Ophtho has lost its luster...

[scienceguy123]

The following is quoted from another forum with the intent of starting a discussion here.

 

"

Now, before you get offended and jump on me, hear me out. Ophtho is very competitive. But I think this is mainly due to people still holding on the old concept of Ophthalmology when they were compensated much better.

 

All the other competitive specialties (on the level of Ophtho -- Urology, Rads, Ortho, Neurosurg) have one thing in common. They all pay very well. Ophtho is not bad but it is more along the lines of IM pay not nearly as good as the others. If you want to practice in a city, you will be hard pressed to make over 200k and will likely be around 150-170k unless you work your ass off. Sure, if you move out to farm country, you could make into the 200s but who wants to do that?

 

Also, job security is in question. Optometrists are making more headway into procedures and can seriously affect Ophtho pay in this time when the nation is trying to cut costs in the medical field.

 

I'm not saying Ophtho is bad but I'm saying it is very overrated as can be seen by the match statistics. I have no dog in the fight but it is silly when very competitive candidates go into the field looking for money/lifestyle and end up disappointed. I'm ready for the onslaught, thoughts?

 

I like most of the Ophtho residents I've met. I am not badmouthing the specialty, it seems very interesting. I am just saying that most competitive specialties are that way because of the money and Ophtho breaks that trend. Personally, I think its because of people still have a view of Ophtho as the booming field it was earlier on with much better compensation. I have no doubt many residents enjoy what they do now but it would be naive to say that many med students apply because they truly enjoy the field. Many of them don't even know what they are getting into b/c their exposure to Ophtho is limited in med school. I think many apply thinking it is a lifestyle specialty that pays very well. And they are misguided to think that because, while the lifestyle is typically decent, it does not pay nearly as well as the other competitive specialties. If students knew that they could very well be looking at a salary of 150k, I think applications would go down. "

 

Last edited by dirtyfalcon99; 07-03-2009 at 02:49 PM.

[sarakj]

I think if you are an ophtho you make in the same line as Radiology even a bit higher at least in Ontario.. I do not really know where u get your data from ! i think the battle of salary is something that never stops in any specialty. So this is not a new concept what so ever. Also I think the people who make residency decision based on Salary are in big big trouble since money is not equal to happiness . It is a tool to make your life easier and more enjoyable only if you are happy in other aspect of your life including what you do on a daily basis. And in Canada, the more you get paid the more tax you have to pay.. so at the end, most of the physicians have a comfortable life. And, as far as CaRMS goes, i believe some specially are more competitive than others b/c of the limited spots available and not higher number of applicants. This is true about Derm and might be true for ophtho as well.

Sara Kj

[bnface]

you're quote is obviously from an american source.....things are quite a bit different south of the border.

[Satsuma]

I would reconsider your source.

Neurosurgery is not competitive in Canada. And it doesn`t pay all that well considering the years of training and insane hours worked.

 

If you like ophtho, you will not starve. And lifestyle is worth alot as well. Ophthomologists get to go procedures AND sleep at night. This is an uncommon combination.

Not sure about how someone moving to farm country would do better than someone in an urban centre....haven`t seen many ORs on the way to the barn.

[sarakj]

love this ....haven`t seen many ORs on the way to the barn...made my day Satsuma!

sarakj

[scienceguy123]

I'd argue that getting a job at a major tertiary care centre of one's choice of city is not at all easy to come by in ophtho...with multiple institutions focussing solely on pumping through cataracts, there is a risk of saturated markets in urban environments. Sure the population is aging, but if cataract surgery wait times are as short as tehy are now (2 weeks in some major cities), the demand for eye specialists may become low compared to other surgical specialties, and the entire wave of baby boomers could have their cataracts treated over a relatively short time span.

 

The OP's comment about working in rural areas is probably reflecting this potential lack of work for ophthalmologists in major cities. Setting up a practise is obviously more costly these days than in the past with modern technologies, yet the fees are declining. There has been talk about further reductions in the fees for a cataract procedure which have undergone marginal cutbacks over the last 10-20 years.

 

Ophthalmic practice of course would remain enjoyable and great for those who want to maintain a lifestyle, but the issue is that future earnings in major cities may fall to much lower than what the current national/provincial averages indicate, and thus the issue of medical students being misinformed. Saturation has already become a problem in many major cities like New York, where some doctors are being offered starting salaries of $90,000 for general ophths- not so great for a specialty requiring 5 years of residency training.

[crockett]

Ophtho is not bad but it is more along the lines of IM pay not nearly as good as the others. If you want to practice in a city, you will be hard pressed to make over 200k and will likely be around 150-170k unless you work your ass off. Sure, if you move out to farm country, you could make into the 200s but who wants to do that?

 

. If students knew that they could very well be looking at a salary of 150k, I think applications would go down. "

 

 

Latest Canadian Physican Data has optho's billing an average of $544 675 across the country, and almost $800 000 in Sask. and Alta. With the exception of NS, they outbill urologists (in the majority of provinces by a couple hundred thousand dollars) and all the rest of the surgical specialties...so I'm not quite sure where you're getting your information!

[mhccdc]

The quote must be from the US. There ophthos make much less. And oddly enough it is not nearly as competitive as in Canada. It is unlikely that the ophtho fee schedule will ever be cut in Canada as it was in the US, but my understanding is that it will not be going up either. Eventually compensation in ophtho will be 'fair' and at that point I predict competitiveness will begin to fall.

[bnface]

what this thread reiterates is the commonly passed on wisdom: do what you love. Don't chase money, because salaries are sinusoidal....some years will be your specialty's "golden days" (kinda like where family med is heading right now)....and a decade or two later, salaries will fall relative to other specialties. if you only entered a specialty for the pay-cheque, you will be quite miserable for at least half your working career (until payments pick up again lol).

[UnderDog]

Latest Canadian Physican Data has optho's billing an average of $544 675 across the country, and almost $800 000 in Sask. and Alta. With the exception of NS, they outbill urologists (in the majority of provinces by a couple hundred thousand dollars) and all the rest of the surgical specialties...so I'm not quite sure where you're getting your information!

 

Do you have the source for this? Seems like a huge differential in USA vs Canada billing. Any idea why?

[Satsuma]

Can`t say for sure.

But one reason why ophthos in Canada have inflated incomes is because procedures such as cataracts used to take many times longer than it does now....but the pay for the procedure was not proportionately reduced. So now they can pump through alot more procedures in a day.

 

Perhaps in the US they changed the renumeration when the length of the procedure changed?? Just one possible explanation I can think of.

[physiology]

The problem with ophtho is that OR time is scarce.

 

No OR time = no cataract surgeries, which is the main way they make big $$$.

 

In some centres, the OR time is already taken up, leaving new grads with nothing. They are forced to do medical ophthalmology, operate once every two weeks, or go to smaller centres.

 

Also, cataract surgeries are elective procedures. Good luck in bargaining with the government for more elective OR time.

 

Opthos in BC bill a million a year - but 1/3 to taxes, 1/3 overhead, 1/3 take-home pay. $333, 333 isn't bad though.

[crockett]

Do you have the source for this? Seems like a huge differential in USA vs Canada billing. Any idea why?

 

PM me with your e-mail if you're interested- someone just sent me the file so I can forward it to you if you'd like!

[kate]

Can`t say for sure.

But one reason why ophthos in Canada have inflated incomes is because procedures such as cataracts used to take many times longer than it does now....but the pay for the procedure was not proportionately reduced. So now they can pump through alot more procedures in a day.

 

Perhaps in the US they changed the renumeration when the length of the procedure changed?? Just one possible explanation I can think of.

 

The scope of practice of ophthalmologists in the States is very different than the scope of practice of ophthalmologists in Canada. The reason? Supply and demand. There is a relative shortage of ophthalmologists in Canada, and therefore Canadian ophthos do more procedures than the average American ophthalmologist and generally speaking restrict their practices to medical management of glaucoma and retina, as well as surgery. In the States, on the other hand, many ophthalmologists find themselves doing more in the way of annual eye checks, refraction etc., and less in the way of surgery.

 

In summary, the way ophthalmology is practised in the States is very different than the way it is practised in Canada, and observations relating to ophthalmology in the USA may not apply to Canadian ophthos and ophtho-hopefuls.

 

(I hope this makes sense... I was busy on-call last night and I'm feeling a bit slow this evening!)

[thebouque]

The scope of practice of ophthalmologists in the States is very different than the scope of practice of ophthalmologists in Canada. The reason? Supply and demand. There is a relative shortage of ophthalmologists in Canada, and therefore Canadian ophthos do more procedures than the average American ophthalmologist and generally speaking restrict their practices to medical management of glaucoma and retina, as well as surgery. In the States, on the other hand, many ophthalmologists find themselves doing more in the way of annual eye checks, refraction etc., and less in the way of surgery.

 

In summary, the way ophthalmology is practised in the States is very different than the way it is practised in Canada, and observations relating to ophthalmology in the USA may not apply to Canadian ophthos and ophtho-hopefuls.

 

(I hope this makes sense... I was busy on-call last night and I'm feeling a bit slow this evening!)

 

Would this mean that there are more optometrists in Canada ?

[sfinch]

Opthalmologists regularly make over 1 million dollars. This thread was started to discourage people from the field.

 

Retinal surgeons throughout Canada manage 1.2-1.3 million mininum easily - minus relatively minor expenses.

 

Anyone doing alot of cataracts should be hitting close to 1 million at least.

 

In some parts of the country (BC because of asians), oculoplastics can make you a fortune!!

 

Laser eye surgery. Easy money.

 

BC published a list of all doctors and how much money the made. 1 ophtho billed over 2 million, and most were in the million range. The ones that were low, probably make their money with cosmetic oculoplastics and laser eye surgery.

 

They are fat cats for sure. Hopefully I'll get in!

[sfinch]

Expenses are not a static 33%. Office space and secretaries are normally fixed cost for most doctors, and often shared. And EVERYONE PAYS TAXES, not just doctors.

 

Bill 1 million.

 

60 K rent and equipment

40 K secretary

5K billing clerk

50 K partime nurse

 

Still looking at 800K income on your income tax. And as you can probably write off your car, computer, etc...your income can be artificially lowered.

 

You live like a king.

[kate]

Expenses are not a static 33%. Office space and secretaries are normally fixed cost for most doctors, and often shared. And EVERYONE PAYS TAXES, not just doctors.

 

Bill 1 million.

 

60 K rent and equipment

40 K secretary

5K billing clerk

50 K partime nurse

 

Still looking at 800K income on your income tax. And as you can probably write off your car, computer, etc...your income can be artificially lowered.

 

You live like a king.

 

If you want to live like a king, I would suggest going into a field other than medicine. Ophthalmologists do well for themselves, but most of them work damn hard, too. If one were to go into *any* field of medicine with the expectation of living like a king, one would inevitably end up very disappointed, cuz it just isn't that easy.

[kate]

Would this mean that there are more optometrists in Canada ?

 

That's a good question. I'm not sure what the relative number of optometrists is in the States as compared to Canada. (Obviously the absolute number of optoms in the States will surpass the absolute number here!) I guess my point is that in the USA, many ophthalmologists supplement their "ophthalmological" practice with "optometric" stuff as well, just because there isn't enough "ophthalmological" work to keep them busy and solvent. That is not the case here. (I'm using quotation marks because there is obviously overlap in what ophthos and optoms do, but I think you know what I mean...)

[thebouque]

If you want to live like a king, I would suggest going into a field other than medicine.

 

I think medicine guarantees a higher income than any other job. It may be a long way to go, but you're sure you'll end up making money. Those who are saying: ''if you want to make money just go into business'', well business is a very risky field and you might make a lot or nothing. It is true however that one should not choose a specialty only because of the money.

 

Peace

[thebouque]

thank you kate!

[sarakj]

Since you guys have some accurate numbers for salaries.. any one have any idea how much radiologists make compare to ophthalmologist..

thanks a million

Sara kj

[sfinch]

If you want to live like a king, I would suggest going into a field other than medicine. Ophthalmologists do well for themselves, but most of them work damn hard, too. If one were to go into *any* field of medicine with the expectation of living like a king, one would inevitably end up very disappointed, cuz it just isn't that easy.

 

You make it seem like I don't know any opthalmologists in real life. They work hard...sure, but they live like kings. They make near professional athlete money, with good hours (8-6 regularly), with great vacation if in a large group. When there were caps on billing, in Ontario Opthalmogists after making 1/2 a million a year, often took 4-5 months OFF as vacation!

 

Don't be a fool. Radiologists and Opthalmogists have it good because of historical difficulties with some procedures. Cataracts make a crap load of money for relatively easy low risk work. Laser eye surgery - pure mint. Getting into a residency is the hard part. Living like a king/queen afterwards - no harder than any other job.

[sfinch]

Interventional radiologists can often hide their incomes better because they usually bill into groups. But they usually make well over a million, with no issues with follow-up required. Risk of being sued is not that high, looking at the CMPA rates they pay - and their vacation and lifestyle is top notch (here in UWO, they seem to get 10 weeks of vacation!!!). Life is good for them. Income is comparable to opthalmogists. If you are an opthalmolgitst and want to only do laser eye surgery - you can probably make close to 2 million a year with a pretty good schedule (fly from city to city), and even have the optometrists do the followup.

[Lactic Folly]

Not sure your info on IR is completely accurate - there is follow-up of patients, and they do get called into hospital in the middle of the night for procedures (with a smaller pool to share call).