Questions on the medical side of ophthalmology and career

[M3HopingForAnswers]

Hey all! Planning on applying ophtho in '21-'22, but I'm without a home program at a mid-to-low tier school in the southeast. It's been hard to spend much time outside of a few days shadowing here and there, especially with the pandemic. So I figured to bring a few questions to the table here!

1. I was really drawn to ophtho because it offers the mix of medicine with surgery. I've read plenty about the surgical side, but what does the medical side of ophtho look like for a general ophthalmologist seeing 35-40 patients per day? How many patients require a work-up and/ or thoughtful medical management? Or is it primarily follow-up visits with mostly normal findings on exam? Disclaimer: I'm not someone who dreams of lengthy differentials and management algorithms. But I do enjoy finding pathology and offering medical management!

2. Microsurgery definitely sounds cool, but it's also intimidating to gauge my passion and knack for it. I didn't grow up building miniature ships in glass bottles, and I wouldn't say I'm passionate for woodworking. Basically, I don't have the "this-is-my-destiny" background of a lot of the surgeons in my class. I have good hand-eye coordination, but I worry that my story seems out of place. Is this a legitimate concern? Or does the enjoyment come with time and patience (and the positive patient outcomes)?

3. My biggest draws to ophtho are the ability to markedly improve quality of life (with rare positive outcomes) + opportunities for longitudinal relationships with patients. Plus, I really enjoy the outpatient setting, and I have a heart for the patient population. I also fit in and comfortable with the general personality in the field, which is great! I do sometimes worry about only getting 9-12 min per visit with my patients. But I've been reassured that these relationships grow over time. But mainly – is it a problem that I'm not coming into the field with surefire passion for the surgical side? Am I alone in enjoying the clinic as much (if not more) than the OR?

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[Dusn]

It’s great if you enjoy clinic as much or more than the OR. Most of our days are spent in clinic and the majority of eyes that we save from going blind and systemic life threatening diseases that we catch are in the clinic. Even our surgical outcomes are largely determined by Post and pre surgical planning and management in the clinic. Even if we sometimes spend less time talking about the clinic than the OR, the clinic is important in ophthalmology.

 

[Trefoil]

There is a large amount of pathology, and what makes it interesting is that it is largely pathology that can be visualized in clinic. In ophthalmology, typically you will have a fair amount of routine pathology that you are very comfortable with, but you will run into things that are cool or unusual not infrequently. Sometimes the stuff you run into is vision or life threatening. A lot of neuro pathology involves the eyes, and a lot of rheumatologic conditions also involve the eyes, so there are always interesting cases floating around. I can think of two or three cases recently that were things I had never seen before or maybe once before several years ago. I will give one as an example if you are interested in reading: PSP (progressive supranuclear palsy) that I found in a routine cataract evaluation. The thing is, people largely tailor their practice to either avoid the weird stuff or to see a specific subset of it, so it depends on what you like doing. The surgery has a steep learning curve, but most people can get there with enough cases.