ocularis

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I am at a complete cross roads of determining which sub-speciality to go into, or for that matter, if any at all.

I enjoy surgery (find it rewarding, it's great to switch up the clinical routine, and in general find operating 'fun'), however I am concerned about the stresses associated with surgery and post-op management. I am wondering if these stresses subside with further experience (it's early for me ...), or if it's a perpetual stress that we improve on managing. As far as long term career goals, minimizing stress is high on my priority list, in addition to overall job satisfaction with good earning potential, work/life balance, and ease of employment in a location close to home (unfortunately - located in an oversaturated market).

For example, I enjoy medical glaucoma - but am wondering if the complexity of glaucoma surgery would make it not enjoyable for me. Of course, it would come with the benefit of seeing many controllable glaucoma patients, but with that niche also will come challenging surgical cases filled with complications, etc. Alternatively, maybe I should go the uveitis or med retina route and minimize surgical exposure. Or just stick with comprehensive, and refer out cases that maybe considered more stressful - the comprehensive route worries me from a marketability and long term job security perspective.

Just curious for some opinions.
 
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cubsrule4e

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To answer your question in general - yes. Surgery will always have a stressful component to it. Ive been operating in private practice for 5 years now, and still get that slight twinge of nervousness driving to work the morning of my OR day... but your other point is also true. With time and experience comes more confidence as well as knowing that 20/200 patient with 3+ corneal edema on post op day 1 will be just fine at their 1 week appointment. Of course, femto/premium IOLs add a stress level of their own, as patients paying a bunch out of pocket are always expecting perfection. The key to this is managing expectations from the beginning. But once I show up and scrub in all of that is put out of mind, and its easy to enjoy and appreciate the fact that youre one of a few in the whole country doing intraocular surgery and providing a great service to your patients, even though complications are inevitable.

I actually applied for a glaucoma fellowship and did not match, but this hasn't hurt me in the least, nor do i expect it to in the long run. MIGS has opened up a whole new world for comprehensive docs with an interest in/a large base of glaucoma patients. At least a quarter of my case load each week (average 18-20 cases) involves a MIGS or Cataract/MIGS combo procedure, and I dont have to deal with the trouble of trabs/tubes as I will refer them out if that becomes an absolute necessity for a patient. Despite the stress level, if you define yourself as a surgeon (ie- its "fun", youre good at it, you like breaking up the clinic week, you enjoy making that difference in peoples lives) you probably would be far less happy if you werent doing it at all.
 

taco bell

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I echo everything the above poster said. Having completed my first year out after cornea fellowship, I think the stress of surgeries and complications initially led me to question my desire to go into ophthalmology. I wasn't sleeping well before surgeries, and the morning drive to the OR was nerve-wrecking. I finally am now getting somewhat comfortable and am dealing with the stress much better. I think the hardest part is knowing your limitations, and knowing when not to operate. Telling patients that you do not recommend surgery, or holding off on taking them to the OR is something I had difficulty doing initially. Be honest with your patient and they will be grateful. Good luck
 
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