people seem so disillusioned...

[anatomyaddict]

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yes...can't really find a better word for it. so far on my ophtho rotations the residents all seem to tell me its not 'what they thought it would be'. Don't get me wrong, they are very nice people, but they just seem a little...disappointed
I keep asking why. Reimbursements are the most obvious reason, but it seems to be more than that
I guess ophtho residency is just a lot more hard work than it looks like initially? Other than the enormous amount of reading, what are some other common 'unanticipated' issues to look out for?

 

[Shnurek]

I take it back nvm

 

[Eyefixer]

I am close to 4 years out of training and I LOVE ophthalmology. I love 99% of what I do and I think that's pretty good. However, knowing what I know now I would probably pick another specialty. Unless you don't mind living in a rural area, ophthalmology job market is MISERABLE. Extreme supersaturation in competitive areas like LA, NY, SF, Boston, etc., ever plunging starting salaries (have you seen $90K for comprehensive in NY and SF on AAO website), predatory older docs who long for those '80 where they used to make $3900/cataract and now feel that the new associates needs to make next to nothing. Even if you take that low salary, many groups don't really want to make you a partner and they churn new associates every few years. It's a pretty sad picture. Again, I love what I do, but it seems comprehensive will be on par with primary care specialities without all the surgical risk and more flexibility. Buyer beware.

yes...can't really find a better word for it. so far on my ophtho rotations the residents all seem to tell me its not 'what they thought it would be'. Don't get me wrong, they are very nice people, but they just seem a little...disappointed
I keep asking why. Reimbursements are the most obvious reason, but it seems to be more than that
I guess ophtho residency is just a lot more hard work than it looks like initially? Other than the enormous amount of reading, what are some other common 'unanticipated' issues to look out for?

 

[crystalgreen]

I am close to 4 years out of training and I LOVE ophthalmology. I love 99% of what I do and I think that's pretty good. However, knowing what I know now I would probably pick another specialty. Unless you don't mind living in a rural area, ophthalmology job market is MISERABLE. Extreme supersaturation in competitive areas like LA, NY, SF, Boston, etc., ever plunging starting salaries (have you seen $90K for comprehensive in NY and SF on AAO website), predatory older docs who long for those '80 where they used to make $3900/cataract and now feel that the new associates needs to make next to nothing. Even if you take that low salary, many groups don't really want to make you a partner and they churn new associates every few years. It's a pretty sad picture. Again, I love what I do, but it seems comprehensive will be on par with primary care specialities without all the surgical risk and more flexibility. Buyer beware.

wtf? that sounds scary and depressing. im not sure i wanto do ophtho now

 

[MR1]

I still don't get why an ocular surgery residency is only 3 years. I mean if you want to keep above us ODs at least make it 4 years. You have general surgery that is 5 years... I think you have to have a passion for eyes to really enjoy it. An attending I worked for she tried her best to stay away from ophthalmology but she still ended up doing it. Retina and diabetic retinopathy fellowships to follow. Her enjoyment of the job....eh mediocre.

First off, lets not start this again. Call me when you finish your 4 years and compare them to my 3 years. Also "diabetic retinopathy fellowship", do you even have any idea the BS that comes out of you!

wtf? that sounds scary and depressing. im not sure i wanto do ophtho now

Bottom line, do what you want to and love. Any job will drain you life if you hate it. If I could make 1 million doing radiology or 100K doing ophtho, I would do ophtho all day long. Everyone is different.

Yes certain things suck nowadays, if you want to practice in a larger town as a general ophtho, you might start at 100-125K. Friends of mine that went to smaller towns started closer to 200-250K for general. You are not going to make it NY,SF,Boston,Chicago, etc.

 

[Mirror Form]

I still don't get why an ocular surgery residency is only 3 years. I mean if you want to keep above us ODs at least make it 4 years. You have general surgery that is 5 years... I think you have to have a passion for eyes to really enjoy it. An attending I worked for she tried her best to stay away from ophthalmology but she still ended up doing it. Retina and diabetic retinopathy fellowships to follow. Her enjoyment of the job....eh mediocre.

Now this troll is asking to be banned.

 

[Mirror Form]

I am close to 4 years out of training and I LOVE ophthalmology. I love 99% of what I do and I think that's pretty good. However, knowing what I know now I would probably pick another specialty. Unless you don't mind living in a rural area, ophthalmology job market is MISERABLE. Extreme supersaturation in competitive areas like LA, NY, SF, Boston, etc., ever plunging starting salaries (have you seen $90K for comprehensive in NY and SF on AAO website), predatory older docs who long for those '80 where they used to make $3900/cataract and now feel that the new associates needs to make next to nothing. Even if you take that low salary, many groups don't really want to make you a partner and they churn new associates every few years. It's a pretty sad picture. Again, I love what I do, but it seems comprehensive will be on par with primary care specialities without all the surgical risk and more flexibility. Buyer beware.

As eyefixer stated, it's generally the job market that has people disallusioned. The job market is okay in some areas, but even in mid sized cities it's not very good.

 

[ChristianJames1]

As eyefixer stated, it's generally the job market that has people disallusioned. The job market is okay in some areas, but even in mid sized cities it's not very good.

With the aging population, pending increase in newly insured and *hopefully* rebounding economy, do you anticipate this improving? Job markets are typically cyclical, but it seems that ophtho has been beaten back pretty hard in recent years.

I have decided to pursue the specialty anyways, but threads like this scare the crap out of me. Kind of makes me feel like I'm jumping down a black hole.

 

[digitalsideburn]

Honestly I don't think most beginning residents know/think too much about the current job market. Other reasons:

Incredibly steep learning curve initially. Taxing home call. Apprenticeship type residency programs with little surgery. Constantly being confused with optometrists/the continued turf war. Need to learn many things that have little to do with medicine. Most importantly- shattered expectations (ophtho is "easy", $$$, call will be a joke)

Last off- will someone please ban shrunek. His flame wars must stop. There is no comparison between ophthalmology residency and optom school in terms of pathology seen/hours worked/emergency patients treated. How many calls do you take anyway? Zero.

 

[tm12]

Is ophtho now the lowest paid competitive specialty?

 

[Mirror Form]

With the aging population, pending increase in newly insured and *hopefully* rebounding economy, do you anticipate this improving? Job markets are typically cyclical, but it seems that ophtho has been beaten back pretty hard in recent years.

I have decided to pursue the specialty anyways, but threads like this scare the crap out of me. Kind of makes me feel like I'm jumping down a black hole.

I'm hopeful for the future once boomers start needing lots of cataract surgery. This is because of premium IOL's, which may be the savior of ophthalmology. But, there will still be ten times more ophthalmologists than are actually needed in any given large city.

 

[Meibomian SxN]

.....Yes certain things suck nowadays, if you want to practice in a larger town as a general ophtho, you might start at 100-125K. Friends of mine that went to smaller towns started closer to 200-250K for general. You are not going to make it NY,SF,Boston,Chicago, etc.

👍 Agreed.

Arizona is becoming a new landing spot for healthcare professionals also. Not too rural and you won't get low balled like the big metro areas.

 

[Eyefixer]

But, there will still be ten times more ophthalmologists than are actually needed in any given large city.

Bingo. I would not count on this any time soon. There are TONS of practices out there that would LOVE to double, triple their patient volume. Double- get more techs, triple- get an optometrist, you get the picture. Eventually though we should all be in demand but probably not until we are in our mid-careers.

 

[Shnurek]

How many calls do you take anyway? Zero.

Now now, lets not assume things all mighty one. There are some ODs on call during residencies and while working at hospitals. So I can choose to undergo that if I wish. Here's one example: http://www.eyecareprofessions.com/optometrist/residency/bvatulsa-ocular.html

"Call is shared between the optometry resident and staff optometrists and ophthalmologists."

Also the clinical manager (an OD) can be on call for TLC LASIK centers for example. I spoke to one and they surprised me that they are on call. There are many others as well.

 

[Frumps]

removed

 

[ChristianJames1]

Now now, lets not assume things all mighty one. There are some ODs on call during residencies and while working at hospitals. So I can choose to undergo that if I wish. Here's one example: http://www.eyecareprofessions.com/optometrist/residency/bvatulsa-ocular.html

"Call is shared between the optometry resident and staff optometrists and ophthalmologists."

Also the clinical manager (an OD) can be on call for TLC LASIK centers for example. I spoke to one and they surprised me that they are on call. There are many others as well.

Shnurek. Seriously. please don't hijack this. Some of us actually use this site to learn valuable information as we make our career choices. You're really not accomplishing anything right now and I think all of us would appreciate it if you keep inflammatory OD vs. MD stuff out of this. If you do have something salient to add to the conversation about the future outlook of ophthalmology please do so. However, the title of this thread is not ophthalmology training vs. optometry training, so if that is what you want to talk about, please go elsewhere.

 

[hello07]

Shnurek, go study, pass your exams in OD school, NBEO Pts I II III and state boards and become a licensed optometrist. Or, take (or retake?) MCAT and apply to med school - go Caribbean or Europe get your MD and talk all you want.
Your aforementioned comments are garbage. OD does not equal MD.
AND MD does not = OD.
Work to your limits, topical-oral whever you practice but don't glorify yourselve and compare yourself with equal footage- ophthalmology.

GLTY!

 

[Shnurek]

Your aforementioned comments are garbage. OD does not equal MD.
AND MD does not = OD.
Work to your limits, topical-oral whever you practice but don't glorify yourselve and compare yourself with equal footage- ophthalmology.

GLTY!

Lol, I never said MD = OD and I admitted many times OMDs get a more surgical education. And I shall shut up because I have been too reckless in my comments in the recent past.

 

[Slide]

On a somewhat related note, how is the job market in Philadelphia or in the surrounding area? Also, how is it for academia? I haven't ruled out private practice but I think I'm likely going to go for a gig at a teaching hospital, and I do plan on a fellowship.

 

[orbitsurgMD]

On a somewhat related note, how is the job market in Philadelphia or in the surrounding area? Also, how is it for academia? I haven't ruled out private practice but I think I'm likely going to go for a gig at a teaching hospital, and I do plan on a fellowship.

What radius surrounding PHL? From what I hear, it is similar to BOS, DCA, LGA.
If you go out an hour to NJ, PA or DE, the situation in private practice may be better. Academics: Philadelphia has several large medical centers and academic eye departments and two major university-affiliated eye institutes that have satellite offices and surgery centers. Usually those departments hire at many levels, both for their main institutions and for their satellites (and sometimes both or combined with a VA position.) For those, you have to contact the centers individually. Are you doing a fellowship in Philadelphia?

 

[Slide]

What radius surrounding PHL? From what I hear, it is similar to BOS, DCA, LGA.
If you go out an hour to NJ, PA or DE, the situation in private practice may be better. Academics: Philadelphia has several large medical centers and academic eye departments and two major university-affiliated eye institutes that have satellite offices and surgery centers. Usually those departments hire at many levels, both for their main institutions and for their satellites (and sometimes both or combined with a VA position.) For those, you have to contact the centers individually. Are you doing a fellowship in Philadelphia?

My ideal of the Philadelphia area includes Philadelphia county and its surrounding counties (Bucks, Montgomery, Chester, Delaware). I'm too young in my residency to know for sure if I want to do a fellowship in Philadelphia but I have a longing to return to the area for a significant amount of time in my career. I'm trying to gather as much information as possible concerning fellowships and job markets early in my residency so I can make more informed decisions as I progress in my residency.

 

[KlineFogelman]

My ideal of the Philadelphia area includes Philadelphia county and its surrounding counties (Bucks, Montgomery, Chester, Delaware). I'm too young in my residency to know for sure if I want to do a fellowship in Philadelphia but I have a longing to return to the area for a significant amount of time in my career. I'm trying to gather as much information as possible concerning fellowships and job markets early in my residency so I can make more informed decisions as I progress in my residency.

My father is an ophthalmologist, like half the applicants on here. I can just tell you that ophthalmology is NOT a lifestyle field, at least it hasn't been since the early 1990s.

My father's practice (and yes, being a private practitioner makes it harder, because you also have to run a business) is 70% medicare. Every time they cut the medicare reimbursement, his salary immediately drops, so his hours worked necessarily go up.

Great thing about the doctor fix: In June 2010, when the doctor fix expired and medicare reimbursements were set to go down 30%, everyone knew it was just a matter of time before Congress stepped in and retroactively set the rates back where they were. So what did Medicare do? For about 6 weeks, between the legislated rate cut and the anticipated new fix, they didn't reimburse at the lowered rate. Rather, they didn't reimburse AT ALL, citing the confusion! When you called their offices and demanded accountability, their response was, I'm not kidding, "Call your congressman."

Equipment is expensive and a functional office requires a large, competent staff. How in the world do you survive seeing 70% of your revenue, EARNED REVENUE FROM A FULL OFFICE, cut to zero for six weeks? My father had to take out of his savings to pay the staff.

If you're in an area with a large concentration of ophthalmologists, you have to advertise if you're going to maintain your patient base. If you want any sort of refractive practice, wherever you are, you have to advertise, and you have to have a competitive pricing model.

So, at least in private practice, it aint all golf and Royal Hawaiian Eye Meetings. It's payroll, medicare fights, politics, turf wars, advertising campaigns, and having your most indispensable employee be your insurance manager.

 

[Visionary]

My father is an ophthalmologist, like half the applicants on here. I can just tell you that ophthalmology is NOT a lifestyle field, at least it hasn't been since the early 1990s.

My father's practice (and yes, being a private practitioner makes it harder, because you also have to run a business) is 70% medicare. Every time they cut the medicare reimbursement, his salary immediately drops, so his hours worked necessarily go up.

Great thing about the doctor fix: In June 2010, when the doctor fix expired and medicare reimbursements were set to go down 30%, everyone knew it was just a matter of time before Congress stepped in and retroactively set the rates back where they were. So what did Medicare do? For about 6 weeks, between the legislated rate cut and the anticipated new fix, they didn't reimburse at the lowered rate. Rather, they didn't reimburse AT ALL, citing the confusion! When you called their offices and demanded accountability, their response was, I'm not kidding, "Call your congressman."

Equipment is expensive and a functional office requires a large, competent staff. How in the world do you survive seeing 70% of your revenue, EARNED REVENUE FROM A FULL OFFICE, cut to zero for six weeks? My father had to take out of his savings to pay the staff.

If you're in an area with a large concentration of ophthalmologists, you have to advertise if you're going to maintain your patient base. If you want any sort of refractive practice, wherever you are, you have to advertise, and you have to have a competitive pricing model.

So, at least in private practice, it aint all golf and Royal Hawaiian Eye Meetings. It's payroll, medicare fights, politics, turf wars, advertising campaigns, and having your most indispensable employee be your insurance manager.

I'd argue that most of what you state here holds true for most of medicine, not just ophthalmology. The majority of the sick and infirm are Medicare patients. If you treat kids, then you have to deal with Medicaid. Cosmetic medicine escapes this governmental mess, but with the current economy, they are being hit hard, as well.

As for my practice, we do quite well, considering. We don't advertise, yet most of the docs book out for months. The lack of advertising keeps our overhead lower than most, which is also nice. It's not all rosey, but a lot depends on where and how you practice.

 

[Meibomian SxN]

.....So, at least in private practice, it aint all golf and Royal Hawaiian Eye Meetings. It's payroll, medicare fights, politics, turf wars, advertising campaigns, and having your most indispensable employee be your insurance manager.

👍 Real talk 👍

 

[Eyefixer]

I'd argue that most of what you state here holds true for most of medicine, not just ophthalmology.

Even though the above statement is true, I believe ophthalmology is unique in the sense that our overhead is probably one of the highest for outpatient specialties (strike 1), hospitals do not need us and therefore do not hire us (with few exceptions) (strike 2); and 80% of our patients are Medicare age with ever decreasing reimbursements ( strike 3). You can also add oversaturation, optometric issues, etc. etc. All this is a recipe for an intellectually stimulating but financially unrewarding field.

 

[Visionary]

Even though the above statement is true, I believe ophthalmology is unique in the sense that our overhead is probably one of the highest for outpatient specialties (strike 1), hospitals do not need us and therefore do not hire us (with few exceptions) (strike 2); and 80% of our patients are Medicare age with ever decreasing reimbursements ( strike 3). You can also add oversaturation, optometric issues, etc. etc. All this is a recipe for an intellectually stimulating but financially unrewarding field.

Yuck, nor would I want them to. I've talked to too many other docs (primarily IM) that sought the "shelter" of hospital employment only to run back to private practice within a year or so. Yes, the business aspect can be a hassle, but your earning potential is better in private practice and you don't sacrifice your autonomy.

 

[Eyefixer]

Yuck, nor would I want them to. I've talked to too many other docs (primarily IM) that sought the "shelter" of hospital employment only to run back to private practice within a year or so. Yes, the business aspect can be a hassle, but your earning potential is better in private practice and you don't sacrifice your autonomy.

I am seeing the opposite where I am. With high overhead and decreasing reimbursement who knows what your earning potential is for the future. The advantage of IM docs (and many many other specialities) is that THERE IS a shelter to run to. We don't have any place to run to. Because ophthalmology private practices do not compete with hospitals, HMOs, etc for best and brightest, initial salaries are even lower (free market, yey!). And you know what else you won't have in private practice: 4 weeks of paid vacation per year, 1 week of CME/year, health, dental, vision, 401K match, flexible spending account, paid disability insurance, long-term care insurance, months and months of paid sick leave, pre-tax child care allowance, paid life insurance, free cell phone, free gym membership, etc., etc. Need I continue?

 

[Visionary]

I am seeing the opposite where I am. With high overhead and decreasing reimbursement who knows what your earning potential is for the future. The advantage of IM docs (and many many other specialities) is that THERE IS a shelter to run to. We don't have any place to run to. Because ophthalmology private practices do not compete with hospitals, HMOs, etc for best and brightest, initial salaries are even lower (free market, yey!). And you know what else you won't have in private practice: 4 weeks of paid vacation per year, 1 week of CME/year, health, dental, vision, 401K match, flexible spending account, paid disability insurance, long-term care insurance, months and months of paid sick leave (show me where you can get "months"), pre-tax child care allowance, paid life insurance (small policy), free cell phone, free gym membership, etc., etc. Need I continue?

I'll have to disagree with most of this. Do you honestly think hospitals/HMOs will keep the docs salaries rising, if reimbursements fall? Are they going to start printing money? Oh, your base salary may stay the same, but your bonus will drop.

You mentioned starting salaries. Well, of course they're better in hospitals/HMOs. That's to get you in the door. They subsidize you because the system as a whole can spare it. When you're up to speed, I guarantee you'll make less than an established private practice doc. Now, if the business aspect turns you off, as it does many docs, it may be worth handing over a percentage to have someone else run it. Keep in mind that you also hand over your autonomy.

I think you're embellishing the benefits a bit, but most of what you list I have as an associate (see bolded).

 

[Meibomian SxN]

....I think you're embellishing the benefits a bit, but most of what you list I have as an associate (see bolded).

Uhh, you probably have it as a retina surgeon. I'm sure if we were to take a poll with the comprehensive oMDs that this is not the case.

Also how would a hospitalist's income go below private practice if its started out high? I find it hard to believe that they lower base salaries.

 

[Eyefixer]

I'll have to disagree with most of this. Do you honestly think hospitals/HMOs will keep the docs salaries rising, if reimbursements fall? Are they going to start printing money? Oh, your base salary may stay the same, but your bonus will drop.

You mentioned starting salaries. Well, of course they're better in hospitals/HMOs. That's to get you in the door. They subsidize you because the system as a whole can spare it. When you're up to speed, I guarantee you'll make less than an established private practice doc. Now, if the business aspect turns you off, as it does many docs, it may be worth handing over a percentage to have someone else run it. Keep in mind that you also hand over your autonomy.

I think you're embellishing the benefits a bit, but most of what you list I have as an associate (see bolded).

Listen, I am not here to pick a fight. I have a unique perspective since I worked in private practice and HMO setting and I have to tell you that you will never ever have the kind of benefits working in private practice as compared to a large organization. All of us are now wondering how to better position ourselves in order to survive in the future. In my opinion, as reimbursements continue to go down, being associated with a large successful organization does give you some protection as compared to "you eat what you kill" private practice model.

Yes, you do give up some autonomy (quite a lot actually). But I think most reasonable people can work with that. If you are a prima donna and need that specific instrument in the OR or you are walking out!!!! maybe private practice is better for you.

Personally, I haven't decided which model will work better for me long-term. But you can see where I am leaning.

P.S. Gees, man, you get 4 weeks paid vacation AND 1 week CME as a retina associate??? Fax over a copy of your contract, I'd like to verify that 😀

 

[KHE]

Listen, I am not here to pick a fight. I have a unique perspective since I worked in private practice and HMO setting and I have to tell you that you will never ever have the kind of benefits working in private practice as compared to a large organization. All of us are now wondering how to better position ourselves in order to survive in the future. In my opinion, as reimbursements continue to go down, being associated with a large successful organization does give you some protection as compared to "you eat what you kill" private practice model.

Yes, you do give up some autonomy (quite a lot actually). But I think most reasonable people can work with that. If you are a prima donna and need that specific instrument in the OR or you are walking out!!!! maybe private practice is better for you.

Personally, I haven't decided which model will work better for me long-term. But you can see where I am leaning.

P.S. Gees, man, you get 4 weeks paid vacation AND 1 week CME as a retina associate??? Fax over a copy of your contract, I'd like to verify that 😀

I have worked for large corporations and I can honestly say that the benefits that I receive in private practice FAR FAR FAAAAR exceed any corporate benefits. WHy? Because I create my own benefit package. And after giving it much thought, I decided I deserve a very generous one. 🙂

That's the key. If you are looking for someone to employ you, you're right. You'll probably do better in the benefit package in an institutional setting but the only way to make any real money in this business (any business really) is to work for yourself.

 

[Visionary]

Uhh, you probably have it as a retina surgeon. I'm sure if we were to take a poll with the comprehensive oMDs that this is not the case.

Also how would a hospitalist's income go below private practice if its started out high? I find it hard to believe that they lower base salaries.

A) I'm not a retina surgeon and I'm not in a retina practice. I'm med ret, and the rest of the docs in my group are predominantly comprehensive.

B) The starting salary in a hospital/HMO model does tend to be higher than that in a private practice model, but the latter has more growth potential. In other words, what you start at in the former is probably what you will continue to make. In the latter, your income will grow during your associate years, then jump when you make partner.

C) I did not say they would lower the base salary, but the productivity bonus will definitely drop if reimbursements do. They aren't just going to subsidize you forever.

 

[Visionary]

Listen, I am not here to pick a fight. I have a unique perspective since I worked in private practice and HMO setting and I have to tell you that you will never ever have the kind of benefits working in private practice as compared to a large organization. All of us are now wondering how to better position ourselves in order to survive in the future. In my opinion, as reimbursements continue to go down, being associated with a large successful organization does give you some protection as compared to "you eat what you kill" private practice model.

Yes, you do give up some autonomy (quite a lot actually). But I think most reasonable people can work with that. If you are a prima donna and need that specific instrument in the OR or you are walking out!!!! maybe private practice is better for you.

Personally, I haven't decided which model will work better for me long-term. But you can see where I am leaning.

P.S. Gees, man, you get 4 weeks paid vacation AND 1 week CME as a retina associate??? Fax over a copy of your contract, I'd like to verify that 😀

Neither am I (trying to pick a fight). I'm just offering a different perspective. As a disclaimer, I am in an 8 doc group, which is on the larger end of private practice groups. Yes, those are my actual benefits. I also get $2500 per year for CME travel expenses. You also left out malpractice, which is also covered. If you join a smaller group, the benefits are clearly going to be harder to come by.

Listen, I would argue that anyone looking to position themselves for the future should consider a large group or merging of smaller groups, rather than seeking employment. Many other specialties are going that route. There have been large urology and ENT mergers in my area in recent years. There's safety in numbers, especially with the ACO/PCMH models that are coming down the pike as part of health care reform. If you go the hospital/HMO route, they own you. Forget about the prima donna BS. I want control over my own hours, my patient volume, how I care for patients, etc.

 

[Meibomian SxN]

A) I'm not a retina surgeon and I'm not in a retina practice. I'm med ret, and the rest of the docs in my group are predominantly comprehensive.

B) The starting salary in a hospital/HMO model does tend to be higher than that in a private practice model, but the latter has more growth potential. In other words, what you start at in the former is probably what you will continue to make. In the latter, your income will grow during your associate years, then jump when you make partner.

C) I did not say they would lower the base salary, but the productivity bonus will definitely drop if reimbursements do. They aren't just going to subsidize you forever.

I see. Sort of like commercial jobs in Optometry. High starting salary with a ceiling and no autonomy.

Did you earn the 4wks or is that given up front? Either way, nice! I guess you're a regular at "Royal Hawaiian Eye Meetings" lol.

 

[Visionary]

I have worked for large corporations and I can honestly say that the benefits that I receive in private practice FAR FAR FAAAAR exceed any corporate benefits. WHy? Because I create my own benefit package. And after giving it much thought, I decided I deserve a very generous one. 🙂

That's the key. If you are looking for someone to employ you, you're right. You'll probably do better in the benefit package in an institutional setting but the only way to make any real money in this business (any business really) is to work for yourself.

I knew you'd find your way into this discussion, Ken! I, of course, agree. What many people may not realize is that self-employment has a lot of pluses, if you can deal with the business aspect. Many of the benefits are actually pre-tax or can be written off. If you structure it right, there is no way you don't make more and have better benefits in private practice (given the same patient volume, that is). You just have to be smart about it, and unfortunately, we don't receive much instruction along those lines. Most of us have to learn on the job.

 

[Visionary]

I see. Sort of like commercial jobs in Optometry. High starting salary with a ceiling and no autonomy.

Did you earn the 4wks or is that given up front? Either way, nice! I guess you're a regular at "Royal Hawaiian Eye Meetings" lol.

Exactly! This mirrors a lot of what I've been seeing on the optometry forum.

Yes, it was up front. Believe it or not, I haven't even used a full 4 weeks in a year, though. I'm trying to maximize my revenue, and thus my productivity bonus (extensive school loans, 2 kids in private school, stay-at-home mom, etc.). I only attend one conference per year. Usually AAO or ASRS. No Hawaiian Eye for me. Once I'm partner, I'm going to force myself to take more time off, however. I owe it to myself and my family.

 

[Eyefixer]

Neither am I (trying to pick a fight). I'm just offering a different perspective. As a disclaimer, I am in an 8 doc group, which is on the larger end of private practice groups. Yes, those are my actual benefits. I also get $2500 per year for CME travel expenses. You also left out malpractice, which is also covered. If you join a smaller group, the benefits are clearly going to be harder to come by.

Listen, I would argue that anyone looking to position themselves for the future should consider a large group or merging of smaller groups, rather than seeking employment. Many other specialties are going that route. There have been large urology and ENT mergers in my area in recent years. There's safety in numbers, especially with the ACO/PCMH models that are coming down the pike as part of health care reform. If you go the hospital/HMO route, they own you. Forget about the prima donna BS. I want control over my own hours, my patient volume, how I care for patients, etc.

Great for you! Unfortunately, based on your previous posts, I can not live where you live. I am tied to a large oversaturated city in a state with worst economy in the country (name starts with a C and ends with an A). There are family reasons, personal reasons, etc. etc. and heck, I grew up here! Going home for me means being where I am now. I am sure lots of people are in my situation as well.

Yes, strength is in numbers. Large groups will survive, I hope. I also think it wouldn't be bad to work for a large successful IPA if the terms were right. But maybe that's just me. What concerns me about private practice is that getting paid for your services is a like a moving target- see above example where medicare stopped paying for 6 weeks out of "confusion". I am afraid this is just a tip of the iceberg. As babyboomers hit cataract age all of us will be busy. There also won't be any money to pay for it. What's a better way to position yourself for the future? Only time will tell...

 

[Visionary]

Great for you! Unfortunately, based on your previous posts, I can not live where you live. I am tied to a large oversaturated city in a state with worst economy in the country (name starts with a C and ends with an A). There are family reasons, personal reasons, etc. etc. and heck, I grew up here! Going home for me means being where I am now. I am sure lots of people are in my situation as well.

Yes, strength is in numbers. Large groups will survive, I hope. I also think it wouldn't be bad to work for a large successful IPA if the terms were right. But maybe that's just me. What concerns me about private practice is that getting paid for your services is a like a moving target- see above example where medicare stopped paying for 6 weeks out of "confusion". I am afraid this is just a tip of the iceberg. As babyboomers hit cataract age all of us will be busy. There also won't be any money to pay for it. What's a better way to position yourself for the future? Only time will tell...

Geez, is everyone on SDN from California or NYC?! Seriously, though, you're getting at another important, though tangentially related, issue. I won't belabor the point, as it's been discussed ad nauseum in other threads, but finding a good job in any field of medicine (or any field at all, for that matter) is going to be tough and probably not completely satisfying to your expectations, given the amount of time and effort you've put into training, if you are set on a saturated area. That's a fact. It's not fair, because most of us don't understand the market forces at work in our profession before or even while in med school. Most just go in with the goal of becoming doctors and figure we'll be able to work wherever we want. And I completely understand the desire to return home to practice. That makes it all the more discouraging when home is one of those saturated regions of the country. It sucks.

Of course, you'll probably find more large groups in those areas, just like I was getting at. The drive to shelter together is even higher, when there is saturation. I'll also concede that in a saturated market, securing a hospital/HMO gig, such at VAMC or Kaiser, may be a good option. In most of the rest of the country, however, the better option is going to be private practice.

The Medicare anecdote, while scary, is not likely to be repeated. That's the closest to the brink we have ever been. I think the folks in Washington even streaked their shorts on that one. While a permanent SGR fix is not in place currently, I will be surprised if something isn't passed in the next few months. The chaos that would ensue with an across the board 30% cut in Medicare reimbursements would be far worse for the politicians than the recent debt ceiling fiasco. I think they understand that now. Only time will tell, as you said.

 

[KHE]

Great for you! Unfortunately, based on your previous posts, I can not live where you live. I am tied to a large oversaturated city in a state with worst economy in the country (name starts with a C and ends with an A). There are family reasons, personal reasons, etc. etc. and heck, I grew up here! Going home for me means being where I am now. I am sure lots of people are in my situation as well.

If that's the case and you are truly limited to a very small geographic area that is supersaturated then it really makes very little sense to lament the fact that salaries are higher elsewhere.

It doesn't matter if salaries and benefits are higher, lower or somewhere in between. You are going where you are going.

In the past, I lamented the problems with my own profession. But what's really help me make peace with all the hassles of it is to remind myself of the famous quote that Hyman Roth made in the Godfather II where he says "This is the business we have chosen." (look for it on youtube if you want or better yet, just watch the Godfather. lol)

Just remind yourself that this is the business you have chosen. And then just go out and try to make it as good for yourself as you can.

 

[Eyefixer]

Geez, is everyone on SDN from California or NYC?!

Are you surprised? By statistics, 50% of all medical school applicants come from CA, NY, TX, and FL.

Seriously, though, you're getting at another important, though tangentially related, issue. I won't belabor the point, as it's been discussed ad nauseum in other threads, but finding a good job in any field of medicine (or any field at all, for that matter) is going to be tough and probably not completely satisfying to your expectations, given the amount of time and effort you've put into training, if you are set on a saturated area. That's a fact. It's not fair, because most of us don't understand the market forces at work in our profession before or even while in med school. Most just go in with the goal of becoming doctors and figure we'll be able to work wherever we want. And I completely understand the desire to return home to practice. That makes it all the more discouraging when home is one of those saturated regions of the country. It sucks.

Very true. But "tough" is a relative term. Physicians in other surgical and non-surgical fields for the most part take pay cuts and possibly have to deal with SOME geographic restrictions, but for ophthalmologists, pathologists, and some other specialities is a whole other ball of wax. 20-30 people in line for any crappy position. "What, you don't like my offer???!!! Next!!!"

Of course, you'll probably find more large groups in those areas, just like I was getting at. The drive to shelter together is even higher, when there is saturation. I'll also concede that in a saturated market, securing a hospital/HMO gig, such at VAMC or Kaiser, may be a good option. In most of the rest of the country, however, the better option is going to be private practice.

I actually find the opposite to be true around here. 1-2 person practices. Very small scale. Offers for new associates do come around sometimes but the base and benefits are so low, makes you want to vomit. Kaiser and VA are good options, as you mentioned.

The Medicare anecdote, while scary, is not likely to be repeated. That's the closest to the brink we have ever been. I think the folks in Washington even streaked their shorts on that one. While a permanent SGR fix is not in place currently, I will be surprised if something isn't passed in the next few months. The chaos that would ensue with an across the board 30% cut in Medicare reimbursements would be far worse for the politicians than the recent debt ceiling fiasco. I think they understand that now. Only time will tell, as you said.

I have to disagree with you here. You know about plans to cut $400 B from Medicare, right? This may not happen this January, but this WILL happen. Mark my words.

P.S. On an unrelated topic, are any of you members of Sermo? This is physician only website (sorry KHE). Lots of good information and spirited discussions going on. Highly recommend you join. You can read through posts of PRACTICING physicians of different specialities and get a better understanding that the term "tough job market" means different things to different people 👍

 

[VikingFavre]

How's the job market in the South? Specifically Texas, Georgia, or Florida?

 

[Visionary]

Are you surprised? By statistics, 50% of all medical school applicants come from CA, NY, TX, and FL.

No, not really.

Very true. But "tough" is a relative term. Physicians in other surgical and non-surgical fields for the most part take pay cuts and possibly have to deal with SOME geographic restrictions, but for ophthalmologists, pathologists, and some other specialities is a whole other ball of wax. 20-30 people in line for any crappy position. "What, you don't like my offer???!!! Next!!!"

Agreed, that it does vary somewhat by specialty, but the I still think it's a fair generalization.

I actually find the opposite to be true around here. 1-2 person practices. Very small scale. Offers for new associates do come around sometimes but the base and benefits are so low, makes you want to vomit. Kaiser and VA are good options, as you mentioned.

Interesting. Are you talking about comprehensive only or also subspecialists? I guess my reference is retina, and most of the docs I know of in the saturated markets are in large groups.

I have to disagree with you here. You know about plans to cut $400 B from Medicare, right? This may not happen this January, but this WILL happen. Mark my words.

Well, no doubt cuts will need to be made, as the current system is not sustainable. I was referring to the game of chicken that was played recently. Looks like there is currently a plan on the table to cut specialists across the board. That will decrease spending and narrow the gap between specialists and primary care docs. Not sure it will fly, though.

P.S. On an unrelated topic, are any of you members of Sermo? This is physician only website (sorry KHE). Lots of good information and spirited discussions going on. Highly recommend you join. You can read through posts of PRACTICING physicians of different specialities and get a better understanding that the term "tough job market" means different things to different people 👍

I've heard of that, but have yet to check it out.

 

[Visionary]

How's the job market in the South? Specifically Texas, Georgia, or Florida?

I have no direct knowledge, but I'd wager that the Florida market is terrible. Major saturation down there. Just checked the ASRS site, and there are 151 registered members in Florida! And that's just retina! For comparison, Texas only has 129 (but larger state) and Georgia 27.

The more rural parts of Texas and Georgia may have opportunities, but I would imagine Dallas/Houston and Atlanta would be tough.

 

[Eyefixer]

Interesting. Are you talking about comprehensive only or also subspecialists? I guess my reference is retina, and most of the docs I know of in the saturated markets are in large groups.

Basically, everything other then retina. Yes, you are correct, retina practices tend to be large even here. Although there are a few docs solo or in 2 doc groups. I don't know how they do it.

I've heard of that, but have yet to check it out.

Go to www.sermo.com. You need to input your medical license. Great forum.

 

[Bgladney]

How's the job market in the South? Specifically Texas, Georgia, or Florida?

There are opportunities out there.....the problem is what everyone is saying.... supersaturation in the metropolitan areas. It is an issue that is not going away anytime soon.

When I first started in the field, 75% of the candidates finishing training grew up in a smaller community (250,000 pop or less). Today....probably less than 10% have lived in a rural location. Due to that comfort level, everyone is looking for an opportunity in the metro locations. Unfortunately, there are less and less opportunities available in those areas that were seen in the past.

Many late career physicians have continued practicing in order to recoup lost retirement funds. Rather than retiring at 65, many are not planning to retire until age 70. At the same time, there are many candidates who would like to relocate but are unable due to the housing market. They are so underwater on their properties, they are unable to leave although unhappy with their practice. These are just two segments of the employment market that help to alleviate the over saturation in the metro areas.

There are plenty of great opportunities available throughout the country....you just need to find out what is most important to you...a busy rewarding practice or a metro lifestyle. In most situations, you are going to have one or the other.

 

[MstaKing10]

keep in mind Florida has a huge retirement population and thus more need for physicians than other areas. Also, there are plenty of underserved areas in Florida, particularly in the north and panhandle areas. Texas is a similar story, with lots of opportunity in west and south Texas. Yes, opportunities are limited but they do exist, just have to search and maybe get a bit lucky.

 

[intoxicatedtiger]

I actually find the opposite to be true around here. 1-2 person practices. Very small scale. Offers for new associates do come around sometimes but the base and benefits are so low, makes you want to vomit. Kaiser and VA are good options, as you mentioned.

I agree. Up here in the Bay Area, I would say that the majority of the non-retina ophthalmologists are 1-3 person practices. In addition, I find most to be older. Given that 40% of patients in California are HMO patients, you do see a good number of folks in the Kaiser system and the likes. So in terms of oversaturation for private practitioners, it's actually a bit worse because we're all fending for the remaining 60% of the population, of which a decent percentage is uninsured.

Yes, there is the issue of the 20-30% paycut and increased cost of living in these saturated metropolitan areas. However, the other issue, at least with the Bay Area, is that since many practices consist of older solo practitioners, newly hired associates end up working in an antequated environment with no new toys. I wouldn't be surprised if you still had to do your IOL calculations with A-scan and manual keratometry in some places. And don't even think about having an OCT. I think some new grads and young ophthalmologists get discouraged by such poor infrastructure that they actually end up leaving shortly after landing their coveted Bay Area job.

Lastly, if you're not doing your residency in the same city where you want to live, you'll be competing with residents with home field advantage. It's pretty tough when you're applying from the outside along with residents from UCSF, CPMC, and Stanford. A lot of the jobs will go under the radar to people from local programs.

In terms of retina, it's way oversaturated here, and most retina folks are large 4-8 man groups. Having said that, some groups have continued to hire recently.

 

[Eyefixer]

I agree. Up here in the Bay Area, I would say that the majority of the non-retina ophthalmologists are 1-3 person practices. In addition, I find most to be older. Given that 40% of patients in California are HMO patients, you do see a good number of folks in the Kaiser system and the likes. So in terms of oversaturation for private practitioners, it's actually a bit worse because we're all fending for the remaining 60% of the population, of which a decent percentage is uninsured.

I heard to up 70% of patients belong to Kaiser and Sutter now. But you may know better.

Yes, there is the issue of the 20-30% paycut and increased cost of living in these saturated metropolitan areas. However, the other issue, at least with the Bay Area, is that since many practices consist of older solo practitioners, newly hired associates end up working in an antequated environment with no new toys. I wouldn't be surprised if you still had to do your IOL calculations with A-scan and manual keratometry in some places. And don't even think about having an OCT. I think some new grads and young ophthalmologists get discouraged by such poor infrastructure that they actually end up leaving shortly after landing their coveted Bay Area job.

Yes, completely agree.

 

[Slide]

How's the job market in the South? Specifically Texas, Georgia, or Florida?

If you're interested in Mississippi, there are many cities that are dying for an ophthalmologist. My hometown only has one ophthalmologist and he is likely to retire in the near future. So far no one has taken up offers to start a practice down there. Not sure what pay is, but I've already had recruiters solicit me for contracts in the future in some towns.

 

[odieoh]

I am seeing the opposite where I am. With high overhead and decreasing reimbursement who knows what your earning potential is for the future. The advantage of IM docs (and many many other specialities) is that THERE IS a shelter to run to. We don't have any place to run to. Because ophthalmology private practices do not compete with hospitals, HMOs, etc for best and brightest, initial salaries are even lower (free market, yey!). And you know what else you won't have in private practice: 4 weeks of paid vacation per year, 1 week of CME/year, health, dental, vision, 401K match, flexible spending account, paid disability insurance, long-term care insurance, months and months of paid sick leave, pre-tax child care allowance, paid life insurance, free cell phone, free gym membership, etc., etc. Need I continue?

I get almost everything you mentioned here. I highly doubt than any specialty gives you ALL of what you listed. I don't think too many places would give you "months and months of paid sick leave.