salaries for ophthalmologists NOT wanting to work in a big city

[docdoc2012]

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Hey guys,
So I have definitely gotten the 'sinking ship' lecture from quite a few people recently regarding compensation for ophtho. No, I will not abandon ophtho if the money isn't good and I do realize that it takes a while to generate volume for a new doc. Do people who don't want to work in big cities still only have 90-120k to look forward to? What about those working in a midsize town an hour outside of a big city?

 

[monkey7247]

Your salary is inversely proportional to how desirable the area is generally. I know of a dinky town in middle-of-nowhere TX offering 300K/yr start off, but you're over 2h from any major city. On the other hand, some applying for jobs in the Bay area, CA are getting offers for 90K. Most other places fall in between.

 

[golfman]

Your salary is inversely proportional to how desirable the area is generally. I know of a dinky town in middle-of-nowhere TX offering 300K/yr start off, but you're over 2h from any major city. On the other hand, some applying for jobs in the Bay area, CA are getting offers for 90K. Most other places fall in between.

Is it possible to work in a medium/big city in a practice for 4 days a week, and then for the other day drive to a small town around 2 hours away (if it geographically works out) and do some work there? I personally would love to work in a medium sized city and then spend one day a week in a town about 2 hours away from where I am right now. Not sure if that would work out though, as I don't know what facility I would use in said small town.

 

[orbitsurgMD]

Is it possible to work in a medium/big city in a practice for 4 days a week, and then for the other day drive to a small town around 2 hours away (if it geographically works out) and do some work there? I personally would love to work in a medium sized city and then spend one day a week in a town about 2 hours away from where I am right now. Not sure if that would work out though, as I don't know what facility I would use in said small town.

It depends on what you do and how your (un)availability on days you are not in the small town affect your referring doctors. Also, 2 hours can mean anything from 50 to 130 miles, and in some locations, you may have a requirement to maintain hospital privileges in order to operate locally, but no practical way to fulfill mandatory local hospital duties like emergency room call. Most EDs require you to be able to be present in the hospital within an hour or less.

I know specialists who do a wide-area practice, traveling from town to town on a circuit-rider schedule, but they do surgery in only one of the locations they service (their "home base.")

 

[Visionary]

Is it possible to work in a medium/big city in a practice for 4 days a week, and then for the other day drive to a small town around 2 hours away (if it geographically works out) and do some work there? I personally would love to work in a medium sized city and then spend one day a week in a town about 2 hours away from where I am right now. Not sure if that would work out though, as I don't know what facility I would use in said small town.

This would be more of a possibility if you are in a group practice of some sort. As orbitsurgMD mentioned, you could disrupt your referral base or run into problems with your local hospital(s), if you are solo. I know quite a few docs who do something similar to what you're suggesting, but they are all in group practices.

On the other end, to make the "small town" part work, you would probably need to hook up with someone locally, likely an optometrist, for clinic space. You'd probably have to do all the surgical cases near your main office, as orbitsurgMD mentioned. Doubt the small town would have an ASC, and it would be tough to secure hospital privileges, if you only plan to be there once a week. Depending on the availability of ophthalmology services locally, such a commute for surgery could impact your practice.

A potential problem also exists, if your volume grows too quickly there. You could be torn between the 2 locations. I experienced a similar situation in fellowship. We had 2 itinerant satellite clinics that were about 1.5-2 hours away. Went to one of them once per week, depending on the rotation. Volume was crazy at both, but there was no possibility of adding a day, because of obligations at the main clinic. Something to think about.

 

[docdoc2012]

thanks for the reply guys!

here's another question- have you personally or any ophthalmologist know of been offered loan repayment when signing on for a job?

 

[Visionary]

thanks for the reply guys!

here's another question- have you personally or any ophthalmologist know of been offered loan repayment when signing on for a job?

I've only heard of something like this in the VA system, but there you're an employee, so you'll never realize your full earning potential (could make it a temporary gig, but then you have to start over afterwards). Usually, the best you can hope for is a signing bonus. May get a high starting base salary, if you go to an area of need. Just live under your means for a while, and you'll be able to take care of the loans.

 

[cme2c]

Have to disagree with some of the posts about small town hospitals. Small town hospitals love ophthalmology, at least in the Midwest. If they are rural enough to qualify as critical access hospitals, they make a ton off an ophthalmologist coming in to do cataracts. I haven't worked at one for about 5 years, so I can't say things haven't changed. But, basically these small town hospitals can get special status with Medicare. They get much higher reimbursement per case than the typical ASC or HOPD. Also as a physician, you also get a bonus for practicing in these rural areas.

Larger hospitals systems in the bigger cities like to have arrangements with these small town hospitals for referral purposes. So if you can hook up with one,they will often help with the process. I know of an ophtho practice that satellites to over 10 locations and the large hospital provides a van and a driver. They typically see patients at an OD clinic in the small town.

 

[Visionary]

I know of an ophtho practice that satellites to over 10 locations and the large hospital provides a van and a driver. They typically see patients at an OD clinic in the small town.

What you stated definitely happens, but the practice is almost always a group. With 10 locations, I assume this is the case with your example. The OP seemed to be inquiring about the possibility of doing this solo. I doubt you could create the same arrangement with a solo (or small) practice. That was my point.

 

[cme2c]

I didn't get the impression from golfman (not the OP) was implying solo practice. Regardless, there are many solo/duo practitioners in my area that do a satellite or two at small community hospitals. It is very doable in many markets.

 

[golfman]

I didn't get the impression from golfman (not the OP) was implying solo practice. Regardless, there are many solo/duo practitioners in my area that do a satellite or two at small community hospitals. It is very doable in many markets.

Yeah I never said it but I really was wondering about solo practice. It makes sense that the only logical way, probably, to do that would be to go to some small town with somebody like an optometrist with an office, and then see patients there and then schedule them to come to your home base to do surgeries. I would be way interested in something like that. Here's hoping I get in somewhere next year.