seeing into the future

stanka said:

i was wondering how saturated the ophtho market is at the moment. i heard from a friend that in the northeast, ophthalmologists make ~150k (which is still pretty amazing for a 9 - 5) and this is likely to worsen in coming years. i am also concerned about the future of the field. if the market may already be "over-saturated", how will the growing number of optometrists and the possibility of their performing surgery affect us.
thanks!

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Are you a medical student? Why are you interested? Are you applying for ophthalmology residencies?

It's interesting how some people still seem worried about the job market for ophthalmology. With the aging baby-boomer population, ophthalmology is in a prime position for growth in the years to come. We tend to cater mainly to these aging folks, especially with refractive surgery on the decline. Just saw a recent article in one of the throwaways regarding this topic. Ophthalmology, as a whole, is looking at long-term shortages, more specifically in certain subspecialties, such as glaucoma, peds, and neuro.

Medicine, in general, may take a hit with regard to falling reimbursements, but even that will have its limits. Docs will continue to do okay. Honestly, if you're going into medicine just to make big bucks, you're better off looking at other fields.

Only if you are dead-set on practicing in a saturated east/west coast metro area will you have a hard time finding a job or at least one at the starting salary you want. Still can't quite understand why anyone would want to do that, but to each his/her own. Your dollar goes a heck of a lot farther elsewhere, and I don't mean rural middle-of-nowhere! I'm in a good-sized midwest metro area, married to a stay-at-home mom with 2 kids, and I got into a 3600 sqft, 4 br, 4.5 bath home on a golf course right out of fellowship. Same money might get you a 1000 sqft apartment in NYC, Boston, etc.

Oh, and BTW, my practice is looking to add another comprehensive doc right now. Anyone interested?

Visionary said:

It's interesting how some people still seem worried about the job market for ophthalmology. With the aging baby-boomer population, ophthalmology is in a prime position for growth in the years to come. We tend to cater mainly to these aging folks, especially with refractive surgery on the decline. Just saw a recent article in one of the throwaways regarding this topic. Ophthalmology, as a whole, is looking at long-term shortages, more specifically in certain subspecialties, such as glaucoma, peds, and neuro.

Medicine, in general, may take a hit with regard to falling reimbursements, but even that will have its limits. Docs will continue to do okay. Honestly, if you're going into medicine just to make big bucks, you're better off looking at other fields.

Only if you are dead-set on practicing in a saturated east/west coast metro area will you have a hard time finding a job or at least one at the starting salary you want. Still can't quite understand why anyone would want to do that, but to each his/her own. Your dollar goes a heck of a lot farther elsewhere, and I don't mean rural middle-of-nowhere! I'm in a good-sized midwest metro area, married to a stay-at-home mom with 2 kids, and I got into a 3600 sqft, 4 br, 4.5 bath home on a golf course right out of fellowship. Same money might get you a 1000 sqft apartment in NYC, Boston, etc.

Oh, and BTW, my practice is looking to add another comprehensive doc right now. Anyone interested?

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Agree with all of the above. The baby boomer wave is coming, there is no doubt about that. Most of them will need eyecare services. A report put out by the government looking at the future need for medical care in 2006 found that ophthalmology will see the biggest rise in demand among all surgical specialties and second overall to cardiology among all fields in medicine. So as far as future outlook is concerned, ophthalmology couldn't be in a better position. Compensation on the other hand is an entirely different thing. We are at the mercy of government and HMO bureaucrats.

Stanka

Well, being a legislatively active optometry student (I have helped during a couple of very successful scope of practice expansion campaigns for Optometry )I have a good background in this information so here goes:

Doctors of Optometry (O.D.'s), Optometrists:
---The primary eyecare doctors in the United States. Provide 75% of the primary eye health and vision care in the US (3 to 1 ratio of optometrists to ophthalmologists). In all states they can prescribe topical ophthalmic medications---in 47 states they can prescribe oral medications, and do peri-ocular injections in 12 states (although many states have legislation on its way to change this). Only 1 state currently allows surgical privileges---Oklahoma---and that is limited to PRK, YAGS, and glaucoma surgeries (all of these are anterior segment lasers with no scalpels used). West Virginia just passed a bill successfully that will allow lasers in the future --when 50% of the optometry schools teach it in their curriculums.)

--Generally speaking OD's can treat primary eye diseases (glaucoma, allergies, infections, ocular surface disease) but only do a handful of in-office, outpatient very minor surgical procedures.

Scope of practice: In general (states vary) limited to treating diseases and disorders of the visual system and its associated parts with topical medications, oral medications, and lenses--(contacts, spectacles, and visual aids). Practice under a designated optometric license which does not allow treatment of systemic disease (only ocular disease or the ocular manifestation of systemic disease).

Ophthalmologists--Doctors of Medicine/Osteopathic Medicine (M.D.'s/ few D.O.'s)
----can provide the FULL spectum of eye care--> medical, surgical, etc...They can be primary eyedoctors, surgical specialists, medical eye specialists, or whatever they choose. Ophthalmologists are Eye Surgeons. Many concentrate on ophthalmic surgery and are subspecialized in that regard. It is a field that gives you better and more consistent insurance reimbursement (although the new Obama bill will prevent provider discrimination on a national level). Ophthalmology gives you a better average salary ($250-$300K versus about $145K for optometrists) and more income potential.

Scope of Practice : Unlimited Medical License, can prescribe basically any drug (oral, topical, or parenteral), operate (but most do so within their scope of fellowhip training), and have the freedom to do any aspect of eyecare they choose. Ophthalmologists can treat any aspect of eye disease systemic or otherwise and are not limited by state laws like optometrists are.

Both are good fields.. Ophthalmology gives you more flexibility than optometry (although I love optometry) so if you can manage to battle your way to Ophthalmology then I would recommend it highly because you can do anything you want regarding eye care. . If you are happy being a primary eye doctor with no "real" surgical priveleges and a limited scope of practice allowing for you to perform primary medical eye and vision care only, then optometry is a good choice.

I hope that helps and good luck..

Well, being a legislatively active optometry student I have a good background in this information so here goes:

Doctors of Optometry (O.D.'s), Optometrists:
---The primary eyecare doctors in the United States. Provide 75% of the primary eye health and vision care in the US. In all states they can prescribe topical ophthalmic medications---in 47 states they can prescribe oral medications, and do peri-ocular injections in 12 states (although many states have legislation on its way to change this). Only 1 state currently allows surgical privileges---Oklahoma---and that is limited to PRK, YAGS, and glaucoma surgeries (all of these are anterior segment lasers with no scalpels used). West Virginia just passed a bill successfully that will allow lasers in the future --when 50% of the optometry schools teach it in their curriculums.)

--Generally speaking OD's can treat primary eye diseases (glaucoma, allergies, infections, ocular surface disease) but only do a handful of in-office, outpatient very minor surgical procedures.

Scope of practice: In general (states vary) limited to treating diseases and disorders of the visual system and its associated parts with topical medications, oral medications, and lenses--(contacts, spectacles, and visual aids). Practice under a designated optometric license which does not allow treatment of systemic disease (only ocular disease or the ocular manifestation of systemic disease).

Ophthalmologists (M.D.'s, few D.O.'s)
----can provide the FULL spectum of eye care--> medical, surgical, etc...Many concentrate on ophthalmic surgery and are subspecialized in that regard. It is a field that gives you better and more consistent insurance reimbursement (although the new Obama bill will prevent provider discrimination on a national level). Ophthalmology gives you a better average salary ($250-275K versus about $145K for optometrists) and more income potential.

Scope of Practice : Unlimited Medical License, can prescribe basically any drug (oral, topical, or parenteral), operate (but most do so within their scope of fellowhip training), and have the freedom to do any aspect of eyecare they choose.

Both are good fields..

I hope that helps

Visionary said:

It's interesting how some people still seem worried about the job market for ophthalmology. With the aging baby-boomer population, ophthalmology is in a prime position for growth in the years to come.

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While that theory sounds great, the reality is that right now, the ophtho job market is abysmal. It was already saturated before the lasik market got cut down to a fraction of what it was. Now it's doubly saturated in both large and medium sized cities.

The fact that many ophthalmologists can't find decent jobs should be a concern to anyone considering the field. I love ophthalmology and am I'm doing fine financially, but if I knew then what I know now I'd probably have gone with another specialty that's actually in demand.

Mirror Form said:

While that theory sounds great, the reality is that right now, the ophtho job market is abysmal. It was already saturated before the lasik market got cut down to a fraction of what it was. Now it's doubly saturated in both large and medium sized cities.

The fact that many ophthalmologists can't find decent jobs should be a concern to anyone considering the field. I love ophthalmology and am I'm doing fine financially, but if I knew then what I know now I'd probably have gone with another specialty that's actually in demand.

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"Abysmal" is an exaggeration. There ARE jobs out there. Unless, like I said, you "must" be in a big east/west coast city. My group, for instance, was looking for another comprehensive doc for several months before landing one. No one seemed interested in a medium-sized midwest town. Most everyone who was approached or inquired was either going to fellowship after graduation or was looking for an east/west coast job. It's all about your priorities.

stanka said:

And what of optometrists doing procedures, etc? how will that affect us?
also, what can opthalmologists do that optometrist cannot?

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Us? Are you currently an ophthalmologist in another country? How about taking your broken English into the office of other ophthalmologists and asking them your rhetorical questions

Meibomian SxN said:

Us? Are you currently an ophthalmologist in another country? How about taking your broken English into the office of other ophthalmologists and asking them your rhetorical questions

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how about you relax and stop being a prick?

Meibomian SxN said:

Us? Are you currently an ophthalmologist in another country? How about taking your broken English into the office of other ophthalmologists and asking them your rhetorical questions

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Real classy.

Visionary said:

"Abysmal" is an exaggeration. There ARE jobs out there. Unless, like I said, you "must" be in a big east/west coast city. My group, for instance, was looking for another comprehensive doc for several months before landing one. No one seemed interested in a medium-sized midwest town. Most everyone who was approached or inquired was either going to fellowship after graduation or was looking for an east/west coast job. It's all about your priorities.

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Actually no, I'm in a medium sized middle-america city. It has a residency program here that pumps out a number of residents every year, many of whom want to stay in this area.

At least in the "big east/west coast" cities there are jobs out there. They're not great jobs, but they're there. In a lot of medium sized cities, there just aren't any jobs out there right now.

Mirror Form said:

Actually no, I'm in a medium sized middle-america city. It has a residency program here that pumps out a number of residents every year, many of whom want to stay in this area.

At least in the "big east/west coast" cities there are jobs out there. They're not great jobs, but they're there. In a lot of medium sized cities, there just aren't any jobs out there right now.

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This is interesting because it seems counterintuitive... In 2009, there were nearly 24,000 ophthalmologists in the US (this # INCLUDES inactive/retired ophthos), and in 2008 there were nearly 35,000 optometrists. Easy to abstract the ratios with the national population...

I just don't understand how there could be a nationwide dearth of jobs for ophthalmologists?

OjoCinco said:

This is interesting because it seems counterintuitive... In 2009, there were nearly 24,000 ophthalmologists in the US (this # INCLUDES inactive/retired ophthos), and in 2008 there were nearly 35,000 optometrists. Easy to abstract the ratios with the national population...

I just don't understand how there could be a nationwide dearth of jobs for ophthalmologists?

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If you don't mind moving to where the jobs are, then you can get a good job in ophtho. The problems arise when you have reasons that prevent you from moving.

Mirror Form said:

If you don't mind moving to where the jobs are, then you can get a good job in ophtho. The problems arise when you have reasons that prevent you from moving.

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I thought you said the job market was "abysmal." Make up your mind. Earlier, I said something very similar to what you just did, and you called me out on it.

Visionary said:

I thought you said the job market was "abysmal." Make up your mind. Earlier, I said something very similar to what you just did, and you called me out on it.

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Well if there are no decent jobs in most large cities and many medium sized cities, then I would stand by my assertion that the job market is abysmal (at least in comparison to most other fields of medicine except maybe pathology). Anyone who is considering entering this field should be aware of that.

I'm currently an intern and starting my ophtho residency in a few months. I've spent a lot of time recently keeping up to date with the ever changing health care system we work under, legislation, etc. I've also been reading the post by a handful of members over the past few months. It seems that the tone of the ophtho forums has shifted a lot- there is a lot of "doom and gloom".

To say that the ophtho job market is "Abysmal" is an example of this. Do you actually know of any board certified eye surgeons that don't have jobs? I have a number of friends both in and recently out of residency and they do have jobs- maybe not their "dream" jobs in terms of salary of location- but still jobs- and all are happy they chose this field. Healthcare economics, especially for physicians, is certainly shifting rapidly at this present time. I'm pretty sure that ALL fields are feeling the effects of this. Even in radiology jobs are MUCH tighter than just a few years ago and the pay is falling. As physicians, we have perhaps the greatest job security of all fields.

I guess i'm writing to say that it's easy to get caught up on numbers- especially money. Does ophtho pay like it used to? No. But ask yourselves why you went into this field. Would you be happy doing ophtho if you made 50% less than what you feel you're entitled to? It's a tough question- and really there's no wrong answer. What worries me more in my future career are other factors such as autonomy/independence.

My thoughts on our current era of healthcare is that things are going to change rapidly, and this will require a cultural shift- both by patients and physicians.

digitalsideburn said:

I'm currently an intern and starting my ophtho residency in a few months. I've spent a lot of time recently keeping up to date with the ever changing health care system we work under, legislation, etc. I've also been reading the post by a handful of members over the past few months. It seems that the tone of the ophtho forums has shifted a lot- there is a lot of "doom and gloom".

To say that the ophtho job market is "Abysmal" is an example of this. Do you actually know of any board certified eye surgeons that don't have jobs? I have a number of friends both in and recently out of residency and they do have jobs- maybe not their "dream" jobs in terms of salary of location- but still jobs- and all are happy they chose this field. Healthcare economics, especially for physicians, is certainly shifting rapidly at this present time. I'm pretty sure that ALL fields are feeling the effects of this. Even in radiology jobs are MUCH tighter than just a few years ago and the pay is falling. As physicians, we have perhaps the greatest job security of all fields.

I guess i'm writing to say that it's easy to get caught up on numbers- especially money. Does ophtho pay like it used to? No. But ask yourselves why you went into this field. Would you be happy doing ophtho if you made 50% less than what you feel you're entitled to? It's a tough question- and really there's no wrong answer. What worries me more in my future career are other factors such as autonomy/independence.

My thoughts on our current era of healthcare is that things are going to change rapidly, and this will require a cultural shift- both by patients and physicians.

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Well-stated. The topic of autonomy is one that has not really been discussed. It seems to me, and perhaps others have more insight, that ophthalmology is somewhat insulated from the "employee" status that many other medical fields are slipping into. I don't know of many ophthalmologists who are working for hospitals, except those in the VA and Kaiser-type systems. Maybe the nature of ophthalmology (i.e., clinic-based with little hospital presence and significant ASC-based surgery) is what is keeping that from occurring. There has, however, been movement away from solo practice and toward formation of large single- and multi-specialty groups. This is likely to dilute overhead expenses and call responsibilities, but those are some of the same factors that are leading to hospital employment of physicians in other specialties. Thoughts?

digitalsideburn said:

To say that the ophtho job market is "Abysmal" is an example of this. Do you actually know of any board certified eye surgeons that don't have jobs? I have a number of friends both in and recently out of residency and they do have jobs- maybe not their "dream" jobs in terms of salary of location- but still jobs- and all are happy they chose this field. Healthcare economics, especially for physicians, is certainly shifting rapidly at this present time. I'm pretty sure that ALL fields are feeling the effects of this. Even in radiology jobs are MUCH tighter than just a few years ago and the pay is falling. As physicians, we have perhaps the greatest job security of all fields.

I guess i'm writing to say that it's easy to get caught up on numbers- especially money. Does ophtho pay like it used to? No. But ask yourselves why you went into this field. Would you be happy doing ophtho if you made 50% less than what you feel you're entitled to? It's a tough question- and really there's no wrong answer. What worries me more in my future career are other factors such as autonomy/independence.

My thoughts on our current era of healthcare is that things are going to change rapidly, and this will require a cultural shift- both by patients and physicians.

Click to expand...

Let me make an observation as a semi-interested observer:

I think far too many young people, whether they are graduating from college or a professional residency program like ophthalmology sort of have this sense of not really entitlement, but that once they are done with their intensive schooling, that they will be on easy street.

And on some level I can't quite blame them. Older people have always said "study hard, stay in school, go to college and you will get a good job."

In ophthalmology, that sense is magnified many fold I believe because to be an ophthalmologist, you usually have to excel in college, get into medical school and excel there, get into a residency and bust your ass there to get trained. As people pursue that goal, outsiders are always saying "wow! an eye surgeon! That's great! You'll make great money and everyone gets cataracts and/or needs glasses so you can pretty much work ANYWHERE YOU WANT and get paid big money! Yay!"

So people naturally have this sense of "ok, I lived up to my end of the bargain. I busted my butt for years. Now someone pay me."

Of course, it doesn't really work that way.

A "good" job or a high paying salary is something that you either create for yourself by starting/buying a practice or you work for someone else but you can't approach working for someone else with the idea of "someone pay me." You have to approach it with the idea of "ok, what can I do to make money for this person/practice/company."

I think that med students in general, are very bad at having that perspective because first of all, thinking about money is sort of taboo in medicine...it's supposed to be "all about the patient" and everyone just sort of gets it into their head that their medical skills should be enough and really it's not.

So try to think of it that way....what can I do to make this person money?

Medicine is now more about money than ever before- from the perspective of all involved. Do I need think that physicians deserve the money they currently make? heck yes. Even more? You bet they do. However, people outside of medicine overwhelmingly believe that physicians make too much money. They see the big houses, the fancy cars, receive huge bills from physicians, and listen to story after story of rich doctors working the system in their favor. And perhaps we're perpetuating this stereotype with all the focus on the message boards regarding salary, job market, etc.

It is quite difficult for people outside of medicine to understand the sacrifice involved in becoming a physician. It is even more difficult for them to understand what it is like to actually work as a physician. I'm a transitional intern and have rotated through almost all specialties at some point in my training- and I think i've gained a lot of perspective on things recently. I think what is most frustrating to physicians at this point is a lot more than money.

In what other vocations do people work as hard as we do? Most people can't even IMAGINE working a 30 hour shift without sleep- let alone making life altering decisions throughout them. When is the last time we got a scheduled break? The amount of responsibility, stress, emotional intensity and sacrifice is unparralled among vocations. I'm confident that if outsiders actually knew what we know, they'd feel differently about how we're compensated, treated and respected for our work.

For example- I remember one morning when I was on the 28th hour of my 30 hour trauma surgery shift when my patient came to the OR and the nurse anesthetist asked "does this patient need antibiotics". I said "i'm pretty sure they've already received some. Can you please check the chart?". Then silence. "Could you please check the chart to see if they've gotten any yet". "Hmm. i'm not sure where it is" the nurse said. Of course, I checked the chart for them and figured it out. Then 30 mins into the case a new nurse anesthetist comes in to give the last one their lunch break while I push on with no sleep, no breaks, and tremendous responsibility.

I think that sufficient monetary compensation is one way that physicians are rewarded for what they do- the sacrifice, responsibility, effort, etc. If you take that away and add even more bureaucracy (=paperwork), restrictions, oversight, etc. you are going to add to the growing cohorts of unhappy physicians. Perhaps that's a lot of what is underlying our ranks today. Yes, ophthalmology is insulated from much of this. But, as things change I think more and more will be absorbed into hospital systems and will be subject to more of these same forces.

digitalsideburn said:

I'm currently an intern and starting my ophtho residency in a few months. I've spent a lot of time recently keeping up to date with the ever changing health care system we work under, legislation, etc. I've also been reading the post by a handful of members over the past few months. It seems that the tone of the ophtho forums has shifted a lot- there is a lot of "doom and gloom".

To say that the ophtho job market is "Abysmal" is an example of this. Do you actually know of any board certified eye surgeons that don't have jobs? I have a number of friends both in and recently out of residency and they do have jobs- maybe not their "dream" jobs in terms of salary of location- but still jobs- and all are happy they chose this field. Healthcare economics, especially for physicians, is certainly shifting rapidly at this present time. I'm pretty sure that ALL fields are feeling the effects of this. Even in radiology jobs are MUCH tighter than just a few years ago and the pay is falling. As physicians, we have perhaps the greatest job security of all fields.

I guess i'm writing to say that it's easy to get caught up on numbers- especially money. Does ophtho pay like it used to? No. But ask yourselves why you went into this field. Would you be happy doing ophtho if you made 50% less than what you feel you're entitled to? It's a tough question- and really there's no wrong answer. What worries me more in my future career are other factors such as autonomy/independence.

My thoughts on our current era of healthcare is that things are going to change rapidly, and this will require a cultural shift- both by patients and physicians.

Click to expand...

Issues of autonomy certainly should give anyone in medicine pause. As the consensus in this country weighs more toward enlarging powers of third parties for payment and governance of the payment mechanisms, the autonomy of both the physician and the patient will be in greater jeopardy. That is going to be unavoidable as there is the growing contest between healthcare and other interests for use of the taxpayer dollar.

As for the jobs market, there has always been an up and down quality with the market. LASIK has "crashed" now twice, first before the beginning of this decade with the stock market crash at the end of the dot-com boom in March, 2000 and now again with this recession. With those crashes, there is collapse and consolidation of the refractive market and many doctors retreat to their general ophthalmology practices to retain income. And hiring suffers, unfortunately.

The broader trend should be more heartening. Doctors eventually must retire, the Baby Boomers will also and that convergence will restore opportunities that seem absent right now. The present market should be an object lesson, though, and a valuable one. You can't count on medical incomes to always remain stable. That should be a lesson in personal planning. Too many ophthalmologists thought the days of $2500 cataracts would never end, but they did. When you have adopted a lifestyle that makes those presumptions, reality can be very painful. Take note.