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I feel a lot of pressure to do a fellowship and would love to hear from people why someone should do comprehensive.
Why comp?
- Thread starter DrQuakerJack
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It may seem obvious, but the main reason to do "just" comprehensive is because you like it and none of the subspecialty fellowships interest you. Unless you do retina or peds, or have super high volume plastics or glaucoma, most ophthalmologists' practice is mostly comprehensive anyways. This is particularly true outside of academics.
Don't do a fellowship because of money. A successful comprehensive/premium lens/refractive practice can make the most money of all.
Don't do a fellowship because of money. A successful comprehensive/premium lens/refractive practice can make the most money of all.
Modern "comprehensive" ophthalmology involves a lot of cataract surgery - more so than any other subspecialty. Sure other subspecialists may do cataract surgery as well, but no one will do as much or be as experienced as you.
At least in Canada, the benefit of being comprehensive means you can take care of less complicated/quick/happier cases and get paid just as much as a subspecialist taking care of train wrecks (you'll bill OHIP the same seeing a simple glaucoma suspect with a OCT/VF then you do with that train wreck advances glaucoma patient with the same tests), which you can refer out.
At least in Canada, the benefit of being comprehensive means you can take care of less complicated/quick/happier cases and get paid just as much as a subspecialist taking care of train wrecks (you'll bill OHIP the same seeing a simple glaucoma suspect with a OCT/VF then you do with that train wreck advances glaucoma patient with the same tests), which you can refer out.
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I asked this in a separate thread but why should a large practice hire a comprehensive ophthalmologist to "take care of less complicated/quick/happier cases and get paid just as much as a subspecialist taking care of train wrecks."
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There's a lot of factors that play into this.
I practice comprehensive ophthalmology - I've posted in the past about some of the things I do.
Without fellowship, depending on how comfortable you are doing basic procedures, you'll be able to take care of 90-95% of the patients that walk through your door as a comprehensive ophthalmologist. I have a great mix of healthy annual visits and pathology in the various subspecialties which I am comfortable handling. In academia everyone pushes fellowship because that's their model and they see more complicated patients. If you have 1 patient with three active problems you just ship them among three different subspecialists to take care of them. But do you really need an oculoplastics fellowship under your belt to tackle that chalazion excision? I would argue no.
You should be able to do functional blepharoplasties and entropion/ectropion repairs, but that new CVA with no lid function is going to need someone more advanced. How often are these going to walk into the door? Once you get out of the tertiary-care hospital, not that often.
You should gain some comfort taking care of the bread and butter in every subspecialty during residency and you should be able to continue this when you graduate.
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From other thread:
The thing is that most subspecialty trained docs want to practice their subspecialty and have no interest in doing tons of cataract Sx... the glaucoma doc wants to do glaucoma Sx, the retina doc wants to do retina Sx, and the corneal doc wants to do corneal Sx... it isn't always about the money. Some of the subspecialists at my centre does not even accept referrals for straight cataracts. There is simply not enough TIME in their clinic and OR to fit in a bunch of cataracts. At the same time there is a huge need for cataract Sx, especially in the upcoming years (every single person on earth eventually gets them), and this has mainly fallen into the realm of comprehensives docs. And like any surgery, the most cataracts you do, the more slick you get at it. If you're only doing 5 phacos a week, you're just not going to be as slick or safe as the person doing 30 a week. Not to mention nowadays there are plenty of advances in IOLs... you got your torics, multifocal, multifocal toric, etc. that you would need to keep up with the changing nuances of such advances on top of your own subspecialty interest.
Comp docs, at least where I am, also perform the most anterior segment lasers such as YAG PCO (as they perform the most cataract Sx) and SLT (as most mild-moderate glaucoma is managed by comps).
Comprehensive docs also receive lots of referrals for undifferentiated patients from GPs and optoms, and depending on the pathology they can generate lots of referrals for the subspecialists in the practice. In fact around where I am (academic centre in medium sized city with large catchment) the subspecialty clinics (outside of peds) rely almost exclusively on referrals from comprehensive ophthalmologists.
Lastly, there are a lot of patients with multiple ocular pathologies that simply does not require subspecialist care. Does it really make sense for a patient to see a glaucoma specialist Monday for their moderate stable glaucoma, then a retina specialist Wednesday to monitor for plaquinil maculopathy, then a cornea specialist Friday to follow up for their cataract, all the while waiting to have a biopsy of a minor lid lesion with an oculoplastic surgeon, when all they need is one visit with a comprehensive doc? This is the case more often than not.
Such is the case in Canada, not sure about the USA.
The thing is that most subspecialty trained docs want to practice their subspecialty and have no interest in doing tons of cataract Sx... the glaucoma doc wants to do glaucoma Sx, the retina doc wants to do retina Sx, and the corneal doc wants to do corneal Sx... it isn't always about the money. Some of the subspecialists at my centre does not even accept referrals for straight cataracts. There is simply not enough TIME in their clinic and OR to fit in a bunch of cataracts. At the same time there is a huge need for cataract Sx, especially in the upcoming years (every single person on earth eventually gets them), and this has mainly fallen into the realm of comprehensives docs. And like any surgery, the most cataracts you do, the more slick you get at it. If you're only doing 5 phacos a week, you're just not going to be as slick or safe as the person doing 30 a week. Not to mention nowadays there are plenty of advances in IOLs... you got your torics, multifocal, multifocal toric, etc. that you would need to keep up with the changing nuances of such advances on top of your own subspecialty interest.
Comp docs, at least where I am, also perform the most anterior segment lasers such as YAG PCO (as they perform the most cataract Sx) and SLT (as most mild-moderate glaucoma is managed by comps).
Comprehensive docs also receive lots of referrals for undifferentiated patients from GPs and optoms, and depending on the pathology they can generate lots of referrals for the subspecialists in the practice. In fact around where I am (academic centre in medium sized city with large catchment) the subspecialty clinics (outside of peds) rely almost exclusively on referrals from comprehensive ophthalmologists.
Lastly, there are a lot of patients with multiple ocular pathologies that simply does not require subspecialist care. Does it really make sense for a patient to see a glaucoma specialist Monday for their moderate stable glaucoma, then a retina specialist Wednesday to monitor for plaquinil maculopathy, then a cornea specialist Friday to follow up for their cataract, all the while waiting to have a biopsy of a minor lid lesion with an oculoplastic surgeon, when all they need is one visit with a comprehensive doc? This is the case more often than not.
Such is the case in Canada, not sure about the USA.
