question from a prospective OD student

[pudgie84]

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hi, i just posted this question in the "allopathic" board and then realized there was a ophthalmology section, so sorry if i'm repeating myself:

i plan on applying to optometry school, but i wanted to dig a little further into what becoming an ophthalmologist entails. i realize you need to get an MD or DO first, but would someone be nice enough to explain the procedure for obtaining a residency and how competitive ophthalmology is? do you have to be a top student in med school and apply to multiple opth residencies to have just a chance of getting into the field? would a DO degree be just as competitive as an MD? thanks!

 

[mydodger]

hi, i just posted this question in the "allopathic" board and then realized there was a ophthalmology section, so sorry if i'm repeating myself:

i plan on applying to optometry school, but i wanted to dig a little further into what becoming an ophthalmologist entails. i realize you need to get an MD or DO first, but would someone be nice enough to explain the procedure for obtaining a residency and how competitive ophthalmology is? do you have to be a top student in med school and apply to multiple opth residencies to have just a chance of getting into the field? would a DO degree be just as competitive as an MD? thanks!

The MD or DO degree is four years of medical training and you apply to residency programs in your last year. As a rule the DO degree is not as competitive, and seeing as medical schools are increasing enrollment but there aren't any new ophthalmology spots it will likely only get more competitive. If you think you want to do Ophthalmology go to an MD school. I'm sure someone on here will argue for the DO degree but the statistics are pretty plain - you have a much better chance to match with an MD.

Ophthalmology is one of the most competitive residencies to get into - you need to have good grades, good board exam scores, volunteer/research experience, etc to get in. There are plenty of people who get in with less than perfect scores or who discovered Ophthalmology late in third year and really didn't have any time to do research before applying who match - but your application should be as well rounded as you can make it. Here [pdf warning] are the stats for recent years. And yes you have to apply to multiple residencies, but it is all done through a simple system - the sfmatch. Last year applicants applied to an average of 57 programs each, but it isn't like you're filling out 57 different sets of paperwork. Even if you had to I don't think it would stop anyone from applying, though.

Ophthalmology residency is four years long - one year of internal medicine and three years of only ophthalmology. You make about $48,000 per year at that point and are on average around $150-200,000 in debt from medical school. Some people (about 50% these days) do a fellowship after that for more training in a particular area.

And not to start a flame war but what the heck it was bound to happen anyway - that's the amount of training that it takes to safely perform surgery on the eye and treat all diseases related to the eye.

 

[pudgie84]

thanks for the response mydodger. from that last sentence, i take it you are pro-ophth, anti-opt? i wrestled back and forth between MD and OD and finally decided on OD because I am not really interested in performing surgery. it also seems that optometry would be a lot less lucrative but also a lot less stressful and more practical in terms of setting up a private office with a somewhat flexible work schedule. are you going into ophthalmology? the optometry school application comes out next week and i guess i'm digging a little more into ophth before i make any FINAL decision. if you can sell ophth, please do. i'm so afraid of making the wrong choice!

 

[mydodger]

thanks for the response mydodger. from that last sentence, i take it you are pro-ophth, anti-opt? i wrestled back and forth between MD and OD and finally decided on OD because I am not really interested in performing surgery. it also seems that optometry would be a lot less lucrative but also a lot less stressful and more practical in terms of setting up a private office with a somewhat flexible work schedule. are you going into ophthalmology? the optometry school application comes out next week and i guess i'm digging a little more into ophth before i make any FINAL decision. if you can sell ophth, please do. i'm so afraid of making the wrong choice!

I am absolutely not anti-optometry! In the real world I have only worked alongside awesome intelligent Optometrists. However I do not think that Optometrists should be doing surgery, and there is a large presence of optometry students and optometrists who think that they should and are very vocal about it here in the ophtho forums. It's just not sufficient training. OMDs and ODs are not equivalent. Keep checking into ophthalmology online but really there is not substitute for experience. If you can, call up Ophthalmologists in your area and ask if they would allow you to shadow them. If you can go to surgery with them once that would be even better. If you're hooked once you watch a cataract or lasik case, you'll know which field to go into. Eyetube.net if you can't see it in person, but it is not at all the same. I've heard from some Optometrists that the field is saturated but I've heard similar things about Ophtho, and I've heard that both fields are still good to go into - so I suppose it will just depend on who you ask. I don't know if I would advise going to medical school if you think that you couldn't possibly enjoy any other field except for Ophthalmology -- there is a real possibility that you won't match. Heck, I may not match. And that would suck. If you go to medical school go somewhere that has an Ophthalmology residency program and get to know the faculty early and get into some research - that's probably the best way for a near-guarantee to be matched.

 

[cubsrule4e]

However I do not think that Optometrists should be doing surgery, and there is a large presence of optometry students and optometrists who think that they should and are very vocal about it here in the ophtho forums.

Luuuuuuuuuke! I feel a presence coming this way that I have not felt in some time....and no, its not your father. Its...the Shnurek! 😱😱😱

 

[Shnurek]

sup guys

 

[Visionary]

Lol!

 

[mydodger]

sup guys

 

[RestoreSight]

Luuuuuuuuuke! I feel a presence coming this way that I have not felt in some time....and no, its not your father. Its...the Shnurek! 😱😱😱

love the star wars plug👍

 

[Shnurek]

thanks for the response mydodger. from that last sentence, i take it you are pro-ophth, anti-opt? i wrestled back and forth between MD and OD and finally decided on OD because I am not really interested in performing surgery. it also seems that optometry would be a lot less lucrative but also a lot less stressful and more practical in terms of setting up a private office with a somewhat flexible work schedule. are you going into ophthalmology? the optometry school application comes out next week and i guess i'm digging a little more into ophth before i make any FINAL decision. if you can sell ophth, please do. i'm so afraid of making the wrong choice!

Good choice then. Here are the surgical minimums every ophthalmologist has to perform before they can be a full attending:

Cataract - 86
Laser Surgery - YAG Capsulotomy - 5
Laser Surgery - Laser trabeculoplasty - 5
Laser Surgery - Laser iridotomy - 4
Laser Surgery - Panretinal laser photcoagulation - 20
Laser Surgery - Focal laser photocoagulation - 5
Corneal Surgery - 3
Keratorefractive Surgery - 6
Strabismus - 10
Glaucoma - Filtering/shunting procedures - 5
Retinal Vitreous - 10
Oculoplastic and Orbit - 28
Oculoplastic and Orbit - Eyelid laceration - 3
Oculoplastic and Orbit - Chalazia Excision - 3
Oculoplastic and Orbit - Ptosis/blepharoplasty - 3
Globe Trauma - 4

Kind of interesting that some ODs somewhere can perform 5/16 of these types of surgeries. Now I see why people can get upset.

 

[xanthomondo]

Good choice then. Here are the surgical minimums every ophthalmologist has to perform before they can be a full attending:

Cataract - 86
Laser Surgery - YAG Capsulotomy - 5
Laser Surgery - Laser trabeculoplasty - 5
Laser Surgery - Laser iridotomy - 4
Laser Surgery - Panretinal laser photcoagulation - 20
Laser Surgery - Focal laser photocoagulation - 5
Corneal Surgery - 3
Keratorefractive Surgery - 6
Strabismus - 10
Glaucoma - Filtering/shunting procedures - 5
Retinal Vitreous - 10
Oculoplastic and Orbit - 28
Oculoplastic and Orbit - Eyelid laceration - 3
Oculoplastic and Orbit - Chalazia Excision - 3
Oculoplastic and Orbit - Ptosis/blepharoplasty - 3
Globe Trauma - 4

Kind of interesting that some ODs somewhere can perform 5/16 of these types of surgeries. Now I see why people can get upset.

...and here we all thought you weren't going to troll this thread.

 

[Shnurek]

...and here we all thought you weren't going to troll this thread.

 

[Visionary]

...and here we all thought you weren't going to troll this thread.

Going with the slow play this time.😎

 

[mydodger]

Going with the slow play this time.😎

He's slowing down but I predict that at this pace he'll be convinced that his OD is equivalent to a qualified vitreoretinal surgeon's training by the time he graduates.

 

[Shnurek]

He's slowing down but I predict that at this pace he'll be convinced that his OD is equivalent to a qualified vitreoretinal surgeon's training by the time he graduates.

 

[Meibomian SxN]

And not to start a flame war but what the heck it was bound to happen anyway - that's the amount of training that it takes to safely perform surgery on the eye and treat all diseases related to the eye.

Safely? All diseases? Not trying to fan a flame war but comparing the number of negligence lawsuits between the two professions, it becomes quite clear what it takes to perform safe procedures and treat all diseases....

just sayin...

 

[Shnurek]

Safely? All diseases? Not trying to fan a flame war but comparing the number of negligence lawsuits between the two professions, it becomes quite clear what it takes to perform safe procedures and treat all diseases....

just sayin...

Exactly. Let's compare professional liability rates of medical optometrists to comprehensive ophthalmologists that don't do surgery 😀

 

[mydodger]

Exactly. Let's compare professional liability rates of medical optometrists to comprehensive ophthalmologists that don't do surgery and refer out all complex cases. 😀

Fixed that for you.

 

[Shnurek]

Fixed that for you.

Yes, but the comprehensive ophthos also refer out to fellowship trained ophthos.

 

[mydodger]

Yes, but the comprehensive ophthos also refer out to fellowship trained ophthos.

Yeah, you're right, they're pretty much exactly the same Optometrists. There is literally no benefit to seeing a general Ophthalmologist. Right Shnurek?

 

[Shnurek]

Yeah, you're right, they're pretty much exactly the same Optometrists. There is literally no benefit to seeing a general Ophthalmologist. Right Shnurek?

They'll be my future competition. I'll let the patients decide 🙂

 

[xanthomondo]

They'll be my future competition. I'll let the patients decide 🙂

I already feel bad for your future patients.

You'll be that provider that refuses to accept when they can't handle something or when patients would be better off in the hands of someone more experienced. You're going to think there is no one more qualified to handle a patient than yourself.

 

[mydodger]

I already feel bad for your future patients.

You'll be that provider that refuses to accept when they can't handle something or when patients would be better off in the hands of someone more experienced. You're going to think there is no one more qualified to handle a patient than yourself.

Well hopefully he'll learn more about his abilities and when to refer during internship and residency.

Oh I forgot Optometrists don't need that to be equivalent to OMDs.

 

[Shnurek]

Well hopefully he'll learn more about his abilities and when to refer during internship and residency.

Oh I forgot Optometrists don't need that to be equivalent to OMDs.

Yes, it is very unfortunate that Optometrists do not have to go through OB/GYN rotations, rotations where they perform testicular palpation, learn about the intricacies of the foot, ankle leg and arms, wait for faxes for attendings, hold retractors for hours while standing while the surgeon yells at you and asks why surgical tape is white, go through a psychiatry rotation and realize that the attendings are about as crazy as their patients, and many more very relevant and useful experiences that you will use as an ophthalmology attending.

The flames are getting bigger 🙂

I already feel bad for your future patients.

You'll be that provider that refuses to accept when they can't handle something or when patients would be better off in the hands of someone more experienced. You're going to think there is no one more qualified to handle a patient than yourself.

That is totally not true. I will be inferior in my knowledge compared to fellowship trained ophthalmologists. There is no doubt about this.

 

[mydodger]

Yes, it is very unfortunate that Optometrists do not have to go through OB/GYN rotations, rotations where they perform testicular palpation, learn about the intricacies of the foot, ankle leg and arms, wait for faxes for attendings, hold retractors for hours while standing while the surgeon yells at you and asks why surgical tape is white, go through a psychiatry rotation and realize that the attendings are about as crazy as their patients, and many more very relevant and useful experiences that you will use as an ophthalmology attending.

I think we have a very different idea about medical care. The Ophthalmologists with whom I speak all talk about their intern year as being very useful learning experiences. And I absolutely feel like I need to know about the whole body - my patients won't JUST have eyeballs after all. And my psych rotation was crazy useful! I wish I would have done it BEFORE internal med so that I would have had a more practiced skill set of communicating to patients through psychiatric differences. Heck a lot of those cataract patients are old enough to have some deficits and it will be GREAT to be able to recognize some pathology and have some experience dealing with it. A little visual impairment combined with a little cognitive impairment can wreak havoc on a patient's life and just because I'll only be doing surgery to correct one doesn't mean that there will be no utility in being able in some ways to deal with both.

Surgeons yelling and asking you why surgical tape is white is a hilarious example though - that part I could do without. But I didn't have much of that on my surgery rotation anyway. Some of my colleagues were not as lucky. I never faxed anything for an attending but I did my share of calling family members and contacting other care providers. You do what you have to do to take care of your patients and I regret nothing about those experiences.

...Except maybe OB/GYN. Glad that one's over.

 

[xanthomondo]

Yes, it is very unfortunate that Optometrists do not have to go through OB/GYN rotations, rotations where they perform testicular palpation, learn about the intricacies of the foot, ankle leg and arms, wait for faxes for attendings, hold retractors for hours while standing while the surgeon yells at you and asks why surgical tape is white, go through a psychiatry rotation and realize that the attendings are about as crazy as their patients, and many more very relevant and useful experiences that you will use as an ophthalmology attending.

The flames are getting bigger 🙂




That is totally not true. I will be inferior in my knowledge compared to fellowship trained ophthalmologists. There is no doubt about this.

I think we have a very different idea about medical care. The Ophthalmologists with whom I speak all talk about their intern year as being very useful learning experiences. And I absolutely feel like I need to know about the whole body - my patients won't JUST have eyeballs after all. And my psych rotation was crazy useful! I wish I would have done it BEFORE internal med so that I would have had a more practiced skill set of communicating to patients through psychiatric differences. Heck a lot of those cataract patients are old enough to have some deficits and it will be GREAT to be able to recognize some pathology and have some experience dealing with it. A little visual impairment combined with a little cognitive impairment can wreak havoc on a patient's life and just because I'll only be doing surgery to correct one doesn't mean that there will be no utility in being able in some ways to deal with both.

Surgeons yelling and asking you why surgical tape is white is a hilarious example though - that part I could do without. But I didn't have much of that on my surgery rotation anyway. Some of my colleagues were not as lucky. I never faxed anything for an attending but I did my share of calling family members and contacting other care providers. You do what you have to do to take care of your patients and I regret nothing about those experiences.

...Except maybe OB/GYN. Glad that one's over.

Yeah OB/Gyn was long.

But what are you going to do when you get a pregnant patient? Are you just going to give whatever meds you want and call it a day like they're not pregnant?

I agree with psych being extremely useful - I've seen plenty of people come into the clinic for problems much beyond eyecare. They got blown off by the OD (I worked with both ODs and MDs during my 4 ophtho rotations in med school). Not to mention it surely helps when the patients aren't taking their drops for whatever reason (but I'm sure you'll argue that any OD is better at having their patients be compliant!)

Medicine, while yes did involve scut work like that (which helped me learn how to navigate the system which is VERY useful) also involved a ton of learning about systemic disease (which do affect the eye!). You will never appreciate that, though.

Surgery was kind of an important rotation because, well, we're doing surgery.

So if your patient has a cataract you won't send them to a general ophtho? You just going to pull that puppy out yourself? What if they have ocular manifestations of a systemic disease, like amyloidosis or SLE, do you really think you'd be the best the handle that?

 

[Shnurek]

Yeah OB/Gyn was long.

But what are you going to do when you get a pregnant patient? Are you just going to give whatever meds you want and call it a day like they're not pregnant?

Yes, I'll make sure to give her tetracycline because I want my malpractice rates to go up.../sarcasm Realize that we take the same pharmacology course as MDs. Hence why we can prescribe oral medications in 47 states, topical medications in 50 states and narcotic medications in 43 states.

So if your patient has a cataract you won't send them to a general ophtho? You just going to pull that puppy out yourself? What if they have ocular manifestations of a systemic disease, like amyloidosis or SLE, do you really think you'd be the best the handle that?

Of course I'd send them to a cataract surgeon if they want it removed. I'll explain to them that it is their decision and we can either wait or get it removed now. We take a multitude of courses on ocular manifestations of systemic diseases but if they have lupus or another systemic disease then coordination with the PCP is necessary.

 

[xanthomondo]

Yes, I'll make sure to give her tetracycline because I want my malpractice rates to go up.../sarcasm Realize that we take the same pharmacology course as MDs. Hence why we can prescribe oral medications in 47 states, topical medications in 50 states and narcotic medications in 43 states.



Of course I'd send them to a cataract surgeon if they want it removed. I'll explain to them that it is their decision and we can either wait or get it removed now. We take a multitude of courses on ocular manifestations of systemic diseases but if they have lupus or another systemic disease then coordination with the PCP is necessary.

Wait wait wait I know what's coming next!!!!

 

[Shnurek]

lolol

 

[cubsrule4e]

lol...looks like Massachusetts upheld Prop 46: "The Shnurek Ban"

 

[Shnurek]

lol...looks like Massachusetts upheld Prop 46: "The Shnurek Ban"

Hmm? I can't find anything online about a proposition 46 in Massachusetts. Could you please link it? or was this a joke?

All I found was prop 446 and that one was for 2011. The current one is: http://www.malegislature.gov/Bills/187/Senate/S00833

 

[LightBox]

Hmm? I can't find anything online about a proposition 46 in Massachusetts. Could you please link it? or was this a joke?

All I found was prop 446 and that one was for 2011. The current one is: http://www.malegislature.gov/Bills/187/Senate/S00833

Shnurek, let me save you some agony: you are going to be VERY BITTER 5-10 years from now.

There...now you know what is coming.

 

[Shnurek]

Shnurek, let me save you some agony: you are going to be VERY BITTER 5-10 years from now.

There...now you know what is coming.

Thanks for the psychic reading. If this is so, as you claim, then I will bite the bullet and go into another career. Such is life.

 

[mydodger]

Thanks for the psychic reading. If this is so, as you claim, then I will bite the bullet and go into another career. Such is life.

I'm thinking you should go into Ophthalmology since we all know that's what you really want to be doing anyway. 😀

 

[xanthomondo]

I'm thinking you should go into Ophthalmology since we all know that's what you really want to be doing anyway. 😀

and go the DO route so you have Shnurek, DOOD on your white coat

 

[Shnurek]

and go the DO route so you have Shnurek, DOOD on your white coat

lol ya I joked about that before. But na I don't have good stereopsis so my surgical skills would kind of suck. I'm happy with what the OD license will provide me, at least in theory, as the law currently states.

Another thing that detracts me from a DO is some of their hocus pocus curriculum: http://forums.studentdoctor.net/showthread.php?t=929420
Thankfully, the OD education is evidence-based and not based on "rhythms and bodily energy". Even vision therapy was recently proved as an effective treatment for convergence insufficiency.