Talk me off a cliff (figuratively)

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I understand what you are trying to say but this is not a very insightful opinion. The reality is the burden of student loans has tremendously worsened to the point where taking on more debt fresh out the gate when you already have nearly $500k, probably are in mid-30s or older, and possibly have a family to provide for isn't exactly being "afraid to take a risk". Especially when you consider the healthcare market is much more competitive now with these mega-hospital chains and large pseudo-academic conglomerates. It's taking a pragmatic approach to getting out of a hole that boomers frankly didn't have to deal with.

I cant imagine there are many subspecialists in other fields out there clearing 7 figures, even in private practice. I know in Rads/IR this isn't even MGMA 90th percentile despite being conventionally considered one of the more lucrative fields. I am glad PP ophthos are getting fair compensation, truly, and are reaping the rewards of their hard work. This is not a guarantee though (as evidenced by other cuts by CMS) and any field with routine opportunities to make a mil+ probably understand this gravy train won't last forever. In fact, an old med school buddy of mine took a PE ophtho job out the gate because he felt with the current healthcare climate, investing another significant sum of money to form a practice could bite him in the ass if some sweeping reform took place. It's far more nuanced than suggesting the younger generation is weak. A wise older doc would appreciate the amazing opportunities they've had to hang a shingle and make boatloads of money for decades working good hours. This is certainly not guaranteed for younger physicians and med students. A good chunk of success in life is predicated on luck.

I always find it interesting to see optho salaries conveniently left out of these yrly top 10 physician salary surveys, while radiology seems to always be top 10.

One of the my radiology attendings father in law is an optho....he makes more than my attending and his wife combined.

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Many newbies going into practice are weak....increasingly value lifestyle instead of initial hard work...and are afraid to take risks (e.g. taking a bank loan and starting their own practice). They want all of the rewards without any of the risks.

There is always opportunity out there for the enterprising young surgeon. I'm in no way saying that it is easy (hence, why many people just want to be employed). And I definitely understand that "luck" plays a significant role. But I am also sick of hearing new grads complain about not making mid-6 figures for their first job out of training. I've been hearing the "doom-and-gloom" of Medicine since I was in college. Yes, cataract surgery reimbursements have been cut... but in its place are the cash payments of FLACS and premium lenses. There will always be something that an entrepreneurial spirit will be able to accomplish.

You have to realize that there is no defined career path. A perfectly-sound plan is to first join a practice...save up as much money as possible while employed... and also build up one's surgical skills. Then after "x" number of years, consider hanging your own shingle. When you start off, you don't have to have a massive office building or 20 techs working for you. Many people I know have ~3 exam rooms and a few staff members -- that's it.

And always remember the saying, "The harder I work, the luckier I seem to get."

And actually, I'm Generation X :)

I think calling those who desire work/life balance as weak is a little harsh lol but otherwise I agree here. A lot of people look at those average salaries and think "all I need to do is make it through medical school and residency and I'll make it." Getting to attending-hood just gives you a ticket to do what you want with your medical career; but the high salaries will go to the grinders and savviest businesspersons. The nice thing is that in medicine you don't have to be a rock-star businessperson to do well. You just need to be average.
 
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7 figures is still achievable in ophthalmology but definitely harder to reach if you're geographically limited. I made a heat map out of my database really quick and there's an easy to see inverse relationship between average income and the density of ophthalmologists practicing in the area. You can be successful anywhere so I think this trend would be stronger the less experience you have in practice.

If you have a specific interest, send me a direct message and I'll share a link for with you.
 
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I always find it interesting to see optho salaries conveniently left out of these yrly top 10 physician salary surveys, while radiology seems to always be top 10.

One of the my radiology attendings father in law is an optho....he makes more than my attending and his wife combined.


As I've mentioned on another thread, we never fill out those salary surveys. There's no way in this world I want the public, or other docs, finding out how much we make. Let everyone keep thinking the salaries listed (both general ophth and retina) are the true average for PP.
 
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Yes, the salary was cut to qualify for the PPE. The practice owners haven't said a word about reinstating my original salary, which was low anyway. Defined timeline? When I asked about a timeline, the owners said they'd increase it when they decide to increase it. That shut me up. We are in a very sick profession, where people are ok with paying the new docs 2-3x less than the established docs, and are ok with retina docs getting 2-3X more than that. Are there any other specialties that screw their young doctors and generalists as much as ophtho?

Unlike many other specialties where owners make 20-30% more than employees, as you've noted, the ophthalmology owners make 2-3x as much as the newer doctors (often times much much more). Why do you think there are so many employed, anesthesiologists, emergency medicine docs, pathologists, radiologists, etc? It's hard to just go out and start your own radiology practice if you don't like the employed position. The barriers to entry are lower and the potential rewards are much greater for ophthalmology.
 
Hey everyone - I just want to thank you all for posting on this and helping me through a rough time. I am sincerely grateful.

I seriously love ophthalmology now! It’s so fun. I’m SO glad I didn’t switch lol 😂

Second year has been a lot of fun. No more primary call, all weekends off, and more OR time!!
 
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Unlike many other specialties where owners make 20-30% more than employees, as you've noted, the ophthalmology owners make 2-3x as much as the newer doctors (often times much much more). Why do you think there are so many employed, anesthesiologists, emergency medicine docs, pathologists, radiologists, etc? It's hard to just go out and start your own radiology practice if you don't like the employed position. The barriers to entry are lower and the potential rewards are much greater for ophthalmology.
There really is not that much employed radiologist although I will admit that is changing.
 
Unlike many other specialties where owners make 20-30% more than employees, as you've noted, the ophthalmology owners make 2-3x as much as the newer doctors (often times much much more). Why do you think there are so many employed, anesthesiologists, emergency medicine docs, pathologists, radiologists, etc? It's hard to just go out and start your own radiology practice if you don't like the employed position. The barriers to entry are lower and the potential rewards are much greater for ophthalmology.
In today’s world it’s really to start your own optho practice fresh out. It’s going to cost you 500k-1M in a bank loan before you see your first patient. Oh do you have student debt to pay while you growing your practice? What’s say you work really hard and do phenomenal. Your ceiling is 500 maybe 700k and your working you but off for that last number. Rads can get legit 750k with 9 weeks vacation granted you work when you are there. Why? Because you don’t own a surgical center which is the only way to make 7 figures in optho today. I agree you have a great job! You will fix an 80 year olds cataract and she will bring you cookies and think your a genius! You won’t tell her it’s one of the safest procedures in medicine with potential for going blind of approximately 1/3000 cases. But unless you get a great partnership opportunity that lets you buy in to a surgical center your not making that 7 figure check or even close to it for that matter.
 
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In today’s world it’s really to start your own optho practice fresh out. It’s going to cost you 500k-1M in a bank loan before you see your first patient. Oh do you have student debt to pay while you growing your practice? What’s say you work really hard and do phenomenal. Your ceiling is 500 maybe 700k and your working you but off for that last number. Rads can get legit 750k with 9 weeks vacation granted you work when you are there. Why? Because you don’t own a surgical center which is the only way to make 7 figures in optho today. I agree you have a great job! You will fix an 80 year olds cataract and she will bring you cookies and think your a genius! You won’t tell her it’s one of the safest procedures in medicine with potential for going blind of approximately 1/3000 cases. But unless you get a great partnership opportunity that lets you buy in to a surgical center your not making that 7 figure check or even close to it for that matter.

This post is full of misinformation. There is a thriving group of old and young solo ophthalmologists in a group called SoloEyeDocs. There are lots of resources there about how to start a large or small practice with whatever startup capital you need. I started with $100K and you can too. Surgical center shares are a minor part of income. Cosmetics/addons is where you get more. Don't listen to the above advice!!
 
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If you think you are going to miss medicine, do ophthalmology and follow it up with a uveitis fellowship. Uveitis docs are often medicine trained, so it’s a back door for either specialty. You will thank yourself later when you have a fun interesting clinic with minimal admin work.
 
In today’s world it’s really to start your own optho practice fresh out. It’s going to cost you 500k-1M in a bank loan before you see your first patient. Oh do you have student debt to pay while you growing your practice? What’s say you work really hard and do phenomenal. Your ceiling is 500 maybe 700k and your working you but off for that last number. Rads can get legit 750k with 9 weeks vacation granted you work when you are there. Why? Because you don’t own a surgical center which is the only way to make 7 figures in optho today. I agree you have a great job! You will fix an 80 year olds cataract and she will bring you cookies and think your a genius! You won’t tell her it’s one of the safest procedures in medicine with potential for going blind of approximately 1/3000 cases. But unless you get a great partnership opportunity that lets you buy in to a surgical center your not making that 7 figure check or even close to it for that matter.
Agree, that this is highly inaccurate on many accounts. You can't even spell Ophtho correctly.
 
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Can anyone please comment on the %collections model vs the RVU model in private equity/hospital set ups. Would you prefer one over the other and why?
 
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This may be a heresy in this forum but really looking for a friend.

I was really fortunate to match at a top ten ophtho program. Really wonderful atmosphere although slightly more tense than I expected. Way more tense than medicine department. Like most places now a days, we have an integrative program with 3-4 months of ophtho and rest of medicine.

For some reason, I’ve lately been feeling sad that I finished my last month of medicine. Sometimes during ophtho clinic, I’ll look at medicine notes and reminisce lol. Ophtho seems very daunting and for some reason it’s very unintuitive for me. I’m just having a hard time conceptualizing some of these things. I suck at everything lol. I also hate trying to do a detailed DFE on patients who can’t keep their eyes open. Nonetheless, it is very cool to see the retina and I do enjoy reading ophtho.

Not sure if I should wait it out and see if PGY2 year, when I’m actually in ophtho, might turn things around or switch to medicine. I’d even be okay with family medicine too. Another thing that’s been on my mind lately is the rather relatively low compensation for ophtho (or maybe I’ve been reading this forum too much). Seems like comp/cornea/glaucoma (basically anything but retina) make as much as IM (250-300k). Not that I went into ophtho or medicine for money but just another thing that’s plagued my mind.

Anyone else felt like this?
Being married to a surgeon and having a ton of friends in internal medicine and family medicine, trust me when I say this but when you get a bit older all you want is to get home at a reasonable time, spend time with family, and enjoy your weekends and vacation, which Ophtho will allow you to do. You will also end up making more than enough money, especially compared to internal medicine or family med.
In regards to your comment on missing medicine notes, it is similar to saying missing biology classes from undergrad, when we were learning it and getting into details of mrna, ribosome, dna etc, or learning about different bugs, it was pretty cool (at least for me) but I am pretty sure you are not missing them now, in fact maybe looking at them with relief that you won't have to learn them in that much into details again. My two cents.
 
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If you think you are going to miss medicine, do ophthalmology and follow it up with a uveitis fellowship. Uveitis docs are often medicine trained, so it’s a back door for either specialty. You will thank yourself later when you have a fun interesting clinic with minimal admin work.
He won’t wanna do uveitis. LOL, trust thé uveitis retina person.

He just didn’t like not being good at something as a someone used to being top at everything. That’s my take on what happened.
 
He won’t wanna do uveitis. LOL, trust thé uveitis retina person.

He just didn’t like not being good at something as a someone used to being top at everything. That’s my take on what happened.
I was just making an argument based on him “missing medicine.” I agree that uveitis is way more work than comp, but it also keeps you in the medicine world. I say this as someone who occasionally misses the information side of medicine without missing inpatient medicine at all.
 
Do you do much uveitis @StupidRoo ?
It’s fairly common in our population. It’s probably nothing compared to your population, but I have sarcoidosis patients and HLAB27 patients. I find it pretty interesting, but I imagine it’s much harder when you have all of the train wrecks.
 
I'd switch to IM. I matched into my #1 spot a top 5 place in Rads and left after 14 months to do IM. I've loved IM for the past 25 years and have branched out into so many things (currently a Regional Campus Dean, a Medical Device company medical director, and still do part-time practice). I've earned 99th% money for 2 decades because I love what I do, do it well, enjoy being "sherlock holmes" and the longitudinal relationships. In the end it doesn't matter if your a pediatrician (the doc in the clinic next to mine was #1 in her med school class and has a rocking private peds practice earning more than 75% of ophthalmologists), a FM, or IM, if you love it you will be WAY HAPPIER the rest of your life than staying in a perceived highly respected specialty/subspecialty. At the end of the day everyone in society respects ANY M.D. for their grind, dedication, and ability to improve quality of life for patients. Do what you love and what your personality leads you to.

I would have been an average to above-average radiologist who would've been less happy, that might happen to you in Ophtho?
 
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