Job outlook in ophthalmology

[Entol]

I'm sorry to post a new thread.. I've seen a few posts dancing around this topic but I just wanted to ask the question point blank: How is the job market for currently graduating ophthalmologist? and are ophthalmologist salaries likely to continue dropping?

I recently finished my ophthalmology rotation, and I thought it was amazing.. the only thing holding me back from going into ophthalmology is the job opportunities in the future and the salary of ophthalmologists. However, I'm in the fortunate position of being in love with several fields, each of which would make me only slightly less happy than ophthalmology. I know Dr. Doan also mentioned in this forum that he would be willing to do ophthalmology for almost nothing because he loves the field so much, and although I feel the same way, I could see myself going into other fields that are significantly more stable and lucrative that I would enjoy slightly less than ophthalmogy if I knew I would be ensured a strong job for the foreseeable future.

I guess my confusion is that I just can't understand how can there be so few jobs available with every diabetic being followed by an ophthalmologist? Isn't cataract surgery the #1 surgery in the country? Isn't AMD an extremely common cause of blindness? How does this translate into fewer available jobs?

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[KHE]

I'm sorry to post a new thread.. I've seen a few posts dancing around this topic but I just wanted to ask the question point blank: How is the job market for currently graduating ophthalmologist? and are ophthalmologist salaries likely to continue dropping?

I recently finished my ophthalmology rotation, and I thought it was amazing.. the only thing holding me back from going into ophthalmology is the job opportunities in the future and the salary of ophthalmologists. However, I'm in the fortunate position of being in love with several fields, each of which would make me only slightly less happy than ophthalmology. I know Dr. Doan also mentioned in this forum that he would be willing to do ophthalmology for almost nothing because he loves the field so much, and although I feel the same way, I could see myself going into other fields that are significantly more stable and lucrative that I would enjoy slightly less than ophthalmogy if I knew I would be ensured a strong job for the foreseeable future.

I guess my confusion is that I just can't understand how can there be so few jobs available with every diabetic being followed by an ophthalmologist? Isn't cataract surgery the #1 surgery in the country? Isn't AMD an extremely common cause of blindness? How does this translate into fewer available jobs?

For the record, I am a practicing optometrist, not ophthalmologist but I responded to this post because we are having similar problems in optometry vis a vis many new graduates working in less than desireable situations and/or for less money than expected.

I think there just isn't any way to deny that we have an oversupply of eye care providers in both fields. I also think that your assertion about diabetics, cataracts and AMD is off a little bit.

It is true that IN THEORY every diabetic needs a yearly exam, but many of them simply do not get yearly exams regardless of how much "education" you give them. We have the same problem in optometry with our diabetic patients and also our contact lens patients. Cataract surgery is extremely common but in eye care, probably more so than in any other field of health care, equipment automation and advances in techniques and technologies allow for many many more people to be seen by fewer and fewer doctors, further exacerbating the oversupply problem. A skilled cataract surgeon can crank out 5-6 eyes per hour with an efficient ASC and some moderately skilled staff.

AMD is likely to become more and more common as boomers get older, but dry AMD is still by far and away the most common type, and there isn't much reimbursement you can get out of those patients because there really aren't any "procedures" that you can do, like in the wet form.

In optometry, we have been begging our academic institutions to reduce class size for years. All that we have seen is class sizes increase.

I don't see any solution to the problem short of reducing the number of eye care providers.

 

[Caffeinated]

I am not sure how likely it is that optometry would reduce the number of graduates. The schools need a certain amount of tuition income to keep the doors open, and reducing class size is like a pay cut for the schools. With optometry school tuition already high, a cut in the number of optometry students would likely drive tuition even higher.

I think it is also unlikely that ophthalmology would ever cut the number of residency training slots. When this happens, there is usually a critical undersupply that happens several years down the road. This was the case for radiology, radiation oncology, and anesthesiology. While this tends to drive up incomes for the professions, it may also open the door to expansion of scope of practice from midlevel providers. This may have been a factor in the rise of the Anesthesia v. CRNA struggle. I am not sure if the same thing would happen with ophthalmology v. optometry. Depending on who you talk to, some people are predicting a nationwide shortage of ophthalmologists in the years to come. So with that kind of uncertainty, I find it unlikely that the number of ophthalmologists coming out of training will decrease.

Just one guy's opinion.
Caff

 

[KHE]

I am not sure how likely it is that optometry would reduce the number of graduates. The schools need a certain amount of tuition income to keep the doors open, and reducing class size is like a pay cut for the schools. With optometry school tuition already high, a cut in the number of optometry students would likely drive tuition even higher.

I think it is also unlikely that ophthalmology would ever cut the number of residency training slots. When this happens, there is usually a critical undersupply that happens several years down the road. This was the case for radiology, radiation oncology, and anesthesiology. While this tends to drive up incomes for the professions, it may also open the door to expansion of scope of practice from midlevel providers. This may have been a factor in the rise of the Anesthesia v. CRNA struggle. I am not sure if the same thing would happen with ophthalmology v. optometry. Depending on who you talk to, some people are predicting a nationwide shortage of ophthalmologists in the years to come. So with that kind of uncertainty, I find it unlikely that the number of ophthalmologists coming out of training will decrease.

Just one guy's opinion.
Caff

If the strategy is to produce a glut of ophthalmologists so as to limit mid level practitioner scope expansion that's just as much a self defeating proposition as allowing midlevel scope expansion. The end result is the same. Decreased incomes for ophthalmologists.

Obviously, I have much more experience with academic optometry than academic ophthalmology, but from the research that I have done, it seems that ophthalmology operates on the same mistaken assumptions that optometry does:

In optometry, people will say "Everyone needs an eye exam every year. Since there are 300 million people in the USA, we need X number of ODs."

They don't consider the fact that millions of people go years and years at a time between exams.

In ophthalmology, it seems as though they look at incidence of diseases and say things like "The incidence of cataracts is 1 in 3, or the incidence of diabetes is 1 in 10" Therefore, do deal with this, we need Y number of ophthalmologists.

They don't consider the fact that many ODs are providing screening for diabetic retinopathy. They don't consider that many PCPs are installing telemedicine systems in their office to not only take (and bill for) retinal photographs but using off site interpretation services. They don't consider that thousands of people will go through life with relatively mild cataracts and not do anything about them. They don't take into consideration that new technologies and techniques allow for far more exams and procedures to be performed by fewer and fewer doctors.

In optometry (as in ophthalmology if some of the threads on here are any indication) we have new graduates working in less than desireable situations and for far less money than expected. Obviously, no one expects to be at the "top of the heap" on their first day out. But if starting salaries are so reduced as compared to other medical specialities, it is going to make ophthalmology less and less attractive to potential students. Is that what anyone in the business wants? I doubt it.

I don't see any solution to the problem other than reducing the number of graduating ophthalmologists AND (especially) optometrists. Maybe someone can clear it up for me but I can not fathom how there can be any conceivable shortage of opthalmologists in the coming years, and there is CERTAINLY not going to be a shortage of optometrists.

 

[Andrew_Doan]

To address this question, one must ask "how much money is enough" and "do I enjoy what I am doing for the money I make"?

I have about $75K in student loans, live in Southern California, and live well on a military salary. However, I am frugal at most times and my version of "well" may not be yours. For instance, I don't pump my money into fancy cars. I rent a house instead of buying (especially when I can rent a $650K home for $2000/month instead of paying a mortgage that will be double my rent!). We live on a tight budget and try to save 20% of what I pull in and give 10% to our church.

A civilian ophthalmologist working for Kaiser in Southern California will start at $150-180K/year. A civilian ophthalmologist starting out will make less, but will ramp up to $250K/year.

Medicare is cutting physician reimbursements by ~4%/year, so physicians accepting insurance will have to work harder and see more patients to make the same amount of money in the future.

Ophthalmologists can make the above working 4-5 days a week with a 40-hour work week. The surgeries are very cool and the medical management of ocular diseases is challenging and rewarding.

My advice is focus on what you love to do, because it'll make you a better physician and more productive. Increased productivity will also translate to more patients/surgery/income. Also, make a realistic budget and STICK TO IT! People get into financial troubles by over spending above their incomes... no matter how much some people make, they will manage to be in debt.

 

[teleret]

So there is a new posting reguarding the job market, yet, somehow, it evolves into phylosophical discussions about why and how we got to this point. The bottom line is that the job market is not great for ophthalmologists . I do not think it will ever be as good as it is for radiology or anesthesia. The job market is not great in general and it is even worse in big cities. I love ophthalmology and I never thought of Mondays as hard days because I love what I do . But it is the reality that gets to you; high buy-ins,low starting salary, people screwing each other in the field. So when the medical student is asking about the job market and has the same love for a few other fields, my answer would be " think twice before going into ophtho "

 

[Caffeinated]

If the strategy is to produce a glut of ophthalmologists so as to limit mid level practitioner scope expansion that's just as much a self defeating proposition as allowing midlevel scope expansion. The end result is the same. Decreased incomes for ophthalmologists.

I don't know that this is a stated strategy. I was just speculating that this may have been considered by organized ophthalmology at some point. But I don't know for certain.

It seems to me that the eye care marketplace is complicated, and we should be careful about oversimplifying it in predicting trends in supply and demand. First, the overlapping scope of optometry and ophthalmology complicates predictions. Also, both professions offer services that go beyond epidemiology of eye disease and populations trends (e.g., glasses, refractive surgery, contact lenses, cosmetic lid procedures, etc). This can make the overall eye care market somewhat susceptible to consumer spending trends. Obviously, specialties such as glaucoma, neuro, retina are less susceptible to these factors.

These are not scientific facts; this is just me sharing what comes to mind.

 

[Mirror Form]

Keep in mind that as the baby boomers age, ophthalmologists will have a lot more work coming their way (as will all dr's, but especially cataract surgeons). The question then will be how medicaire will ever be able to afford to pay for the healthcare of the baby boomers.

 

[rubensan]

for almost nothing because he loves the field so much, and although I feel the same way, I could see myself going into other fields that are significantly more stable and lucrative that I would enjoy slightly less than ophthalmogy if I knew I would be ensured a strong job for the foreseeable future.

it sounds like you have some more searching to do. ophthalmology is a great field of medicine, but there are others. for me it came down to ophthalmology, urology, and endocrine and infertility (a subspecialty of OBGYN). i did subIs in all, talked to many people, weighed all the pros and cons and decided to pursue what made me want to "get out of bed the most" every morning. the hardest thing to understand while choosing a career, especially in medicine is that NOTHING is guaranteed and what might be stable today may become unstable in 10 years. it all depends on how you want to live your life and what is important to you. will you make a good living as an ophthalmologist? yes! is there a shortage of glaucoma specialists? yes. can you make a killing as a vitreal retinal surgeon or occuloplastic surgeon? yes, but you will work very hard for it. whether you decide to pursue ophthalmology or not (and i hope you do), you need to understand that making a lot of money in life requires a lot of work. and one thing i learned from some of my patients in internship is that at the end of the day, no one wishes they made more money in life, rather they wished they had spent more time with family and friends. now, can you make more money in other fields (especially outside of medicine)? YES. if you decide that lucrativeness is important to you, (and there is nothing wrong with that) try choosing a fee for service field like plastic surgery or endocrine infertility. best of luck to you!

 

[PBEA]

Keep in mind that as the baby boomers age, ophthalmologists will have a lot more work coming their way (as will all dr's, but especially cataract surgeons). The question then will be how medicaire will ever be able to afford to pay for the healthcare of the baby boomers.

Aren't we into baby boomers already? Everybody refers to "the huge boomer wave" ready to hit, but I think its already hit us. And I dont see any larger waves on the horizon. I tend to disagree with this assertion (I'm not interested in any "studies" on the topic, lest I point out all their flaws). IMO, we already have a huge oversupply of OMD (and OD). The only "justification" that OMD's have for producing current numbers is a political one, and that is to prevent OD's from taking larger market share. It seems totally self serving. May the free-market prevail.

 

[PBEA]

If the strategy is to produce a glut of ophthalmologists so as to limit mid level practitioner scope expansion that's just as much a self defeating proposition as allowing midlevel scope expansion. The end result is the same. Decreased incomes for ophthalmologists.

Obviously, I have much more experience with academic optometry than academic ophthalmology, but from the research that I have done, it seems that ophthalmology operates on the same mistaken assumptions that optometry does:

In optometry, people will say "Everyone needs an eye exam every year. Since there are 300 million people in the USA, we need X number of ODs."

They don't consider the fact that millions of people go years and years at a time between exams.

In ophthalmology, it seems as though they look at incidence of diseases and say things like "The incidence of cataracts is 1 in 3, or the incidence of diabetes is 1 in 10" Therefore, do deal with this, we need Y number of ophthalmologists.

They don't consider the fact that many ODs are providing screening for diabetic retinopathy. They don't consider that many PCPs are installing telemedicine systems in their office to not only take (and bill for) retinal photographs but using off site interpretation services. They don't consider that thousands of people will go through life with relatively mild cataracts and not do anything about them. They don't take into consideration that new technologies and techniques allow for far more exams and procedures to be performed by fewer and fewer doctors.

In optometry (as in ophthalmology if some of the threads on here are any indication) we have new graduates working in less than desireable situations and for far less money than expected. Obviously, no one expects to be at the "top of the heap" on their first day out. But if starting salaries are so reduced as compared to other medical specialities, it is going to make ophthalmology less and less attractive to potential students. Is that what anyone in the business wants? I doubt it.

I don't see any solution to the problem other than reducing the number of graduating ophthalmologists AND (especially) optometrists. Maybe someone can clear it up for me but I can not fathom how there can be any conceivable shortage of opthalmologists in the coming years, and there is CERTAINLY not going to be a shortage of optometrists.

Well said, I have myself remarked that the "demand" side of the eye equation seems out of balance with the facts. When determining "need" we should be using "usage" figures, not the incidence values which are either inaccurate, or dont reflect exam frequency well enough. Until this is done, then most people will just say "the baby boomers are coming, the baby boomers are coming".

 

[Mirror Form]

Aren't we into baby boomers already? Everybody refers to "the huge boomer wave" ready to hit, but I think its already hit us. And I dont see any larger waves on the horizon. I tend to disagree with this assertion (I'm not interested in any "studies" on the topic, lest I point out all their flaws). IMO, we already have a huge oversupply of OMD (and OD). The only "justification" that OMD's have for producing current numbers is a political one, and that is to prevent OD's from taking larger market share. It seems totally self serving. May the free-market prevail.

Baby boomers are just hitting their early 60's. Once they're 75, the medical system and medicaire will be greatly stressed.

 

[Olddog1]

Aren't we into baby boomers already? Everybody refers to "the huge boomer wave" ready to hit, but I think its already hit us. And I dont see any larger waves on the horizon. I tend to disagree with this assertion (I'm not interested in any "studies" on the topic, lest I point out all their flaws). IMO, we already have a huge oversupply of OMD (and OD). The only "justification" that OMD's have for producing current numbers is a political one, and that is to prevent OD's from taking larger market share. It seems totally self serving. May the free-market prevail.

I think ophthalmology produces about 410 new docs per year in the US. To my knowledge there is no plan to increase the number of spots, and if there is a change it would likely be around 1-2% (higher or lower). Usually, if a program folds other programs essentially pick up their spots as Emory and Duke did when UT Chat closed it's residency, thereby making the numbers essentially neutral. In 2004 Optometry Schools graduated 1025 ODs. I know there is also a proposal to open another optometry school in NC. It seems to me the oversupply rests with the optometry schools turning out too many ODs. They are competing more with each other for a smaller piece of the pie as their scope of practice (rightly) is limited. It appears the self serving ones are the Optometry Schools as they are trying to bring in more money by training more ODs. Also, the more ODs that are turned out, more money to PACs, and the ability to legislate scope of practice to increase the OD market share, leads to more ODs, more schools, etc...

 

[Andrew_Doan]

Let's put things into to perspective...

Intel is planning to eliminate more than 10,000 jobs this fall. Does anyone know an unemployed ophthalmologist due to the current economic conditions in medicine?

 

[PBEA]

I think ophthalmology produces about 410 new docs per year in the US. To my knowledge there is no plan to increase the number of spots, and if there is a change it would likely be around 1-2% (higher or lower). Usually, if a program folds other programs essentially pick up their spots as Emory and Duke did when UT Chat closed it's residency, thereby making the numbers essentially neutral. In 2004 Optometry Schools graduated 1025 ODs. I know there is also a proposal to open another optometry school in NC. It seems to me the oversupply rests with the optometry schools turning out too many ODs. They are competing more with each other for a smaller piece of the pie as their scope of practice (rightly) is limited. It appears the self serving ones are the Optometry Schools as they are trying to bring in more money by training more ODs. Also, the more ODs that are turned out, more money to PACs, and the ability to legislate scope of practice to increase the OD market share, leads to more ODs, more schools, etc...

I agree there is an oversupply of OD (as well as OMD). But you should not look at the "pie" as what our relative scopes of practice allow (rightfully). Instead, the "pie" is made up of the pt population we serve, and OD's are clearly able to handle the overwhelming majority. So, in fact, too many OMDs often compete for the same "pie" as too many OD's do. Yes, OD's try to achieve more marketshare by performing some of the "traditional" tasks of an OMD, but OMD's do same when they venture into "historic" OD tasks, so both are equally guilty. My solution is still the same. Combine the fields, somehow, educationally, clinically, etc., and exhibit some self restraint (like the savvy dentists have done) on our own marketplace.

 

[Mirror Form]

My solution is still the same. Combine the fields, somehow, educationally, clinically, etc., and exhibit some self restraint (like the savvy dentists have done) on our own marketplace.

How would combining the fields help? It may help out OD's since they're a little more over produced than OMD's, but it wouldn't help OMD's whatsoever.

More importantly, combining the fields isn't just about marketshare. You have to take into account what type of education is required.

 

[Beau Geste]

Baby boomers are just hitting their early 60's. Once they're 75, the medical system and medicaire will be greatly stressed.

Yep, my dad is 60 - the first year for the baby boomers (1946).

 

[GuP]

Aren't we into baby boomers already? Everybody refers to "the huge boomer wave" ready to hit, but I think its already hit us. And I dont see any larger waves on the horizon. I tend to disagree with this assertion (I'm not interested in any "studies" on the topic, lest I point out all their flaws). IMO, we already have a huge oversupply of OMD (and OD). The only "justification" that OMD's have for producing current numbers is a political one, and that is to prevent OD's from taking larger market share. It seems totally self serving. May the free-market prevail.

Why do you always come on the ophtho forum and take shots at ophthalmologists? I have noticed this in a quite a few of your posts. What's the deal?

In another one of your posts, you mention combiinig the fields. How is that possible? There is a huge difference between the scope of practice and the level of education. Moreover, how will that help the ophthalmologists?

 

[PBEA]

How would combining the fields help? It may help out OD's since they're a little more over produced than OMD's, but it wouldn't help OMD's whatsoever.

Its my assertion that they are both overproduced. More of either field, hurts both of them. If your practice only ever sees complex medical problems and lots of surgery, then maybe it wont effect you, but if your practice resembles the last few private ophthalmologists I worked with, then most of the exams are well within an ODs grasp ("routine" diabetic checks, glaucoma, red eye, etc). Many ODs already practice in this fashion, with many more to come. If the educational tracts were the same (but tiered) then this would allow better balance to be had with the actual demand. In other words, people who do surgery, only do surgery and there followup. I'll go one further and include that these surgeons ONLY reside in hospitals and/or ASC's. Not out on main street doing humdrum primary care work. To me it would waste all that extra training.

More importantly, combining the fields isn't just about marketshare. You have to take into account what type of education is required.

Agreed, my solution accounts for this. Hypothetically, if after 4 years focus on primary eyecare, a student has the option to continue with advanced eyecare (say another 2-3 years), then these students could enter these residencies, way ahead of the eye curve compared to the current first year OMD resident. I dont even know what these poor residents do? The initial fumbling with the mechanics of an exam, while also trying to learn surgery and the volumes of eyecare minutia? Let alone the limited time to let these skills "season", seems less efficient to me. Of course USMLE, etc would be standard. I know alot of people here dont like the comparison with dentistry and OMFS, but it sure fits, pure symmetry. Now that is how you work the supply/demand ratio. You know what would happen? Fees would rise. Period. How does filling a few cavities pay better then cataract surgery? Thats got to be a joke right? (I hope no dentists see this) I mean really though, friggin microsurgical cataract extraction with implant vs cavities? WTF!?! Why is this so hard to understand, I'll never know.

 

[PBEA]

Why do you always come on the ophtho forum and take shots at ophthalmologists? I have noticed this in a quite a few of your posts. What's the deal?

In another one of your posts, you mention combiinig the fields. How is that possible? There is a huge difference between the scope of practice and the level of education. Moreover, how will that help the ophthalmologists?

I'm sorry if I offended you. Maybe I'm wrong and OMDs are produced based on the best incidence/demand numbers that are available, I concede that possibility. My shots should not be directed at OMD's, they are more geared towards a system that IMO is slowly becoming more complicated (outdated?). I'm a little jaded with regard to my method, but I mean no ill will.
When I propose "combining fields" I mean that "scope" issues and education levels are no longer an issue (they are dealt with from the git go). See my previous post in regard to helping the entire eyecare arena.

 

[Caffeinated]

Oh, man. I see where this thread is going. Not again....

 

[drgregory]

since this thread has already been hijacked by ODs, ill jump in.

1) there are wwaaaayyy too many ODs, and ODs that churn out 50 eye exams/day for $29 at wally world et al eat up a large portion of "patient pie"

2) understand ophthalmology's frustration as medicare reimbursements have sharply DECREASED for cataract surgery - their bread and butter.

3) if MD reimursements were a little better they wouldnt have to churn out 4 phacos/hour to make a living, and there would be a larger volume of surgical eyecare availible.

the good old days of eye care have come and gone. ODs no longer make $400 for a contact lens fitting and MDs no longer make $3000/eye on cataract surgery. one way to remedy this is to decrease numbers of practicing providers. another way is for ODs and MDs alike to demand appropriate fees for the valuable services they perform.

 

[drgregory]

let me add another thing, as long as im speaking with an irrelevant point of view since im not an ophthalmologist.

- your reimbursement for cataract surgery, certainly NOT a simple procedure, and certainly a procedure whereby complications could result in significant quality of life loss, is reimbursed at a lower rate than what it might cost to have a dental crown done. im not saying that it doesnt take skill to fit a crown (im not a dentist), im just saying it is not a procedure whereby risk level is as high as cataract surgery. im also saying that the dentist is getting reimbursed at what a highly trained professional should. the ophthalmologist isnt. imagine their frustration. we quibble about the measly amounts we as ODs get from vision insurers. they are in the same boat with the measly reimbursement they get from medicare.

 

[Olddog1]

let me add another thing, as long as im speaking with an irrelevant point of view since im not an ophthalmologist.

- your reimbursement for cataract surgery, certainly NOT a simple procedure, and certainly a procedure whereby complications could result in significant quality of life loss, is reimbursed at a lower rate than what it might cost to have a dental crown done. im not saying that it doesnt take skill to fit a crown (im not a dentist), im just saying it is not a procedure whereby risk level is as high as cataract surgery. im also saying that the dentist is getting reimbursed at what a highly trained professional should. the ophthalmologist isnt. imagine their frustration. we quibble about the measly amounts we as ODs get from vision insurers. they are in the same boat with the measly reimbursement they get from medicare.

Another unfortunate thing with all of medicine is the pot of money in medicare has to remain "budget neutral", although the federal gov't is also decreasing the size of the pot. Consequently, if you are paying $1500 for an Avastin injection someone else is going to get less money for something else. With the new "advances" which are definately good for some drug companies (and a minority of patients), there will be an even bigger squeeze on cataract surgery, consults, yearly exams, etc...

That being said I really enjoy being an Ophthalomologist. If you ask a physician in another specialty if they are happy about their reimbursement they will likely say no. To echo what Dr. Doan said, I don't know any starving Ophthalmologist.

 

[drgregory]

That being said I really enjoy being an Ophthalomologist. If you ask a physician in another specialty if they are happy about their reimbursement they will likely say no. To echo what Dr. Doan said, I don't know any starving Ophthalmologist.

great point.

 

[MacGyver]

one way to remedy this is to decrease numbers of practicing providers.

You do that and I guarantee you that the states will start allowing midlevels or "other doctors" to invade the field. Thats exactly what is happening with psychologists being granted RX privileges and now competing directly against psychiatrists.

Another option is that the fed can always open the floodgates to FMGs.

Thats 2 trump cards that states/fed have over doctors. The days of doctor autonomy are over.

another way is for ODs and MDs alike to demand appropriate fees for the valuable services they perform.

Doctors arent in a position to "demand" anything. Medicare currently controls 60% of all healthcare dollras in the USA. By 2020, that percentage will be 75%. Thats de facto monopoly status folks. Say goodbye to any leverage you once had.

Even though we dont have socialized medicine, the bottom line is that the government holds all the trump cards here. They've got multiple options for circumventing any pressure created by doctors. Doctors cant unionize, which is a major leverage card. Secondly, midlevels are always available so they can arbitrarily expand scope. Thirdly, they can play the FMG card. Finally, teh fed controls sufficient market share to dictate salary with no leverage by doctors.

 

[drgregory]

Even though we dont have socialized medicine, the bottom line is that the government holds all the trump cards here. They've got multiple options for circumventing any pressure created by doctors.

unfortunately, i have no rebuttal.

i assume you are right. if ODs stopped doing eye exams, and MDs stopped doing eye surgery, the gov has plenty of options

 

[Mirror Form]

Agreed, my solution accounts for this. Hypothetically, if after 4 years focus on primary eyecare, a student has the option to continue with advanced eyecare (say another 2-3 years), then these students could enter these residencies, way ahead of the eye curve compared to the current first year OMD resident. I dont even know what these poor residents do? The initial fumbling with the mechanics of an exam, while also trying to learn surgery and the volumes of eyecare minutia? Let alone the limited time to let these skills "season", seems less efficient to me. Of course USMLE, etc would be standard. I know alot of people here dont like the comparison with dentistry and OMFS, but it sure fits, pure symmetry. Now that is how you work the supply/demand ratio. You know what would happen? Fees would rise. Period. How does filling a few cavities pay better then cataract surgery? Thats got to be a joke right? (I hope no dentists see this) I mean really though, friggin microsurgical cataract extraction with implant vs cavities? WTF!?! Why is this so hard to understand, I'll never know.

Please save this garbage for the appropriate thread.

 

[Mirror Form]

Another option is that the fed can always open the floodgates to FMGs.

That's incorrect. FMG's would still have to become board certified in the US, which requires a US residency. So that isn't an option for the state.

 

[smiegal]

Agreed, my solution accounts for this. Hypothetically, if after 4 years focus on primary eyecare, a student has the option to continue with advanced eyecare (say another 2-3 years), then these students could enter these residencies, way ahead of the eye curve compared to the current first year OMD resident. I dont even know what these poor residents do? The initial fumbling with the mechanics of an exam, while also trying to learn surgery and the volumes of eyecare minutia? Let alone the limited time to let these skills "season", seems less efficient to me.

When would they learn anything about general medicine? After optom school?

So train in basic science (less rigorous) for 2 years, then 2 years of clinical optom, THEN learn basic medicine for 2 years (like they do for OMF surgery), THEN learn "advanced eyecare." What a backassward training setup!

If it ain't broke, don't try to fix it. There's no benefit to society in the plan you suggest over the current Ophthalmology training setup. There's no shortage of Ophthalmologists, no difficulty getting med school grads to try to get into Ophthalmology, so why shorten the training? Why put out less- trained specialists? If an optom wants to be an ophthalmologist bad enough they have every right to go to medical school.

 

[DiveMD]

When would they learn anything about general medicine? After optom school?

So train in basic science (less rigorous) for 2 years, then 2 years of clinical optom, THEN learn basic medicine for 2 years (like they do for OMF surgery), THEN learn "advanced eyecare." What a backassward training setup!

If it ain't broke, don't try to fix it. There's no benefit to society in the plan you suggest over the current Ophthalmology training setup. There's no shortage of Ophthalmologists, no difficulty getting med school grads to try to get into Ophthalmology, so why shorten the training? Why put out less- trained specialists? If an optom wants to be an ophthalmologist bad enough they have every right to go to medical school.

Well said...

 

[PBEA]

Please save this garbage for the appropriate thread.

Screww you pal, you asked the questions, I was only responding. I dont presume that my ideas are to be made into reality. I am only presenting them as food for thought, as a means for solving an oversupply issue that I think is relevent to the OP.

 

[PBEA]

When would they learn anything about general medicine? After optom school?

So train in basic science (less rigorous) for 2 years, then 2 years of clinical optom, THEN learn basic medicine for 2 years (like they do for OMF surgery), THEN learn "advanced eyecare." What a backassward training setup!

If it ain't broke, don't try to fix it. There's no benefit to society in the plan you suggest over the current Ophthalmology training setup. There's no shortage of Ophthalmologists, no difficulty getting med school grads to try to get into Ophthalmology, so why shorten the training? Why put out less- trained specialists? If an optom wants to be an ophthalmologist bad enough they have every right to go to medical school.

I'm not workin out the details! I'm just free thinking here!

The core of my comments refer to oversupply. Period. Face it there are too many ophthalmologists in the US. Not a shortage? (where did you get that idea from?) I'm not talking about ODs or their practice? If you disagree then we have nothing to discuss. The OP seems to intimate otherwise, and I happen to agree with it, tough luck.

 

[Pinkertinkle]

I'm not workin out the details! I'm just free thinking here!

The core of my comments refer to oversupply. Period. Face it there are too many ophthalmologists in the US. Not a shortage? (where did you get that idea from?) I'm not talking about ODs or their practice? If you disagree then we have nothing to discuss. The OP seems to intimate otherwise, and I happen to agree with it, tough luck.

How many ophthalmologists are produced and how many OD's are produced every year?

 

[Andrew_Doan]

How many ophthalmologists are produced and how many OD's are produced every year?

Ophthalmologists - ~440/year
Optometrists- ~1100-1200/year

It's about a 1:3 ratio.

 

[drgregory]

Ophthalmologists - ~440/year
Optometrists- ~1100-1200/year

It's about a 1:3 ratio.

the oversupply problem lies in optometry much more than ophthalmology. it also lies in optometry's habits, ie doing 50 "eye exams" (if thats what youd call them) in a mall somewhere every day.
until surgical scheduling time (at least in my area) for a cataract is within two weeks, i dont think there is a huge oversupply of eye surgeons.
call any OD office and you will likely get an appointment the same day.
lower the numbers of ODs. make sure this smaller group is adequately trained. it makes sense, doesnt it?

 

[orbitsurgMD]

the oversupply problem lies in optometry much more than ophthalmology. it also lies in optometry's habits, ie doing 50 "eye exams" (if thats what youd call them) in a mall somewhere every day.
until surgical scheduling time (at least in my area) for a cataract is within two weeks, i dont think there is a huge oversupply of eye surgeons.
call any OD office and you will likely get an appointment the same day.
lower the numbers of ODs. make sure this smaller group is adequately trained. it makes sense, doesnt it?

Interesting times. The model of ophthalmology private practice is changing for sure. Soon to go I think is the "goodwill" buy-in, as most assessments show patients driven by their insurance affiliations. So the "will" part of goodwill is dubious, and with projected Medicare cuts and the cuts in private insurance that customarily follow, the "good" isn't so hot either. Practices that demand over-the-top buy-ins, far greater than the undepreciated asset value are just not going to find buyers if the projected future incomes are declining and uncertain. And high-dollar senior partner buyouts will surely follow. ("I'm not buying the same practice that made you rich, and you don't have it any more to sell, either".)

I think there is a breaking point for cataract surgery too. As many more patients' postoperative expectations now approach those of refractive surgery patients, the risk to the cataract surgeon for heretofore ordinary refractive outcomes, like bifocal spectacle wearing, will become significant.
Coupling that with the equipment cost--$25K+ for an IOL-Master--and you can see that while there may still be a demand, the incentive to offer surgery will be diminished. Even only a year from the introduction of the latest variable-focus IOLs, which are available only at an additional out-of-pocket cost to the patient over Medicare's standard collection, I have seen patients peevish and resentful that this much more time-consuming and risky enhancement to standard cataract procedure wasn't covered by Medicare. Will notions like these soon make catraract extraction as a refractive procedure for presbyopia as much a "right" of Medicare beneficiaries as cataract surgery is today? Will refraction and gonioscopy become a bundled service even with the lowest E/M service? What will happen to surgery center fees, now seen as a revenue offset for some cataract practices? Already the trade literature is peppered with articles on the use of cosmetic service as practice revenue enhancers to offset falling revenues from traditional office activities. I think we can expect even more of the same. Who knows, maybe we can trade tips with the family docs, many of whom have gone the same cosmetic route and for the same reasons, although perhaps not having experienced the same steep drop in practice income.

I think ophthalmology has nothing to fear from the high-volume O.D.s working in the WalMarts and the like. They may make decent money, but they run like rats on a wheel to get it. They are in a production mode, and don't have time to sort out anything non-refractive or that isn't easily corrected by glasses or contacts. They are also fearful of missing significant medical problems and generally grateful of the availability of ophthalmologists to see anything even remotely suspicious. I get lots of referrals that way.

 

[smiegal]

The core of my comments refer to oversupply. Period. Face it there are too many ophthalmologists in the US. Not a shortage? (where did you get that idea from?) I'm not talking about ODs or their practice? If you disagree then we have nothing to discuss. The OP seems to intimate otherwise, and I happen to agree with it, tough luck.

I stated that there is no shortage because that would be the only logical time to propose adding another route to become an ophthalmologist (especially one with less training). You are, essentially, proposing a short cut to ophthalmology while arguing that there is currently an oversupply. This doesn't make sense.

 

[Andrew_Doan]

I think ophthalmology has nothing to fear from the high-volume O.D.s working in the WalMarts and the like. They may make decent money, but they run like rats on a wheel to get it. They are in a production mode, and don't have time to sort out anything non-refractive or that isn't easily corrected by glasses or contacts. They are also fearful of missing significant medical problems and generally grateful of the availability of ophthalmologists to see anything even remotely suspicious. I get lots of referrals that way.

Great points! I agree completely. We actually need a good number of O.D.'s to take care of the bread-n-butter stuff. The high-volume O.D.'s in WalMart serve an important role in the delivery of eye care in the U.S.

 

[Caffeinated]

I agree with you, Andrew, on the idea that high-volume O.D.'s can serve an important role. However, I take issue with the image it portrays when optometrists work in these environments. It fosters a customer-client relationship rather than patient-doctor relationship. To the extent that the general public does not know the difference between optometry and ophthalmology, this image affects both professions. The high-volume nature of such practices results from obscenely low exam fees and pressure from the corporate side to churn out Rx's. This can affect the quality of care. In my experience moonlighting in corporate settings, I was extremely frustrated and I often made the staff unhappy because of the way I practiced. I hated that these offices created a financial disincentive toward dilated exams by charging extra for a routine DFE. I would refuse to fit patients with contact lenses if they were contraindicated (e.g., amblyope emmetropic in one eye, BCVA 20/80 in the fellow eye wants colored contacts).

While I am not thrilled about optometrists practicing in corporate settings, I would be less bothered by this if there was a consistent standard of professionalism. But in a market that is oversupplied with O.D.'s, professionalism and standard of care tends to become a casualty of maintaining financial viability of the practice. This is a problem that optometry needs to address from within. Before anyone jumps on me about the "it's not where you practice but how you practice" lecture, let me say that I know several optometrists who practice in corporate environments and give great care, and for this I salute them. But there is a wide spectrum of professionalism in the corporate setting, and the problems I addressed above are very prevalent. Ultimately, I think that if optometry could raise the standard of professionalism and address the oversupply issue, more young optometrists would feel professionally fulfilled by being competent optometrists and would be less aggressive about expanding their scope of practice. To that end, the relationship between optometry and ophthalmology could greatly improve. It may never be perfect, but there is room for improvement.

Great points! I agree completely. We actually need a good number of O.D.'s to take care of the bread-n-butter stuff. The high-volume O.D.'s in WalMart serve an important role in the delivery of eye care in the U.S.

 

[PBEA]

I stated that there is no shortage because that would be the only logical time to propose adding another route to become an ophthalmologist (especially one with less training). You are, essentially, proposing a short cut to ophthalmology while arguing that there is currently an oversupply. This doesn't make sense.

No, this is incorrect. I am not advocating for a "short cut"!! I don't propose a second type of eye surgeon. Ophthalmology already produces enough (too many IMO) as you have stated. I try and describe an alternative method for delivering ALL eye doctors/surgeons. This equates to the destruction of BOTH fields, and their reimergence. It is in this way that the house of eye will join hands and sing coom-bye-yah. Oh, and the new collective has near total control of its own, and its own market. Forget AMA, they have too much other shiiit to deal with. Lets form the eyecare consortium, and press home the skills and knowledge. Time to let bygones be bygones and focus on the prize.

 

[Andrew_Doan]

It's really not realistic that we "combine" the two fields. What's going to happen, IMO, is that optometry will make their own "surgical training track".

 

[drgregory]

i think the abolishment of any new OD degrees and in turn putting out more ophthalmology residencies is the answer. the difficulty lies in the still practicing ODs (like me). we would be dinosaurs until we died off and new MD eye care was the only option.

 

[PBEA]

It's really not realistic that we "combine" the two fields.

If you say so, it may seem impossible, but I doubt that it is. If you and I had all the power (like if we were on a newly discovered habitable planet ) to create an efficient system for producing eyedocs/surgeons, then imo a combined approach would be inevitable. Making them seperate tracts would make no sense. The sloppy historic development of these fields is to blame for the current state of affairs, and it is a shame that it seems unsolvable.

What's going to happen, IMO, is that optometry will make their own "surgical training track".

I hope OD's dont create a second type of eye surgeon, this seems pointless. Although, if the goal is to create a totally new educational tract for all eye surgeons, then that's basically what I've been pining for lo' these many years. But if it is merely a second route, then I disagree with it. There is just no need for a second eye surgeon.

 

[PBEA]

i think the abolishment of any new OD degrees and in turn putting out more ophthalmology residencies is the answer. the difficulty lies in the still practicing ODs (like me). we would be dinosaurs until we died off and new MD eye care was the only option.

I'm not so sure about this. Why couldnt ophthalmic training start with 4 years of basic science/medicine, with additional residencies for those that qualify? To me this makes much more sense. Adding more OMD residency will probably result in lesser quality training and lead to even greater access problems. No, that will just not work. Totally abolishing either one is not the answer. The only way (as I see it) is to form a different approach, a combined effort.

 

[SamuelAdams]

Why couldnt ophthalmic training start with 4 years of basic science/medicine, with additional residencies for those that qualify?

This sounds like a great idea, but I think it's already been done: it's called medical school and then ophthalmology residency.

 

[smiegal]

No, this is incorrect. I am not advocating for a "short cut"!! I don't propose a second type of eye surgeon. Ophthalmology already produces enough (too many IMO) as you have stated. I try and describe an alternative method for delivering ALL eye doctors/surgeons.

Yes, you are advocating a short cut in the sense that your proposal adds up to 6-7 total years of training for eye surgeons. Currently, Ophthalmology is an 8-10 year training program (4 years med school + 1 year internship + 3 years residency + ?1-2 years fellowship). If there are plenty of excellent candidates to enter this pathway, why would you establish a shorter route? Eye surgery is more involved than you think, based on your posts.

 

[Taurus]

Is there a popular site that lists optho jobs?

 

[NR117]

Is there a popular site that lists optho jobs?

Try the Academy of Ophthalmology website (Professional Choices) :

https://secure3.aao.org/professionalchoices/index.cfm

 

[jjmcentee@hotma]

All of these theories are brilliant. But keep in mind the dynamic that truly puzzles the architects of health care training and government involvment.

Its that in Opthalmology, as well as many other well paid specialties, there is an overall surpluss but a shortage in rural and less than disirable locations.

There is a log jam in beverly hills, the hamptons, and the varying degrees of these loci, but not so in rural detroit, or hicksville alabama.

So the schools can justify pumping out more students, or opening up charter schools, but the problem is hard to solve.

This dynamic of distribution is most likely the way Optometry will eventaully expand their role in healthcare, by getting privledges in rural areas where there is a shortage or complete lack of Ophthalmology.

No judgment here, just an observation of one aspect of the "market"