What subspecialties are the most surgically/procedurally heavy?

[Pre-Medguy1995]

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Current M2 really interested in ophthalmology but was wondering what the distribution between clinic time vs OR was. The general ophthalmologists I've worked with spend 3.5 days in clinic, 1 day in the OR, and a 0.5 day on administrative work. Is this typical for general ophthalmologists?

Secondly, is there a subspeciality where it would feasible to spend most of the time operating? or a subspeciality where you can spend most of the time in the clinic and hardly ever operate? Is there a drastic difference in lifestyle/compensation between the two types of practices?

 

[mjohnsonets]

You are likely to find high volume cataract surgeons(can be comprehensive, cornea fellowship trained, anterior segment fellowship trained, sometimes glaucoma fellowship trained) to operate the most and be in the OR the most. Some I work with are in the OR a full two days per week, some even more. This is due mostly to referral patterns and practice models and not necessarily something that applies to all cataract surgeons.

I know a couple retina docs who operate more than one day per week but you will find most revenue in retina is built in the clinic not the OR. Having a heavily surgical retina practice might not produce the best lifestyle and compensation.

So difference in lifestyle/compensaiton - yes, for sure. Being that I'm not an ophthalmologist though, I think it would be best to defer to them for comments on lifestyle.

 

[Cawolf]

The docs in neuro-ophthalmology and uveitis tend to not spend much/any time in the OR. As said above some of our cataract and glaucoma people seem to be in the OR 1.5 days a week, sometimes 2 days a week. I have seen an anterior segment person alternate 2 days in the OR one week, and 1 the next.

These are my limited experiences at an academic center, and I am still a student.

 

[AQ888]

Some oculoplastic surgeons operate up to 3 days in a week

 

[TheLesPaul]

In plastics I have between 1-3 days of OR a week (average 1.5-2). Cases can be quite long as well (4-6 hours depending on the work done). Pts are usually discharged after they have healed from surgery so you don't have too many follow-ups in clinic either.

 

[dantt]

As mentioned earlier by a few other posters, it really depends on the setup and referral patterns. Some practices receive surgical referrals from optometrists and the ophthalmologists in those type of practices tend to see higher surgical volumes than practices that receive general eye referrals from primary care doctors. The schedule you described above would be typical for a non-comanaging ophthalmologist.

Most surgical would be a co-managing/corporate chain LASIK surgeon (go around meeting patients day of surgery, never see them again). Least surgical would likely be neuro-ophthalmologist or uveitis.

 

[Pre-Medguy1995]

In plastics I have between 1-3 days of OR a week (average 1.5-2). Cases can be quite long as well (4-6 hours depending on the work done). Pts are usually discharged after they have healed from surgery so you don't have too many follow-ups in clinic either.

This sounds close to the type of "ideal" type of setup. Do you find that you have to "fight" off general plastic surgeons for cases and referrals though? Or are there enough cases for everyone?

Also, thank you so much for taking the time to respond! Optho is one of the specialities where there just isn't a wealth of faculty support at my school, so every bit helps

 

[Pre-Medguy1995]

As mentioned earlier by a few other posters, it really depends on the setup and referral patterns. Some practices receive surgical referrals from optometrists and the ophthalmologists in those type of practices tend to see higher surgical volumes than practices that receive general eye referrals from primary care doctors. The schedule you described above would be typical for a non-comanaging ophthalmologist.

Most surgical would be a co-managing/corporate chain LASIK surgeon (go around meeting patients day of surgery, never see them again). Least surgical would likely be neuro-ophthalmologist or uveitis.

What type of cases does a non-comanaging ophthalmologist do? And for the LASIK surgeon, how difficult is it to break into that sort of corporate structure and how does compensation compare?

Also, thank you so much for taking the time to respond! Optho is one of the specialities where there just isn't a wealth of faculty support at my school, so every bit helps!

 

[mjohnsonets]

What type of cases does a non-comanaging ophthalmologist do? And for the LASIK surgeon, how difficult is it to break into that sort of corporate structure and how does compensation compare?

Also, thank you so much for taking the time to respond! Optho is one of the specialities where there just isn't a wealth of faculty support at my school, so every bit helps!

Non co-managing ophthalmologists do the same cases as one's who co-manage. Co-management has to do with the practice model than the actual surgeon.

As for LASIK, volume is mostly related to marketing, advertising budgets, and co-management with optometrists. The more of each, the more volume you do. You must certainly have a great name to be high volume though. There is even a push by the Refractive Surgery Alliance to make refractive surgery it's own sub-specialty through a fellowship.

As for the corporate structure of LASIK, you are typically paid a fee per eye you do LASIK on. I wouldn't say it's particularly difficult to break into with many traveling(flying) to different centers to do cases. This can be quite lucrative but many of the clinics are open Saturdays.

 

[dantt]

As for the corporate structure of LASIK, you are typically paid a fee per eye you do LASIK on. I wouldn't say it's particularly difficult to break into with many traveling(flying) to different centers to do cases. This can be quite lucrative but many of the clinics are open Saturdays.

Indeed not very difficult to break into. The question is whether you want to fly around as a nameless doctor doing surgery on patients you've never met and will never see again for a few hundred per eye.

 

[whatsthepoint]

Indeed not very difficult to break into. The question is whether you want to fly around as a nameless doctor doing surgery on patients you've never met and will never see again for a few hundred per eye.

Can you elaborate on this? Is this a thing still?

 

[Slide]

Can you elaborate on this? Is this a thing still?

Talk about thread necro. It's not complex, someone evaluates and signs up the patient for you, then you come in and knock out several LASIK procedures a day. You travel from city to city doing this, and you don't see your patients post-op unless something bizarre occurs. Great if you like operating, hate continual care, and are ok having a not so great lifestyle.

 

[mjohnsonets]

Can you elaborate on this? Is this a thing still?

It is still a thing and will continue to be a thing. However, LASIK volume is down right now so less of it. I haven't been around all of it but many of the large national LASIK providers have had trouble over the years because it's a cyclical business dependent on consumer strength. If people are eating out less they are definitely getting less elective surgery. Localized refractive practices have less issues due to an ability to focus more on refractive cataract surgery in down times however, still affected.