Optho: Enough Variety?

Started by James105
Get help with your application

Use all the free resources available to you from SDN: articles, guides, expert advising, forums discussions, and school research.

Browse articles Compare schools My application plan Read Interview Feedback
Practice for interviews Ask an Advisor
J

James105

Membership Revoked
Removed
10+ Year Member
Hello Forum,

M2 here. I have recently begun to consider optho as a possible specialty choice. I think that optho offers a wonderful opportunity to do surgery, work with cool gadgets, and to truly become an expert in a field...not to mention being home by dinner most nights.

My main hold up at this point is that I am afraid that I would mourn the loss of a more systemic career. I really enjoy cardio physio & path, for example, and obviously I would not be doing cardio examinations very often as an optho.

So, my question is: how did you deal with forgoing much of the general medical training when choosing optho. In other words, does optho offer adequate fulfillment from the medical point of view.

And secondly, do you feel that your practice is varied enough, medically and surgically, to continue to challenge you sufficiently.

Thank you for your time!
 
What do you mean by "adequate fulfillment from the medical point of view"? From talking to the physicians I know, they get professional fulfillment from gaining the trust and improving the lives of patients (surgically, medically or by giving reassurance), forming good relationships with the people in their practice (whether physicians or other members of the team), collaboration on intriguing cases, teaching students and residents, working on their research, working on their surgical skills and/or working on their business model.

You most likely get fulfillment at this point by learning how different organ systems work/don't work and seeing how this knowledge can be applied to clinic situations. This, plus inspirational teachers make second year so amazing. But don't assume that what is exciting now will be as exciting when you are practicing or even as a resident. Maybe it will be, but I don' think that is a safe assumption. The other factors mentioned above will give fulfillment. And all those things can be found in ophthalmology. In addition, the lifestyle is good so you'll have a chance to live a fulfilling personal life in addition to a fulfilling professional life.

But no need to make a decision now. During third year have your eyes and ears open and see what inspires you, and shadow whenever you get the chance. This year, do well on Step 1 so you have as many doors open as possible.

But I could be completely wrong, curious to hear what other people advise you.
 
determining the right balance between medical and surgical as well as generalist versus specialists is a problem for all fields of medicines.
its a personal one and hard to make before your clinical years. i came into medical school wanting to be an internist, but realize it did not have enough surgery/procedures and not specialized enough. ophthalmology is a good mix of the two and i really enjoy it. even within ophthalmology, you'll be faced with the decision to specialize more with retina, oculoplastics, peds, neuro, glaucoma, cornea. there's more than enough to keep you mentally stimulated in ophthalmology. it's not for everyone though.
 
Probably a huge over-generalization here, but from personal experience (talking to 7 people in my class pursuing ophtho this year), it seems like most people who choose ophtho would otherwise have chosen some other surgical or medical subspecialty where they still concentrate primarily on one system. If this sounds like you then I don't think you'd be missing out on a whole lot of variety. Sure, you won't be doing cardiopulm exams on all your patients, but neither would a heme/onc doctor or GI doctor (except when they do the cursory exam so they can check the boxes for billing purposes). This does not, by any means, imply that you WON'T be thinking about the heart/lungs/liver/blood/etc; I'm sure you can think of tons of ophtho conditions that have systemic manifestations (or vice-versa). Retina patients, for example, are sick patients and have a lot of concomitant medical problems that you as an ophthalmologist will have to know about in order to treat adequately. People often think the eye is completely isolated from the rest of the body... sure, it's more isolated than many other organs--a blessing to ophthalmologists IMO--but you're not going to get away with ignoring the rest of the body. You definitely won't know as much about the rest of the body as your IM-trained friends, but you'll be a complete baller when it comes to the eye.

In terms of variety WITHIN ophthalmology, there are tons of conditions/procedures to learn, so much that there are 6+ subspecialties within the field. I know you're an M2 right now, but next year you'll see that all fields have their bread-and-butter conditions that take up 90% of clinic. Ophtho is no different in that sense.
 
I appreciate your insightful replies. I know that a lot of my questions will be decided in 3rd year, so I'm not freaking out about the decision; I just like to think the different options available.

I worked as an EMT before med school, and I really enjoyed it. So coming into med school, I thought EM would be the best match (due to procedures, excitement, general medicine exposure, decent lifestyle). However, the longer I am in med school, the more I feel drawn to depth of medicine (which is typically not found in EM), continuity, and fixing things.

Since optho is much more specialized, and I have had much less exposure, I thought this would be a good place to find answers to questions.

At the end of the day my two precise questions:

1. Will there be enough medicine in the optho clinic to keep me interested.
2. Will there be enough variety in optho surgery to keep me interested. Or would something like ENT be a better fit due to the variety of surgical options...

I started shadowing an optho recently. The exam was cool, there was lots of discussion about systemic diseases (TA, sarcoid, HIV, etc). I know I have a lot to learn, not to mention I have to kill STEP 1, but I do appreciate your thoughts!
 
James105 said:
I appreciate your insightful replies. I know that a lot of my questions will be decided in 3rd year, so I'm not freaking out about the decision; I just like to think the different options available.

I worked as an EMT before med school, and I really enjoyed it. So coming into med school, I thought EM would be the best match (due to procedures, excitement, general medicine exposure, decent lifestyle). However, the longer I am in med school, the more I feel drawn to depth of medicine (which is typically not found in EM), continuity, and fixing things.

Since optho is much more specialized, and I have had much less exposure, I thought this would be a good place to find answers to questions.

At the end of the day my two precise questions:

1. Will there be enough medicine in the optho clinic to keep me interested.
2. Will there be enough variety in optho surgery to keep me interested. Or would something like ENT be a better fit due to the variety of surgical options...

I started shadowing an optho recently. The exam was cool, there was lots of discussion about systemic diseases (TA, sarcoid, HIV, etc). I know I have a lot to learn, not to mention I have to kill STEP 1, but I do appreciate your thoughts!
Click to expand...

Only you can answer those two questions for yourself. For me the answer is yes to both of them. There is lots of systemic diseases that have manifestation in the eye. In my practice I have helped patients diagnose their diabetes through an eye exam, help determine that someone has metastatic breast cancer because there was mets to the choroids, see patient with optic neuritis which can be first sign of MS, see patient with papilledema which could be caused brain mass or pseudo tumor cerebri, etc. Of course I don't manage those diseases but I can be involved in the patient care and help my colleagues with the diagnosis and management which I find very fulfilling.

What types of surgeries you do as an ophthalmologist varies depending what kind of setting you work at and how comfortable you feel. I practice as general/glaucoma and to good diversity of surgeries. In the OR I will do cataract surgeries (both phaco and extracaps), glaucoma tube shunts/trab, pterygium excision, blepharoplasty, eyelid lesion excision. In the clinic I do variety of procedures including PRP, yag capsulotomy, iridectomy, chalazion removal, intravitreal injection. I love that my clinic days have different procedures I do and see different types of patients. One of the best thing about ophtho is that most of the problems we see, we can fix. Patients are very happy and thankful for the services you provide.

With any specialty, there is going to be something you commonly do and will become bread and butter thing (for ophtho will be cataracts). But that is how you become good at it. When I was a student after watching your 20th cataract surgery it become boring. But it is very different when you are doing them. I really enjoy doing cataract surgery and each eye I operate on is always something different about the case and I am always trying to improve and trying different tools or technique. I would high recommend ophthalmology to any students that are interested in exploring the field. It is just unfortunate that you don't get much exposure to ophtho as a med student.
 
Here's a question: why not ENT? To me ENT offers more variety in the clinic and in surgery. So what made optho more appealing than ENT?

PS. I don't say this to bash optho, I only ask it as I imagine that many of you answered this question on your own specialty search
 
James105 said:
Here's a question: why not ENT? To me ENT offers more variety in the clinic and in surgery. So what made optho more appealing than ENT?

PS. I don't say this to bash optho, I only ask it as I imagine that many of you answered this question on your own specialty search
Click to expand...

If you become more interested in ophtho after second year, make sure you know it's spelled opHthalmology ;-)
 
James105 said:
Here's a question: why not ENT? To me ENT offers more variety in the clinic and in surgery. So what made optho more appealing than ENT?

PS. I don't say this to bash optho, I only ask it as I imagine that many of you answered this question on your own specialty search
Click to expand...

I was actually deciding between ENT and Ophtho when I got to third year. ENT has a lot more surgery and very much of a surgical lifestyle, at least in residency (that's 5 years of your life!) which was a con for me. Then I did an elective in each during third year and did not enjoy ENT but looooved ophtho. So wait until you try it to see which you like more. These are 2 specialties that students very often consider at the same time.
Plus, ENT doesn't really have that much more variety in what you end up doing in your own practice. If you're general ENT, most likely it's tonsillectomies and ear tubes. If you specialize, it's also few things you do very often. This is the case for almost all specialties.
 
James105 said:
Hello Forum,


So, my question is: how did you deal with forgoing much of the general medical training when choosing optho. In other words, does optho offer adequate fulfillment from the medical point of view.

And secondly, do you feel that your practice is varied enough, medically and surgically, to continue to challenge you sufficiently.

Thank you for your time!
Click to expand...

1. Depends on the person. I chose eyes specifically because I did not want to manage a patient's blood pressure, lung problems, psychiatric issues, etc. ever again. I routinely diagnose systemic problems, but then send them straight back to the primary care doc for management. Certain subspecialties like Uveitis deal more with systemic conditions, so that's always available (and non-competitive) if you're into it.

2. Depends on the practice setting and intent of the surgeon. I came into private practice doing a large variety of surgical procedures, but over the years I've intentionally whittled it down to just a few. I've found I'm a happier and less stressed person that way. 95% of what I do now is cataracts, I do a few other anterior segment procedures here and there, and I refer the rest out to subspecialists. But with the right training and the right practice setting, you can do anything you feel comfortable with.
 
James105 said:
I appreciate your insightful replies. I know that a lot of my questions will be decided in 3rd year, so I'm not freaking out about the decision; I just like to think the different options available.

I worked as an EMT before med school, and I really enjoyed it. So coming into med school, I thought EM would be the best match (due to procedures, excitement, general medicine exposure, decent lifestyle). However, the longer I am in med school, the more I feel drawn to depth of medicine (which is typically not found in EM), continuity, and fixing things.

Since optho is much more specialized, and I have had much less exposure, I thought this would be a good place to find answers to questions.

At the end of the day my two precise questions:

1. Will there be enough medicine in the optho clinic to keep me interested.
2. Will there be enough variety in optho surgery to keep me interested. Or would something like ENT be a better fit due to the variety of surgical options...

I started shadowing an optho recently. The exam was cool, there was lots of discussion about systemic diseases (TA, sarcoid, HIV, etc). I know I have a lot to learn, not to mention I have to kill STEP 1, but I do appreciate your thoughts!
Click to expand...

Having struggled extensively with these very same issues, I'll tell you that there is as much medicine as you want there to be. If you want to actively think, engage, run through differentials, and search for underlying/unifying causes for a patient's symptoms, you can (and you will be a better doctor for it). It is much easier in ophthalmology, compared to other specialties, to ignore all else that is going on with a patient, and I guess it's technically possible for you to be a mediocre/possibly adequate ophthalmologist by just dealing with eye stuff. But then you might as well have not gone to med school.

Re: ENT -- as a more "Gen Surg-y" specialty than ophtho, the approach to a patient is also less hypothesis-driven than one would have with a prelim medicine year >> ophthalmology.

One issue with ophthalmology is that there are no life-and-death situations (or very very few of them). On the one hand, that's much less sexy. On the other hand, you can take call from home. One can find satisfaction in being the hero who swoops in and shocks the patient back to life as well as helping a blind grandmother see her grandchildren for the first time in years. :shrug:
 
I'll add a little insight from someone who has been in practice for 4.5 years now. It's interesting, because I was told something similar by a friend prior to making my decision to stop with medical retina. In medical school, residency, fellowship, and the first few years of practice, you are still learning a lot almost every day. Once you have been working in your chosen specialty for a number of years, you have pretty well mastered it. There's not much more you can learn. You don't see much that surprises you. It becomes somewhat mundane. Don't get me wrong. I still enjoy what I do and I do get the occasion surprise or challenging case, but the fact is that you will never be as intellectually stimulated as you are in training. For that reason, lifestyle choices are pretty important in making a decision about where to land. If you pick a challenging specialty with terrible hours, it doesn't really matter how well it pays. You will eventually come to hate it, because it will lose it's luster, but not it's drain on your time and energy. I'm not mentioning this to be a downer. I'm being a realist. I think this is something everyone should know going into medicine. After your practice is built, you will find that you will work harder for less money over the course of your career. That's a known fact. Ask those who came before you. Unfortunately, it's not going to get better with the changes coming to our field. My advice is definitely choose a specialty that interests you, but also keep in mind the lifestyle it will afford you. You don't want to end up resenting your job for the time it takes you away from your family and friends.
 
Thank you all for your fantastic responses! I think the decision will be a portion of my soul searching for next year (M3) year. When entering medical school, I had never considered ophthalmology, so it is transition of mindset to consider saving a patient's vision vs saving their life.

As I begin to engage with physicians regarding their chosen specialty, it is clear that- in most specialties- the job becomes routine...by design. Something that I am learning to come to terms with is that the routine is what makes us good at our particular craft. That is not something that I considered before entering medical school. Therefore, I do agree with you all that lifestyle concerns become very important.

Finally, not to reroute my thread too much, I do have an additional question. I am beginning to study for STEP 1. I am a good student at a P/F school, that is a well known state school. I have been thinking that a 230 is kind of the basement score for me to have a shot at ophthalmology. For you with more experience, do you think that this is a correct assumption.
 
I'd say 230 def allows you to have a "shot" at ophthalmology. Your goal should be atleast 240 though...if you fall short, obviously you can strengthen your application through research, aways, and contacts within the field.


Sent from my iPhone using Tapatalk
 
I have a sub-215 step 1 and still got 6 interviews... that being said, I am not 100% confident that I'll match and it would have been a much easier path had I gotten 230+. Make it a priority.
 
You must log in or register to reply here.