What is the reality of being a cornea specialist in the real world?

[Eyeball Tickler]

I have heard that cornea fellowship trained providers mostly work as comprehensive docs in private practice? And that if you wanted to practice true cornea, you have to do academics? Is that true? I like K transplants, DSAEKs/meks/alks, and refractive stuff. But I want to do private practice vs. academia.

Any thoughts or advice? Thanks

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[OphthoApplicant04]

The cornea folks in our community definitely do some cornea, but like you said, it's mainly cataracts. There's still the opportunity to do DSAEKs and the occasional PKP. If you want to do high volume cornea (like complex cataract, transplants all day...), you probably need to be in academia.

 

[dantt]

Depends on where you practice. I know many cornea specialists in private practice who do plenty of cornea (just as much or more than people in academia). They're in mid sized cities.

 

[hello lady!]

I have heard that cornea fellowship trained providers mostly work as comprehensive docs in private practice? And that if you wanted to practice true cornea, you have to do academics? Is that true? I like K transplants, DSAEKs/meks/alks, and refractive stuff. But I want to do private practice vs. academia.

Any thoughts or advice? Thanks

When you start off you're probably going to be mostly comp just so you can have a decent paycheck. As the years go on and you get more popular you'll be able to trim down your scope of practice quite a bit. It might take 10 years of practicing before you get the referral pattern and patient numbers to support a cornea-only practice though.

 

[mjohnsonets]

Cornea docs doing mostly comprehensive is true for a fair amount of them but as mentioned previously, if you get away from an academic center and are in an area with a sizable population you can certainly build a healthy cornea practice. There are also cornea specific private practices which may be more what you want if you want a hefty cornea practice. They still do cataracts and refractive most times too.

Leaning into the business side of medicine a bit here but transplants take a lot of OR time and follow-ups. In private practice, it is much more profitable to do a few cataracts (maybe an upgrade or two) than to do a transplant generally. Your revenue per hour of ASC time is higher - this is one of the reasons some cornea docs have shared with me they have lessened their interest in transplants.

I have only heard it in California specifically but with HMO patients, practices have told me it can be hard to clear a reasonable profit on a transplant so it's easier to refer to the academic centers.

 

[eyeviking]

I have heard that cornea fellowship trained providers mostly work as comprehensive docs in private practice? And that if you wanted to practice true cornea, you have to do academics? Is that true? I like K transplants, DSAEKs/meks/alks, and refractive stuff. But I want to do private practice vs. academia.

Any thoughts or advice? Thanks

It all depends on where you practice. I live in a mid-sized metropolitan area with no university so I do a decent amount of all the procedures you mentioned. My friends who live in the same area as an academic center do very little cornea and mainly do cataract surgery.

 

[dantt]

When you start off you're probably going to be mostly comp just so you can have a decent paycheck. As the years go on and you get more popular you'll be able to trim down your scope of practice quite a bit. It might take 10 years of practicing before you get the referral pattern and patient numbers to support a cornea-only practice though.

Probably the opposite of this. When you start off you get the disasters nobody wants to deal with. As the years go on, you become more popular and start getting the good stuff (premium iols, lasik, etc) . . . unless you want to keep dealing with the disasters.

One other thing. If you don't start dong cornea after fellowship, you will start losing critical skills and may start falling behind as new techniques are developed.

 

[Eyeball Tickler]

Thanks guys! What about in terms of getting donor grafts from eye banks when you're in private practice... I've heard it's something that you would incur a loss on. Is this true?