Landing Your First Ophthalmology Job: Green Lights and Red Flags in Choosing a Practice

Finding your first job is daunting. The first step involves understanding your options—do you want to work in academics, private practice, a large medical group, or in a different setting?

After deciding on the general type of job you imagine for yourself, next up comes interviewing for the job. They will ask you all sorts of questions regarding your surgical experience, what you imagine your clinical day and surgical day to look like, and what types of surgeries or procedures you enjoy.

Throughout it all, there will be positives and negatives, which you will discover through the different interactions with the practice. This could be during the interview phone call, the actual in-person interview, or it could be things you find out from colleagues or previous employees you reach out to.

It is important to remember each job is different, and during the interview, they are trying to sell you on the positives and undermine the negatives that may be part of the job.

Green lights within an ophthalmology practice

Below are six key “green light” traits in an ophthalmology practice to be aware of:

Transparency¹
Employee satisfaction
1. Positive work-life balance
2. Flexibility
Competitive compensations²
Patient-first mentality
Updated equipment
Positive reviews and reputation

1. Transparency

Having transparency at work and about the job is an important quality to look for during a job interview. For each question you ask, they should be able to give you an answer or be able to get back to you with an answer.

Questions could include but are not limited to:

What is the amount of patients I would see in a day?
What is the number of patients I would be expected to operate on in the beginning?
- How is this number expected to change over time?
How many operating days (or half days) will I have per week?
- Will it be weekly, biweekly, or depending on the operating room (OR) availability for that month?
Will I have the opportunity to add more OR days in the future?
How long have previous employees stayed with this practice?
What were previous employees’ reasons for leaving?
Will I have scribes?
- Will it be the same scribe or different scribes?
What electric medical record (EMR) system do you use?
What phaco machine is at the surgery center?
What biometer or corneal topographer are you using?
What lasers are available, and are they located in-clinic, at a surgery center, or both?

2. Employee satisfaction

When making a decision on your future, you obviously want a workplace that provides a high level of job satisfaction to the majority of its employees. To assess this, it is important to find out whether the other ophthalmologists and employees are generally happy at work.

This is easier to establish upon visiting the practice. Generally, interviews are scheduled during the work week so you are able to see the clinic flow. Other things you can notice during the interview day are if the patients are happy in the waiting room or if they appear agitated.

Often, in interviews, particularly during the interview lunches, you are able to meet with the other ophthalmologists. During this time, you can ask and find out what their thoughts are on the practice, the reasons they came to work at this particular practice, and why they have stayed.

Work-life balance

A major aspect of job satisfaction is the ability to maintain work-life balance. This is important to prevent burnout and allow for longevity in your career as an ophthalmologist.

Again, this can be assessed during the interview day and by talking to other ophthalmologists or optometrists at the practice and asking the following:

Do they feel clinic and surgical duties are running into time at home?
What is the call schedule like?
Do they feel their lives are balanced to a sufficient degree between work and family?

Flexibility

Another important quality to assess is if there is flexibility in the job schedule. Knowing the employer has a reasonable amount of flexibility is a key component to work-life balance and being able to dedicate time to mental/physical well-being, family and friends, and outside interests.

Questions to help determine the flexibility of an ophthalmology practice include:

How many days are you working per week?
How many patients are you expected to see?
- Will you have adequate support staff to see this number of patients?
- Are there partners/other ophthalmologists that can cover seeing these patients if you have to leave/have an emergency?
If you have an emergency, what is the procedure for calling off if needed?
How many vacation weeks are provided, and what is the protocol for getting those weeks off?
What is the maternity leave policy?

3. Competitive compensation

Obviously, after spending years—and a great deal of money—preparing for your career in ophthalmology, a desirable salary is also an important topic. Focus on finding a job with competitive compensation depending on the region.

In general, the compensation should be competitive to the state that you are going to be living in—starting salaries can vary from $250,000 to $300,000 with the opportunity for sign-on bonuses.^3,4 It is helpful to ask colleagues and mentors about what is a fair compensation for starting out of residency or fellowship, or at a new job in a different state.

Remember, compensation is not only the base salary, it also includes the retirement package (and if there is a match), health and dental insurance coverage, net collections amount, production bonuses, sign-on or retention bonuses, etc. Make certain to have all of the pertinent information you need as well as an idea of the minimum you will accept before entering into negotiations.

4. Updated equipment

Having state-of-the-art equipment at a practice can go a long way to helping you provide optimal patient care. Alternatively, having to utilize outdated equipment can lead to frustrations and even medical mistakes. The right equipment can allow you to reach correct refractive targets, and generally provide patients with the latest technology and (hopefully) quality care.

State-of-the-art equipment to consider can include:

Surgical equipment (ex., phaco machine, femtosecond laser options)
Biometry (IOLMaster, ARGOS, etc)
Topography options (Pentacam, Atlas, Keratograph, etc)⁵
A-scan
Lasers (e.g., YAG, selective laser trabeculoplasty [SLT], argon, panretinal photocoagulation [PRP])
Optical coherence tomography (OCT) machines
Visual field testing
Fluorescein angiography capabilities

5. Reviews and practice reputation

Another aspect that can help you determine if you would enjoy working at the practice is if they have stellar reviews. What do the reviews on the internet for the practice say? Is there a sufficient amount? What do they say about the other ophthalmologists or optometrists you interviewed with? This is helpful for getting a different perspective on the practice.

As a first course of action, one can simply Google “(Name of practice) reviews.” This search will direct you to reviews from a range of sources. Of course, if the review is found on the practices’ website, remember that most businesses only highlight the best reviews, so take these reviews with a grain of salt.

The following sites should prove helpful in this process:

Yelp (use the “eye doctors near me” feature with the practice location)
Zocdoc
WebMD
Healthgrades
Vitals
RateMDs

Ophthalmology practice red flags

Now that we have identified the “green lights,” let us go through some potential red flags, which may mean you should continue your job hunt instead of settling for a particular practice.

Red flags to be on the lookout for include:

High turnover
Unrealistic expectations (ex., patient volume, call, or schedule)
Low compensation or unwilling to negotiate
No onboarding training
Outdated equipment

1. High turnover

Having a high turnover rate at a practice should definitely make you think twice about accepting a position within the organization. Though perhaps a bit tricky, it is important to find out how many people have left the practice in the last year (or even the last 5 years) and for what reason (this includes staff and doctors).

Although there is some degree of turnover at many jobs, it is important to recognize that some practices are looking to take advantage of new graduates. Furthermore, if a lot of employees are leaving, it is probably a sign that the practice is not putting their employees' needs first.

2. Unrealistic expectations

If an employer has unrealistic expectations for your work or surgery schedule, this is a red flag. This is a negative quality, which can be better assessed throughout the interview process.

For example, if they want a provider to see 50 patients a day, but they don’t have a reliable scribe for you to work with, then it isn’t feasible. This is just one example, and what may work for some providers may be different than what will work for you (depending on years of out of practice, efficiency, etc.).

Other potential red flags could be how the cataract referral is based. If it is hierarchical and by years at the practice, the new ophthalmologist may not receive any referrals, which would then limit their ability to operate.

Another example could be if all the neuro-ophthalmology referrals are sent to the newest member. This would limit their ability to generate cataract referrals, and in general, neuro-ophthalmology appointments require more history and more time, thus limiting how many patients the ophthalmologist could see in a day.

Tip: The best way to learn about potential red flags is to talk to the different ophthalmologists, especially the most junior or ones who have recently left the practice.

3. Unsatisfactory salary

Another potential red flag is a job offering unreasonably low compensation or if a practice is generally unwilling to negotiate in the initial salary conversation. If the location (i.e. Southern California, New York City, etc.) makes for a highly competitive job market, they can often afford to be rigid.

However, if they are unwilling to negotiate at all, this may not bode well if you would like to make any requests or suggestions in the future.

4. Minimal or no onboarding or training

When starting a new job, it is important to have onboarding and training to help familiarize yourself with the practice. If they have a different EMR than you are used to, it is important to have a training session that will allow you to familiarize yourself with the health record system. This is important because the notes are a legal record, and you don’t want to make mistakes.

Generally, a job will have you shadow a provider in the beginning of the hiring process, which can help you to see how their clinic flow is set up. Onboarding starts months prior to starting the job with insurance and medical certification for the state you are going to be living in.

When starting the job, orientation may vary. You may have a few weeks, in which you may shadow or set up smart phrases for the medical record system.⁶They will generally start you with a lighter clinic schedule, and then work up from there. An employee handbook is generally provided, where the practice will list different protocols they have for different visit types and encounters.

5. Outdated or poorly kept facility

It is important to look at the equipment at the practice and see if it is outdated or poorly maintained. The facility includes the waiting room because this will provide patients with their first impressions.

Other factors to take into account when checking the state of the facilities in an ophthalmology practice include:

Exam rooms
Ergonomics for staff and patients
Stocked and organized supplies
EMR and data
Computer systems
Biometry
Topography
Lasers
Slit lamps

Although the equipment does not need to be brand new, it is important to have updated technology. It is important to be flexible and realize that not everything needs to be perfect, but it should be equipment that you can familiarize yourself with.

Furthermore, if the biometer or topographer is very old, it may be possible to have suboptimal surgical and refractive outcomes, as well as lower levels of patient satisfaction.

Take note…literally

When you are in the midst of an interview, it is easy to only focus on the impression you are making on your potential employer and not vice versa. Remind yourself that the interview is ideally a two-way street.

Throughout, mentally keep track of the positives as well as the negatives. Immediately upon completion, write down detailed notes so you can review the information later and weigh the pros and cons.

In conclusion

In summary, finding your first job is a challenge. It is important to understand your options, interview for the job, and learn more about the positives and negatives associated with working for that company.

Each job is different, and the company or practice will try to sell you on the positives and undermine the negatives. So, it is helpful to have multiple job interviews, because then it will allow you to better reflect on which job seemed the best for you.

It does take time, but it is worth it to find the job you will enjoy!