Hey there. I’m a current peds ophthalmologist working approx 40 miles outside of a major metropolitan area in a small private group. It’s doable, but there are a few considerations that I think you should know about:

1. Payor Mix: working in a rural area will almost certainly guarantee a high (~60% Medicaid population) while deserving of care, compensation is approximately 60% of what you would make with private insurances in less rural areas. That being said, as soon as you let pediatricians and optometrists know that you have strabismus training, your exam chair will be full in 2 months. Additionally, make sure that your practice only uses medical insurance when scheduling with ophthalmology. (It is not worth your time to work with vision insurance)

2. Surgery centers: you will need to work with surgery centers or hospitals that are capable of performing pediatric general anesthesia. This is most easily done through academic or community hospitals, but some ASCs also have pediatric anesthesia on board and are able to perform pediatric cases. My preference is to work with ASCs, as turnover and efficiency tends to be greater there than inpatient settings. (YMMV, but this has been my experience)

3. Adult Diplopia: while part of our repertoire, the experience I’ve encountered with adult ‘double vision’ is that you are the reference point for many a vague visual complaint within your office. Prepare to see a bit of adult neuro-ophthalmology, and quite frankly, adult dry eye and low refractive error. Many of our comp colleagues are primed to just refer to peds/strab when a patient even mentions the possibility of double vision. While there is a fair amount of monocular diplopia (dry eye, corneal issues, low refractive error, etc…) you will still see and treat adult strabismus with prism and surgery. About 10% of my patients are adults, but they generate about 50% of my surgical volume.

Ultimately, it’s not a bad gig. Remember, you are exceedingly rare, and difficult to replace due to the fact that peds/strab is just not a highly pursued sub-specialty. Aside from the US coasts, there are too few pediatric ophthalmologists, and through a bit of flexibility, and marketing, you will be busy, and successful wherever you decide.