Med student curious about career in ophtho

Messages:
2
Joined:
23 Jul 2018

From SDN:
Hello all,
I'm in the summer between MS 1 & 2 and have had the chance to re-explore the specialties I could see myself in a little more. I've been interested both in ophtho and neurosurg for quite a while now based on a lot of shadowing, and both are very intriguing.
I love the OR, and I like being busy and productive, and thus I've been leaning toward neurosurgery just based on that and on my experiences with my (very benign) home program. At the same time, I wouldn't mind a more relaxed schedule and happier patients with better prognoses. The main reason I am concerned with ophtho is that every attending I have talked to only operates a half day to a day per week. Personally, I can't imagine being in the OR so little, and while people have told me you can do more surgery, I've never seen anyone do it in practice. I'd probably rather have more surgery than clinic if it were possible. But I can't see how one could provide enough patient volume to even get more than maybe a day and a half of surgery a week since the procedures are so short, at least based on what I've seen with the doctors I've worked with.
What do you all think? What's realistically feasible? Does this change by subspecialty? I'm interested in a non-academic career not particularly close to any major city, if that makes a difference.
Thank you all in advance! Sorry for the long post.
#1 23 Jul 2018 at 04:21 AM
Wizard of OQ
Creator of Worlds
Messages:
29
Joined:
09 Aug 2011

Welcome to the forum!

Ophthalmology and Neurosurgery are very different fields imho.  In Neurosurgery, you are dealing with often life-threatening issues.  While in Ophthalmology, it is generally about improving a person's quality of life.  Because of the differences in responsibility, there is a huge difference in stress levels between the two fields.  Some people feed off of this stress/adrenaline especially when it is brand-new to them (e.g. during medical school).  But what you really need to ask yourself is this:  "what type of daily/weekly life will make me truly happy in the long-run?" For some individuals, they cannot imagine doing anything besides neurosurgery or cardiothoracic surgery.  For me personally, I couldn't imagine doing 6 hour long cases and then rounding on patients in the hospital afterwards.  I would much rather operate or see patients in clinic for 35-40 hours a week and then spend my ample free time with my family or pursuing my other passions in life.  Trust me:  all jobs will become routine after awhile.  You want to make sure that the worst part of your job is bearable.

There are many Ophthalmologists out there that operate several days a week, but this is probably not the "average" Ophthalmologist.  You have to remember that most mid-career Ophthalmologists can feasibly do 20-30 cases a day.  Thus, it is not efficient to spread those 20-30 cases over multiple OR days, since OR time is very expensive (especially if you own the OR!).  It is more cost-effective to stack all of your cases in one day if possible because you can perform those 20-30 cases much more efficiently.  Hint:  efficiency == more $$ that you take home (instead of spending those $$ in staff wages).  Since an average Neurosurgery case can last several hours, you can only do a few cases a day at most.  That is the reason they may be in the OR several days a week.  I don't think Neurosurgeons are doing 30 craniotomies or whatever per day!

If you are worried about $, please don't be.  Those Medscape surveys are very skewed to people who actually fill them out.  Most of my colleagues in private practice make in the high 6-digit area while a significant number of them make 7-digits.  We even have friends in the ~3MM/year stratosphere working 4 days/week, but they are in a very fortuitous situation.  After a certain point, saving another million dollars is not going to bring you significantly more happiness.  But having quality time to spend with your friends & family will make a huge difference with your happiness as you get older.

I think the biggest service you could do for yourself is to spend some time shadowing several private practice physicians in both Ophthalmology and Neurosurgery, and really see who is happier.  Don't forget to ask about their work-life balance.  Best of luck!
#2 24 Jul 2018 at 12:29 AM
Messages:
2
Joined:
23 Jul 2018

Wizard of OQ
Welcome to the forum!

Ophthalmology and Neurosurgery are very different fields imho.  In Neurosurgery, you are dealing with often life-threatening issues.  While in Ophthalmology, it is generally about improving a person's quality of life.  Because of the differences in responsibility, there is a huge difference in stress levels between the two fields.  Some people feed off of this stress/adrenaline especially when it is brand-new to them (e.g. during medical school).  But what you really need to ask yourself is this:  "what type of daily/weekly life will make me truly happy in the long-run?" For some individuals, they cannot imagine doing anything besides neurosurgery or cardiothoracic surgery.  For me personally, I couldn't imagine doing 6 hour long cases and then rounding on patients in the hospital afterwards.  I would much rather operate or see patients in clinic for 35-40 hours a week and then spend my ample free time with my family or pursuing my other passions in life.  Trust me:  all jobs will become routine after awhile.  You want to make sure that the worst part of your job is bearable.

There are many Ophthalmologists out there that operate several days a week, but this is probably not the "average" Ophthalmologist.  You have to remember that most mid-career Ophthalmologists can feasibly do 20-30 cases a day.  Thus, it is not efficient to spread those 20-30 cases over multiple OR days, since OR time is very expensive (especially if you own the OR!).  It is more cost-effective to stack all of your cases in one day if possible because you can perform those 20-30 cases much more efficiently.  Hint:  efficiency == more $$ that you take home (instead of spending those $$ in staff wages).  Since an average Neurosurgery case can last several hours, you can only do a few cases a day at most.  That is the reason they may be in the OR several days a week.  I don't think Neurosurgeons are doing 30 craniotomies or whatever per day!

If you are worried about $, please don't be.  Those Medscape surveys are very skewed to people who actually fill them out.  Most of my colleagues in private practice make in the high 6-digit area while a significant number of them make 7-digits.  We even have friends in the ~3MM/year stratosphere working 4 days/week, but they are in a very fortuitous situation.  After a certain point, saving another million dollars is not going to bring you significantly more happiness.  But having quality time to spend with your friends & family will make a huge difference with your happiness as you get older.

I think the biggest service you could do for yourself is to spend some time shadowing several private practice physicians in both Ophthalmology and Neurosurgery, and really see who is happier.  Don't forget to ask about their work-life balance.  Best of luck!
Thank you very much for this detailed and honest reply!  I think the stress / responsibility question has been heavy on my mind of late.  I love the long OR procedures and the amount of work, but I've started to realize going so long without sleep and pushing myself as much as possible is just more draining than I want with the rest of my life.  Especially since I'm married and want kids.  The money issue worries me only in so much as it affects other ambitions - my wife and I would love to own a small business someday, whether that's a small medical practice or something completely different, like a small winery or something else that relates to our interests.  That wouldn't be feasible with some of the very lowball salaries I've seen on surveys.  So it is good to know they tend to be on the lowest side of the scale.

Thank you again!
#3 31 Jul 2018 at 05:00 PM
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