Fair salary for newly graduated ophthalmologist?

[Dapathguy]

Hello all,

I am just wondering what is a fair offer for a comprehensive ophthalmologist that just graduated? I know this varies by location, practice type and lifestyle choices. I am just wondering what I should expect if I am willing to work hard and live anywhere, would a ballpark figure be 200-250k? Or less since the M.D. in question is a newly graduated ophthalmologist?

Thanks in advance, and Merry Christmas to all!

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[ball123]

There’s others on here that can answer this better than I can since I am still a resident.

The salary is good to great but starting salary has always been notoriously low. Newly grad comprehensive/general ophthalmologists can expect between 200-300k starting salary for private practice (for hospital based practice, it's usually higher but lower earning potential). The advice I get is that don’t let your starting salary numbers fool you! The better question is what can I expect my compensation to be in 3-5 years as partner. General ophthalmologists usually average anywhere between 300-500k.

Glaucoma will have higher starting salary and so will retina. Retina continues to be the highest paying subspecialty. John Pinto, the leading expert on the business of ophthalmology, has an incredibly informative lecture series on Iowa Eyerounds.

Mid career salaries for various specialties:

General/Cornea/Glaucoma/Refractive: ~300-500k (high volume cataract, refractive, MIGS can make >700k). If you are willing to work hard, you can make more (~millions). Glaucoma is in high demand currently and they sometimes have higher starting salary offers.

Retina: 500k to more than a million. Compensation that averages close to or more than a million is reasonable if you work hard. Overhead is less in retina than in other subspecialties on average.

Oculoplastics: Very variable but probably less than retina but more than General.

Peds: ~200-300k.

Keep in mind that reimbursements for all these subspecialties continues to fall. This is the case for all specialties in medicine, not just ophthalmology. With Medicare having a net neutral budget, a lot of the reimbursement for specialty care is being shifted to primary care. Primary care reimbursement is looking better and better every year! Thankfully, we do have out of pocket procedures that might safeguard us from declining reimbursement.

The job market for ophthalmology (especially comprehensive) has never been brighter. Jobs in both desirable and undesirable locations are wide open!!! There is way more retiring ophthalmologists than new graduating ophthalmologists since the number of residency spots has remained predominately stable over the decade. They need you more than you need them affording you better negotiating leverage at times.

Remember that being an eye surgeon is one of the best lifestyle specialties in medicine with very low burn out rate and incredible career satisfaction in comparison to other specialties. We may not get paid as well as neurosurgery, orthopedic surgery, etc. but we do get paid quite well relative to hours worked - hence why ophthalmology continues to be one of the most competitive specialties in medicine. As aforementioned, our reimbursements do continue to drop but this is a theme across almost all other specialties. At the same time, it is our absolute duty to continue to lobby and be advocates for our field so that it continues to be a great profession. It is truly a privilege to do eyeball surgery and try to improve/save vision!

 

[dantt]

The salary is good to great but starting salary has always been notoriously low. Newly grad comprehensive/general ophthalmologists can expect between 200-300k starting salary. The advice I get is that don’t let your starting salary numbers fool you! The better question is what can I expect my compensation to be in 3-5 years as partner. General ophthalmologists usually average anywhere between 300-500k.

Take the higher salary up front. I would not count on the partner salary in this day and age. Half the time you will never reach partnership as it was never intended to be offered or the practice is sold. If you are offered partnership, expect a significant buy in that will take near a decade to break even.

 

[airplanes]

Take the higher salary up front. I would not count on the partner salary in this day and age. Half the time you will never reach partnership as it was never intended to be offered or the practice is sold. If you are offered partnership, expect a significant buy in that will take near a decade to break even.

Except the higher starting salaries are often offered by private equity groups with zero hope of legitimate partnership, employed positions like Kaiser or smaller cities. The advice to see the job for the future potential is still valid. Many groups have a good track record of taking on associates and moving them to partnership after several years. Obvious red flags are a pattern of associates who only stay 1-2 years and move on. Practices should always give you the contact info of anybody who has left so you can get their take. If they refuse, that is another red flag. You're right that partnership buy in can be pretty high, but many will only take 3-4 years to break even and the good groups will allow your buy in to come out of your partnership earnings.

To OP, yes, most starting salaries for comprehensive surgeons is going to be ~225k, closer to ~250k with an anterior segment fellowship.

 

[CarpetWindow7]

In process of signing for comprehensive and impressed by what you find. In non large metro areas, it’s wide open. At the minimum 250

 

[LightBox]

There’s others on here that can answer this better than I can since I am still a resident.

Not to be a pessimist, but I don't believe compensation is going to increase in the future. Reimbursements continue to fall. Private equity is gobbling up many of the good practices out there, so the chance of true "partnership" is fading. If I was a newly-graduated resident, I would definitely go independent. Or perhaps work for a practice for a few years... save up my $... and then start up solo.

 

[mjohnsonets]

All answers above are spot on. I would add that in hospital-based settings you can find starting salaries in the $350K+ range but bonuses can be hard to achieve/non-existent. This is for someone coming out of training.

Based on demand, glaucoma salaries will likely continue to rise quickly in the near future. This being mostly driven by supply and demand. I worked with a newly graduated fellow who got a $400,000 offer from a private practice this year because they needed someone bad enough.

LightBox, I agree there is reasonable skepticism that compensation will continue to rise in the future due to falling reimbursements. Compensation seems to be growing fairly quickly based on the average incomes I'm seeing on my desk for now. It will be hard to tell in the future how falling reimbursements will meet the supply/demand of physicians and what that will do to compensation.

 

[dantt]

Compensation seems to be growing fairly quickly based on the average incomes I'm seeing on my desk for now. It will be hard to tell in the future how falling reimbursements will meet the supply/demand of physicians and what that will do to compensation.

Matt, I assume you are referring to starting salaries? I anticipate starting salaries will continue to rise in the short term as new graduates increasingly accept permanently employed positions, whether private equity or hospital based, and shun the concept of "sweat equity."

I have no doubt overall compensation will decrease over time. There is a finite amount of health care dollars with significant downward pressure and there will be increasing mouths to feed including mid levels, administrators, and of course the investors.

 

[mjohnsonets]

Matt, I assume you are referring to starting salaries? I anticipate starting salaries will continue to rise in the short term as new graduates increasingly accept permanently employed positions, whether private equity or hospital based, and shun the concept of "sweat equity."

I have no doubt overall compensation will decrease over time. There is a finite amount of health care dollars with significant downward pressure and there will be increasing mouths to feed including mid levels, administrators, and of course the investors.

Yes, starting salaries. I agree that overall comp will decrease in the long term.

 

[Equality]

Are these starting salaries (200 to 400k) inclusive of bonus?? If they’re base salary without bonus, isn’t it harder to reach the bonus threshold with higher base because the bonus threshold is usually 2.5xbase?

 

[airplanes]

Are these starting salaries (200 to 400k) inclusive of bonus?? If they’re base salary without bonus, isn’t it harder to reach the bonus threshold with higher base because the bonus threshold is usually 2.5xbase?

Yes, for example coming out of glaucoma fellowship in a large SE city, I was offered a 2 year contract for 250k with a 30% of collections over a bonus threshold of 800k. They did mention it was negotiable but I didn’t push them as I had a different opportunity I was more interested in.

That being said, a friend of mine took a glaucoma job at 350k with bonus threshold of 600k in a smaller city. They had been looking for someone for years.

 

[Bgladney]

That being said, a friend of mine took a glaucoma job at 350k with bonus threshold of 600k in a smaller city. They had been looking for someone for years.

That is either a very well run practice....overhead less than 50% or they practice is losing money having your friend there. At a 50% overhead, his threshold should be $700K.

 

[airplanes]

That is either a very well run practice....overhead less than 50% or they practice is losing money having your friend there. At a 50% overhead, his threshold should be $700K.

Well run but also desperate practice that also owns their own surgery center so on the ASC side they more than make up for the salary.

 

[Dapathguy]

Thank you all for your insight!

 

[cubsrule4e]

Thank you all for your insight!

As an additional data point, referencing the above, its not just the base/salary, its the production incentive. I started at $175 as a salary, but production based at 30% of collections. So by the time I hit 4-6 months, I was already earning more than my "Base" each month, so it didnt really matter what that was anyway - just a safeguard for the beginning 2 year contract I signed to make sure Id have some income if things for some reason werent working.

 

[schistosomiasis]

Guys and gals, if you care about what your salary will be, please take three minutes and write the decision makers- your politicians- urging them not to cut physician pay (at the expense of administrators, investors, insurance companies etc as some of you have intelligently pointed out above. See this link for more details and how to do so: How to avoid declining Medicare reimbursements

and your first Year salary depends on:
1. How many patients you see and procedures you do
2. Reimbursement rates negotiated by your practice
3. How well your practice is run- you want to have enough support and equipment but not work at a place where they buy a new OCT every two years and didn’t negotiate the rent
4. How greedy the owner is/ supply and demand/ how easy you can be replaced
5. That’s why starting salaries are all over the map. No one is trying to hide any information from anyone. Someone who sees 50 patients per day and takes trauma call 10 weeks per year deserves to be paid more than someone who is building a satellite office starting with 10 patients per day with no call.
6. I would look at where you want to be in five or six years rather than focus solely on the first year salary. But there’s nothing wrong with working at a job for a few years to get your feet wet/ clinical experience and confidence/ live like a resident and save some cash before moving on... or perhaps going solo.

Agree with Lightbox above about starting a solo practice: Steps To Start a Medical Practice

 

[Equality]

Schistosomiasis is so spot on. I've had friends who started with 110k base but with threshold of ZERO for bonus; another one with $350k but with over $1mil as threshold to start collecting bonus. Somewhere in the middle is $200k with $450k as threshold. Don't get hung up on the base salary. Look at the big picture--are you gonna be happy with the people at the practice and the location and your potential for growth? Are they gonna sell out to private equity before you make partner!!??!

Talk to a HEALTH CARE contract lawyer before you sign a contract. There's more to a contract than just salary/bonus. They can tell you if the numbers look right, and if there's something missing like malpractice tail coverage and all kinds of situations for which the practice should cover your malpractice; indemnity; reasonable non-compete clause; CME reimbursement, etc etc. Lawyers can cost like $300-$800 for review of a contract, but they'll be worth your money.

Also, don't talk to your friends who are in ortho or cardiology (or I guess any other field) cuz they have a very different salary set up (very very high) and even interview process.

 

[Rhexis]

I would also add that you need to try and gain some understanding of the volume of patients you should expect to see, and where they are expected to come from (the practice you are joining or all from yourself bringing in new patients). I have seen many people (myself included) who joined practices under false pretenses that the volume of patients would be high right from the start from the "busy" practice, and that you would be able to meet whatever threshold was in your contract. Many times people join groups not understanding that being busy right off the bat isn't a given. This can often occur when somebody joins another solo doctor who is looking to make money off of an associate. These docs will keep the lucrative patients for themselves (cataracts, LASIK) and often times all the patients that they can if their schedule is not full. Often times they expect the new incoming doc to bring in all of their own patients (and pay 50% of the overhead), and in a saturated market that can take time. That is fine if that was discussed before and was the expectation, but I've seen too often where this is the cause of people leaving a practice after 2 years or so.

 

[CovFEFE]

Location, location, location will determine a lot here.

I trained in a big midwestern city, and starting salary for recent graduates there (comp) was around $200-225K, usually guaranteed for 1 year.

I was interested in practicing in a small to midsize city, and I ended up signing with a hospital in a small/midsize midwestern city as a comprehensive doc.

Starting salary was $390k guaranteed for 2 years (with $30K signon bonus and $30k 2yr retention bonus), essentially $410k for the first 2 years.

I'm 1.5 years into practice, and for 2019 (1st full year in practice), I produced ~$420k thus exceeding my base salary (my salary model pays the higher of RVU production or base guarantee).

All in all, I'm very happy with my practice and the city (although it's harder to meet ppl if u're single).

If you're flexible, geographically, there are lots of great options out there. If your little city has easy access to an airport, you can fly out frequently too to seek excitement/adventure too