I am wondering what type of opportunities there are for ophtho residents to moonlight. I know that technically anyone can moonlight after they complete their intern year and step III, but do ophtho residents moonlight? As an ophtho resident would you feel comfortable in an ER, or urgent treatment center? It is not allowed at my institution, and I was wondering if that is the exception or the rule. The Chief resident here said that there is no time to moonlight due to the vast amount of reading required for the residency. I'm going for ophtho regardless of the moonlighting opportunities, but I just want some perspective. Thanks.
Moonlighting
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It's not allowed here either. The fellows can moonlight, and they find ophthalmology related work and some do physicals for the VA. I suppose you could do internal medicine if your background is strong enough, e.g. cover nursing homes and VAs.
I've realized that this field require vast amounts of reading, and there isn't much time for moonlighting on the side. Remember one thing, the ACGME has now made the 80-hour work week rule. This rule includes both residency and moonlighting. If you go over, then you could jeopardize your career and the program.
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When I read stats on average hours worked in a residency... does that just mean in the hospital or does it also include study time. It seems that optho is very cush, but if you have to spend all night studying all the time then what is the difference between it and a more intense residency?
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Average hours worked is in the hospital.
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how many hours a week do you spend studying? Unconscionable?
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I need to do more, but I try to do at least 1 hour each day. I should be doing (or at least aim to) at least 2 hours each day and 10 hours on the weekends. Having a family makes it difficult to hit the books hard.
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Some of the residents in the Detroit area moonlight as "optoms" after the first year. Those chain optom places like D.O.C. and Wal-Mart allow ophtho residents to refract and fit contacts. It is convenient because they are open on weekends when you aren't usually working anyways. You work in minus cylinder instead of plus cylinder at these places. In some of the stores the techs do the Ks and autorefraction so all you have to do is refine the refraction and pick the proper lens. I think they pay about 50 bucks/hour. Of course any moonlighting has to fit into the 80 hour workweek and be approved by the program director and DME.
I think it would be a brave ophtho resident to moonlight in an ER or urgent care.
I think it would be a brave ophtho resident to moonlight in an ER or urgent care.
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TomOD,
I don't moonlight, but I would feel comfortable prescribing glasses and fitting contact lenses after one year of ophthalmology training. After the first year, I've spent considerable time in contact lens clinic, cornea, pediatrics, glaucoma, neuro-ophthalmology, general ophthalmology, plastics, and retina. After the first year, we see and manage over 2500 patients, and taken over 45 days of call.
Additionally, if there was a difficult case, then I would just refer like all the optometrists do.
Just joking there TomOD... I'm yanking your chain.
Best regards,
Andrew
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The review on scutwork.com of the Texas Tech (Lubbock) program also says that one of the plusses about working there is that there are several OD's in the area who will let you moonlight in their offices.
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Originally posted by Ophtho_MudPhud
TomOD,
Additionally, if there was a difficult case, then I would just refer like all the optometrists do.
Just joking there TomOD... I'm yanking your chain.
Best regards,
Andrew
No problem
Unfortunately (or fortunately.......either way you look at it), what you say about commerical work is true. Many refractions, a line of "customers" waiting and little time to do anything more "substantial" than refering anything out of the ordinary..............to the Ophthalmologist. No OD will refer to another OD. That's almost unheard unless it is for speciality CL work or low vision.
Hey, I say we should get all the Ophthalmolgy residents we can into Walmart to force OD's to go out and get real jobs.
As an aside, I have a lady with neovascular glaucoma secondary to OIS, s/p PRP and CPC that I have been comanaging with a retinal MD and an glaucoma MD. She's started out at Duke but just didn't like their attitude! (her words, not mine). They have done their work and have washed their hands of her. She is LP only in the OD and I have her on 3 topical glaucoma meds and PF qid (dosing left over from the glaucoma specialist). I have been slowy tapering her and she is doing well. Glaucoma guy says she is fine.
The problem is, once the eye lost sight, my friendly Ophthalmologists "dumped" her back on me. I'm fine with that. I enjoy working with her. She calls about once per week in pain with 50 IOP's. This time, the pharmacy was out of her PF and she just decided to stop the drops all together (last week). She is too hard-headed to take her meds as directed.
Now I try not to make it a habit to work on Saturdays but this lady has been in pain for the last week and waits until Friday at 5:00 to call. I have to go in tomorrow and expect her pressure to be very high again.
She is already blind in that eye. She might be a good candidate for me to practice a little surgery on.......maybe an anterior chamber paracentesis?
..........Now I'm just jerking your chain Andrew (sort of
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She is already blind in that eye. She might be a good candidate for me to practice a little surgery on.......maybe an anterior chamber paracentesis?
That solution would only work for about a few hours considering the production of aqueous is about 2 microliters per minute.
She needs to be evaluated for CPC again. How much CPC was done before? If she only underwent one round, then I bet there is room to do more.
Alternatively, because she is NLP and suffering from high IOPs and pain, she should be referred to an ophthalmologist for possible retrobulbar EtOH injection.
If both of the above fails, then she should consider removing the eye.
That solution would only work for about a few hours considering the production of aqueous is about 2 microliters per minute.
She needs to be evaluated for CPC again. How much CPC was done before? If she only underwent one round, then I bet there is room to do more.
Alternatively, because she is NLP and suffering from high IOPs and pain, she should be referred to an ophthalmologist for possible retrobulbar EtOH injection.
If both of the above fails, then she should consider removing the eye.
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Oh no! Not the optoms performing Sx debate again! J/K
I don't moonlight since I am still a first year, and I haven't decided if I am going to or not. I would feel comfortable moonlighting after a quickie review of the different CL brands avail at the office/store in question. In my resident clinic we have a CL fitter who does most of our fittings, but we still have to know how to do it. If it was a really complicated fit as for keratoconus, I would refer to the OD in the area that the cornea guys use as that is her forte. A patient like that should be seen by cornea anyways...after which they can refer out.
After a 2 week orientation with the Kresge crew (of which about 2 hours was spent on refraction) I was just thrown into the trenches in my clinic and expected to know how to refract. I have had significant exposure to the subspecialties though most of my time has been in the comprehensive resident clinic. I have performed several laser procedures, and count 4 PKEs and 2 lid procedures where I am the primary surgeon though I have been performing selected parts of cases since my 2nd month into residency. I have been on call every other week for a week at a time during which I cover 5 hospitals, and whether I am on call or not I cover consults at 2 hospitals during normal business hours.
I have had to learn early and learn fast since my program is small, since my co-first year had a change of heart and left to pursue an ER residency, and since 3 of the residents had babies and either went on extended maternity leave or shorter paternity breaks. A day of refractions at lenscrafters would be a welcome break almost! My main issue is giving up my weekends after a year of having been overworked. Make that 2 years, I was trying to forget about that wretched internship year but just had a flashback! Haha.
I don't moonlight since I am still a first year, and I haven't decided if I am going to or not. I would feel comfortable moonlighting after a quickie review of the different CL brands avail at the office/store in question. In my resident clinic we have a CL fitter who does most of our fittings, but we still have to know how to do it. If it was a really complicated fit as for keratoconus, I would refer to the OD in the area that the cornea guys use as that is her forte. A patient like that should be seen by cornea anyways...after which they can refer out.
After a 2 week orientation with the Kresge crew (of which about 2 hours was spent on refraction) I was just thrown into the trenches in my clinic and expected to know how to refract. I have had significant exposure to the subspecialties though most of my time has been in the comprehensive resident clinic. I have performed several laser procedures, and count 4 PKEs and 2 lid procedures where I am the primary surgeon though I have been performing selected parts of cases since my 2nd month into residency. I have been on call every other week for a week at a time during which I cover 5 hospitals, and whether I am on call or not I cover consults at 2 hospitals during normal business hours.
I have had to learn early and learn fast since my program is small, since my co-first year had a change of heart and left to pursue an ER residency, and since 3 of the residents had babies and either went on extended maternity leave or shorter paternity breaks. A day of refractions at lenscrafters would be a welcome break almost! My main issue is giving up my weekends after a year of having been overworked. Make that 2 years, I was trying to forget about that wretched internship year but just had a flashback! Haha.
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Sounds like you have your hands full...
PGY-3 is just around the corner now! Hang in there.
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Turns out her IOP was 10 mmHg. She had a mod. corneal abrasion because she felt something was in her eye last night and her friend decided to try to dig it out with a q-tip
(mind you, both of these ladies are in the very presbyopic near 70 age!)Her main problem is that she appears to have a HZ flare-up (with classic vesicular rash along the forehead and down the nose- "Hutchinson's sign" and a mild ant. chamber rx). The question is, is the corneal involvement the result of the zoster virus or the abrasion (or perhaps both)?
I rx'ed Valtrex, gave her a bandage CL with Tobradex soln, arranged for her to see her internist on Monday (he was at the beach today).
See, yet another benefit for me, as an OD, to be able to prescribe oral meds. I didn't have to try to find the on-call Ophthalmologist or send her to the ER and waste everyone's time. Her PCP will take over the systemic care and I will see her back Monday. It's a win-win for everyone (provided I get paid by Medicare/Medicaid).
Poor lady.......but at least the virus had the decency to hit the blind eye. That was nice.
On a more serious note, I'm afraid this poor lady is going to loose her mind. I really need to get her to a counselor. And Andrew, I'm with you. If this lady's pressure goes back up dramatically, I will surely send her back to the glaucoma guy.
