Retina docs earn more because their average OR procedure, usually a vit/endolaser/bubble or buckle pays better on most reimbursement scales, including Medicare, than other typical procedures. Office procedures typically bill better, and most exams are at least level 4 E/M. Retina docs have no business competition except one another. All that adds up. Cataract surgeons can earn well only if they have volume and are efficient, skilled surgeons with low complication rates. Working in a cooperative outpatient surgery center that provides two rooms on an operating day is part of the requirement. Plastics generally does not earn better than general. Plastics cases take longer to do well and, although they may qualify for multiple CPT codes for a given surgery, the discounts imposed on second and third codes applied do not compensate for the additional time that those procedures require. Operating in the office setting is a mixed blessing and much depends on how well you can get reimbursed for the materials costs. In many places it simply does not make good practice business sense to do this. And the poster above is correct, where oculoplastics is able to perform cash-paid elective cosmetic procedures, there is plenty of other well-funded competition: general plastics, ENT, OMFS, dermatologists and even family practitioners.
