance companies/reps, equipment companies/reps, drug reps, EMR companies, hospitals...Think of all the peripheral people that are employed because of what physicians do - many have zero influence on patient care.). This will only continue to drive up prices. Medicare can cut cataract surgeon reimbursement more, but the ophthalmologist will just add another case on.

 

[Andrew_Doan]

Medicare can cut cataract surgeon reimbursement more, but the ophthalmologist will just add another case on.

Within reason. We don't want to become surgical factories just to keep our practices open.