As you get further into your ophthalmology training and the light at the end of the tunnel approaches, you start thinking about what your career will look like.
Do you want to do private practice, work in academics, or work for a large medical group such as the Veterans Affairs (VA) or Kaiser Permanente?
Each of these clinical options has pros and cons, and this article is designed to help you navigate the decision.
What is the current breakdown of ophthalmology jobs?
Figure 1 illustrates the career options and trends in ophthalmology practice.3
Figure 1: Courtesy of Parisah Moghaddampour, MD.
The path of private ophthalmology practice jobs
Private ophthalmology practice has changed throughout the years. Private practice is traditionally defined as a practice owned and operated by providers rather than a hospital, health system, or other entity.1 When applying for jobs, there are private practices owned by physicians and private equity-owned ophthalmology practices.
The model of private equity is to buy a practice and transition the workplace model to be more financially lucrative, with the eventual goal of reselling the practice for a higher price.2 Despite this, more and more ophthalmologists are working for private equity-owned ophthalmology practices when entering the workforce (myself included).
According to a 2021 survey by the American Academy of Ophthalmology (AAO) of their members, 72% of ophthalmologists work at an ophthalmic group practice.3 The ability to choose a practice that matches your interests is one of the pros of private practice.
Common considerations for joining a private ophthalmology practice include:
- What call schedule would you find acceptable?
- Is a 4-day workweek preferable?
- How many patients would you prefer to see in a day?
- How many days per week do you want to operate?
- What surgeries do you want to perform?
What to expect in a private ophthalmology practice
These are aspects that can be negotiated and vary depending on the practice. In general, private practice allows for more freedom.
Typical duties include seeing patients throughout a regular clinic day (the number of patients seen per day varies by the practice) and then operating (different private practices have different operating schedules). The frequency can be a half-day per week, a whole day once a week, multiple days a week, or some places operate every other week.
The usual work day is generally a 40-hour week, Monday through Friday, but again, this is negotiable and depends on the practice. Even if your outlook and goals change over time, there are more options for freedom of decision compared to academics, where bureaucracy can slow down change and limit decisions.
Potential drawbacks of private practice jobs
There are a few potential downsides, however. Private practice tends to have a higher volume of patients. There is more of a focus on efficiency, both in the clinic and in the operating room (OR). Often, you must wait to get added to different insurance plans.
In addition, it takes time for you to build rapport in the community. An ophthalmologist may need to market themselves to different groups, including optometrists and primary care physicians, to build a referral base. There is more of a focus on the “business” of ophthalmology compared to a career in academics and working in a large medical group.
Assessing academic ophthalmology jobs
Working in “academics” generally refers to working at an academic institution; examples include Bascom Palmer Eye Institute, Wills Eye Hospital, and Massachusetts Eye and Ear, among others.4 According to the AAO, around 19% of ophthalmologists work in academics.3
A typical schedule includes seeing patients up to 3 days a week and having dedicated time for research, administrative duties, and teaching.5 Depending on the physician's interests, they may be on a clinical track where their schedule is more clinic-heavy versus a research track with less clinical workload.
The benefits and costs of academic ophthalmology jobs
Important positive qualities of academic work include intellectual stimulation with access to research. There is also often a higher degree of camaraderie in that there often are multiple subspecialists whom you can bounce ideas off of each other.
This realm also offers the opportunity to interact with and teach residents, which allows you to help future ophthalmologists improve their skill sets as young clinicians and surgeons. Additionally, there is less pressure to see a high volume of patients, and a subspecialist (to some degree) can spend more time with complex cases.
Cons of academics can include a lower base salary than private practice, bureaucracy and lengthy approval processes for change to occur, having to take calls (including globe trauma) and rounds on inpatients in the hospital, and less ability to negotiate changes into your contract compared to private practice.
Leaning toward a sizeable medical group?
Working for a large medical group has some similarities to both academics and private practice. A large medical group is a group of three or more physicians formally organized as a “legal entity in which business, clinical, and administrative facilities are shared.”6 According to the AAO, around 6% of ophthalmologists work in a large medical group setting.3
Kaiser Permanente is a large medical group that generally has a compensation package provided to each applicant. The VA is another large medical association serving our nation's veterans. Normal duties are similar to private practice in that there are 3 to 4 clinical days a week and an operating day every week or every other week.7
Pros and cons of large medical group ophthalmology jobs
Generally, with large medical groups, the retirement package is generally well-rounded and may offer a pension. Work-life balance is more of a priority, and there are fewer administrative headaches as the medical group decides on those aspects.
There is also access to different subspecialists that can be referred to within the same medical group. Additionally, there is generally a large pool of patients; thus, when a provider starts, it takes less time to build a full schedule of patients. However, within large medical groups, there is less ability to negotiate changes to a contract.
Comparing private practice, academic, and large medical group ophthalmology jobs
Table 1 outlines the pros and cons of private practice, academic, and large medical group ophthalmology jobs.
| Private Practice | Academics | Large Medical Group (Kaiser Permanente, VA) | |
|---|---|---|---|
| Pros | More freedom in work decisions | Intellectual stimulation | Attractive retirement benefits and pension |
| Higher volume of patients and surgery | Research and innovation | Work-life balance | |
| Able to negotiate contracts | Camaraderie between multiple subspecialists | Less business minutiae (managed by the company, not you) | |
| More time with patients | Start with a full schedule of patients (less based on referrals) | ||
| Cons | Takes time to get on insurance plans | Lower base salary compared to private practice | Less contract negotiation ability compared to private practice |
| Need time to establish rapport and referrals | Less ability to negotiate contract details | Less freedom to make changes | |
| Bureaucracy of medicine (e.g., which insurance plans can you accept, medical coding, business minutiae, etc.) | Slow to make changes | Call schedule may be more compared to private practice | |
| Call schedule (globe call, inpatient rounding) |
Table 1: Courtesy of Parisah Moghaddampour, MD.
Other options in ophthalmology
Alternatives to these options include medical consulting, public health, or ophthalmology advocacy.
Consulting
Medical consulting includes being hired by a company to consult on a project that utilizes your clinical or surgical expertise.8 Examples could include working for a pharmaceutical, medical device, or electronic health record company.
Hours and pay are variable depending on the job but have been reported as up to 150% of clinical hourly pay with flights and meals included in the training.9
Pros: Flexibility and utilizing your expertise to expand medical technology or pharmaceutics further.
Cons: Less consistent pay schedule and potential need for travel away from family.
International ophthalmology/public health
International ophthalmology or public health are also options, often with an altruistic component. These careers are often tied in with working at academic institutions, as outreach work is included as part of the academic institution’s mission. Other potential avenues include fellowship options or working at a charitable institution.10
Pros: Serving others while helping to expand ophthalmologic clinical or surgical care in areas with limited providers.
Cons: Lower compensation and potential travel risks, depending on the area being served.
Advocacy
Ophthalmologic advocacy is of increasing importance as the scope of practice becomes more prevalent. Advocacy is something that individual physicians can do while working by becoming a member of their state’s society (e.g., California Academy of Eye Physicians and Surgeons [CAEPS] for California). Additionally, there are advocacy ambassador programs included in residency and fellowship training.
Finally, an important annual advocacy program is the Mid-Year Forum. To take on a heavier role in advocacy, reach out to your respective state society or the AAO and inquire about the current initiatives.
Pros: Helping patients through legislation and using your voice to shape the future of ophthalmology.
Cons: Out-of-clinic time and travel commitment to speak to state or congressional legislators.
The journey in landing my first ophthalmology job
As a new attending ophthalmologist, I chose to work at a private practice in Las Vegas. I went on six different interviews between Southern California and Las Vegas and had four solid job offers before I decided on the practice I work for now.
The reasons I chose this practice included:
- The people (I both enjoyed their company and felt they could offer good mentorship guidance for me as a new attending)
- Competitive salary with a sign-on bonus
- One guaranteed OR day each week (compared to less frequently at other places)
- The option to perform more surgeries in general
- The ability to build up in volume both in surgery as well as clinic
- The opportunity to learn new technology (LenSx) and add microinvasive glaucoma surgery (MIGS) procedures to my repertoire
The practice really made it clear they wanted me and would accommodate my surgical interests (e.g., MIGs procedures, laser in situ keratomileusis [LASIK], refractive, etc.). It has taken time for me to get on all the insurance plans, so my clinic schedule has been light in the first few months.
I marketed with local optometrists in the area, which was a new experience. As time has progressed, more patients have been added to my schedule and I am starting to fill up my OR days. Again, building rapport and patient volume in private practice takes time.
Final thoughts
There are many decisions that factor into play when choosing your first ophthalmology job. Each private practice, large medical group, and academic job is unique. The people, atmosphere, and clinic flow are unique, and their surgery centers vary in equipment and environment.
I strongly suggest interviewing at multiple places, as it helps narrow down exactly what you are looking for. You can look back and say, “Oh, these qualities were attractive, and these other things I thought would be important are now less valuable.”
I was better able to identify what I wanted after my fourth interview clearly. Additionally, when you have multiple job offers, you have more leveraging power to negotiate your contract.
Finally, remember your first job does not necessarily mean your perfect job. It is a learning experience; even if it is only for a couple of years, it can help you grow as an ophthalmologist and equip you to find your dream job.
