Is ophthalmology a fairly safe field to enter?

[Student189045]

I am a first year medical student beginning to grow an interest in ophthalmology. Prior to using SDN, I wouldn't have even considered this a reasonable question, however, I have seen the forums for rad onc and pathology and am now wary of investing substantial time and money into a field where I will struggle to find a job. I was wondering what practicing ophthalmologists have to say about the job security/ salary outlook for someone who won't be entering the field until 2028.

I would imagine that the aging population will keep the demand for ophthalmologists high, however, salaries can be easily slashed as the primary population is medicare patients.

I also noticed that ophthalmology residencies are increasing at a much slower rate than others that are ballooning such as EM and derm, which seems to be a good sign.

Thoughts?

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[The Doctor]

It's good that you are thinking far ahead in advance. As hackneyed as it sounds, my advice would be to choose a field that you enjoy and that has a reasonable lifestyle compatible with your life goals. This way you will be happy with your choice no matter what happens with compensation in the future. Physician salaries are certain to drop in the future. The healthcare system will likely become increasingly governmental or perhaps even nationalized during your career. With that said, as a comprehensive ophthalmologist I feel well-compensated and I am optimistic about the future of ophthalmology. Refractive lens-based surgery is on the rise, along with adoption of better multifocal and astigmatism correcting lenses, laser-assisted surgery and minimally invasive glaucoma procedures. The baby boomers are coming and there is predicted to be a shortage of eye surgeons. At some point, the optometrists are certain to win more legislative victories and encroach further on surgery but this seems more on the 15-20 year time horizon to me. Salaries across all fields are very dependent on practice location and configuration; if your goal is to make money you can find a way. For me, I enjoy clocking in at 8:30 and leaving at 5 with minimal paperwork compared to most other specialities.

 

[mjohnsonets]

Good to think about and I think you can consider ophthalmology a field to consider based on your stated concerns. Yes, ophthalmology is tied heavily to a medicare population that is open to reimbursement cuts and the will of the gov't but ophthalmology is very innovative and constantly developing new technology/offerings to patients. With fee for service offerings, this helps insulate some aspects of the field from changes in reimbursement. I will say I choose the word insulate very intentionally though.

The current income of ophthalmologists is a very large range. I've heard from low six figures to million(s) depending on your focus.

As The Doctor mentioned, do something you like and fits your goals. The two biggest reasons I get from ophthalmologist on why they chose the field are:
1.) ability to change patients lives in minutes(mostly through cataract surgery)
2.) typically happy patients after receiving care

 

[Spikebd]

The pathology forum also has plenty of people talking about how their practices were more profitable in 2020 than in 2019. A US grad in pathology who is capable would be highly sought after by many places. It seems the fields dealing with midlevel encroachment are currently the ones stressing out at the most increasing rates, such as EM and Critical care.

Ophtho seems pretty safe to me but I’m not in ophtho.

 

[Slide]

The one thing I will add is that you may feel pressure to do a fellowship for financial reasons. As the above authors have stated, with declining reimbursements and more scope encroachment, you'll need a skillset that's more than just lasers and phacoemulsification to stay competitive in the job market unless you go into an underserved/rural area. Even with the boomer population increasing into Medicare age, there's only so many cataracts go around, and the more experienced surgeons now have to do more to keep their current revenue. With an additional skillset(s), you have more ways to practice and survive.

 

[DrZeke]

I am the only dummy that doesn't think about money as much, it is a priority but it's not my number 1. I always chose with my heart and happiness and thought that if I am happy and enjoy what I am doing then money will come. Maybe not the most money, but enough money that I will inevitably more than survive. I did not come from a wealthy family, though we were mostly comfortable. I have 0 intergenerational wealth and am already behind when it comes to most of my medical school classmates.

I am in academics and I think I am compensated fairly well. I will probably never make as much as my private practice colleagues once they are partner, but I will not starve. I am predominantly a surgical retina specialist, but also do a fair amount of uveitis. I have other friends who have chosen my path with dual training but they are in private practice. As someone else stated there is a lot of variety across the board with ophthalmology when it comes to chosen scope of practice and money.

I was drawn to ophthalmology by systemic manifestations of disease. Looking at the retina and seeing naked blood vessels and being able to study them in office without an invasive procedure BLEW me away. I am the biggest nerd imaginable. While I had fun learning cataract surgery and it was exciting, I am not passionate about refractive and cataract surgery or giving my patients multifocal or mono vision. I do choose lenses for my patients when I do sew in lenses and I am happy to help a patient who was CF and return them to 20/25 when their lens is dislocated, but I don't miss cataract surgery. I learned these things about myself in residency. I admire my colleagues who do different subspecialties than I do as they are excellent collaborators and have saved my butt many times.

I think you need to do the following (and I expect this to evolve since you are a 1st year)

1) Identify interest in certain specialties
- Which part of medicine fascinates you?

2) What specific things about medical practice speak to you?
- do you like hospital based medicine or outpatient based medicine?
- do you need patient interaction? long term relationships or just limited
- do you care if you are an expert?
- do you like rounding?
- do you like shift work?
- do you want to work half the month in chunks (think hospitalist, ED, anesthesia) vs. M-F weekends off

3) What are you life priorities?
- some specialties REALISTICALLY just make certain things less possible. People can say "oh yeah you can do anything if you want to" but your personality, how your brain thrive and what you want more than anything else, that can limit doing everything all at once...
- it's not lame to have different priorities from your colleagues and it's easy to get caught up in a rat race.

You can often carve a lifestyle out for yourself in several specialties that may not look like your classic picture that you are exposed to in medical school. I think most physicians can find job security depending on the type of work they are willing to do. Again - this comes back to your priorities. If money is your priority and nothing else, ophthalmology is probably not the way to go unless you're really into device design/science and do a LOT of consulting OR you love the refractive bit. Just my 2 cents.

 

[cal75]

Mississippi HB1302 | 2021 | Regular Session

Summary (2021-03-17) Optometry; Board shall define practice of, and authorize to perform certain procedures and use and prescribe certain drugs. [Approved by Governor]

legiscan.com

Is this going to be inevitable (optometrists getting surgery rights)?

 

[RetinaDude]

Throughout my training, and now years of private practice, I’ve known many ODs. Just like in the MD world, there are some that are very cavalier and believe they are smarted (or more gifted) than “the average bear”. Overall, most of the ones I know are very comfortable doing what they do now and have no desire to do surgery, even if legislation passed. They tell me this as well. Many ODs make very good money running a “primary care” eye practice selling glasses. Doing surgery adds an entire new layer of headaches (increased malpractice, increased concern over lawsuits, and covering call for these surgery patients). Most ODs realize this and have no desire to complicate their lives. I’ll tell ya this much. If an OD starts doing intravitreal injections then they better know how to treat endo as well, because I’m not coming in at midnight to take care of their problem

 

[cal75]

Throughout my training, and now years of private practice, I’ve known many ODs. Just like in the MD world, there are some that are very cavalier and believe they are smarted (or more gifted) than “the average bear”. Overall, most of the ones I know are very comfortable doing what they do now and have no desire to do surgery, even if legislation passed. They tell me this as well. Many ODs make very good money running a “primary care” eye practice selling glasses. Doing surgery adds an entire new layer of headaches (increased malpractice, increased concern over lawsuits, and covering call for these surgery patients). Most ODs realize this and have no desire to complicate their lives. I’ll tell ya this much. If an OD starts doing intravitreal injections then they better know how to treat endo as well, because I’m not coming in at midnight to take care of their problem

Would you still recommend ophthalmology/retina as a good field to pursue? I’m also interested ENT and it seems like they have less reimbursement/scope issues at the expense of a more surgical lifestyle.

 

[Student189045]

Thank you all for the amazing replies

 

[VA Hopeful Dr]

. If an OD starts doing intravitreal injections then they better know how to treat endo as well, because I’m not coming in at midnight to take care of their problem

Everybody says that, but the situation you describe is very very common in medicine and usually the specialists doesn't refuse care.

I'm an FP. If I do a joint injection that later gets infected, ortho isn't going to refuse to take care of that patient.

If an OB nicks a ureter during a hysterectomy, urology isn't going to refuse to fix it.

If cardiology prescribes amiodarone to a patient who ends with with thyroid problems, endocrine isn't going to refuse to see that patient. You get the idea.

That said, my threshold to report to the board would be very low were I in your shoes and this kind of thing starts happening with anything approaching regularity.

 

[linevasel]

VA hopeful.

At some point I am sure that some enterprising, intrepid, and slightly crazy OD will garner enough support to advance legislation for injection privileges. There are PAs already doing injections. There are NPs who have also injected eyeballs. I myself would never come in at midnight to take care of an optometrist's endophthalmitis. However, I am 100% sure that some Retina specialist will. If a procedure can be reimbursed or a relationship can be monetized.... someone in medicine will try to do it. I suspect two possible outcomes once this occurs.
1 - It will remain a localized phenomenon. Medical privileges are for the most part decided at the state level. You have some states were ODs are well represented in the legislature. Other states where the balance of power is more even. If it cuts into reimbursement too much, I imagine providers will vote with their feet. You already have areas in the midwest that are relative retina "deserts"
2 - Depending on the drug landscape, retina providers will evolve their practice and start hiring optoms (or arrnage favorable partnerships) themselves to do injections under their purview. They can an offer the benefit of expertise, insurance, and endophthalmitis coverage. I can't see this becoming a global phenomenon. Individuals may disagree, but as a pgy4, I thought the decision to inject was pretty cut and dry. But after fellowship, I can assure you there are some nuances to treatment that are not evident with a ophthalmology residency, let alone Optometry School ( no disrespect intended--I am simply speaking about the benefit of subspecialty training). And as the drug armamentarium proliferates, the decision tree will become increasingly complex. All things are possible, but it will be an uphill battle I think for our OD colleagues to start injecting eyeballs.

I'd be interested in the thoughts or more senior providers.

 

[linevasel]

pats98/ student189045

Predicting 2028 is basically impossible. Also, you aren't really interested in 2028. You are really interested in 2032, the reimbursement rates 3-5 years into your practice. Dr. Zeke has offered some sage counsel. Money is important. How important it is and how important it should be is really a value judgement that is informed by many things (upbringing, debt, personality, financial responsibilities, worldview etc). I was completely blown away by the earning potential of my field. I would do this job for much less and not feel cheated. I was a pretty curious med student with posts like yours and I still didn't understand how money was made in my specialty until my very last year of training. What you have to understand about ophtho and more specifically Retina is that there is a wide range of income. Really really wide range. From my limited understanding of ENT, the range is narrower. Also at this time, Retina/ophtho is less hospital dependent than ENT. I think that is a good thing if we can keep it so. But we just don't know how the future will look. I would really give both specialties a chance and see what tickles your fancy.

A note about predicting future reimbursement. 2 decades ago, all the RADonc specialists were foreign trained. American grads weren't interested. When I was in med school several years ago, you couldn't dream of matching Radonc unless you had started preparing from MS1. The competition was that intense. The earning potential was that lucrative. Then they expanded the spots for training, and now rAdonc is losing some luster because geographic flexibility is limited and there is a relative oversupply of grads. Not even Nostradamus could have predicted this roller coaster.

 

[VA Hopeful Dr]

VA hopeful.

At some point I am sure that some enterprising, intrepid, and slightly crazy OD will garner enough support to advance legislation for injection privileges. There are PAs already doing injections. There are NPs who have also injected eyeballs. I myself would never come in at midnight to take care of an optometrist's endophthalmitis. However, I am 100% sure that some Retina specialist will. If a procedure can be reimbursed or a relationship can be monetized.... someone in medicine will try to do it. I suspect two possible outcomes once this occurs.
1 - It will remain a localized phenomenon. Medical privileges are for the most part decided at the state level. You have some states were ODs are well represented in the legislature. Other states where the balance of power is more even. If it cuts into reimbursement too much, I imagine providers will vote with their feet. You already have areas in the midwest that are relative retina "deserts"
2 - Depending on the drug landscape, retina providers will evolve their practice and start hiring optoms (or arrnage favorable partnerships) themselves to do injections under their purview. They can an offer the benefit of expertise, insurance, and endophthalmitis coverage. I can't see this becoming a global phenomenon. Individuals may disagree, but as a pgy4, I thought the decision to inject was pretty cut and dry. But after fellowship, I can assure you there are some nuances to treatment that are not evident with a ophthalmology residency, let alone Optometry School ( no disrespect intended--I am simply speaking about the benefit of subspecialty training). And as the drug armamentarium proliferates, the decision tree will become increasingly complex. All things are possible, but it will be an uphill battle I think for our OD colleagues to start injecting eyeballs.

I'd be interested in the thoughts or more senior providers.

My knowledge of the actual treatment y'all provide is exceptionally limited, so I can't really comment on that.

I was going after the "refuse to deal with complications" part which I'm sad to see you also stating. Dealing with other doctors' complications is part of the job the more specialized you get. I'm sure it is very frustrating from your end but I find it exceptionally concerning that you'd let a patient go blind because they chose their doctor poorly.

 

[Slide]

My knowledge of the actual treatment y'all provide is exceptionally limited, so I can't really comment on that.

I was going after the "refuse to deal with complications" part which I'm sad to see you also stating. Dealing with other doctors' complications is part of the job the more specialized you get. I'm sure it is very frustrating from your end but I find it exceptionally concerning that you'd let a patient go blind because they chose their doctor poorly.

Unfortunately you will be surprised (or maybe not actually, depending on your metro area) how often this occurs. In fellowship, we got dumped on with dealing with other doctor's complications and due to the local medical politics there, I got the brunt of it rather than the local specialists.

Now as an attending, I don't see it as much, and right now I do still take care of other physicians' complications (to a point). However, if ODs started doing intravitreal injections and the inevitable complications rate began to shoot up, I will still continue to take care of these complications up to a point. If my reporting to the medical and optometry board resulted in no action, then yes, I would actually force the OD to own up to his/her deficiencies and address their own complications like I do with my own patients.

The reason why some of us would have to resort to such extreme actions is different from your scenario: in the cases you've brought up, there is accountability by the same medical board that regulates you and the surgeons. In this case, all the current bills state that a board of optometrists are the ones deciding regulation and disciplinary action without a single MD/DO on the board. Thus, I could report to my medical board all I wanted, but it would be for naught because they have no recourse to address it. If the optometry regulatory board decides to do nothing (which would certainly be in their interest), or give a slap on the wrist with little effect, the offending OD would have little reason to stop because we would be there to bail them out.

 

[VA Hopeful Dr]

Unfortunately you will be surprised (or maybe not actually, depending on your metro area) how often this occurs. In fellowship, we got dumped on with dealing with other doctor's complications and due to the local medical politics there, I got the brunt of it rather than the local specialists.

Now as an attending, I don't see it as much, and right now I do still take care of other physicians' complications (to a point). However, if ODs started doing intravitreal injections and the inevitable complications rate began to shoot up, I will still continue to take care of these complications up to a point. If my reporting to the medical and optometry board resulted in no action, then yes, I would actually force the OD to own up to his/her deficiencies and address their own complications like I do with my own patients.

The reason why some of us would have to resort to such extreme actions is different from your scenario: in the cases you've brought up, there is accountability by the same medical board that regulates you and the surgeons. In this case, all the current bills state that a board of optometrists are the ones deciding regulation and disciplinary action without a single MD/DO on the board. Thus, I could report to my medical board all I wanted, but it would be for naught because they have no recourse to address it. If the optometry regulatory board decides to do nothing (which would certainly be in their interest), or give a slap on the wrist with little effect, the offending OD would have little reason to stop because we would be there to bail them out.

I do know that our largest ophthalmology group opened their own surgery center in part so that they could stop being on the hospital's call schedule, so definitely not a shock.

In the scenario you describe, not an exceptionally far-fetched one given how we don't really know how optometry boards would deal with surgical complications since right now they can't really do any surgical procedures, you do have one final recourse: lawyers. I'm always very hesitant to recommend that for the obvious reasons, but if there are local optometrists who are having significantly higher rates of infection following intra vitreal injections I could absolutely see encouraging the patients to sue.

 

[Slide]

I do know that our largest ophthalmology group opened their own surgery center in part so that they could stop being on the hospital's call schedule, so definitely not a shock.

In the scenario you describe, not an exceptionally far-fetched one given how we don't really know how optometry boards would deal with surgical complications since right now they can't really do any surgical procedures, you do have one final recourse: lawyers. I'm always very hesitant to recommend that for the obvious reasons, but if there are local optometrists who are having significantly higher rates of infection following intra vitreal injections I could absolutely see encouraging the patients to sue.

Very true on the last part. The only thing that doesn't give me much to hope for is that per some of my colleagues in IM/FM, lawsuits involving mid-levels are not as severe because apparently they are not held to the same level as MD/DOs. Unless the penalties are much higher and more public, the costs of these lawsuits may just be seen as the price of doing business, with the patients always losing in the end.

 

[VA Hopeful Dr]

Very true on the last part. The only thing that doesn't give me much to hope for is that per some of my colleagues in IM/FM, lawsuits involving mid-levels are not as severe because apparently they are not held to the same level as MD/DOs. Unless the penalties are much higher and more public, the costs of these lawsuits may just be seen as the price of doing business, with the patients always losing in the end.

I think that's true for hospitals, but the vast majority of ODs who would actually increase their practice if allowed to do so are in PP.

Plus, midlevels (which I don't include ODs in since they have never required physician supervision - they're closer to dentists to my mind) until very recently had to work under someone else's license. That person was usually the target.

 

[RetinaDude]

A common legal argument, when trying to sue someone like a group of ODs is you are trying to “restrain their trade” because you want to keep market share for yourself and they are your competition. The worry about PT safety then gets pushed under the table

 

[DrZeke]

I think that's true for hospitals, but the vast majority of ODs who would actually increase their practice if allowed to do so are in PP.

Plus, midlevels (which I don't include ODs in since they have never required physician supervision - they're closer to dentists to my mind) until very recently had to work under someone else's license. That person was usually the target.

woof insulting the dentists...sorry but dentists have training very similar to medical training when it comes to anatomy and physiology and medication reactions. Many of them are true surgeons. I don't think it's fair to suggest OD's are anything like dentists.

 

[VA Hopeful Dr]

woof insulting the dentists...sorry but dentists have training very similar to medical training when it comes to anatomy and physiology and medication reactions. Many of them are true surgeons. I don't think it's fair to suggest OD's are anything like dentists.

Do optometrists not study anatomy, physiology, and pharmacology?

 

[DrZeke]

Do optometrists not study anatomy, physiology, and pharmacology?

Sure, but dentists are trained to cut gums, extract teeth from bone, interpret x-rays and CT scans and MRI and know about hemostatic and surgery. They are trained surgeons. Not trying to succeed in backdoor opportunity for procedures and surgeries.

I dunno....I think dentistry school is very competitive similar to getting into med school if not harder and many of my friends that went to dentistry school shared some classes with the med students...

 

[percyeye]

woof insulting the dentists...sorry but dentists have training very similar to medical training when it comes to anatomy and physiology and medication reactions. Many of them are true surgeons. I don't think it's fair to suggest OD's are anything like dentists.

At my school (OD) our first 2 years were shared in the exact same classroom as dentists learning basic sciences, anatomy & physiology, pharmacology, cadaver lab etc all together. After the 2 years we split and they do their dental stuff and we learn about the eye and eye pharm and have our clinical rotations for the next 2 years.

So our medical/scientific base is exactly like a Dentist.

I'm not the slightest interested in surgery but just thought I'd share.

 

[DrZeke]

At my school (OD) our first 2 years were shared in the exact same classroom as dentists learning basic sciences, anatomy & physiology, pharmacology, cadaver lab etc all together. After the 2 years we split and they do their dental stuff and we learn about the eye and eye pharm and have our clinical rotations for the next 2 years.

So our medical/scientific base is exactly like a Dentist.

I'm not the slightest interested in surgery but just thought I'd share.

So essentially we are saying It's pointless for me to try to say that dentists are trained as surgeons and optometrists are not? And the reason is because you took the same preclinical classes? Obviously my point is about the surgery and not about classroom dynamics. Maybe a dentist can chime in and tell us he's a mouth optometrist .

 

[VA Hopeful Dr]

Sure, but dentists are trained to cut gums, extract teeth from bone, interpret x-rays and CT scans and MRI and know about hemostatic and surgery. They are trained surgeons. Not trying to succeed in backdoor opportunity for procedures and surgeries.

I dunno....I think dentistry school is very competitive similar to getting into med school if not harder and many of my friends that went to dentistry school shared some classes with the med students...

I would wager that 99% of optometrists don't consider themselves surgeons in any sense. That wasn't the comparison I was trying to make. I was more going for "4 year programs in professions separate from medicine and don't require any post graduate education to get full licensure". I wasn't commenting on optometry's legislative agenda (I'm against them getting 99% of procedures if it matters).

I'm an FP and while legally I can perform surgery, I don't and I'm not a surgeon in any sense of the word. I can't really interpret MRIs at all or CTs if I'm being honest. So does that make me inferior to dentists?

Dental school is more competitive in large part because dentists (and their subspecialties) make WAY more than ODs. If optometrists were routinely breaking 200k I bet it would be much more competitive.

 

[Trefoil]

Anecdotally, I find it insane that an optometrist would even want to try an intravitreal injection without training. They aren’t particularly difficult, but it’s easy to cause a massive amount of damage with even the slightest wrong movement. It seems crazy to me that you would just walk up and try doing one after a weekend course, when the potential complications are so great. We were carefully supervised for like a year before we were allowed to inject independently.

 

[linevasel]

@VA Hopeful Dr & Percyeye,

good to see your comment. Correct me if I'm wrong, but I'm pretty sure Optoms routinely break 200k. I know the listed average is 130s, but my impression is that Optoms routinely break 150 in private practice in the Midwest. And, I think it is fairly competitive. More competitive than pharmacy school (no shade on the pharmacists) and NP school (no shade again, my wife is a NP...) and you need a bachelors before you can go to optometry school. No accelerated path unlike the Nurse practitioner schools and pharmacy.

Percyeye - are my facts right ?

 

[percyeye]

@VA Hopeful Dr & Percyeye,

good to see your comment. Correct me if I'm wrong, but I'm pretty sure Optoms routinely break 200k. I know the listed average is 130s, but my impression is that Optoms routinely break 150 in private practice in the Midwest. And, I think it is fairly competitive. More competitive than pharmacy school (no shade on the pharmacists) and NP school (no shade again, my wife is a NP...) and you need a bachelors before you can go to optometry school. No accelerated path unlike the Nurse practitioner schools and pharmacy.

Percyeye - are my facts right ?

It is pretty similar to most medical professions where being employed in larger cities you make less. Ball park is going to be $120-150Kish as an employee generally but can go higher with production bonuses.

Private practice owners, especially in the Midwest will do better. I just recently purchased my practice (in the Midwest) I expect I should do >$400-$450K this year. A different practice I looked at purchasing the guy was doing $350K so these numbers are not as rare as you would think. My buddy who just bought a practice in a different state but also Midwest says he expects to do $300-$400K this year.

Most people know you do better in rural private practice but 95% prefer to work as an employee in the cities.

 

[cal75]

It is pretty similar to most medical professions where being employed in larger cities you make less. Ball park is going to be $120-150Kish as an employee generally but can go higher with production bonuses.

Private practice owners, especially in the Midwest will do better. I just recently purchased my practice (in the Midwest) I expect I should do >$400-$450K this year. A different practice I looked at purchasing the guy was doing $350K so these numbers are not as rare as you would think. My buddy who just bought a practice in a different state but also Midwest says he expects to do $300-$400K this year.

Most people know you do better in rural private practice but 95% prefer to work as an employee in the cities.

How much would an ophtho make in those areas? Seems like I should’ve went to optometry school instead if I liked working with the eye

 

[DrZeke]

How much would an ophtho make in those areas? Seems like I should’ve went to optometry school instead if I liked working with the eye

are you in med school ?

 

[cal75]

are you in med school ?

Yep, interested in ophtho but it's getting even more competitive year over year so just trying to learn more about the field

 

[DrZeke]

Yep, interested in ophtho but it's getting even more competitive year over year so just trying to learn more about the field

From your posts, you seem to be highly motivated by lifestyle and the promise of money. While you can have a good lifestyle in Ophtho and make money, there are probably some other specialties that might be more lucrative. I'm not sure how you know that you "like working with eyes", but I'm sure you chose med school over optometry school for a reason.

 

[cal75]

From your posts, you seem to be highly motivated by lifestyle and the promise of money. While you can have a good lifestyle in Ophtho and make money, there are probably some other specialties that might be more lucrative. I'm not sure how you know that you "like working with eyes", but I'm sure you chose med school over optometry school for a reason.

Thanks for the input. Just trying to do my due diligence on a field that is incredibly competitive to match (80% for US MD seniors this year) before I go “all in” so to speak. I worked in ophtho before school and kept it on my shortlist and it hasn’t been eliminated yet, but I’m still keeping an open mind to other fields. Ultimately, this will be a job that has required years of work and hundreds of thousands of dollars so I was hoping questions about hours and compensation wouldn’t be too inflammatory for a student to ask.

 

[DrZeke]

Thanks for the input. Just trying to do my due diligence on a field that is incredibly competitive to match (80% for US MD seniors this year) before I go “all in” so to speak. I worked in ophtho before school and kept it on my shortlist and it hasn’t been eliminated yet, but I’m still keeping an open mind to other fields. Ultimately, this will be a job that has required years of work and hundreds of thousands of dollars so I was hoping questions about hours and compensation wouldn’t be too inflammatory for a student to ask.

What would your ideal practice in ophthalmology look like?

 

[OphthoApplicant04]

It is pretty similar to most medical professions where being employed in larger cities you make less. Ball park is going to be $120-150Kish as an employee generally but can go higher with production bonuses.

Private practice owners, especially in the Midwest will do better. I just recently purchased my practice (in the Midwest) I expect I should do >$400-$450K this year. A different practice I looked at purchasing the guy was doing $350K so these numbers are not as rare as you would think. My buddy who just bought a practice in a different state but also Midwest says he expects to do $300-$400K this year.

Most people know you do better in rural private practice but 95% prefer to work as an employee in the cities.

Good for you! May I ask, what portion of that is from medical/exam type billing and what portion from the optical business?

 

[percyeye]

Good for you! May I ask, what portion of that is from medical/exam type billing and what portion from the optical business?

A standard Optometry business revenue is ~40% exam/medical and ~60% from optical. Or so they say.

I just looked at our statistics and we closer to 60% exams/medical and 40% Optical so that is what pushes our net income higher which is common for more rural practices. We don't have to rely as heavy on making income from glasses.

On top of being a smaller rural area our costs are lower with employees and rent etc. But another perk of being a business owner is owning the building and paying yourself rent which is some nice income.

A standard net collections is ~30-33%. Due to us being rural our net is higher than average closer to the 40% range. Doing over $1 million gross really is not the difficult in an area like this which is why you see incomes of private practice ODs in the $300-$400K or more range.

I'm just sharing this because I enjoy the business side of eye care just as much as the science part and some here might find it interesting. I'm sure it goes for Ophthalmology as well. Run a well oiled business and you'll be light years ahead of colleagues who are employed as far as income goes.

 

[RetinaDude]

Percyeye, I’ve always been impressed with the ODs in my community. Most are very entrepreneurial and not only own their practice but the real estate too (like you). Before joining the private practice world, I also had no idea ODs did so well financially. Now, that I’m friends with a lot of them, I find that your $$$ numbers are more common than people think (or expect)

 

[cal75]

What would your ideal practice in ophthalmology look like?

I've been looking for a field that has both a clinic/surgical component, don't care too much about hours/lifestyle at this point but that could change down the road. I'd also like a speciality with a lot of technology and all signs pointed to ophtho, although I am still back and forth on ENT. Scratched out IR/urology/derm and still exploring other fields that fit that bill. I'd love to hear your thoughts on if ophtho could fit that description and what made you pick ophtho.