How Much do Retina Specialists Make?

[bad_bunny]

Curious to get input on what you heard new grads make. I've heard that it's not uncommon to earn $600,000 out of fellowship... although these were anecdotal and there is no way to know if those numbers are true. Many people view it as the most lucrative field in ophthalmology. Kind of sounds like Mohs surgery in terms of how lucrative it is. I know compensation obviously can vary drastically based on where you are, patient load, etc... I'm just trying to get a ball park picture.

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[LightBox]

New grads probably around 400 to 500k. But then increases significantly with partnership. I have multiple friends who make 2M or more.

 

[Equality]

My friend who signed with an academic institution right out of fellowship for a retina position got $300k + bonus.

 

[RetinaDude]

I would not focus too much on what you are starting at but focus more on the long term potential. I think my starting salary was around $200k but I also had bonus opportunities. With the bonus, I don't think I ever made less than $300,000 and my highest (non-partner) salary was somewhere around $750k. As a partner, I don't believe I've ever made less than a 7 figure income. My starting salary was relatively low compared to some of my retina friends but I was joining a good group that had an open book standard, so I knew what my future might look like

 

[MstaKing10]

I would not focus too much on what you are starting at but focus more on the long term potential. I think my starting salary was around $200k but I also had bonus opportunities. With the bonus, I don't think I ever made less than $300,000 and my highest (non-partner) salary was somewhere around $750k. As a partner, I don't believe I've ever made less than a 7 figure income. My starting salary was relatively low compared to some of my retina friends but I was joining a good group that had an open book standard, so I knew what my future might look like

This is spot on. Don't be "that guy/gal" asking for partner income as a first year associate. Are excepting guaranteed partnership. Work for it and it'll work out as long as the group is solid and partners ethical

 

[LightBox]

Yes, they definitely need to lower FA/ICG/OCT reimbursement and also limit the drug costs associated with these injections. (Ok, awaiting the vehement responses from retinal specialists saying "we are underpaid!"

 

[hello lady!]

I would not focus too much on what you are starting at but focus more on the long term potential. I think my starting salary was around $200k but I also had bonus opportunities. With the bonus, I don't think I ever made less than $300,000 and my highest (non-partner) salary was somewhere around $750k. As a partner, I don't believe I've ever made less than a 7 figure income. My starting salary was relatively low compared to some of my retina friends but I was joining a good group that had an open book standard, so I knew what my future might look like

How many patients per day do you see on average?

 

[docdoc2012]

Yes, they definitely need to lower FA/ICG/OCT reimbursement and also limit the drug costs associated with these injections. (Ok, awaiting the vehement responses from retinal specialists saying "we are underpaid!"

So bitter lol.
Most retina specialists are too busy to get routine FA's in clinic unless there is a clinical suspicion. Those who have oct-a get this instead and get the same reimbursement as an Oct- which has already been cut.
As for drug costs - let's be clear - retina specialists are not pocketing those. If you actually think about the financial cost of an injection from chair time, tech time, stocking, ordering, doing proper inventory - you are better off doing a 92012 red eye exam.

 

[DrZeke]

New grads probably around 400 to 500k. But then increases significantly with partnership. I have multiple friends who make 2M or more.

I think it's more common to make that if you're singing with private equity group. Base salary is usually 275-375 and then there may be a bonus the first year. With partnership the salary typical doubles at least.

 

[MstaKing10]

Yes, they definitely need to lower FA/ICG/OCT reimbursement and also limit the drug costs associated with these injections. (Ok, awaiting the vehement responses from retinal specialists saying "we are underpaid!"

It's already happening.

I would argue to some degree we are all underpaid relative to our skills/knowledge and time and money spent to acquire said skills/knowledge. I hope everyone got reimbursed more for their services. That includes cataract, glaucoma, cornea etc.

 

[mjohnsonets]

I think it's more common to make that if you're singing with private equity group. Base salary is usually 275-375 and then there may be a bonus the first year. With partnership the salary typical doubles at least.

This is more what a new fellow will make as a base salary. I do see $400K but this is typically not in metro areas. I know some still accepting $250K because they're geographically limited to a certain area. It generally comes down to supply and demand of docs in the area. Reaching a $2M+ income as a partner such as LightBox mentioned is still very achievable and not concentrated only in one area.

For your own negotiations, I wouldn't try to negotiate something over $400,000 unless the initial offer is already in that range. Instead, if they are an open book, check the collections of the other docs and negotiate your production bonus to be more favorable and it will likely work out better for you in short time if it's expected to a be a busy position.

 

[DrZeke]

This is more what a new fellow will make as a base salary. I do see $400K but this is typically not in metro areas. I know some still accepting $250K because they're geographically limited to a certain area.

Yes I believe the OP asked about newly graduated fellows.

 

[PhillyMed777]

It honestly sounds like you guys are making the most of anyone in medicine

 

[docdoc2012]

It honestly sounds like you guys are making the most of anyone in medicine

I wouldnt say that's true. I have friends a few years out in ortho, interventional cardiology and cardiothoracic anesthesia a few years out who had starting offers in the high 6 figures

 

[DrZeke]

It honestly sounds like you guys are making the most of anyone in medicine

definitely not true.

 

[PhillyMed777]

In what other field is making more than 2 M “very achievable,” as quoted above?

definitely not true.

 

[MstaKing10]

It honestly sounds like you guys are making the most of anyone in medicine

Not even close. Hospital CEO's, Pharma and Insurance company executives, administrative staff, government officials etc all make way more and do way less, at least for direct patient care. And take on less risk, and spend a lot less time and money than we do to acquire our knowledge and skills. Docs are near the bottom of the totem poll. We need to help each other because all of the above want to blame us for the ballooning cost of healthcare then use that to take our piece of the pie to line their pockets.

 

[PhillyMed777]

Not even close. Hospital CEO's, Pharma and Insurance company executives, administrative staff, government officials etc all make way more and do way less, at least for direct patient care. And take on less risk, and spend a lot less time and money than we do to acquire our knowledge and skills. Docs are near the bottom of the totem poll. We need to help each other because all of the above want to take our piece of the pie.

See above
Those people are irrelevant to my question however, trust me I’m all about physicians helping other physicians.

 

[MstaKing10]

On a public forum, if a lay person looks at these posts, or a medical student drowning in student loan debt, they will get the wrong impression. Think it has to be said.

 

[Slide]

Just to throw it out there, I’m pretty sure I’ll never be able to make 2 mil a year as retina. I’ll be lucky to just approach close to 1 mil.

 

[linevasel]

This Forum has changed for the better. 5 years ago, I'm not sure Bad_Bunny's question would have gotten a serious response. Someone would've given the obligatory "don't worry about money" etc etc etc.

Anyway, good question Bad_bunny
PE the going rate for new grad is 400-500 for 2-3 years followed by 35-40% take home of collections (absent drug money) usually with some opportunity to purchase equity. I would personally not accept anything south of 400K for PE.

For non-PE, lower starting salary I've seen this year is 250. Highest salary I've seen is 400. It is reasonable to expect 300-350K as starting salary for non-PE. Once you include bonusing, I would expect the majority of starting grads to be making somewhere between 350-450K when its all said and done your first year (depends on how busy you are and if you make bonus etc etc). Shortest associateship I've seen is 1 year.

I personally have not encountered any associateship track longer than 3 years but I know of groups with 7 year track where your salary increases every year until you are partner.

I'm not sure how far you are along in your training Bad-bunny but Partner means you eat what you kill. Usually there is some level of profit-sharing as well. Retina has enjoyed some very lucrative years. I'm not sure if new grads should expect to see the same kinds of reimbursements, especially in PE, but that's just my young take.

I am thinking through the interview process right now. If anyone wants to discuss numbers offline, PM me. Transparency is better for all of us. My 2 cents

 

[RetinaDude]

It honestly sounds like you guys are making the most of anyone in medicine

Shhhh, don't tell anybody. No one else in the medical world needs to know about us

 

[RetinaDude]

How many patients per day do you see on average?

It varies. Never less than 45 and almost never over 65. This is for full days. Usually do 3-7 surgeries per week and A LOT of injections. I'm usually done by 4:30 and only work a half day every Friday. Also take about 6-8 weeks of vacation per year

 

[rs_jr]

I think it's more common to make that if you're singing with private equity group. Base salary is usually 275-375 and then there may be a bonus the first year. With partnership the salary typical doubles at least.

How do they end up making that much in private equity? i though if you were in private equity you are an employee not a partner

 

[linevasel]

How do they end up making that much in private equity? i though if you were in private equity you are an employee not a partner

rs_jr, private equity has to pay newer grads a higher salary in order to be competitive. So their starting offers are usually higher. Remember that all the partners in the group received payouts somewhere in the order of 4 to 10 times (depends...0 the annualized cash flow). As the new grad, you missed this pay out and will possibly make less money over time with PE (again it depends on if there is a second capitalization event or "bite" and if you have equity shares when that happens) than with the traditional private practice model. The finance guys know all this and need to pull good doctors to join in order to capitalize on your future revenue stream. So they have to pay you accordingly. Depending on your focus, interest, and preferred practice setting this can be advantageous to your future finances or not....

 

[rs_jr]

some private equity offer buy in ( so i guess it means you get equity) after a certain time working there, how does that work in regards to new grads?

 

[mjohnsonets]

some private equity offer buy in ( so i guess it means you get equity) after a certain time working there, how does that work in regards to new grads?

Some offer it after a certain time period of working or meeting certain thresholds. Some home stock buys ins that occur on a fairly predictable 2 year timeline and if you're employed with them, it's offered to you no matter how long you've been there. I know there is one with a "sweat equity" buy in, it's given to you for great performance. For a new grad you could fall into any of these models. One thing to watch out for is if they are planning to sell soon they may retract stock/equity offers to the docs before the sale. Generally, a sale is planned every 5-7 years so asking when the last sale was will give you an idea of when the next may occur If you're joining, it will be important to be bought in before that.

There are different models for buy ins like there is for partnership buy ins. As linevasel mentioned, you get your cash out when the practice sells.

 

[ocularis]

What is average overhead for retina groups?

 

[RetinaDude]

What is average overhead for retina groups?

To be honest, I'm not sure anymore. Traditionally, it's been lower than general ophthalmology

 

[Eye-eye]

I'm an M4 applying for ophtho this year and planning on retina in the long run, and while I'm not in it for the money, these sorts of conversations are certainly encouraging. I have heard, however, that retina's reimbursements mostly come from just a small few codes, and thus that if CMS were to cut one or two of those in any significant way, it would be a huge hit to retina docs' wallets, in a way that perhaps isn't the case for a lot of other specialists. Do you feel that there's any validity to this, or do you think that retina is overall no more (or less) susceptible to CMS cuts than any other field?

 

[MstaKing10]

retina is overall no more (or less) susceptible to CMS cuts than any other field?

This

 

[Eye-eye]

Fair enough, thanks!

 

[Dusn]

I appreciate the candor from some of the posters on this thread. While most threads are doom and gloom, I almost feel like this thread might even be too far in the other direction.

Some retina specialists are making 1 mil+ but not everyone is. While the tips to not worry about starting salary are well reasoned, unfortunately every single one of my co-residents, including those in retina, have left their first Private practice jobs because of issues with their partnership offers or the group being sold to private equity. Most then started their own practices and I hope they’ll be better off in the long run because of it.

Just because you’re retina, million+ salaries are not assured, especially if you want to be in a saturated geographic area.

The other issue is that many of these retina specialists who are making these very high salaries are seeing close to 100 patients a day. That’s my idea of hell. I’m not good at getting out of the room when the patient is asking questions and sometimes they ask a lot of questions and need reassurance (most retina patients have serious eye diseases and are on the verge of going blind). If you look young, you may need to provide more reassurance and that slows you down. I see about 20 patients a day (no scribe), work 4 days a week and take no primary call.

The great thing is that I don’t think you really need to make 1mil+ a year to live comfortably. I make 300k as a retina specialist. My wife makes 100K. We keep our spending low ~70-100k, even while living near a very expensive city, and we’ve invested the savings well. By our late 30s we have saved about 2 mil. And even if we don’t save a penny more, I think the interest from that should more than cover our retirement and maybe even part of the college expenses for our kids ( 2mil at 7% interest in an index fund should compound to over 11mil in 26 years)

It would be nice to see 50+ patients and day and make more. I personally just don’t know how to do it and feel like I’m being thorough and answering all my patients questions. I also don’t know if new graduates should put as much trust in making partnership in their first jobs as they have in the past.

 

[RetinaDude]

DUSN, great answer here.

I enjoy the money I make but I'm actually envious of the way you have your practice set up. Twenty pts seems like a really good number to allow time to think, show compassion, and make good decisions.

 

[MstaKing10]

I see 40-50 pts a day, though on a busy day may be 60. I'm in a pretty saturated coastal setting. Perhaps I got very lucky but have been with my practice for over 8 years and not looking to switch anytime soon. Seven figure income very doable. Have to consider other revenue streams including clinical research, surgery centers etc. Personally if I saw 20 patients a day I would be miserable. Perhaps I’ve gotten used to the pace but 40-50 is perfect for me. 100 is ludicrous. Call is split among our doctors, as a large retina only group basically I’m on call 3-4 times a year for one week at a time. Start work at 830, done at 430 with one hour lunch break. Work 4.5 days a week and two half days of surgery a week.

Great thing is everyone can tailor their practice to their preference.

Also, first three years of practice I was employed and hustled and made between $300-$400k. Finances didn’t ramp up until I made partner starting year 4. So fellows looking for jobs need to keep that in mind.

 

[MstaKing10]

The great thing is that I don’t think you really need to make 1mil+ a year to live comfortably. I make 300k as a retina specialist. My wife makes 100K. We keep our spending low ~70-100k, even while living near a very expensive city, and we’ve invested the savings well. By our late 30s we have saved about 2 mil. And even if we don’t save a penny more, I think the interest from that should more than cover our retirement and maybe even part of the college expenses for our kids ( 2mil at 7% interest in an index fund should compound to over 11mil in 26 years)

Probably best starting on another thread but I’m very impressed with your numbers. Your a rockstar! Savings rate is fantastic and I’m sure you will retire very well. Would love to hear how you did it and what you invest in.

 

[Dusn]

So to be honest, all we did was keep spending low, paid off debt quickly, and shoveled extra savings into vanguard index funds.

There’s variability in income and savings each year and I didn’t keep keep strict track of our finances, so I’m trying to piece together everything retrospectively. Luckily we only had ~100k in student loan debt.
Looking at my investment accounts, it looks like ~500k of the 2mil are gains from investments. Finished training about 7 years ago, so I guess we've saved around 200-240k a year of our work income per year (about 1/3 of the income went to taxes, soc sec etc). Luckily our savings rate was higher early on (prior to having kids). We were working full-time prior to kids so our income was a little higher early on and did not increase our spending for a few years after residency/fellowship so our spending then may have been 50k). (We’d take vacations to cheaper cities like Madrid instead of London/Paris.)

The most important thing is to pay off debt and start saving as quickly as possible to get that compounding interest snowball of your savings interest rolling (and also stop that compound interest snowball from student loan debt that’s working in the opposite direction).

I’d recommend looking for a compound interest calculator online and playing around with numbers to fully appreciate the concepts of compounding interest and the importance of saving early. (Just to give you an idea of how important early savings is - the calculator seems to indicate that If someone had skipped medschool, invested the 200k of medschool tuition at the age of 21 and gotten a job straight from college that allowed them to invest about 30k each year, their net worth would be over 2mil by age 40 - higher than mine).

I also avoid individual stock picking. I learned the risk of that after buying ophthotech stock before the lousy phase 3 results on fovista came out. Because Of the time-value of money, any financial mistakes you make early on are much more costly than they appear. Early on I was 100% stocks; now I’m 80% stocks, 20% bonds and 2/3 of stocks are US and 1/3 are international.

Honestly, the strategy is extremely simple. But if anyone needs convincing there’s so much material online. (It’s hard to know if you can trust a financial advisor so I don’t use them). I’d look at the vanguard website, bogleheads, white coat investor.

 

[LightBox]

Nothing wrong with using debt as a way to leverage. I think too many doctors are "debt adverse" and thus risk-adverse.

 

[Dusn]

How have you used debt as a way to leverage, LightBox? I think it depends on the individual scenario. The most common issue for residents is, if they have extra savings... should they pay off their loans or put money in a roth IRA? Or pay off a mortgage more quickly or invest? And the answer probably depends on the interest rate of the loans. I'm guessing that since you've been out of training for awhile, you are thinking of a different type of scenario?

MstaKing and others... I'd be interested in hearing what work-flow practices other doctors have found effective in improving their clinic efficiency without compromising patient care? What's different compared to the academic practices you trained in?

 

[Lazyeye9]

I appreciate the candor from some of the posters on this thread. While most threads are doom and gloom, I almost feel like this thread might even be too far in the other direction.

Some retina specialists are making 1 mil+ but not everyone is. While the tips to not worry about starting salary are well reasoned, unfortunately every single one of my co-residents, including those in retina, have left their first Private practice jobs because of issues with their partnership offers or the group being sold to private equity. Most then started their own practices and I hope they’ll be better off in the long run because of it.

Just because you’re retina, million+ salaries are not assured, especially if you want to be in a saturated geographic area.

The other issue is that many of these retina specialists who are making these very high salaries are seeing close to 100 patients a day. That’s my idea of hell. I’m not good at getting out of the room when the patient is asking questions and sometimes they ask a lot of questions and need reassurance (most retina patients have serious eye diseases and are on the verge of going blind). If you look young, you may need to provide more reassurance and that slows you down. I see about 20 patients a day (no scribe), work 4 days a week and take no primary call.

The great thing is that I don’t think you really need to make 1mil+ a year to live comfortably. I make 300k as a retina specialist. My wife makes 100K. We keep our spending low ~70-100k, even while living near a very expensive city, and we’ve invested the savings well. By our late 30s we have saved about 2 mil. And even if we don’t save a penny more, I think the interest from that should more than cover our retirement and maybe even part of the college expenses for our kids ( 2mil at 7% interest in an index fund should compound to over 11mil in 26 years)

It would be nice to see 50+ patients and day and make more. I personally just don’t know how to do it and feel like I’m being thorough and answering all my patients questions. I also don’t know if new graduates should put as much trust in making partnership in their first jobs as they have in the past.

Post of the year right here, great perspective and very smart life choices!!!

 

[MstaKing10]

Nothing wrong with using debt as a way to leverage. I think too many doctors are "debt adverse" and thus risk-adverse.

until it doesn't work. Nothing wrong in NOT using debt either. Everyone has different risk tolerance. Can be very successful using either strategy.

 

[MstaKing10]

How have you used debt as a way to leverage, LightBox? I think it depends on the individual scenario. The most common issue for residents is, if they have extra savings... should they pay off their loans or put money in a roth IRA? Or pay off a mortgage more quickly or invest? And the answer probably depends on the interest rate of the loans. I'm guessing that since you've been out of training for awhile, you are thinking of a different type of scenario?

MstaKing and others... I'd be interested in hearing what work-flow practices other doctors have found effective in improving their clinic efficiency without compromising patient care? What's different compared to the academic practices you trained in?

Two techs, one photographer, and a scribe. Patient worked up, OCT done then placed in exam room. Scribe is really helpful for preparing injection and filling out all pertinent information in the EMR. Also fills the rooms and guides patient to check out to schedule future appts as well as flushes the eye post injection. I use a scribe about 50% of the time. If one is not available then the techs will help out with all of the above (minus EMR duties, I will do that alone). Billing done by me in EMR. Usually two front desk staff (one checkin in one checkin out). I'm sure there are more specifics to get into (ie referrals, authorizations, consents etc). but that's a quick overview.

 

[ER BlueBlood]

Not even close. Hospital CEO's, Pharma and Insurance company executives, administrative staff, government officials etc all make way more and do way less, at least for direct patient care. And take on less risk, and spend a lot less time and money than we do to acquire our knowledge and skills. Docs are near the bottom of the totem poll. We need to help each other because all of the above want to blame us for the ballooning cost of healthcare then use that to take our piece of the pie to line their pockets.

Just curious, why are you comparing to a CEO? Totally different skill set

 

[MstaKing10]

I was referring to a prior comment stating that retina docs were the highest paid people in healthcare. I was simply stating that as an industry, doctors are not the highest paid.

 

[percyeye]

Who has the highest ceiling for earning potential. A very busy Retina person or a very busy lasik/refractive implant doc?

 

[mjohnsonets]

Who has the highest ceiling for earning potential. A very busy Retina person or a very busy lasik/refractive implant doc?

Highest, yearly taxable income I've heard of was a refractive surgeon.

 

[AQ888]

Highest reported medicare reimbursement has been for a retina specialist

 

[docdoc2012]

Highest reported medicare reimbursement has been for a retina specialist

This is not because of the physician service reimbursement, this is because of intravitreal drug costs

 

[Dusn]

Also LASIK is not a Medicare reimbursement. Medicare reimbursements will falsely skew towards ophthalmologists higher than everyone else because a much larger percentage of our patients are Medicare age than any specialty besides geriatrics.

 

[RetinaDude]

Who has the highest ceiling for earning potential. A very busy Retina person or a very busy lasik/refractive implant doc?

Becoming a well known, highly paid LASIK surgeon is probably not as common as becoming a highly paid retina doc.