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The Ultimate Guide to Ophthalmology Residency—with Free eBook

Nov 2, 2021
33 min read
🔥 11.2k views
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Whether you’re getting ready to apply for ophthalmology residency, eagerly awaiting Match Day, or getting ready for your first day as a resident, you want to know what to expect. What do you need to know before your first day as an intern? What kinds of questions can you ask hospital staff? How should you interact with your faculty or older residents?

This ultimate guide will walk you through the journey from medical school through residency. We've also gathered advice from 23 of today's top ophthalmologists who have shared their answers to the question: What do you wish you'd known as an ophthalmology resident?

First, here are the facts about ophthalmology residency

Is ophthalmology a competitive residency?

Yes. In January 2021, 498 ophthalmology residents were filled from an applicant pool of 677 (a 74% match rate).

How many ophthalmology residency programs are there?

In January 2021, there were 499 positions for ophthalmology residents, 498 of which were filled. 38% of matched applicants matched with their first choice; 19% with their second choice and 10% with their third.

How many spots does each program have?

Most ophthalmology programs typically have only three to four spots.

How much do ophthalmology residents make?

The 2021 MedScape survey reported that residents earned $64,000 per year.

How long is ophthalmology residency?

Ophthalmology residency takes four years: one year of internship, followed by three years of ophthalmology-specific residency to be completed in either an integrated, joint, or professional program.

How do you choose which ophthalmology residency programs to apply to?

The application process for ophthalmology residency is long, and since there are over 120 ophthalmology residency programs in the US, you must narrow down your choices to a reasonable number. The criteria that drive your decision are unique to you, but likely include the reputation of a program, the number of spots, the surgical statistics, and the location. If you're just getting started with the research process, check out our handy tool!

Starting in the summer of 2020, the American Academy of Ophthalmology is moving towards an integrated four-year structure. This means that beginning with the January 2020 match cycle, ophthalmology residencies will now all include a PGY-1 year linked with the ophthalmology residency, or an integrated program with PGY-1-4 all run through a department of ophthalmology. This process will be fully implemented by the 2023 match cycle.

What that means is that wherever you match for your ophthalmology residency, that is where you'll be for the next four years. That same hospital is where you'll be doing your intern year, and incorporated into that intern year is three months of ophthalmology. So you'll spend nine months doing either internal medicine, family medicine, pediatrics, or general surgery, depending on the program arrangement.

This is a new process for ophthalmology; other surgical subspecialties, like ear, nose, and throat; plastic surgery; urology; and others have already operated in this model. When I applied to residency, it was a different process—I applied for my intern year separately from my ophthalmology residency.

I appreciated that I was able to do a transitional year residency close to home; I felt like a third-year medical student all over again. Each month I was on a different service—pediatric surgery, radiation oncology, ICU. I was able to pick rotations that I thought would have some overlap with ophthalmology—like radiation oncology, since a lot of times patients with brain tumors or optic nerve tumors get radiation therapy, which can affect their vision.

In the old model, you had a little more flexibility when it came to choice, but you weren’t guaranteed any ophthalmology training during your intern year. It was at the discretion of your program. With the new residency match model, applicants are saving money by not having to pay two sets of fees and go on two sets of interviews—not to mention the time saved by not having to write two separate sets of statements.

What to expect from the residency match process

Along with implementation of the new model, there have been changes to the SF Match application process: for instance, the personal statement has now been replaced with a "life summary" statement and essay responses to two of four prompts.

When you’re applying to residency in your fourth year of medical school, the core components of the application are:

  • Board scores.
  • Medical school transcripts.
  • College transcripts.
  • A "life summary" statement and essay responses to two of four prompts.
  • Three letters of recommendation.

The recommended submission date is usually in August of your fourth year of medical school.

Once your completed application proves you meet all the criteria for an incoming resident at a specific program, the interview process begins.

The interview process gives you a chance to demonstrate what makes you unique as an individual, highlight your strengths, and show exactly what you can bring to the program. With COVID restrictions, the interview process has moved to a virtual format at many institutions, which presents new challenges but the core advice from our experts still holds true.

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For more advice like this, download The Ophthalmology Resident's Guide to Success now!

Interviews start in September and end in December, and are usually staggered by program. For instance, the Midwest programs usually start interviewing in September-October, but the rest of the programs hold interviews in November and December.

Once you’ve interviewed, your rank list is due along with the rank lists from the residency programs in early January. Then, SF Match runs each of these lists through their algorithm, and releases the matches about a week later. The process is like a cross between the Sorting Hat and rushing a sorority or fraternity, but it’s said that the algorithm is weighted in favor of the applicant.

Then on Match Day, which for ophthalmology residency is in the second week of January, you discover where you’ll be spending the next four years of your life.

The cadence of the next four years: from internship to planning on fellowship

Residency is a time to identify and hone your skills as a surgeon, and even choose a subspecialty such as glaucoma, neuro, or a host of others. It is also a time to define and adopt the set of professional standards that will serve you throughout your career.

Professional standards and expectations

Our panel of ophthalmologists agree on these integral professional standards:

  • Show respect: Treat everyone, including patients, co-residents, attendings, consultants, ancillary staff, and medical students, with the utmost respect.
  • Look professional: Dress for the job you want, not the job you have.
  • Practice punctuality: Always be on time.
  • Keep your word: Do what you say you will do when you say you will do it.
  • Exhibit excellent work ethic: Start early, stay late, and take pride in what you do.

Making the most of your intern year

Your intern year is perhaps the most formative. You’ve just graduated medical school, and the very next day you’re a doctor. On my first day, I remember walking into the hospital, and having one of the hospital staff say to me, “Dr. Agarwal, what do you want to order for this patient?” I remember thinking: Wait a second, just yesterday I had a safety net!

But those nurses know that every year, on July 1st, comes a new batch of fresh-faced doctors. The people you work with from day one know that you’re young, still adjusting to this newfound responsibility, and will be by your side to support you for the next four years.

During this year, focus on learning the flow of the hospital, EMR, and the administrative side of things in addition to the basics of medicine. For example, if I had completed my internship at my ophthalmology residency program, I would have struggled much less in figuring out how to set up social work for disabled patients, ordering outpatient IV steroids, and getting prior-authorization approval for medications.

Ophthalmology residency: year one

Your second year—the first year of your ophthalmology residency—is where things really start going. Now, you’re a resident doctor in ophthalmology, and this is when you realize that you truly know nothing. The language of ophthalmology is a new one, and you have to pick it up quickly. You’ll feel slow, like you don’t know anything, but don’t worry—you’re learning more than you think.

In your first year as an ophthalmology resident, you’ll take a ton of primary calls and you’ll see a huge variety of pathology. Depending on your residency, it might be an ER call with local hospitals and potentially even a children’s hospital. Everything will be very new because you haven’t seen it all before—pay attention and keep learning!

There will also be a lot of eye trauma, especially if you are at a Level I trauma facility. You'll be called in to consult with your colleagues from medical school in other departments who don’t know anything about the eye but know that you do. You’ll be figuring things out on the job and learning that you know more than you think. You’ll keep doing exams, reading about central diagnoses, and practicing. You’ll be scared, thinking, “Who is letting me, someone who has only been doing this for a few days or weeks, treat these patients?! What if they go blind because of me?!”

Keep in mind, you’ll always have your chief resident and your attendings guiding you through workups, plans, exam findings, and management. The goal of your first year is to get comfortable doing the complete 8-Point exam, learning the basic management of eye emergencies, and getting the flow of managing clinic patients down.

Some programs will have scheduled operating room time for the first years, where you’ll start off with oculoplastics—trauma, eyelid lacerations, globe trauma, and the like—or pediatrics. These are the kinds of gross ophthalmic surgeries you’ll start off with. As you continue in your residency, you’ll begin to do the more intricate microscopic surgery.

Depending on the program, you might also have the opportunity to start performing some routine in-office laser surgeries, such as for glaucoma or posterior capsular opacification. This gives you the opportunity to get more comfortable with the feel of microscopic procedures without throwing you into the deep end of cataract surgery.

Year two: It’s time for subspecialties

In the second year of your ophthalmology residency, you start rotating on subspecialties. You’ll experience rotations in cornea, retina, pediatrics, oculoplastics, glaucoma, and neuro-ophthalmology. You’ll be working with fellowship-trained physicians, observing and sometimes participating in their cornea or retina procedures and also seeing how they manage those patients in their clinics.

Residencies are structured differently in terms of how the subspecialty clinics are set up. Some have departments dedicated to specific subspecialties and others have rotations within private practices. This is when you build on your fundamentals from first year and start ironing out the details clinically and surgically. You’ll find your fund of knowledge has grown immensely, and the intricate questions your seniors were asking finally make sense to you.

In some programs, you’ll get a short introduction to cataract surgery in your second year. In some, you might be doing a graded approach where you’re performing some of the steps. You will also have more hands-on experience with glaucoma, pediatric, cornea, and globe trauma surgeries.

In most programs, slowly taper off taking primary calls or stop taking them altogether. At a select few, you might still be taking primary ER call and dealing with the same ER consults and coverage that you were doing as a first-year resident, but functioning more autonomously clinically and surgically.

Luckily, you’ll be more comfortable with it, because you’ve been doing it for a year. And then, before you know it, you’re a third-year resident.

Third-year residency: time for intraocular surgery

In your final year of residency, you begin to perform intraocular surgery. You might find yourself performing some glaucoma or cornea surgery, but your true bread and butter is cataract surgery.

Keep in mind that almost no programs will have third-year residents doing retina surgery, because those are really saved for fellowship.

As a third-year ophthalmology resident, you’re also responsible for mentoring the first-year residents—showing them the ropes, seeing patients with them, being their backup on call, and helping them as you were helped in your first year. You’ll also be managing the inpatient service and overseeing the appropriate workups and treatments as well as communicating with the attendings about what’s going on on the service. If the patients need to be rounded on with an attending, you may be part of that; it’s become your role to supervise and manage the service in addition to your clinic responsibilities and doing surgery.

Each year your responsibilities grow, but you also get more comfortable because now you know the language of the exam, and ophthalmology becomes more comfortable for you. The pathology is no longer as foreign or overwhelming, and you’ll find that you're able to teach and educate.

That’s when it’s time to decide whether you want to keep going—and apply for fellowship.

How to succeed in an ophthalmology residency

During residency, gathering the right team of colleagues, finding time management and study strategies, joining professional organizations, and choosing the right mentor can all be huge factors in your level of success.

Build relationships

I had strong ties to my intern-year hospital staff and personnel, and that’s something I wish I still had easy access to. When the pharmacists would call me, saying that I ordered something wrong, they would joke with me and educate me rather than scold me. They’re not mad; there are just a lot of checks and balances, thank goodness!

The nurses, the respiratory therapists and everyone else who makes up the healthcare team is used to these kinds of mistakes from interns, so they expect you to turn to them and say, “What do you usually do in this situation? You’ve been doing this longer than I have” or “I’ve never ordered that before, can you please show me how?”

During my ophthalmology residency, I felt like I had to start building these relationships all over again. But if you remember to be kind, humble, and respectful to everyone around you—including the janitorial staff—you’ll realize they can help you out more than you can imagine. There were often times the ER secretary would hold on paging me for 30 minutes when she knew I had a busy night, just so I could get a bit of sleep in. Similarly, I’ve had the OR bump my case ahead of scheduled cases because I was the “helpful doc” (helping transfer patients from stretchers, moving beds, grabbing supplies for the case, etc).

Save toward the future

While you are amassing knowledge, don’t forget to build your personal case base. Residency is the time to develop the mindful habit of collecting clinical images and videos.
Make it an ongoing practice to make digital copies of your medical case photos and patient imaging, along with the ID number, and download them on a regular schedule to a high-volume portable electronic storage device. To maintain patient confidentiality, scrape any identifying information prior. Having such a collection can ease the transition into being a practicing ophthalmologist.

Capitalize on communication

Showing up and being engaged is more than half the game. You can know everything, but if you don’t have the work ethic, the camaraderie, and teamwork-focused attitude to work with your nurses, attendings, and fellow residents, you’re not going to deliver the best possible care you can for a patient. Communication is key. Being reliable and following through on things is key. Just because you have great board scores or got honors on all of your tests doesn’t automatically make you superior to your colleagues. You have to show you are more than just numbers on a page—and it takes more than just knowing all the answers.

I can’t overemphasize how important communication is—even the simple motion of telling a nurse that you’re going to order a medication or a test—because if you forget, there’s another person who can follow up with you. Your coworkers are an important resource, and it’s part of your job to rely on them to support you, and vice versa.

Finding mentors during your residency is another way you can set yourself up for success in your career down the line. And that starts with, again, communication! Just talking to your attendings early on, you’ll get a feeling of who shares your mindset and would be a good mentor.

This is the part where many residents miss an opportunity; not everyone is going to be the perfect mentor. Just because someone is in a prominent position in the department doesn’t mean they’re going to make a good mentor for you. Instead, look for someone you feel will give you honest advice about your career and shares a similar mindset with you.

Also, don’t wait until you’re struggling to ask for help or to reach out for guidance from a mentor. Start early, once you’ve realized that these are people you’ve clicked with, and have real conversations with them. Many of the attendings will have stories to share, and you can learn so much just from listening. Ask them how their practice is going, and later you’ll realize just how much you were learning from those conversations!

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The most common mistakes made by residents

It’s actually expected for you not to know everything—that’s the point of being an intern, being a resident, and going through this process. If you already knew everything, then there would be no point in residency. Because of this, the three most common mistakes made by residents all have more to do with mindset than with a lack of knowledge.

Mistake #1: Procrastination

The biggest mistake residents make is procrastinating. With the advent of EMR, we all get bogged down in paperwork, charting, returning patient phone calls, etc. The best piece of advice I got from an attending was to do everything while the patient is in the room.

Patients want to know that you’re spending time on them. They don’t know any of the time you spend when you take your notes home; to them, you were in the room with them for two minutes. Not to mention the fact that when you take things home to work on at night, you’re going to forget details and feel more rushed.

So, do everything when the patient is in the room. Most importantly, tell the patient everything! Don’t just order a test, see that it’s negative, and not call them with the results. They’re worried and anxious! Help them understand why you are ordering these tests. I have found that discussing the care plan with a patient helps them be more engaged and motivated about their care and the outcomes are substantial. They take the initiative to get their medications filled (and actually take them), get labs drawn, and show up for follow-up appointments. You can do all the work behind the scenes, but what’s it worth when the patient doesn’t follow through on any of it?

Do they need a note sent to their rheumatologist or primary care physician? Write that note in front of the patient, and make sure they know what you’re doing. Your patient will feel heard, and that leads to them being more confident in the care you’re providing. They’ll know that their doctor is doing everything they said they were going to do—and you’re getting it done.

This is particularly crucial for residency because of how busy you are, all the time. I have residents on my service who still haven’t written up their notes from the beginning of the year—and that leads to confusion for everyone. If patients call about their records or for instructions on their medication, the front desk staff won’t know what’s going on because the notes aren’t available. This is especially a faux-pas if another service is relying on your evaluation to make a treatment decision (i.e., rheumatology, neurosurgery, etc!)

If your colleagues don’t know what’s going on, you’re not being a good member of the team.

Mistake #2: Not asking for help

The second big mistake residents make is directly related to procrastination, and it’s not asking for help when you need it.

As a second-year resident and even as a chief resident, I have this idea that I’m supposed to know everything. I’ve come to realize that no, I’m still a resident—I’ve been doing this for barely two and a half years. I have the right to ask what I may think are “dumb” questions, but there’s no shame in that.

You should never feel ashamed to ask a question, to ask for advice, or to say that you don’t know. It’s better to admit that and ask the advice of the experts and the experienced practitioners around you, because this is your time to learn. That’s what this time is designed for. Hindsight is 20/20, and it’s not worth risking something going wrong because you were afraid to ask for help.

If I could go back in time and give myself advice before my first day of residency, I would tell myself not to be afraid. It’s going to be very hard to make a mistake that someone else isn’t going to catch, although it can happen! I felt a lot of personal pressure, because I wasn’t aware of all of these checks and balances. There are a lot of safety nets in place, especially if you vocalize you need help. As one of the contributors to The Ophthalmology Resident's Guide to Success, Laura Periman, MD, offers this advice.

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Don’t make mistakes intentionally, obviously, but if you do, there are people around to help. The most important thing you can do to set yourself up for success in your residency is to establish yourself as someone who is reliable and communicative. You have to be able to collaborate with other people, otherwise, you will not be delivering quality care. Own what you know, own what you don’t know, and don’t be afraid to ask for help.

Mistake #3: Forgetting self-care

The final big mistake that I made and learned from was not prioritizing my own well-being. It’s very easy to get bogged down and feel like there aren't enough hours in the day. You feel like that one hour you do have free in the day should be spent studying or doing clinical work. However, it’s very important to schedule time for yourself and to say, "No, I'm going to work out" or "I’m going to cook myself dinner."

I lived the first few years of residency thinking that every hour I wasn’t spending studying or doing clinical work was an hour lost. I thought I was slacking off, but I wasn’t realizing how unproductive that time actually was. If I was sitting in the library for 16 hours, only five of those hours were truly productive. Now, I’ve reprioritized my sleep, exercise, and eating, and what used to take me five hours to complete takes me two—because I’m rested, clear-minded, and energized by the time I took to prioritize my well-being.

Your physical health affects all aspects of your life. If you’re tired, you’ll make mistakes and forget things. Taking care of yourself improves your mood, your perspective, and your memory—it’s just as important as studying and practicing surgery.

A lot of the fear that drives these three mistakes comes from the anxiety and pressure that we put on ourselves. But it’s expected that you don’t know everything. This is the point of being an intern and being a resident: if you already knew all of this, you wouldn’t need to go through the process.

Fellowship or the job market?

Just like it’s never too soon to start looking for mentors, it’s never too soon to be thinking about life after residency. Are you going to go straight into practice or will you apply to fellowship? There are so many paths residents can take, so it really depends on finding which one is right for you.

There are a multitude of reasons to delve into fellowship—be it retina, cornea, glaucoma, or other—and the most prominent is because you want to advance your knowledge in your subspecialty of choice. During fellowship, you’ll gain invaluable clinical experience, insight into scientific research, and access to the latest technology. And becoming a fellow also gives you access to entry into certain organizations and a competitive edge when stepping into the field and finding your first job.

I’m an atypical representative of the fellowship path. Usually, what most residents experience is one of the following: you come into ophthalmology residency knowing that you’re going to pursue a specific fellowship, you’re leaning towards a comprehensive practice, or you have no idea and are just happy to have matched into ophthalmology.

Many times, you’ll find yourself drawn to a particular subspecialty because you’ve had a brilliant mentor in that field. Sometimes you find this mentor or this field in your second year by getting exposure to the subspecialties and realizing you enjoy this subject, both clinically and surgically.

Additionally, many residents start to think about lifestyle and family, and that has a strong impact on your decision to pursue fellowship or not. Fellowship is another one to two years of study, and if you have a family that can add additional pressure. At this point, you’ve been in school for eight years beyond college, so another two years can seem like asking a lot when instead you could settle down with your family and start taking in that ophthalmology salary.

It’s all about what is right for you and your career. Talking to your attendings and mentors about their work-life balance can help you make your future decisions.

I came to an anterior segment fellowship through an atypical path: I entered residency thinking I was going to do oculoplastics. I was set on it! And then, I started my residency and realized that oculoplastics was very different than I thought. I hadn’t planned on the trauma aspect, and oculoplastics is partly an emergency specialty.

Once I came to the realization that I wanted to focus on intraocular surgery, I considered focusing on cataract surgery—which meant I wouldn’t need a fellowship. But then, as I saw more patients, I realized that many patients come into the clinic wanting the latest and greatest procedures. Cataract procedures combined with minimally invasive glaucoma surgery, LASIK, refractive surgery—a lot of newer specialty surgeries that residencies don’t offer a lot of exposure to, but certain fellowships would.

That’s when I found the small but growing field of anterior segment, which is doing exactly what I described. There are only a handful of programs out there, and I’m excited to be heading to one of them this year.

For me, fellowship is a way to grow that foundation of knowledge and build on what I’ve already developed in residency. This way I will know that when I’m in practice, I’m offering the best care possible to my patients, from a position of formal training.

If you opt for a fellowship, consider this advice from Van Thompson, MD, from The Ophthalmology Resident's Guide to Success.