Just wanted to give a broad perspective on the "Retina lifestyle". I have several friends and a fiancee that do full-time retina (CA, NY, DC, TN, OK, MI, LA). Academic retina is different than private practice retina. Most of my friends are not in academia and have very rewarding and comfortable lifestyles. In most large cities most eye trauma goes to the University teaching hospital. I do about 2-4 after-hours surgical cases a year from referring ophthalmologists (retinal detachments, trauma, some endophthalmitis cases). I get home before 9pm in those rare instances. I occasionally refer these cases to the university (not often in order to reliably be there for my referring doctors). I'm on staff at only one hospital and was relieved of call duty after one year (atypical, but nice that the Gen. ophthos in town waived hospital call for my retina group). I belong to a retina-only group, and I believe this is generally better than a general-retina mix practice (ie. multispecialty group). I work 3.5 - 4 days a week (about 35 - 40 hours) depending on my surgery schedule. Most endopthalmitis cases (eye infections) and about 60% of retinal detachments are treated in the office (20-45 minute procedures thanks to our great staff). Thus, the RARE 2-4 yearly after-hours cases. The rest are elective cases on my surgery days. I see about 150 patients per week (I think I've learned to balance giving patients my time and being efficient). I have 2 partners and that allows us to spread the work around. We see a large amount of diabetic retinopathy, exudative macular degeneration, retinal detachments, cataract surgery complications, and all the other stuff that keeps it interesting. I have 2-3 half days a week off to do personal errands, meet referal MD's and OD's, and occasionally to catch up on paperwork at the office. I perform about 1-3 in-office procedures per week, 25-30 laser treatments per week, and about 2-6 OR surgeries a week. The OR surgeries vary from 40 minute macular hole/epiretinal membrane cases, 1.25 hour routine RD/diabetic cases, to 2-2.5 hour PVR/TRD cases. We are fortunate to have an efficient 2 OR setup and can do up to 5 cases in one day and be done as early as 3pm, depending on the cases. I occasionally use one of my free half-days to even out the cases during the week and to always have an elective surgery day within about 2-3 days of seeing a patient. So, in general I think it is a misconception that retinal surgeons necessarily have a terrible lifestyle (I laugh when people compare it to General Surgery). Not all my retina friends have the same schedule as I do, but most are in similar situations. I think one reason for the misconception is that academia is MUCH different than private practice. My fiancee actually works less than I do but doesn't want to be as busy, she basically works about 3 days a week (less than 30 hours). I would say that my lifestyle is comparable to the general ophthalmologists in my city, except that I work until 5:00 pm on friday and all the gen ophthos in town are gone at noon! Another misconception is that all our patients end up with horrible vision. Our local OD's and MD's refer early in the disease process, and I have come to enjoy how well many patients do compared to what I saw in residency and fellowship. Pneumatic retinopexy frequently can take a macula-off retinal detachment from hand motion vision to 20/30 or better vision (about 60% of our RD patients are fixed in the office). I see diabetics with count fingers vision that can see well enough to read or drive after vitrectomy. I also enjoy the surgical variety of vitreoretinal surgery. Doing retina does pay well, I average about 800K. One of my partners makes more, and one contemplating retirement makes less as he is slowing down. Generally retinal surgeons average more than the general ophthalmologists, but every city has a few super high-volume cataract/refractive surgeons that make some the highest salaries in medicine. Our local super doc makes close to 2 mill per year. But realize that only a fraction of all the general ophthalmologists in the country can build that kind of practice. As far as hospital work, I admit 2-4 patients a year to the hospital (its enjoyable to occasionally round on patients in the hospital). In terms of fellowships, I would recommend that you seek training in an environment where you have a large amount of hands-on experience in the OR. I would never discourage anyone from getting the best medical retina training they can, but if you can't do the difficult surgical cases well and efficiently, then some of the negative attitudes about retinal surgery will come true. You have to be able to do the tough surgeries in order to get the clinic referals. One of my friends didn't have the best surgical training and he struggled for several years in private practice before he began enjoying his practice more. I would reiterate that practicing in an ALL-RETINA group may be more satisfying than being the only retina person for a large multispecialty group. In my group we spread the call around (I very rarely go to the office after hours), there is a wonderful comraderie and we discuss tough cases together, and we get more referals because we don't compete with general ophthalmologists. Also, things can be more efficient when everyone in the office is geared toward retinal diseases. I believe most people that get good training in surgical retina can practice in this manner. You may be somewhat geographically limited as the best jobs don't grow on trees, but if you find partners willing to treat you with respect, and more importantly if you treat your patients and refering docs well, I think retinal surgery can be extremely rewarding. Good luck to everyone making career choices out there!
