Anyone with a dissenting opinion?
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I'll support the unpopular opinion in this thread. I kind of talked about what to expect in your practice vs salary in
this thread. Remember, if you are a partner (owner) of the practice, your salary won't depend on whether or not you did fellowship. To see where is currently hiring, you can personally reach out to the recruiting companies (sea-change, the eye group, etc) and ask them about their listings in various areas. You will find jobs for comprehensive ophthalmologists everywhere. Usually you can take care of what you're comfortable with.
Even if you do fellowship, or two, you're never going to learn everything. You will have to be a lifetime learner and you will have to pick up new techniques, new surgeries, new philosophies on your own. Does doing a fellowship help with this? I doubt it. Also, unless you go into solo practice you will always have your colleagues (who trained in different places) to ask how they would approach things. You'll have opportunities at AAO and other meetings to bump into colleagues and bounce ideas off of each other. You also have to be wary of fellowships that use you more than they teach you. There are PLENTY of ones out there that will use you and won't give you great surgical experience or autonomy.
I WOULD do fellowship if you want to subspecialize and focus on super complex cases and ignore other sections of ophthalmology. Want to do a re-op on a complicated strabismus patient who still have diplopia after two prior surgeries? Do you want to be doing retinal detachment surgery? Do you want to do complex orbital reconstructions? Yeah you're going to want a fellowship for those. You'll probably need to be living in a big city at a big academic center to get this kind of pathology.
I elected not to do a fellowship and do comprehensive work in a group of a handful of comprehensive docs about 2-3 hours outside of a major city. I wanted to do a little bit of everything instead of focusing on 1 area and subspecializing. I also hate when a patient has 4 different ophthalmologists managing their care. Inevitably something usually gets missed because there's not one person taking care of everything. I've seen it often where a diabetic goes YEARS to a cornea clinic and never gets a DFE until they dramatically drop vision. I like that I get to manage everything (and my patients appreciate that we can wrap everything into 1 copay).
In my short career (just graduated last year from what is probably considered a Podunk residency, been working since soon after graduation) I've been doing surgically:
Cataracts (any severity/grade, premiums, etc), IOL dislocations, sutured IOLs, etc
Glaucoma: trabs, tubes, starting MIGS in the next few months (never did these in training)
Retina: injections, laser (PRP, retinopexies, focals)
Plastics: Blephs, ectropions (wedge resection, tarsal strips, etc), excisional biopsies/minor reconstructions, entropions, botox
Strabismus: horizontal muscle surgery only
Cornea: Pterygia, (havent gotten into PKP or DSEK because of graft tissue handling issues), scrapings, etc.
I feel comfortable doing all of this. They're all pretty basic, straightforward cases. Anything absolutely crazy I will refer to a subspecialist for treatment. I keep track of all of my outcomes and so far things have been going well. In the clinic I also see neuro, uveitis, kids, glasses/contacts; pretty much whatever needs to be done.
If optometry were ever to get the ability to do the above procedures, my plan is not to do fellowship but to go to law school. I will finish my career by suing optometrists for malpractice. I'll probably be able buy a helicopter at that point, too.
So far I am very happy with my decision.
