Talk me off a cliff (figuratively)

[eyeguyhopeful]

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?

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[LightBox]

Low compensation for Ophtho?!? You are severely misinformed. Please stop reading MedScape salary survey results. Ophtho's make a ton and making 7 digits is not a rarity. And the lifestyle in Ophtho is truly invaluable. Trust me -- when you get older, you will value your free time just as much as you do your high compensation. And luckily for us in Ophtho, we have both! There is no way I could fathom dealing with patients in Family Medicine, etc.

 

[Eyeball Tickler]

Honestly if you're having doubts then there are plenty of candidates who would kill to be in your position who have spent years pursuing ophthalmology but haven't and maybe won't match in the future for whatever reasons. It's still pretty early on so your program would be able to find a replacement easily for your spot and it would go to someone who is passionately obsessed with the field. If you like IM, then go for it. Most IM programs let you stay on to complete all 3 years and they would be happy to have you especially during this time.

 

[MstaKing10]

Don’t do it. You just got through another exciting hurdle in your training and a bit worried about the next step. Totally natural. In a few years you will still appreciate what you learned intern year but loving the world of optho. We all enter ophtho not knowing a lot about the pathology or basics of exam and so on. We are used to being high achievers and this lack of knowledge and skill makes us uncomfortable. Stick with it, you won’t regret it. The learning curve is steep and the info comes hard and fast (yup, like drinking through a fire hose) but at the end there is nothing like it

 

[mjohnsonets]

Low compensation for Ophtho?!? You are severely misinformed. Please stop reading MedScape salary survey results. Ophtho's make a ton and making 7 digits is not a rarity. And the lifestyle in Ophtho is truly invaluable. Trust me -- when you get older, you will value your free time just as much as you do your high compensation. And luckily for us in Ophtho, we have both! There is no way I could fathom dealing with patients in Family Medicine, etc.

I second this on compensation. The $250-300K number you quoted is within the possible base salary range for those sub-specialties in private practice. With a production bonus and time in a busy practice you should be able to easily double this. In a hospital you would likely find this number well into the $300's and in some cases (not a major metro generally), there are hospitals offering into the $400's.

 

[docdoc2012]

I had the same feeling coming off of IM. Its completely natural. You basically spent all of medical school preparing for IM,and you have done enough of the routine stuff at this point that it makes you feel you know your stuff. At the end of our prelim year, my entire ophtho class was better at IM than IM residents.
Ophtho is definitely daunting initially. You are trying to obtain clinical skills and basically going to medschool again in terms of learning new info. The positioning during exams can feel awkward. It doesn't come naturally to anybody, and if you are someone who is used to things happening right the first time, you will need to readjust your perspective. But then one day, magically it all just clicks into place and you know what you are doing. I echo what everyone said above about compensation.
For those of us who enjoyed IM, there's always a little twinge leaving the hospital setting. But now it feels like the best decision ever. You are the master of your craft, no 'care teams', you provide an essential medical skill and get to keep the best parts of IM

 

[RetinaDude]

Yeah the money in ophthalmology is huge. The only cataract/retina folks I know, who are making less than $500k, have chosen to structure their practice in such a way that they are low volume cataract surgeons, winding down their career, or choosing to be part time. It is a very lucrative field with very reasonable hours.

As far as the exam stuff goes, you'll get it. I was the same way. It took me forever to learn to properly use a 20D. I felt like such a failure, and considered dropping out to do ER work.......I moonlighted a lot but THANK GOD I did not choose this route. Once it happens, and you get the hang of it, you can master it very quickly.

I also missed being a "real doctor" once I started doing ophth. But, you have to remember, ophth is a very special niche. You can always stop being an ophth, brush up on medicine, and get back to being a GP, but no other doc can quit their job, brush up on ophth, and then practice ophth. It's too complicated, and this provides very good job security

Also, as an ophthalmologist, if you have your own surgery center then you have no need for the hospital. You will find out eventually that hospitals are not your friend. They want your service, and that's it.

 

[RetinaDude]

lol I really love how know one really knows how to accurately look up salaries and ophtho salaries seem to be an enigma. The problem with ophthalmology is that there is so much variability.

Personally, I think it is an awesome field... but if you were to look into $$$. I actually just got off the phone with an ophthalmology recruiter.

STARTING salaries are what the OP mentioned in private practice, but after you buy in, it is not surprising to be making $600-1.5 million. This is 100% dependent on how much you hustle. But to say that money is declining, is absolutely false. If you ask anyone, salaries are actually increasing and there is a higher demand for ophthalmology.

Like I said, this is besides the fact that ophthalmology is awesome...

We get salary surveys in the mail all the time. Have received them for years but we've never once submitted any income information. As one of my partners says "no way in hell I'm filling that survey out. I don't want anyone knowing about this gold mine"

 

[dantt]

lol I really love how know one really knows how to accurately look up salaries and ophtho salaries seem to be an enigma. The problem with ophthalmology is that there is so much variability.

Personally, I think it is an awesome field... but if you were to look into $$$. I actually just got off the phone with an ophthalmology recruiter.

STARTING salaries are what the OP mentioned in private practice, but after you buy in, it is not surprising to be making $600-1.5 million. This is 100% dependent on how much you hustle. But to say that money is declining, is absolutely false. If you ask anyone, salaries are actually increasing and there is a higher demand for ophthalmology.

Like I said, this is besides the fact that ophthalmology is awesome...

One thing I've learned as a young doctor. Just because your boss or future colleague makes over 1 million a year doesn't mean you will. Ophthalmology is particularly unkind to it's young associates. There are many many potentially bad jobs or situations out there. Aside from a lot of PE jobs where you will forever be an employee (and definitely not making that $600-1.5 million), the private practice jobs are a mine field of revolving door practices that churn and burn associates, salary structures that make it impossible for you to achieve a significant bonus in addition to no moon lighting and large non competes, huge buy ins into high overhead practices where all the money going towards overhead is actually goes into the original owners pockets, etc. Let's not forget that medicare just cut cataracts 15%. Retina is on the chopping block. The state of medicine is very sad.

 

[RetinaDude]

One thing I've learned as a young doctor. Just because your boss or future colleague makes over 1 million a year doesn't mean you will. Ophthalmology is particularly unkind to it's young associates. There are many many potentially bad jobs or situations out there. Aside from a lot of PE jobs where you will forever be an employee (and definitely not making that $600-1.5 million), the private practice jobs are a mine field of revolving door practices that churn and burn associates, salary structures that make it impossible for you to achieve a significant bonus in addition to no moon lighting and large non competes, huge buy ins into high overhead practices where all the money going towards overhead is actually goes into the original owners pockets, etc. Let's not forget that medicare just cut cataracts 15%. Retina is on the chopping block. The state of medicine is very sad.

I recall hearing all the same doom and gloom before I became a partner. I was always thinking "the partners are making all this money and, as soon as I become a partner, it's all going to dry up". That was nearly twenty years ago and it still has not happened. Dont get me wrong, it could happen, but ve done very well in recent years.....actually making more now than I did ten years ago.

Also, when you do go look for a job, look at how the current associate physicians are treated. From day one, we all share call equally, all holidays are distributed equally, bad cases and no insurance pts are shared equally, and the new doc is involved in all discussions whether it's about buying new equipment or financial info related to the practice. No one has ever left our group (except for retirements), and everyone who joins has become partner. Once they become partner, there's none of this "I'll keep 51% and sell you 49%". You buy an equal share just like the others so we are all equal, whether you are the new partner or you are the original doc who started the practice. These are the type of good signs you look for to know you are joining a good long term deal.

Before joining my group, I looked at several opportunities and was scared away by what I thought could be trouble spots down the road. One example was a small group, with two older docs, where they wanted to divvy up the partner shares where they were still slightly higher percentage owners (as in my example above). They said it was to account for "goodwill". True or not, that did not sit well with me. If I worked very hard to build my practice then I wanna be able to share in the hardwork profit, and not still be giving up some to them forever. I made the right decision to not join them as they went thru at least 3-4 new docs (none of which became partner) before one finally stayed (and only because the most senior doc had to quit because of health reasons)

 

[VikingFavre]

These feelings are normal. Don’t do it; the first year of ophthalmology is the toughest adjustment but worth it 100 percent. If you are really thinking about this PM me and we will talk on the phone.

 

[suji0]

the further I get in ophthalmology residency, the luckier I feel to be in this field. the possibilities and flexibility in the styles of practice and surgeries in ophtho are amazing and despite the first year of ophtho residency being the hardest year academically/physically/etc ive experienced, it is all adding up to be quite well worth it. money later on might be an issue, it worries me a bit too - but you will still be able to live comfortably with a good lifestyle and have the time to dedicate yourself to other pursuits if need be (which isn't always an option in other fields that have similar pay scales, lifestyles, or cool surgeries). however i am still a resident and my perspective is still overall naive compared to some of the more experienced posters above.

 

[percyeye]

I actually talked to the recruiter about the PE take over and he said it benefits new graduates as well. The recruiter said "private equity practices reward hard work and efficiency" and he said it is likely that you can make $500-750k. Of course private equities will take 20-30% of your profit, however they exchange it for ease. You don't have to worry about keeping the lights on or hiring new techs etc. The way the recruiter made it seem was that PEs kind of suit the style of the millennial generation (aka more lifestyle friendly). The recruiter also repeatedly said the people who hate PEs are the ones who want total control over the practice, which makes sense.

Don't take the PE Bait. The recruiter is working on his commission. They don't care if you hate your job in 3-5 years.

 

[dantt]

I actually talked to the recruiter about the PE take over and he said it benefits new graduates as well. The recruiter said "private equity practices reward hard work and efficiency" and he said it is likely that you can make $500-750k. Of course private equities will take 20-30% of your profit, however they exchange it for ease. You don't have to worry about keeping the lights on or hiring new techs etc. The way the recruiter made it seem was that PEs kind of suit the style of the millennial generation (aka more lifestyle friendly). The recruiter also repeatedly said the people who hate PEs are the ones who want total control over the practice, which makes sense.

Let me ask you this. What was the salary structure? How do you anticipate making $500-750k after PE takes 20-30% profit?

 

[TheLesPaul]

haha I don't think I will. The recruiter wasn't really promoting PE. He was just explaining the pros and cons of each setting, and what I should be discussing in the future.

Rule #1 is to never trust what recruiters say. Everyone wants total control over their practice, they just don't realize it yet.


To the OP, I hated ophtho my 1st year as well and I wanted to go back to medicine. You should realize you went into the field to operate, not be a glorified optometrist, which is what most of first year is. Once your hands get wet you will like it a lot more.

 

[orbitsurgMD]

First year of ophthalmology residency is the least representative of the specialty and of your likely future experience of the specialty. It is fairly well understood to be discouraging if not unpleasant. The main reason is that while you have accrued a decent amount of clinical acumen and confidence in being an internal medicine house officer after AIs and an internship, very little in medical school or internship prepares you to function with similar confidence and skill in ophthalmology. Med school gives you relatively little knowledge base or clinical skill in ophtho and you have a steep learning curve on entry, all a perfect formula for anti-fun.

The good news is that things quickly get better.

 

[Fascia Lata]

PE is awful. Really sucks. Zero control over anything in your practice. You are just shuffled around.

Back to the OP’s question. Can you regret going into ophthalmology after you have gained some mastery? Yes you may. I wouldn’t go as far as admitting I regret becoming an ophthalmologist myself, but I immensely miss “real” medicine (my contender specialties were general surgery and cardiothoracic surgery). I always enjoyed reading ophthalmology more than anything else in medicine, and I always thought the physics, optics, and pathology were super cool. But in real life, while fighting blindness and “bringing someone back to the sighted world” is super cool and fulfilling, it doesn’t quite hit that “surgeon thrill” that I needed in my career. They always tell you, everything becomes routine or boring after having done it for a number of years. But I never got the thrill buzz I was hoping for doing anything in ophthalmology (first end to end cataract surgery, angle surgery, vitrectomy, etc).

I have a good lifestyle and I feel I am compensated fairly. I like my practice set up, and I believe I am really good at what I do. I also challenge myself (intellectually and technically) and do research and learn new procedures all the time. But I cannot help but sometimes (often enough that it is bothersome) feel the void. I know it is silly, but I always day dream about switching to general surgery, and then realize it is too late. I am not depressed or anything and life goes on. In fact, I do appreciate the progress I made in my career path so far, and I am quite happy my work is often recognized and commended by my peers. And I realize many general surgeons and cardiothoracic surgeons would kill for my work-life balance, but I just am slightly remorseful for missing the chance to be that surgeon I wanted to be. The inner satisfaction is not complete.

So if I were you, and miss the “big picture” and I am still a first year resident, I would definitely switch to medicine now. The longer you wait, the harder it will become. Yes, regret can be real, even when you are successful. However, if the issue is that you are frustrated you lack the exam skills but would love to do it if you master it, you need to know that we have all been there. The learning curves for basic ophthalmology exam and ophthalmic microsurgery are quite steep initially, and you will get past that stage just like everyone of us did. I am only recommending you switch if you feel that you would still miss medicine after you achieve mastery.

This was a “confession” on my part, I never told the closest people to me about my “fantasies”, but since this is anonymous, I wanted to tell you how it can feel after a few years.

 

[Brathmore]

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?

YES, I hear you! I am a relatively young general ophthalmologist; I probably should have left ophtho in residency. I'm not happy with how things have worked out. My already low compensation has been cut by 50% for an indefinite future, so $1.00 separates me from an annualized 5 figure income (it shouldn't be too hard to figure out what I'm making from this info!). The only way to make more money is to churn through patients faster and faster. Everybody thinks that every eye problem is an emergency that needs to be seen immediately. Want to see your Dermatologist? Wait 5 months. Want to see your ophthalmologist? Wait 5 minutes, then complain about the wait. 75% of my patients are either annual diabetic exams, "my eye is burning" exams, etc. Think that retina is the way to go? Talk about a factory. They think things are moving slow if they spend more than 5 minutes on a patient. The job market is saturated for general opthos, so nowdays more and more people are spending another year of their lives in fellowships where they have to spend an entire year learning a few extra things that most of them don't use much anyway (corneal transplants, trabs). The Board of Ophthalmology is the most anal organization that exists on earth - they will test you on things that you'll never seen, and won't test you on stuff that patients ask about. As you can see, I'm totally unhappy. Things would be different if I were paid fairly, but I'm not, and there's a glut of people who would be happy to replace me. Most likely you won't end up as unhappy as I currrently am, and most likely you'll find unhappy people in lots of professions. But don't let everybody tell you that things are simply roses and daisies out there. Not everybody is thrilled with ophtho.

 

[LightBox]

^^ What is your practice location? That probably has a huge bearing on why you are unhappy and making a pittance. You also are definitely not an equity owner.l from the sounds of it.

 

[RetinaDude]

Brathmore, sounds like you've chosen the wrong practice, and possibly the wrong place to practice. The general ophth I know do see a fair number of patients but they also do a lot of surgery. In return, they make a lot of money. Of course, I don't know what they all make but I'm close with a few and they easily bring home $400 - $500,000 with their days ending before 5:00 almost every day.

And yes patients do complain but you will get that in almost any specialty. But, vision scares people more than a skin rash, so they call wanting to be seen NOW! Luckily for us, there's a shortage of ophth (if you choose the right places) and our patient population (65 and older) is growing by leaps and bounds, so we have job security. When a patient complains about their wait, I just tell them "if you think it's bad now, wait another five years when there's fewer docs and double the patients, you'll be thankful for this current wait time". Yeah it pisses off some of them but I've gotten where I don't really care because I try to appreciate the larger portion of my patients who are thankful I'm available to help them

 

[hello lady!]

I actually talked to the recruiter about the PE take over and he said it benefits new graduates as well. The recruiter said "private equity practices reward hard work and efficiency" and he said it is likely that you can make $500-750k. Of course private equities will take 20-30% of your profit, however they exchange it for ease. You don't have to worry about keeping the lights on or hiring new techs etc. The way the recruiter made it seem was that PEs kind of suit the style of the millennial generation (aka more lifestyle friendly). The recruiter also repeatedly said the people who hate PEs are the ones who want total control over the practice, which makes sense.

This is the WORST advice I have seen on here.

First, recruiters are scum. Their interest is getting their commission check. They could CARE LESS about you. In fact, they have a financial interest in your failure at a practice. The more you fail = the more job placements that they get access to. The Eye Group, Sea Change - all as slimy and garbage as the advice they give.


Regards to private equity: I would GLADLY give away 20-30% of my collections and have no admin duties. Come in, see patients, go home. Take 70-80%? Sign me up!!

The issue is that you will never be giving 30% up. You'll be lucky to get 30% of the money you collect.

When one does a cataract surgery, the physician fee is about $550 but the total collections for the private equity will be around $3,000. You'll get credit for 70% of the $550 (= $385) which really equates to about 13% of what the group is seeing. In the office, you'll be excluded from optical earnings and the technical component of the testing that you order. So your glaucoma patient who is there for their comprehensive exam will get you credit for about $150 (70% = $105) while the practice gets about $500-$700 if they sell a pair of glasses (now you're getting 15-20%). Overall you'll probably collect ~$1.5 million and will get a salary of $400k in return. >$1 million dollars in overhead? You're getting ripped off!. Private equity benefits NO ONE except for the bankers with the money. The docs get screwed, the patients get screwed (because you will have a complex patient scheduled every 8.5 minutes).

Also, ask around to see what happened to some of our colleagues with the coronavirus situation. The CARES act came out and reimbursed physician practices (some well into six figures) free money to offset the losses imposed by the coronavirus situation. In addition, there was money given out in the form of SBA loans which are forgiven when the money is spent on salaries. The private equity groups took this money and still laid off their physicians (or reduced their salaries). There should have been language put into law to prevent this abuse but it wasn't done.

Long story short, there are NO benefits to private equity for the physician! Especially if you are young!

 

[hello lady!]

YES, I hear you! I am a relatively young general ophthalmologist; I probably should have left ophtho in residency. I'm not happy with how things have worked out. My already low compensation has been cut by 50% for an indefinite future, so $1.00 separates me from an annualized 5 figure income (it shouldn't be too hard to figure out what I'm making from this info!). The only way to make more money is to churn through patients faster and faster. Everybody thinks that every eye problem is an emergency that needs to be seen immediately. Want to see your Dermatologist? Wait 5 months. Want to see your ophthalmologist? Wait 5 minutes, then complain about the wait. 75% of my patients are either annual diabetic exams, "my eye is burning" exams, etc. Think that retina is the way to go? Talk about a factory. They think things are moving slow if they spend more than 5 minutes on a patient. The job market is saturated for general opthos, so nowdays more and more people are spending another year of their lives in fellowships where they have to spend an entire year learning a few extra things that most of them don't use much anyway (corneal transplants, trabs). The Board of Ophthalmology is the most anal organization that exists on earth - they will test you on things that you'll never seen, and won't test you on stuff that patients ask about. As you can see, I'm totally unhappy. Things would be different if I were paid fairly, but I'm not, and there's a glut of people who would be happy to replace me. Most likely you won't end up as unhappy as I currrently am, and most likely you'll find unhappy people in lots of professions. But don't let everybody tell you that things are simply roses and daisies out there. Not everybody is thrilled with ophtho.

Yikes. I'm sorry you're unhappy with your current situation.

We obviously don't know specifics to your situation (like are you geographically limited?) but you do have options to change things for the better. Don't be afraid to take 1 step back to get 2 steps forward in your career.

 

[hello lady!]

Thank you!

So my question is, since Private Equities seem to be the devil, WHY ARE WE ACCEPTING THEM?? If everyone hates them, shouldn't we just make a collective effort to shoo them away?

Private equity isn't actually new. There was a wave of this happening in the 90s and then they got out of it. This isn't the last time we will see them, either.

It's tough - the private equity firms are paying tons of money to be featured in our throwaway magazines (how many articles have you seen published in Ocular Surgery News? How many free dinners did you see advertised?) This normalizes the process to young ophthalmologists who otherwise don't know any better. The second factor I believe is that senior retiring docs are looking to get a quick, guaranteed cashout - which is a huge boost to their retirement portfolio. It screws their colleagues but some just don't care. I've seen some neighboring practices just spiral down after the owners cashed out to PE. The associates all left which led to massive recruitment of new ones followed by their unhappiness and departures. Wash and repeat.

 

[Slide]

YES, I hear you! I am a relatively young general ophthalmologist; I probably should have left ophtho in residency. I'm not happy with how things have worked out. My already low compensation has been cut by 50% for an indefinite future, so $1.00 separates me from an annualized 5 figure income (it shouldn't be too hard to figure out what I'm making from this info!). The only way to make more money is to churn through patients faster and faster. Everybody thinks that every eye problem is an emergency that needs to be seen immediately. Want to see your Dermatologist? Wait 5 months. Want to see your ophthalmologist? Wait 5 minutes, then complain about the wait. 75% of my patients are either annual diabetic exams, "my eye is burning" exams, etc. Think that retina is the way to go? Talk about a factory. They think things are moving slow if they spend more than 5 minutes on a patient. The job market is saturated for general opthos, so nowdays more and more people are spending another year of their lives in fellowships where they have to spend an entire year learning a few extra things that most of them don't use much anyway (corneal transplants, trabs). The Board of Ophthalmology is the most anal organization that exists on earth - they will test you on things that you'll never seen, and won't test you on stuff that patients ask about. As you can see, I'm totally unhappy. Things would be different if I were paid fairly, but I'm not, and there's a glut of people who would be happy to replace me. Most likely you won't end up as unhappy as I currrently am, and most likely you'll find unhappy people in lots of professions. But don't let everybody tell you that things are simply roses and daisies out there. Not everybody is thrilled with ophtho.

No offense dude, but if you’re at least 3 years out and still only making that much, you are partly responsible for your own blight. No one I know a few years is making that little, even in academics. If your practice is paying you that little, you need to leave.

 

[MstaKing10]

Private equity isn't actually new. There was a wave of this happening in the 90s and then they got out of it. This isn't the last time we will see them, either.

It's tough - the private equity firms are paying tons of money to be featured in our throwaway magazines (how many articles have you seen published in Ocular Surgery News? How many free dinners did you see advertised?) This normalizes the process to young ophthalmologists who otherwise don't know any better. The second factor I believe is that senior retiring docs are looking to get a quick, guaranteed cashout - which is a huge boost to their retirement portfolio. It screws their colleagues but some just don't care. I've seen some neighboring practices just spiral down after the owners cashed out to PE. The associates all left which led to massive recruitment of new ones followed by their unhappiness and departures. Wash and repeat.

The cycle of PE buyouts in the 90s was vastly different. They had much less capital and the buyout was highly leveraged with payouts coming in the form of equity, which at the time of failure was worth nothing. PE firms now are much better financed with high cash payouts up front. My area has seen a lot of PE activity and I have yet to see one spiral out of control as you mention despite the pandemic. That said they have been much more aggressive about making cuts and furloughing staff and docs. Clearly these deals benefit the older docs looking for their golden parachute, cash buyout. Young partner physicians still benefit to some degree as well. Associate employed docs that I know of get a pretty competetive starting salary but their top earnings will be capped earlier. They don’t need to worry about administrative issues or issues related to running a practice which for some is a plus. Not sure how different it is from a kaiser type job.

 

[RetinaDude]

PE can be a great deal for the senior physicians in a practice. Big cash payout, to pad the retirement, and an agreement to remain with the practice a few more years. Selling to PE pretty much guarantees the younger docs in the practice that they'll never be making the "big bucks" the senior partners made unless their shares are sold for a profit or they absolutely work their butts off to produce produce produce

I was at a meeting last year and interviewed a few ophthalmology residents. Everyone of them I talked to were steering clear of PE backed ophthalmology groups. They felt like they'd never be able to be a true partner and would never be able to make the great salaries while "working for the suits"

 

[docdoc2012]

YES, I hear you! I am a relatively young general ophthalmologist; I probably should have left ophtho in residency. I'm not happy with how things have worked out. My already low compensation has been cut by 50% for an indefinite future, so $1.00 separates me from an annualized 5 figure income (it shouldn't be too hard to figure out what I'm making from this info!). The only way to make more money is to churn through patients faster and faster. Everybody thinks that every eye problem is an emergency that needs to be seen immediately. Want to see your Dermatologist? Wait 5 months. Want to see your ophthalmologist? Wait 5 minutes, then complain about the wait. 75% of my patients are either annual diabetic exams, "my eye is burning" exams, etc. Think that retina is the way to go? Talk about a factory. They think things are moving slow if they spend more than 5 minutes on a patient. The job market is saturated for general opthos, so nowdays more and more people are spending another year of their lives in fellowships where they have to spend an entire year learning a few extra things that most of them don't use much anyway (corneal transplants, trabs). The Board of Ophthalmology is the most anal organization that exists on earth - they will test you on things that you'll never seen, and won't test you on stuff that patients ask about. As you can see, I'm totally unhappy. Things would be different if I were paid fairly, but I'm not, and there's a glut of people who would be happy to replace me. Most likely you won't end up as unhappy as I currrently am, and most likely you'll find unhappy people in lots of professions. But don't let everybody tell you that things are simply roses and daisies out there. Not everybody is thrilled with ophtho.

Just to clear things up, you are talking about the current situation with covid correct? Are you getting paid per the PPE loan standard (stipulating that all employees get paid 75% upto 100k)?

 

[Slide]

The cycle of PE buyouts in the 90s was vastly different. They had much less capital and the buyout was highly leveraged with payouts coming in the form of equity, which at the time of failure was worth nothing. PE firms now are much better financed with high cash payouts up front. My area has seen a lot of PE activity and I have yet to see one spiral out of control as you mention despite the pandemic. That said they have been much more aggressive about making cuts and furloughing staff and docs. Clearly these deals benefit the older docs looking for their golden parachute, cash buyout. Young partner physicians still benefit to some degree as well. Associate employed docs that I know of get a pretty competetive starting salary but their top earnings will be capped earlier. They don’t need to worry about administrative issues or issues related to running a practice which for some is a plus. Not sure how different it is from a kaiser type job.

They've learned from the mistakes that you've mentioned. The PEs in the 90s actually worked out for savvy docs because once the PE went bankrupt, the original owners could poach it off cheap like a short sell. Now, the contracts are written so these maneuvers aren't possible anymore.

The few colleagues I knew in a PE firm have all jumped ship, who are around my age (we're < 5 years in practice). All the throwaways and opinion articles have people praising the values of PE, but in reality it's like Wolf of Wall Street, where the hype is to build false value for people to also take the leap. The senior people who are advertising it need more young docs to join in order to pump up its value.

 

[dantt]

Just to clear things up, you are talking about the current situation with covid correct? Are you getting paid per the PPE loan standard (stipulating that all employees get paid 75% upto 100k)?

Wow. I didn't even make that connection but the number makes sense now.

At this point, practices pretty much need to be on a defined time line to restart normal salaries. The world has not ended. Pretty much everybody is back to work.

 

[Brathmore]

Wow. I didn't even make that connection but the number makes sense now.

At this point, practices pretty much need to be on a defined time line to restart normal salaries. The world has not ended. Pretty much everybody is back to work.

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?

 

[airplanes]

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?

Yes, it’s not all sunshine and rainbows in other specialties either.

Did you sign a non-compete or something? Why does your practice hold so much apparent leverage over you?

To residents and med students, young professional friends of mine in the NW, NE, Midwest and South in a variety of cities and locations are doing just fine. About a quarter have changed jobs within their first 3 years. The job market is not perfect but there good practices out there.

 

[Slide]

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?

You are absolutely right that in our field, the older physicians for some reason really want to stick it to the younger guys and see them only as a monetary cog. If your owners are saying they’ll increase it when they think about it, you need to start thinking about exit plans, now. Your practice has shown its true colors.

Hell, If I were you, I’d even consider going solo if possible. It’s tough but still very possible, and then you’ll be your own boss.

 

[OurDeadGrass]

It sounds like these 400-500k with reasonable workload gigs are moreso the exception than the rule? It seems like a lot people cannot hit these numbers. People in academics, people employed by hospitals or kaiser like spots, people in private practice with bad senior physicians, people at PE owned places etc.

Seems like hitting it off at a healthy private practice with non-predatory older docs (who also wouldn't sell to PE) or starting a solo practice (which also is no guarantee) are the only ways to hit that comp/lifestyle described above?

 

[docdoc2012]

Once again this is boiling down to the classic question in this forum : WHERE DO YOU PRACTICE?

People have said multiple times above that their friends basically outside of the major metro cities are doing great.

It's not that dire. It really isn't. We just need to stop accepting crap contracts from predatory older docs as a group, and insisting on living in the middle of LA or NYC. but the problem is that new grads in this situation always get lulled into thinking they are the exception to the rule -'oh they seem great, who knows what really happened with that ex associate', 'oh he just seems disgruntled' 'oh they said I would have 50 a day by year 1'.

No. Just no. Stop taking people at face value and your life will be so much easier.

Other specialties are in the same boat - anyone employed exclusively by hospitals is at their mercy and usually contracted out by large PE groups. We've seen what happened to so many with COVID. The grass is always greener. Atleast most of our crap is internal and not perpetuated by huge hospital systems.

So we all need to negotiate a contract hard, learn to read people, and if you are tied to an area with bad options, go solo.[/QUOTE]

 

[dantt]

It sounds like these 400-500k with reasonable workload gigs are moreso the exception than the rule? It seems like a lot people cannot hit these numbers. People in academics, people employed by hospitals or kaiser like spots, people in private practice with bad senior physicians, people at PE owned places etc.

Seems like hitting it off at a healthy private practice with non-predatory older docs (who also wouldn't sell to PE) or starting a solo practice (which also is no guarantee) are the only ways to hit that comp/lifestyle described above?

Kaiser docs get paid quite a bit...there are many academic positions that allow you to reach the compensation stated above.

 

[Brathmore]

Once again this is boiling down to the classic question in this forum : WHERE DO YOU PRACTICE?

People have said multiple times above that their friends basically outside of the major metro cities are doing great.

It's not that dire. It really isn't. We just need to stop accepting crap contracts from predatory older docs as a group, and insisting on living in the middle of LA or NYC. but the problem is that new grads in this situation always get lulled into thinking they are the exception to the rule -'oh they seem great, who knows what really happened with that ex associate', 'oh he just seems disgruntled' 'oh they said I would have 50 a day by year 1'.

No. Just no. Stop taking people at face value and your life will be so much easier.

Other specialties are in the same boat - anyone employed exclusively by hospitals is at their mercy and usually contracted out by large PE groups. We've seen what happened to so many with COVID. The grass is always greener. Atleast most of our crap is internal and not perpetuated by huge hospital systems.

So we all need to negotiate a contract hard, learn to read people, and if you are tied to an area with bad options, go solo.

[/QUOTE]
You are assuming that people honor their contracts. What do you do when they don't? If you sue, you're fired. You can take another job and then sue, but the cost of the suit will probably exceed what you stand to gain, and you might get blackballed by other ophthalmologists. Going solo sounds like a terrible option, which is probably why so few people choose to do it.

 

[docdoc2012]

You are assuming that people honor their contracts. What do you do when they don't? If you sue, you're fired. You can take another job and then sue, but the cost of the suit will probably exceed what you stand to gain, and you might get blackballed by other ophthalmologists. Going solo sounds like a terrible option, which is probably why so few people choose to do it.
[/QUOTE]


I think this is living in way too much fear. No practice wants a lawsuit. It's their reputation on the line as much as yours. A practice can get just as easily blackballed as an individual doctor. There are many practices out there with the churn and burn rep for example. They can never get good recruits, and if they do they can't keep them

The real question is - why would you want to stay with a practice where you are not even sure your contract will be honored? If this is CoVID related, many are unfortunately in the same boat as you and im sorry you are going through it.

I am going to echo the question of so many folks on here- what is keeping you at the practice? Are you geographically tied down?

 

[LightBox]

Going solo is always an option...and actually better than you think. The autonomy is worth its price in gold.

 

[airplanes]

Kaiser docs get paid quite a bit...there are many academic positions that allow you to reach the compensation stated above.

Agreed.

 

[beijing67]

I am going to echo the question of so many folks on here- what is keeping you at the practice? Are you geographically tied down?

Going solo is always an option...and actually better than you think. The autonomy is worth its price in gold.

If it is the case that they are tied down to a saturated city/region, how feasible would going solo still be?

 

[orbitsurgMD]

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?

You need to get a definite date on when your pay goes back up. And locate your ejector handle because you might need to bail.

 

[orbitsurgMD]

You are assuming that people honor their contracts. What do you do when they don't? If you sue, you're fired. You can take another job and then sue, but the cost of the suit will probably exceed what you stand to gain, and you might get blackballed by other ophthalmologists. Going solo sounds like a terrible option, which is probably why so few people choose to do it.
[/QUOTE]
Going solo is not a terrible option.

 

[chudat]

Hows the job market along the coasts and major metropolitans?

 

[docdoc2012]

Hows the job market along the coasts and major metropolitans?

Bad.
Too many people vying for a few jobs. There is always someone with family money cushioning that will accept the ****ty pay, thereby keeping the market pay down. High overheads lead to consolidation, megapractice formation and PE deals, so you work harder and take home less.
There are obviously exceptions to this, and some metros are worse than others, but overall you are taking a pay hit to live the city life.

 

[NDcienporciento100]

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?

Interesting I think in 90s optho was a cash cow, taking home 1 million a year. Wonder what happened.

 

[RetinaDude]

Interesting I think in 90s optho was a cash cow, taking home 1 million a year. Wonder what happened.

That is still very much possible

 

[LightBox]

Interesting I think in 90s optho was a cash cow, taking home 1 million a year. Wonder what happened.

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.

 

[TheLesPaul]

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.

OK boomer. This is such a BS take.


The fat cats of the 80s and 90s who billed Medicare outrageous amounts for phaco and put all our CPT codes on CMS' radar and on the chopping block have a lot to answer for.

 

[Kuratz]

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.

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.

 

[LightBox]

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