Question regarding switching into ophthalmology

[undecided2032]

Hello,

I wanted to ask you all a (complex) career question. To make a long story short. The bullet points about me are:

Age 35 (was a non-traditional medical student originally)
Went to a top-10 medical school
~top 1/2 of class, board scores 251. Honors in medicine, surgery, ophtho, and OB-Gyn
Was ultimately deciding between ophthalmology and internal medicine and decided to go with medicine since I was somewhat worried that I would miss applying the rest of my medical training if I went with ophtho.

To make a long story short, I am currently a cardiology fellow, and I have been thinking more and more over the past year that I might have missed the boat. I find myself thinking that I might want to focus on quality of life issues rather than emergent life-or-death issues. I am kind of tired of being tied to the hospital and am wondering whether something with an outpatient focus might be a bit of a better fit for me. Perhaps I am a bit beaten down by medical school and then residency. At the same time, primary care never quite clicked with me and I do very much like being a specialist. I really do remember liking ophtho a ton during my elective rotation, too.

At this point, I'm set on finishing my fellowship. That said I have to think about where to go next. Options I have considered include working as a hospitalist, doing another fellowship like rheumatology/allergy, or even looking for a job in industry (e.g.; pharma, insurance).

I am kind of kicking myself since I more than likely would have matched somewhere in ophtho had I applied initially (no guarantees of course, but odds are with a good medical school, decent grades, and a good board score, it would have probably worked out) and now I would definitely not be your typical applicant and am not even sure what I would have to do to be considered. I am very aware that ophtho PDs weight commitment to the field quite heavily (which is hard for me to show at this point, and perhaps it is fair that this would be held against me). I guess its really easy to get yourself down when you think about what could have been. I also realize that the grass is always greener.

Anyway, I am talking with a career counselor to help figure things out, but I figured that I would see if anyone has any input here as well.

Realistically, at this point I would want to think very long and hard before doing what I would need to do to set myself up to apply for another residency, complete the residency, and take another set of boards. I can only imagine that the way in which applications are completed (you apply ~two years ahead of time) would make things even harder, and I see that the available spots outside the match are limited.

This is honestly not a troll post and I do not expect any brilliant solutions to my conundrum. In some ways I realize that I am being greedy. I have a good career lined up and I realize that most working people make much less than I will make and don't necessarily like their jobs, either.

Anyway, those are my thoughts. Would appreciate any input. Thanks in advance.

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[long]

I may be completely off base on this, but would an electrophysiology fellowship give you a bit of what you're looking for in dealing with less emergent stuff and more quality of life issues?


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[ophthope]

You're looking at 3 more years of residency to make less money on average than a non-interventional cardiologist. Probably around $1,000,000 in lost wages just in those 3 years and you'll start off making around $200-$225,000 in Ophthalmology which you may not have realized, and have to build your practice to get to our median salary where you'll probably start at in Cardiology.

I'd look for a lower volume outpatient cardiology practice, don't do interventional since procedures by their nature are stressful, and you'll probably be happier than you think once you're out of training.

It may not be life or death but when you have a surgical complication inside of someone's eye it hits you hard. The field is not without significant patient-care related stresses and you may find it isn't the cure for that stress. I know finances aren't everything but I'd wager that it definitely won't be $1,000,000 less stressful.

 

[undecided2032]

Thanks for your input ophthope and long... you two both raise good points. The truth is that I've felt pretty burnt out for about the past year and have really struggled to find out how to get back the enthusiasm I had for medicine when I started out. I do realize that ophthalmology residency (especially the PGY-2 year) is not a piece of cake, that there would be pretty significant lost income, and that I'd have to take a whole other set of boards. After thinking about it, it would really be more than three years of lost income, since most of you guys do a fellowship, and the application process is geared for someone to start two years after the application date. In effect, I kind of realize that it's not really realistic at this point.

Like I mentioned, I am actually talking to a career counselor and am considering a bunch of options including either part-time work or even something not in practice (medical director for pharma or an insurance company). Hopefully I'll find my way.

 

[EyeApply]

I won’t deny money is important, but life is short, and you don’t want to be doing something you aren’t actively enjoying. Lost wages argument is kinda silly, and if you focus on that your focus is all wrong. If you put yourself in your attending’s shoes and that isn’t the life you want then I do not think you are silly to consider something else. Also, with your board scores and background, I’d say you have a 98% chance of matching in Ophtho.

 

[undecided2032]

Thanks EyeApply! I really appreciate your thoughts.

One thing I have been thinking about after reading the above posts is the option of potentially doing one of the outpatient fellowships such as allergy and immunology after I finish up with my current one. It definitely would be a bit less stressful and I did enjoy the rotation quite a bit in residency. Plus, the application cycle is a lot shorter (I could potentially even start right after my current training program is over in 18 months).

All three of you have been really nice to hear me out. I see these sorts of posts on SDN every once in a while and people are often pretty harsh.

 

[ophthope]

There were times in my PGY2 year where I was pretty burnt out. When your weekend of call has only allowed you a couple of two or three hour bursts of sleep, it's pretty easy to get burnt out no matter what field you're in. Definitely had plenty of moments where I wondered why I didn't do derm. I can't imagine how I'd be if I had done IMED and was halfway through Cardiology. Just make sure it isn't that medicine in general has you burnt out. It may not be as Cardiology-related as you feel right now in the midst of being an overworked fellow.

I'd also caution against looking at attending life from the outside only. It is a lot different from the inside that it looks and there are a lot more varied job types in your field than you are exposed to at an academic training center. The facebook group my spouse is a part uses the term "IGB1" to describe their spouse's first job after residency. As in "it gets better." Which it does. Which is why I highly recommend you try attending Cardiology life - in a low stress position if that is best for you - before going straight back into fellowship.

If in the end you do end up pursuing Ophthalmology at some point you definitely don't have to do a fellowship. It waxes and wanes but only about 50% of residents do a fellowship and aside from retina our fellowship don't increase your earning potential significantly. It's not like Ortho or Rads.

Still recommend trying cards first though! You made it all this way. Give it a fair shake!

 

[DrQuakerJack]

It must be tough to have this many doubts after so much training. I don't want to be a downer but I remember hearing that residents are paid by Medicare and once you complete residency you will no longer qualify for Medicare reimbursement so the program will be out the money. It's something to look into. I could be wrong.

 

[undecided2032]

Thanks ophthope. I sometimes wonder if you may be right about being burnt out by medicine in general. I definitely remember during my ophtho rotation (and during my internal medicine residency) being kind of surprised at how hard the ophtho residents got worked! It's interesting to hear you talk about your burnout during PGY-2. I am honestly of the camp that eventually medical training (and medical practice) will have to change. I mean, there are some folks who can do a neurosurgery residency without missing a beat but for many people medical training just changes them. I am really amazed by some of the studies looking at the rates of depression in residents -- its just nuts! In fact, looking back to around 12 months ago I am almost sure I met the criteria for depression (feeling a lot better now thankfully with the help of family and friends).

At any rate, I'm really working hard to explore my options -- one of the good things about internal medicine is that there are a decent number of non-clinical options to fall back on if it comes to that.

I really am feeling a bit more optimistic now than when I posted earlier. I am kind of humbled by how nice you guys have been to hear me out. I guess I'll let you all know where I end up!

 

[Slide]

To me it sounds like burn-out. I've been there as an ophthalmology fellow; I was burnt out by my last year of fellowship and if I had to do another year for some reason I would have quit entirely. Hopefully, there are tracks as an attending in cardiology that are much less stressful than what it was during fellowship. I had similar thoughts as you, but now as an attending, I love what I do because so many factors change as an attending - you're finally getting paid a respectable amount for your worth, you have more autonomy (big plus!), and most of all, in the end if there is something you don't want to do or you have no desire to do, you have the power to say "no, I don't feel comfortable/don't have a desire to take something like X or Y on". After taking some weeks off between fellowship and being an attending, and having a much lighter load when starting off, I promise you, it'll feel so much better.

Plus, as you have seen, ophthalmology residents get worked...hard. The PGY-2 learning curve is steep, and that's not including the surgical learning curve. Personally, after 6 years of training myself, I could not see myself learning another specialty from scratch - maybe there are stronger people out there but personally at this point in my life, my brain would be mush. The grass always seems greener on the other side until you're in it, then you realize "greener" grass is still grass.

Last, don't overlook the lost wages argument. Yes, money isn't everything, but to do another 3-4 years of work back at the PGY2-4 scale while already being underpaid >6 years with 4 years medical school debt - eventually, the finances will matter, especially if you have a family. If not that, at least the lifestyle will matter significantly.

 

[Dusn]

I don't believe ophtho will be that different than cards to be worth switching.

Remember once you've saved 25x what you spend per year you can pretty much retire for life and do anything else you want. (read a blog post on Mrmoneymustache and financial independence blogs if you need more info -- basically you can invest your money in index funds and live off the gains). That seems really hard but if you keep your spending close to what it is as a resident/fellow and are a cardiologist (generally a high paying specialty) it's doable in not many more years than redoing a residency/fellowship. Also the 4% rule (or saving 25x your spending) is if you want to stop working completely. You don't actually have to save 25x times what you spend per year if you save a good chunk, invest it, and then you can switch to a lower paying job that you enjoy more (even outside of clinical medicine) and covers your health insurance.