A Day in the Life of an Ophthalmologist

[DrWJohnson]

I was wondering about the working day of an ophthalmologist. Do you do procedures (surgical) everyday? Or are you in the clinic 4 days a week doing consults/VAs/&glaucoma chks? Basically, give me what A Day in the Life of an Ophthalmologist would be? Thanks in advance.

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[VA Hopeful Dr]

One OMD that I worked for ran the following schedule:

Monday - Cataract surgery all day, usually about 14 (7am-4pm).
Tuesday - 1 day post-ops with the rest of the day filled with clinic time
Wednesday - Clinic in the morning; YAGs and ALTs in the afternoon (usually about 8-10 cases).
Thursday - Varied in each month, usually did a roation of cataracts one week, clinic one week.
Friday - Half day, office surgeries (blephs, lid work and the like) with clinic time to fill up the day until noon. Once a month he would do LASIK in the afternoon on fridays (3-5 patients per month).

He also had an OD working for him M-F to pick up the extra clinic patients. Hope this helps. His clinic time was about 40% glaucoma patients (IOP checks being the big thing), 30% pre-op checks for cataract patients from OD referrals (comprehensive dilated exam followed by a-scan), 15% yearly check-ups from established patients, 10% new patient exams, and about 5% other problems (corneal abrasions, patients seeing flashes of light, and the like).

Hope this answers some of your questions.

 

[Andrew_Doan]

Several of the private practice ophthalmologists I know work 4 days a week.

Monday: Clinic

Tuesday: Preop & Clinic

Wed: OR with 14-16 cataracts

Thurs: Post-OPs & Minor Room Stuff

Fridays: Off

Lasers are done on the clinic days.

Contrary to what Ben the optometrist claims on this forum, general ophthalmologists are not glorified optometrists. In addition, many fellowship trained ophthalmologists also practice general ophthalmology.

 

[monkey7247]

Several of the private practice ophthalmologists I know work 4 days a week.

Monday: Clinic

Tuesday: Preop & Clinic

Wed: OR with 14-16 cataracts

Thurs: Post-OPs & Minor Room Stuff

Fridays: Off

Lasers are done on the clinic days.

Contrary to what Ben the optometrist claims on this forum, general ophthalmologists are not glorified optometrists. In addition, many fellowship trained ophthalmologists also practice general ophthalmology.

God I love ophtho!!!

I don't know why my colleagues think I'm weird for wanting to work "only" 40 hours/week. What's funny is that they'll say things like "what will do with the rest of your time?". As if sleeping, spending time with your family, and having some time for hobbies was not desirable.

 

[ReMD]

Do any of you know whether an Eye physician/surgeon's 4 day work week is b/c of choice or b/c of lack of surgical/clinical pts?

 

[Redhawk]

Definitely the former

 

[Andrew_Doan]

Do any of you know whether an Eye physician/surgeon's 4 day work week is b/c of choice or b/c of lack of surgical/clinical pts?

By choice.

 

[golgi]

Several of the private practice ophthalmologists I know work 4 days a week.

Monday: Clinic

Tuesday: Preop & Clinic

Wed: OR with 14-16 cataracts

Thurs: Post-OPs & Minor Room Stuff

Fridays: Off

Lasers are done on the clinic days.

Contrary to what Ben the optometrist claims on this forum, general ophthalmologists are not glorified optometrists. In addition, many fellowship trained ophthalmologists also practice general ophthalmology.

It's great and all that OMDs work only 4 days a week but does this mean they have to stay in the clinic/office till 8 pm or later on the days they do work? Andrew, the OMDs you know -- what time are they generally done for the day?

 

[Andrew_Doan]

It's great and all that OMDs work only 4 days a week but does this mean they have to stay in the clinic/office till 8 pm or later on the days they do work? Andrew, the OMDs you know -- what time are they generally done for the day?

It's a 8-6 type schedule. They squeeze 40-50 hours into 4 days.

 

[DocBrown]

Plenty o' specialties with 40 hr weeks. (I was considering ophtho for a time, even did research and presented at ARVO). Emergency medicine, family medicine, pathology...it all depends on where you live and how much you want to work.

Anyway, I still think ophtho kicks ass!

 

[Andrew_Doan]

Anyway, I still think ophtho kicks ass!

I agree. Ocular diseases and systemic manifestations are fascinating.

As a resident, I am operating 2 days a week and see patients 3 days a week in clinic. It's awesome!

 

[sether52do]

There's an OMD here in Des Moines that does 35 cateracts 3 days a week and then 2 days of office in between. He averages 8 minutes per eye. Can you imagine his billing?

 

[Andrew_Doan]

There's an OMD here in Des Moines that does 35 cateracts 3 days a week and then 2 days of office in between. He averages 8 minutes per eye. Can you imagine his billing?

35 x $600 = $21,000/day

$21,000 x 3 days/week = $63,000/week

$63,000 x 4 weeks/month = $252,000 monthly billing for cataracts

 

[JL_Nightwing]

"35 cataracts a day, 3 days a week, 8 min per eye"

When the CMS (Medicare) reviews these types of numbers for their five-year review of work values, it's not surprising that high volume ophthalmology codes are always targeted for cuts. Hopefully, the AMA RUC will understand the relative value of physician work involved in cataract extraction, but it seems like ophthalmologists may be hurting themselves by focusing so much on volume, especially if some surgeons do a lot more cases than others.

 

[Andrew_Doan]

"35 cataracts a day, 3 days a week, 8 min per eye"

When the CMS (Medicare) reviews these types of numbers for their five-year review of work values, it's not surprising that high volume ophthalmology codes are always targeted for cuts. Hopefully, the AMA RUC will understand the relative value of physician work involved in cataract extraction, but it seems like ophthalmologists may be hurting themselves by focusing so much on volume, especially if some surgeons do a lot more cases than others.

Absolutely, this is not the norm. Most people only do 1/4 of this volume. To do 100 cataracts/week requires co-management with optometrists.

 

[eye3md]

I am a retina specialist and I do surgery two days per week and clinic the other three days. Since some of my clinics are satellites, and I may not go there every week, I will sometimes work a four day workweek. I am not working 8 to 6. I usually start at 8:45 or 9:00 and finish between 4:00 and 5:30. My partners are similar. We see 25 to 50 pts per day and perform 3 to 15 retina cases per week (per surgeon).

Some of the general guys I know work a four day week (by choice) and perform a ton of cataracts.

On a per hour basis, some ophth. have to be the highest paid folks in all of medicine. Not only that, we get to enjoy our work at the same time.

 

[abcde]

eye3md how lang have you been in practice?

 

[eye3md]

eye3md how lang have you been in practice?

Three years.

I remember when I was in training and I heard all the doom and gloom about ophth. Don't believe a word you hear. You make the right choices and you can have it all. Private practice is FANTASTIC!!!!!!!!!!

 

[yagmd]

I remember when I was in training and I heard all the doom and gloom about ophth. Don't believe a word you hear. You make the right choices and you can have it all. Private practice is FANTASTIC!!!!!!!!!!

Eye3MD, what region of the country do you practice in (West, South, Midwest, Northeast, etc)? What size town do you live in?

From what most people have said, it sounds like there are still good opportunities in smaller towns in the Midwest, South, Southwest but that's the ophtho market very oversaturated and difficult to find good jobs in larger cities on the coasts. Have you found that to be true?

 

[eyeball]

I am a retina specialist and I do surgery two days per week and clinic the other three days. Since some of my clinics are satellites, and I may not go there every week, I will sometimes work a four day workweek. I am not working 8 to 6. I usually start at 8:45 or 9:00 and finish between 4:00 and 5:30. My partners are similar. We see 25 to 50 pts per day and perform 3 to 15 retina cases per week (per surgeon).

Some of the general guys I know work a four day week (by choice) and perform a ton of cataracts.

On a per hour basis, some ophth. have to be the highest paid folks in all of medicine. Not only that, we get to enjoy our work at the same time.

always good to hear from someone on the outside. a quick question...does it ever bum you out that retina patients generally have poor vision and don't have the dramatic improvement seen with cataract and lasik patients. i am interested in retina but this one aspect holds me back a bit. i'd appreciate your thoughts. thanks

 

[eye3md]

I am a southern boy and practice in the south.

Yes, retina can be very depressing at times. I remember in med school making fun of neurologist because they could diagnose disease but then had to turn around and say but I cannot do anything to help you. Retina can be like that in many cases. Even though we have lasers for ARMD and diabetes, most all of these folks will still suffer disabling visual loss over the years. We can do good stuff also like repair RDs and repair macular holes, but I am in an area with high pathology and a lot of diabetes so I see a lot of disappointing cases.

 

[ReMD]

What do you think about general ophthalmology in the future. Is specialty training going to be a necessity? Do the general ophtho docs in your area have any major concerns?

 

[eye3md]

What do you think about general ophthalmology in the future. Is specialty training going to be a necessity? Do the general ophtho docs in your area have any major concerns?

I still feel that gen ophth is bright. Recently, I saw statistics showing that something like 35 to 40% of all ophth are over the age of 55. With the continued growth of the elderly population, we have nothing but a positive future ahead. The demand will be great and is already showing signs of that. All ophth types will be needed. No, the gen ophth in my area are not voicing any concerns. Many of them have 3 to 4 month backlogs before they can see a cataract eval.

 

[woowoo]

Eye3md I Just Sent You A Pm

 

[ball123]

Would it be possible to bump this thread? I’m very interested in whether the average work week has changed over the years. (I know this is heavily dependent on many factors but it’s nice to read these even if it is n=1).

Thank you everyone

 

[cubsrule4e]

Would it be possible to bump this thread? I’m very interested in whether the average work week has changed over the years. (I know this is heavily dependent on many factors but it’s nice to read these even if it is n=1).

Thank you everyone

General ophtho here, I work a 4.5 day work week

Monday: Main office. Start cases at 8 (average 18-20 cases; cataracts, MIGS, pterygiums, and combos), finish around 1130-12, lasers immediately following (anywhere from 5-15). Start a short clinic around 1 and try to get out of there by 330-4

Tuesday: Satellite clinic. Busiest day, average 40-50 pts which includes some 1 day and 1 week post ops, OD sees a fair number of them for me also. 9-4:30 typically.

Wednesday: Main office. Off AM, See about 20 pts from 1-4:30

Thursday: Satellite clinic. Average 30-40 pts, 9-4:30

Friday: Main office. Average 25-35 pts. 9-3:30, Lasik every other Friday afternoon (do about 4-5 cases a month, older doc still gets the majority of the lasik cases, also have 2 other partners)

So an average 34 hour work week, doing stuff you love.... not a bad gig at all!

 

[schistosomiasis]

When I worked for the Indian health service, about 10-12 patients per day 8:30-4:30, three surgery half days every month, and fly to satellite clinic on reservations six times a month, leave at 6:45 AM and back at 3:30 or 4.

My HMO mill job: two offices, Monday to Friday, 32-40 patients from 8:30- 4 or 4:30 and stay another hour to finish up paperwork and charts. Two half days of surgery on Tuesday AM and Thursday PM.

Solo practice: the most flexible, because you can make your own schedule. One of my colleagues works 9-3:30 Monday through Thursdays so she can spend time to take care of her kids. Does she make as much as the guy who works 7:30- 6 six days a week? No, but her kids are only young once.

I have another friend who took five weeks off to go to Asia with her daughter. Her income during that time: zero.

Here’s how my co- blogger’s schedule looks like:
Dr. Choi Version 2.017

Mine is similar, I work Monday through Friday (late start Thursday AM) and have one half day for surgery.

You can make a very good living even seeing under 20 patients a day, even without doing cash elective procedures, pushing femto, over coding/ billing, or other schenanigans if you simply run your practice efficiently:
Efficiency; The Case For Going Solo

The bottom line is there’s no free lunch. If you want to work less hours and take more vacation (I took seven weeks last year) you generate less revenue than someone who works 10 hours a day and whose only time off is two weeks to attend conferences.

Personally, I have no interest in seeing 30 patients a day when I can make a great salary seeing under 20. The type of folks who think $300k isn’t enough, will also think $400k or $800k isn’t enough because there’s always someone else making more, seeing more patients, living in a bigger house, or driving a better car.

If you’re making $300k and seeing forty patients a day read this:
Why a $300,000 junior associate salary may not be as good as it seems

Ophtho is a great field because you get to do surgical procedures that significantly improve the quality of people’s lives, and can still run an independent solo practice, only having to answer to yourself rather than some numb chuck administrator who has no clue.
Is solo practice still possible? The answer is yes!

There will always be the doom and gloom folks who think solo practice went the way of dinosaurs 20 years ago. Not true at all, read the post below. Our opinion is they want you to work for their group (or HMO mill/ Kaiser) so they can underpay you and keep the profits for themselves.
They tried to discourage me from starting a solo medical practice

 

[ball123]

Thank you cubsrule4e and schistosomiasis for your kind and informative responses. On behalf of this forum, I think we all appreciate each of your experiences and wisdom.

I'm a big fan of yours and Dr. Choi's blog. Such a great service for those who eventually want to go into private practice.

 

[sfeyedoc]

Would like to echo the sentiments in Schistosomiasis's post and thank others who have continued to forge ahead in solo private practice despite the naysayers out there.

I was in a similar position to many well-trained graduating residents/fellows out there on these threads, wherein many were discouraged by their attendings to do private practice or solo and immediately sought out "highly prized" Kaiser or hospital-employed positions right out of training because of the high salary guarantee and stability. This is definitely a good career option for some, but it's not necessarily the "right" practice setting for everyone.

I worked as a comprehensive ophthalmologist for two large multi-specialty groups in Southern California for a year and a half after finishing residency and hustled my ass to make less than $175k a year.. before deciding that I didn't want to be an employee and wanted to be my own boss. Coastal California in SD/LA/SF is super saturated with ophthalmologists on every corner; everyone knows that and we all have heard of the predatory practices who churn out junior associates who pay nothing. After experiencing this, I decided to leave and pursue ownership. I moved up to SF and decided to buy over a practice with two offices and an already established staff because of a fantastic opportunity and loyal patient base. I can't tell you how many times I've told my colleagues and friends that it was the best decision in my career. Yes -- there were many who said I was taking a big risk, but then again, you can't have reward unless you take risks.

Today, I've been a practice owner for over 3 years now and I still love it and wouldn't trade it for anything else. I love that I make my own decisions and answer only to myself, forge my own vision of how I want to run my practice, control my own schedule and vacation, enjoy taking care of very loyal and super fun staff, and make a very comfortable living now in one of the most saturated markets in the country. I also am a partner in my local ASC and profit from two optical shops in my practice. I slowly upgraded my equipment since I took over from a guy who had stuff from the 1980's and now have the latest Heidelberg OCT, YAG, chairs/stands, Pentacam, etc. and toys that I like. I work 4-4.5 days a week, see 20-25 patients a day, work 9-5 and take shared private group call (no ER or hospital coverage) q 6 weeks. I take between 4-6 weeks of vacation a year whenever I want and am very happy. I do Femto, premium IOLs, MIGS and some LASIK, but it's not to the extent that I'm pushing these for every patient and being unethical or greedy. I'm also on faculty at a local academic center and teach residents. I make about $400-450k a year now, and I am paying down my practice acquisition debt with 6 years or so left to go.

The road to success is definitely not easy in private practice and requires a lot of hustle and grit, and I have learned a TON of business and practice management lessons (many quite tough!) along the way, but I can tell you that it's worth it for those who want it and are willing to work hard. There are pros and cons to every practice type, and this is not to say private practice is the only way. But I wanted to be another bright voice out there for those young ophthalmologists who are considering this path to say that it is still definitely possible and viable today for the right person.

Shout out to Ho Sun's blog and Schistosomiasis for their contributions. I realized how uncanny and similar our experiences have been after reading through your posts! Keep up the good work.

 

[dantt]

Much has been said about the large variations in the typical day in the life of an ophthalmologist. I don't remember if I posted some of the pros of practicing in a large group here previously but in certain setups, you can spend a lot more time seeing patients and doing surgeries and much less time dealing with administrative tasks and the actual business burdens of running your own practice. Of course this means your overhead will be much higher. It is still debatable what results in higher career and life satisfaction but to each their own I suppose.

I follow Ho Sun and Howie's blog despite not being in solo practice as they offer great advice for young ophthalmologists as they start out. Having scoped out jobs and the practice environment all over the country, I totally agree with their findings that many of the solo practitioners are indeed concentrated in urban areas due to the lack of "good" jobs there. There is one very important thing to note. Ho Sun describes what a successful practice in California looks like after 7 years: 20 patients a day and 120 cataracts a year. I would be constantly wondering why I put myself through SAT's, MCAT's, Med School, USMLE, residency, OKAPS, ABO certification to do 2-3 cataracts a week instead of going to optometry school. Contrast that to 120 cataracts every 2-3 months the first year out in a large group in middle America. I do a fair amount for charity (no direct compensation) and they are every bit as satisfying.

 

[intoxicatedtiger]

dantt,

This is Ho Sun. I think you're missing the point here. I am CHOOSING to see 20 patients a day, and do 120 cataract surgeries of year. I also choose not to upsell premium IOLs. (I've placed 3 MFIOLs in my entire life, and have discouraged many from doing it) I even do my LRI's and refractions for free. My patients love me and my clinical and surgical outcomes are excellent. There is almost no chance of me doing wrong eye, wrong IOL surgery because I actually don't need a chart in front of me to know my patients. I have a meaningful relationships with most of them, much greater than what you can achieve with a 5 to 8 minute encounter.

I'm currently booked out by over a month, and things actually have been super overwhelming for me. People get mad they can't see me. However, I'm purposefully capping my inflow of patients because I am very happy with my current situation. Yes, I can hire a tech and more employees to increase my patient load IF I wanted to do so. The demand is there. But why would I???

Although, I do admit that my weakness has always lied in my marketing and networking. I hate shaking hands and kissing rear-ends, and just didn't do too much of it. Hence, my ramp up has been slower than others. Nevertheless, I am very happy with my professional life.

Here's a bit of simple math: If I see 20 patients a day at 33% overhead, 13.33 patients is pure profit. If I see 40 patients a day at 66% overhead, 13.33 patients is also pure profit. Why would anyone want to do twice the work for the same compensation, unless they don't know how to work less and more efficiently?

All in all, including admin and clinic duties, I work about 45 hours a week, take 5 weeks off each year, and have been smashing the average salaries you see on Medscape.

 

[schistosomiasis]

Thank you sfeyedoc for your wise comments, there are many folks in our google group who are young ophthalmologists in the exact same situation as you and me. As you said, the similarities are uncanny.

To Dan: thanks for the kind words about our blog, we hope it's been useful and helpful. A few pointers and tips:
1. I agree with you that there's geographic arbitrage. If you live in a low cost of living area, your buck goes further than it does in the bay area, or metro LA or NYC. On the other hand, you might have less cultural opportunities, public schools might not be as good, airport doesn't have as many flights. There are tradeoffs in life to everything. Phoenix is great for me since we have all four professional sports teams, a symphony, huge airport with direct flights, and outdoors activities. Others may find it small or boring (or too hot!)
2. I also agree in a less competitive area you won't be fighting as hard for cases as in a urban saturated area. But I also want to point out that in several- odd years, I expect to exceed the number of cases I was doing at my HMO mill job, where I had primaries in my group automatically send me patients (about 350 cases a year). Just like Ho Sun, this is without co-management or kissing butts/ hanging at the golf course or country club. Several of my primary care referring doctors, I met for the first time when they showed up as my patients- because THEIR patients liked my services/ results and spread the word. That's how you build a successful practice.
3. I've posted this before- but there is a study by Rick Pinto that shows NO correlation between number of cases, income (over $100k), patients seen and happiness. Interestingly enough, there was a strong correlation with percent of income saved with happiness! The happiest folks are ones that live under their means. If you make $1.2 million per year, and spend $1.22 million, you'll go broke. My hypothesis is the folks that value time with family, hobbies, respect from patients tend to be happier than the ones who want to earn the most or do the most surgeries- there's always gonna be someone with a bigger house, a busier practice, a higher conversion rate for premium lenses. Also, burnout is becoming more common among physicians- a micropractice where you control your environment is a great way of preventing burnout. I think many (but not all of course) of those in big groups who are close to financial independence would rather "chuck it" and run a concierge type practice.
4. Looking at Ho Sun's overhead numbers above, say there's a 5% revenue/reimbursement cut over the next 10 years. The 33% overhead practice will take a 7.5% decline in pay (5 divided by 67). But the 66% overhead practice will take a 15.2% decline in pay (5 divided by 33). Then you'll have to run like a hamster on a wheel to make the same amount- because it's harder to increase revenue when overhead is high.

 

[Shufflin]

Ho Sun!.... Is that someone's name?