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Derm with MOHS. No one knows what the insurance landscape will look like in 10 years. Ophthalmology reimbursement will be closely tied to Medicare rates. Cosmetics and resulting cash payers are much higher in dermatology. Less insurance bullcrap. Lower malpractice insurance. Better (meaning, no) call. She will generally see younger, healthier, patients in dermatology (or if not, see older patients who don't mind paying to look younger - try collecting a refraction fee from these patients is another issue). Derm also gives her the flexibility of concierge (cash) medicine in the future. Sorry to sound mercenary and cynical.
Potential income isn't a primary consideration in the career change (principally because we'll be a two physician income household ultimately).
I want her to be happy professionally. It sounds like the attendings on this forum would not recommend that she go into ophthalmology. If differences in income were eliminated from consideration, would you still recommend a career in dermatology over ophthy?
Based on my limited exposure to the field through my rotations in anesthesia residency, I would think that ophthy has a more rewarding daily routine, because essentially everyone deeply cares about their vision (is there a more important sense?). It must feel good as an ophthalmologist to improve the vision of your patients.
For the attendings in the forum, do you still find your work as an ophthalmologist to be fun and meaningful? If issues with compensation are excluded from the equation, would you recommend the field to someone like my wife--i.e., a person with a surgical inclination who wants low acuity patients, great outcomes, and a flexible work schedule with a very tolerable call burden?
"Just one word about your future: . . . ."
LOL. People at my institution always refer to ophthalmology as ophthy--must be an idiosyncracy with my institution. I didn't know that ophtho was more common. Sorry about that.
I think she'll probably end up pursuing derm, but I just don't want her to make another mistake. She already lost several years in her current specialty--years that she can never get back.
Potential income isn't a primary consideration in the career change (principally because we'll be a two physician income household ultimately).
I want her to be happy professionally. It sounds like the attendings on this forum would not recommend that she go into ophthalmology. If differences in income were eliminated from consideration, would you still recommend a career in dermatology over ophthy?
Based on my limited exposure to the field through my rotations in anesthesia residency, I would think that ophthy has a more rewarding daily routine, because essentially everyone deeply cares about their vision (is there a more important sense?). It must feel good as an ophthalmologist to improve the vision of your patients.
For the attendings in the forum, do you still find your work as an ophthalmologist to be fun and meaningful? If issues with compensation are excluded from the equation, would you recommend the field to someone like my wife--i.e., a person with a surgical inclination who wants low acuity patients, great outcomes, and a flexible work schedule with a very tolerable call burden?
If your wife is currently in a surgical field, I think she will like ophtho more than derm. She will still get to operate on a regular basis, although probably less so than other surgical subspecialties. The surgeries in ophtho are intricate, challenging and rewarding and patients usually have good outcomes. It also offers the best lifestyle among the surgical fields, though it is still more demanding than derm during residency.
This is actually a really good article I read and I'm glad you posted it. I think there are several variables that are unknown. We have an aging population with a massive increase in patients over the age of 65 who will be in need of treatment for cataract, AMD, DR, etc. We have a fixed number of new ophthalmologists entering the pipeline with no new residency slots opening up anytime soon and an estimate of between 20-30% of older docs preparing to retire in the next 20 years or so. I may be naively optimistic, but I think supply and demand will ensure a viable future for ophthalmologists despite what the naysayers say on this site. In fact, of the ROAD specialties I think ophthalmology is poised to do very well, better than rads and anesthesia.
Full disclosure, my long time GF is a dermatologist, and she is not nearly as optimistic as some of you on this site. Dermatology pays well, but day-to-day clinic is BORING. Mohs and dermpath are the two primary subspecialties that pay well and she likes neither. She tells me there is actually a fairly high burn-out rate in derm because it is so boring (which I can't verify). Cosmetics and laser procedures are big money items, but a lot of dermatology is skin rashes, biopsies, and acne meds. Consider variety when choosing.
She wants to be in a specialty with predictable hours, flexibility, and great outcomes. She wants low acuity. Although she's amenable to call, ideally she wants a career with minimal call burden so she can focus on raising kids. Basically she wants a field that affords excellent balance between personal demands (i.e., family time) and professional commitments.
The potential boredom in derm is something that she's concerned about. On the otther hand, she doesn't want to be in an "exciting" specialty but have a relatively poor lifestyle.
The future demand for ophthalmology should be enormous. I can't imagine why ophthalmologists 10 years from now would struggle financially.
The potential boredom in derm is something that she's concerned about. On the otther hand, she doesn't want to be in an "exciting" specialty but have a relatively poor lifestyle.
The future demand for ophthalmology should be enormous. I can't imagine why ophthalmologists 10 years from now would struggle financially.
I know grass is always greener; we will ALL have plenty of patients to take care of but I do feel that derm will fare better financially in the future for several reasons: 1. Less dependence on insurance and cosmetic component; ophtho also has this component but to a lesser degree; 2. high demand for derm in most areas (have you tried to make an appointment with a dermatologist lately?); 3. True practice flexibility with your schedule and call (most hospitals do not have a derm call panel but they sure have or trying to have an ophtho call panel).
Everyone on here keeps saying "a job is a job after a while"
Everyone seems to agree with your point #1 about derm
Anyway, all that to say that I think the insurance-proof claims of a dermatology practice are way overblown.
1. So she's going to have to decide which one is king: liking the job or an extremely flexible work schedule.
2. And the big cosmetic derm stuff: laser peels, tattoo removal, etc can be done by basically any physician. If you guys don't think some savvy family medicine docs are going to be opening up cosmetic centers once the APNs and PAs encroach further on their territory, I think you're wrong.
3. And please don't tell me patients are going to be checking which board-certification the doctor doing their skin resurfacing has, because you know most of the time they don't know you're not the same thing as an Optometrist.
4. Anyway, all that to say that I think the insurance-proof claims of a dermatology practice are way overblown. They aren't as invulnerable as everyone thinks, just like Ophthalmologists don't make $1,000,000 per year like everyone thinks. This ain't the 80s folks. Plus if Medicare dies I'll bet you my IRA that people will be paying cash for cataracts before they'll be paying to get skin smoothed. And we'll be there to provide it - probably cheaper and more efficiently than we did with Medicare anyway.
Ummmm.....okay. I have no idea how to interpret that.
A cinema reference from once-popular movie called "The Graduate" featuring a once-popular actor named Dustin Hoffman.
Since the original point of this thread basically concluded, I was wondering if there were any other specialties about which you guys could have a similar debate. Instead of Derm vs. Ophtho, maybe ENT and your speculation of both fields moving into the future. Any thoughts?
I considered ENT. It's not a bad specialty.
Nope. Derm is pretty much it.
Well, cataract surgery used to pay $3800/eye in late 80's. Up until this January, it was around $650. It was cut again 10% in January of this year before 2% sequester cut.