Struggling with Career Choice in Eyes

[strider7791]

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Hi everyone,

I'm currently pre-med, but I figured this question would be better suited for this forum. I've wanted to work with eyes most of my life. I started out high school wanting to be an optometrist, but at the end of my sophomore year of undergrad began to seriously consider going for an MD and becoming an ophthalmologist. I'm now a senior and am applying to med school, but going to interviews is actually making me less excited to become an MD (I keep hearing about residency and the surgery requirements for ophthalmologists and it scares me more than anything). Don't mean to offend anyone, I'm just trying to explain my position.

You see, I'm more interested in diseases of the eye rather than prescribing lenses. I know (from experience) that a lot of optometrists do treat eye disorders, but I also know that many do end up spending most of their time doing refractions. I am afraid of performing surgery though and don't know if I'm cut out for micro-surgery. I know there are some sub-specialties that do clinical procedures rather than surgery, but are those difficult/risky?

I guess my main question is whether or not becoming an ophthalmologist is worth it if I don't want to do surgery. Between internship, residency, and fellowship, that's an extra 5 years of training that I'm not quite sure I can justify (over going to optometry school at least). I know compensation for ophthalmologists is far better than for optometrists, but optometrists can still lead very comfortable, fulfilling lives.

Sorry for the long post, and thank you all for any insight you can provide.

 

[LightBox]

Everyone is nervous when they first start operating. But luckily, that is what TRAINING is for. Good mentors in training programs ease their residents into surgery so that you don't get traumatized by bad results. Trust me: it's all about training, and you just have to be patient through the process.

I would say that Ophthalmology is about 10x better than Optometry in terms of excitement and career opportunities. I am not knocking Optometry, but it would get old real fast for me.

Also, there are non-surgical subspecialties in Ophthalmology that are very intellectually-stimulating (e.g. medical retina, neuro-ophthalmology, uveitis).

 

[strider7791]

I think my other big fear is the residency itself. Is it rigorous/stressful? I know they're all different and they're supposed to be challenging, but what were your impressions overall?

 

[ophthope]

I think my other big fear is the residency itself. Is it rigorous/stressful? I know they're all different and they're supposed to be challenging, but what were your impressions overall?

Medical school is rigorous and stressful, as is intern year, as is residency. However when you're doing something with a goal in mind and then by residency finally getting to the more specific aspects of your chosen field it is rewarding. You should know about the stress and the level of work that you'll be committing to before jumping into medical school. Most people feel overwhelmed and stressed at many points during their medical education - but it fades with experience and when it comes to patient care you NEED to have a strong, strong sense of when you are in too deep and need another care provider to assist with the patient's care. This is something that you will not develop in Optometry school, and is a big difference between the two professions.

All political trolling and internet-bravado-animosity aside, people generally choose Optometry or Ophthalmology for very different reasons. Most Optometry students went to Optometry school because they didn't want to do surgery, didn't want the risk and responsibility of higher acuity patients, but still wanted to prescribe lenses and treat common low-acuity eye complaints to make a difference helping people see better. The pay is still good and the lifestyle is great - which is a common reason to choose either profession. Optometrists trade lower pay for less stress and more time off. Most Ophthalmology students either find the profession during medical school, find it when exploring surgical subspecialties, or have some exposure prior to medical school that gets them interested in eye care through some academic interest.

Outside of SDN and a few hyper-political areas this is the reality of the two professions. and we often work together.

It really sounds to me like you're scared of the training, but really are interested in Ophthalmology rather than Optometry. By choosing Ophthalmology you are making a real decision here to go through a lot tougher training. But, that training is necessary to surgically and medically treat complex eye disease. In the end you will need to decide if you are willing to put in the 8 years of much more rigorous training to become an Ophthalmologist and treat patients at a higher level. Optometry school is much less rigorous - and once again outside of SDN everyone realizes this and nobody argues about it, it's not a big deal and Optometrists are still trained well to work in their scope of practice and generally we all respect each other. Doing surgery as an Ophthalmologist seems like a whole lot of fun - try to shadow an Ophthalmologist and scrub in on a few cataract cases if you can. It would also be good to spend a day in clinic with an Ophthalmologist and a day in clinic with an Optometrist. I know a number of people interviewing with me for Ophtho residency spots this year who have parents that are Optometrists - and they decided they wanted more after seeing the difference. However, if you aren't willing to take on that extra stress that is a completely and totally reasonable decision - choose Optometry. It's a respected profession and you'll be doing good. This is a personal decision and you have to know yourself to know which career to choose.

 

[4424]

I'd also present the perspective of considering medical school vs optometry. There are many very competitive people who do not match into ophthalmology every year. Are you ok with the thought of internal medicine or family practice? Personally, I think it's great to know what you want to do before medical school but I would make sure FIRST that you want to be a doctor and then worry about ophthalmology. Otherwise I agree with the other posts 🙂

 

[JMK2005]

I entered medical school thinking I wanted to be in primary care. I remember specifically talking to friends before medical school telling them how I wanted to do a little of everything like family or internal medicine, so being so specialized like ophthalmology would be out. How you view medicine/healthcare before and after medical school will change. Ophthalmology is great and gives me a lot of satisfaction. I wouldn't want to do anything else.

It's good to know what you want to do, but go into medical school with an open mind. Medical training is tough, but it's a gradual process with pre-clinical years, clinical years, internship, residency, maybe fellowship. Each step of the way gives you more confidence and you'll find out what type of doctor you want to become.

 

[strider7791]

Thank you everyone for the responses, looks like I have a lot to think about these next few months. I've shadowed both an optometrist and an ophthalmologist already. . . And I loved both experiences. Hopefully I'll be able to figure this out soon.

 

[speyeder]

Medical school is rigorous and stressful, as is intern year, as is residency. However when you're doing something with a goal in mind and then by residency finally getting to the more specific aspects of your chosen field it is rewarding. You should know about the stress and the level of work that you'll be committing to before jumping into medical school. Most people feel overwhelmed and stressed at many points during their medical education - but it fades with experience and when it comes to patient care you NEED to have a strong, strong sense of when you are in too deep and need another care provider to assist with the patient's care. This is something that you will not develop in Optometry school, and is a big difference between the two professions.

All political trolling and internet-bravado-animosity aside, people generally choose Optometry or Ophthalmology for very different reasons. Most Optometry students went to Optometry school because they didn't want to do surgery, didn't want the risk and responsibility of higher acuity patients, but still wanted to prescribe lenses and treat common low-acuity eye complaints to make a difference helping people see better. The pay is still good and the lifestyle is great - which is a common reason to choose either profession. Optometrists trade lower pay for less stress and more time off. Most Ophthalmology students either find the profession during medical school, find it when exploring surgical subspecialties, or have some exposure prior to medical school that gets them interested in eye care through some academic interest.

Outside of SDN and a few hyper-political areas this is the reality of the two professions. and we often work together.

It really sounds to me like you're scared of the training, but really are interested in Ophthalmology rather than Optometry. By choosing Ophthalmology you are making a real decision here to go through a lot tougher training. But, that training is necessary to surgically and medically treat complex eye disease. In the end you will need to decide if you are willing to put in the 8 years of much more rigorous training to become an Ophthalmologist and treat patients at a higher level. Optometry school is much less rigorous - and once again outside of SDN everyone realizes this and nobody argues about it, it's not a big deal and Optometrists are still trained well to work in their scope of practice and generally we all respect each other. Doing surgery as an Ophthalmologist seems like a whole lot of fun - try to shadow an Ophthalmologist and scrub in on a few cataract cases if you can. It would also be good to spend a day in clinic with an Ophthalmologist and a day in clinic with an Optometrist. I know a number of people interviewing with me for Ophtho residency spots this year who have parents that are Optometrists - and they decided they wanted more after seeing the difference. However, if you aren't willing to take on that extra stress that is a completely and totally reasonable decision - choose Optometry. It's a respected profession and you'll be doing good. This is a personal decision and you have to know yourself to know which career to choose.

Great post. Well thought-out and insightful.

 

[KHE]

I've asked this before and no one has ever really given me an answer....

For people who don't match into ophthalmology, people talk about a "transitional year" or a "research year" or something and then applying in.

For people rejected a second time, it seems that that is the end of the road. What happens to those people? Is it family practice or nothing else at that point?

 

[guttata]

I've asked this before and no one has ever really given me an answer....

For people who don't match into ophthalmology, people talk about a "transitional year" or a "research year" or something and then applying in.

For people rejected a second time, it seems that that is the end of the road. What happens to those people? Is it family practice or nothing else at that point?

A transitional year or internship year is required for residency. The benefit of doing an internship year is the ability to apply for an open spot outside the normal match. Each year a spot or two may open up because someone switches out of ophthalmology.

After two unsuccessful matches, the chances of matching is low. The applicant can choose to apply for any field of medicine, not just family medicine or internal medicine. However, some fields are more competitive than others. If you are uncompetitive for ophthalmology, you will likely be uncompetitive for the other 'desirable' fields.

 

[guttata]

For the original poster, you first need to decide whether you have the desire to become a medical doctor. It is a long,smelly, frustrating, demeaning, stressful, depressing, maddening, and punishing path. But, at the same time, it is exhilarating, amazing, rewarding, gratifying, and fulfilling. Physicians and physicians-in-training often take the process for granted, but we are offered the most intimate insights into patients, starting with gross anatomy.

One major difference between medicine and 'peripheral medical' fields (ie, dental, optometry, pharmacy) is taking care of sick patients. You need to decide if you want this extra responsibility. Ophthalmology has historically been a competitive match and there is no guarantee of matching.

Unless you have prior exposure (ie, family member is an eye doctor), it is unusual to have such an early interest in the field. What do you like about the eyes? Would you be happy with medical diagnosis on other parts of the body? The beauty of medical school is that you have three years to pick your specialty, and you have a broad range of choices. If you like seeing disease, perhaps you would enjoy pathology or radiology (non-surgical fields). But, any time you treat anything, especially surgically, there is a risk of choosing the wrong treatment, of having a complication, of encountering a side effect.

 

[ophthope]

I've asked this before and no one has ever really given me an answer....

For people who don't match into ophthalmology, people talk about a "transitional year" or a "research year" or something and then applying in.

For people rejected a second time, it seems that that is the end of the road. What happens to those people? Is it family practice or nothing else at that point?

A transitional year is just a form of intern year which is required for ophthalmology training. You can do that intern year in internal medicine, general surgery, or as a transitional year which is a mix of fields.

People do a research year if they fail to match as an opportunity to boost their resume and become a more competitive applicant. Then they reapply in the hopes that they will match the next time around. You can apply like this as many times as you want, but yes after failed attempt #2 many people choose another field.

I entered medical school thinking I wanted to be in primary care. I remember specifically talking to friends before medical school telling them how I wanted to do a little of everything like family or internal medicine, so being so specialized like ophthalmology would be out. How you view medicine/healthcare before and after medical school will change. Ophthalmology is great and gives me a lot of satisfaction. I wouldn't want to do anything else.

It's good to know what you want to do, but go into medical school with an open mind. Medical training is tough, but it's a gradual process with pre-clinical years, clinical years, internship, residency, maybe fellowship. Each step of the way gives you more confidence and you'll find out what type of doctor you want to become.

As mentioned by JMK2005 and others this is a good point. I was exactly the same - came into medical school thinking I wanted to do primary care outpatient internal medicine.You should go into medical school being willing to explore medicine and possible end up in another field because you just may not be able to match Ophtho.

 

[GoodmanBrown]

A poster above mentioned non-surgical sub-specialties, and I was hoping to get a bit more info. I'm an MS3, and deciding my 4th year schedule and to a certain extent, my career.

I really enjoy eyes and the eye exam, but I could take or leave surgery. I did an elective in cornea and found cataracts tolerable because it's such a short procedure, but found cornea replacements a bore. I kinda dread the hours-long retina and oculoplastics surgeries. Is this a red flag for me for ophtho?

Ideally, I think I'd like to be a general ophthalmologist who doesn't do surgery. I'd like to see things like HSV keratitis, glaucoma, uveitis, and retinal issues, but not be an active surgeon. Injections and in-office procedures (e.g. YAG) would be fine. Is there any space in the private world for this? In academics?

Also, as a side note, are MD and diabetic retinopathy the main reasons people are seen by medical retina? Thanks!

 

[Visionary]

Have you visited the optometry forum recently? If not, you should.

 

[JMK2005]

Ophthalmolgy is a surgical specialty. You will need to be proficient in surgery to graduate residency. Realize however that cataract surgery is much different when you are doing it yourself.

After residency, you can limit your practice to medical ophthalmology.

 

[orbitsurgMD]

You should not do ophthalmology if you do not want to do surgery. Period.

 

[linevasel]

To Goodman Brown:

Or... you could be THE Uveitis guy. You'd probably have to commit to a somewhat academic path ( conducting researching, training fellows, and seeiing patients with various forms of uveitis). I'm not sure if there is enough volume in the Private world to support a Uveitis doc who doesn't do surgery. But in academica, you can find those positions (of course, you have to be interested in contributing advancements to the field .... research, etc).
Ex: Dr. Foster in Boston, Dr. Nussenblatt @ NEI, etc..

There is also Medical Retina... and ocular path - see Hans Grossniklaus @ Emory. I'm not an attending, and I think its probably unwise to go into ophthalmology if you absolutely hate surgery. But you can definitely find a position related to seeing eyes without surgery. It just might not be the traditional gen/comp ophthalmologist.

There are even FDA positions for ophthalmologists reviewing medical devices. The spots are out there if you are flexible...

 

[KHE]

A transitional year is just a form of intern year which is required for ophthalmology training. You can do that intern year in internal medicine, general surgery, or as a transitional year which is a mix of fields.

People do a research year if they fail to match as an opportunity to boost their resume and become a more competitive applicant. Then they reapply in the hopes that they will match the next time around. You can apply like this as many times as you want, but yes after failed attempt #2 many people choose another field..

What are the top 3 "other fields" that rejected candidates end up in?

 

[LightBox]

I think good options for "rejected" Ophtho applicants are anesthesia and rads.

Yes, these fields are still competitive, but not as competitive as ophtho. And yes, the compensation is currently much better on average in these fields 🙂

 

[ophthope]

I think good options for "rejected" Ophtho applicants are anesthesia and rads.

Yes, these fields are still competitive, but not as competitive as ophtho. And yes, the compensation is currently much better on average in these fields 🙂

Yeah, pretty funny how that works huh?

Rejected from Ophthalmology because you weren't competitive enough? Be an Anesthesiologist instead and make more money than an Ophthalmologist anyway!