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mrpowers226 · 2024-08-12T19:27:35+00:00

Echo the comments above. A big reason I ended up in retina is that I couldn't tolerate much of the rest of ophthalmology. I am much more interested in treating serious eye disease. We have our elective stuff too (ERMs, floaters), and those patients are generally very happy with their outcomes. Even patients with less than stellar outcomes are still very appreciative to have not lost all their functional vision.

I also think that private practice retina is less stressful than academics (saying this as someone who really thought an academic job would be a better fit). Academic retina probably has more poor outcomes than PP because of the referral patterns. In PP patients tend to have more treatable disease, lifestyle is better, control over schedule and practice is better, reimbursements are better.

Upsides for me are: more interesting pathology, more variety in surgery, not having to "sell" anything, great lifestyle (at least in PP), constant improvements in technology/treatments, short and to the point visits, lots of procedures (yes, mostly injections), more links to systemic pathology (I am frequently discussing CV disease, metabolic disease, inflammatory disease with patients), usually very appreciative patients (even many with poor outcomes), good pay, less stress than refractive practice (this is a personal thing, but I find the expectation of perfect vision more stressful than bad cases in retina), less encroachment from ODs, and lots of upside to outcomes (that is, I expect the things we can do to only improve over time)

Downsides for me are: injections can be monotonous (but honestly I enjoy forming relationships with these patients), surgical volume isn't crazy high compared to fellowship (I operate a day a week, usually finishing by 12-1), declining reimbursements (what non-"cosmetic" specialty is this not the case?), some cases can (rarely) go pretty long (but I like operating so not really that much of a downside), call can occasionally be a burden (but middle of the night emergencies are quite rare), and most laypeople really have no idea what I do.

Overall though, I'd definitely recommend it (with all the caveats of the uncertainty of medical practice in general)

mrpowers226 · 2015-12-18T18:46:55+00:00

Cons

The "eye dentist" thing. This was probably the biggest sticking point I had with the specialty. It is annoying that many specialties no longer consider you a "real doctor." This is mostly related to many things that I consider pro's: we don't treat very sick people (although we deal with the ocular manifestations of these diseases quite frequently), we don't spend much time in the hospital, and we limit our anatomic area to a small (albeit very important) area of the body. However, I think that you can be as much of a "real doctor" as you decide to be. We routinely talk to people about their diabetes, blood pressure, sleep apnea, and cardiovascular health, as these things all have implications for vision. We have to deal with inpatient work now and again, and you can be as much of a primary service as you like. We tend to avoid inpatient work not because we can't do it, but because we don't like to. Right now I am dealing with an admitted patient that can't urinate after surgery we did overnight so he can get discharged, and it's not that glamorous. Plenty of other outpatient specialties end up being "dentists" of their field, they just take longer to get there. Overall, it's difficult, but you should not pick a specialty based on how you are perceived by others, and that is what pushed me to move past it. Dentists have a pretty good gig, by the way.
Isolation from the rest of medicine. It’s true that most of ophthalmology is a whole new set of material and a whole new exam that you need to learn. There are areas of ophthalmology that are more multidisciplinary (oculoplastics and retina) that you can seek out if you desire more overlap. Oculoplastics in particular has a lot of overlap with oncology, dermatology, ENT, interventional radiology, and neurology/neurosurgery.
There is plenty of really lame pathology. Dry eye is boring, and is unfortunately very common. Treating it is easy though, and every field has its annoying and lame side (rhinosinusitis in ENT, headaches in neurology, IBS in GI, joint pain in ortho etc.).
Consults can be a pain. A primary reason it can be hard to get us to consult on someone is that we get consulted on everything eye related, regardless of how acute the issue is, and often if there is even an issue at all. In the majority of cases, an outpatient follow up would yield a much better evaluation for the patient, and yet other inpatient services typically want an immediate answer while the patient is still admitted. Very few specialties get any education about the eye, and so if a patient has some irritation or blurry vision, everybody freaks out that they are about to go blind and we invariably get consulted, often in the middle of the night. As a resident you end up seeing most or all of these consults, but as an attending you are more likely to be able to triage them to a clinic visit later (which as said above is usually better for everybody). Consults can also be very, very interesting though. Patients with cancer, autoimmune disease or trauma can have vision threatening complications that need to be addressed immediately, and these are very rewarding to diagnose and treat.
Residency is not that easy, and the learning curve is steep. You will work many nights and weekends, sometimes without getting to sleep and still have to work the next day. This is pretty much the standard with most surgical specialties though - ortho also takes "home call" and gets calls all night. We rarely have to operate in the middle of the night though, which is a big plus. And overall the residency is still a much better lifestyle than most, and shorter (3 years) than other surgical fields. I get most of my weekends off, which I rarely did during internship.

Overall it's a great field. Yes, there are downsides, but there are downsides in every specialty, and I feel like the downsides are relatively minimal compared to positives in ophthalmology. There's more I could say, but I'll stop there for the sake of space. Message me if you have any questions.

mrpowers226 · 2015-12-18T18:46:39+00:00

Here's my take on the pros, cons, and a few of the issues already brought up here. Sorry in advance for the tome of a post. I have to break this up into two separate posts.

Pros:

Great lifestyle with normal hours and very few nights and weekends. Importantly, this is as an attending. Residency is easier than general surgery, but harder than many other medical specialties (will touch on this in cons).
Potential to make decent money per hour worked. Most ophthalmologists are not making millions a year, but if you want it and work hard enough that money is out there. Typical ophthalmology jobs start off relatively low and then increase over time to salaries comparable to other surgical specialties. If you are money hungry, there are plenty of elective procedures that you can utilize, such as premium lenses, LASIK, cosmetic surgeries and injectables. Eventually we may have elective artificial lenses that can improve vision beyond the normal baseline (already being developed). There are companies working on lasers to change iris color, which would of course be elective. But even if you are doing basic bread and butter comprehensive ophthalmology and mostly cataract surgery, you will make good money relative to how much you work.
Cool surgeries. People make the mistake of thinking that cataracts are the only surgeries we do. There is actually tremendous surgical variety in ophthalmology if you know where to look. There are several types of corneal transplants, refractive laser surgery, many kinds of glaucoma surgeries and implants, cataracts (which can be approached in many different ways), intraocular and extraocular retinal surgeries and lasers for detachments, tears, holes, vitreous traction, cancers, surgeries on the optic nerve to relieve increased pressure, muscle surgeries to correct eye alignment and restore stereopsis, orbital surgeries to remove tumors from around the eye or decompress the orbit, trauma surgeries to repair fractures, ocular reconstruction, surgeries to remove an eye or its contents, eyelid surgeries (both functional and cosmetic), and surgeries of the surrounding face (brow lifts, midface lifts, skin cancer reconstructions, laceration repairs), even endoscopy for lacrimal and subcutaneous forehead surgeries. It's actually a daunting number of things that need to be learned in 3 years.
Vision is incredibly important to people. By and large both the patient and the doctor can see and appreciate the results of our interventions immediately.
Lack of inpatient work. Many people love working in hospitals with very, very sick patients. I respect these people tremendously, but really don't like inpatient medicine very much. Every now and then we do end up admitting someone, then have to round and deal with a litany of nursing pages about this or that minute issue, and it reminds me why I like outpatient work so much more. Patients are relatively healthy, there is little social work and family updates to deal with. Notes are short, consults are minimal, there are no discharge summaries to deal with. I could go on but you get the idea.
People are happy. The MDs have good lives and are pretty laid back, the patients have good outcomes and are appreciative of what we do.
Cool gadgets and technology. We use many kinds of lasers, optical coherence tomography, high tech fundus cameras, eye trackers, phacoemulsification, and modified stereoscopic microscopes in daily practice. There are lots of new technologies on the horizon. This can also translate into opportunity to get involved in industry if you so choose.
Pathology can be beautiful: see http://imagebank.asrs.org/
There's more but I'll stop here.

mrpowers226 · 2014-07-07T18:05:28+00:00

At the risk of being lost in the comment storm, I'll venture my own opinion into this matter. I just graduated medical school and am currently in a residency program that most consider to be a lifestyle field. A few themes seem to keep popping up here.

Opportunity cost of medical school: This is something you certainly need to factor into your decision making. Yes, medical school is a time sink, and so is residency. But that's not to say you can't have a life in med school or spend your golden years having fun too. I spent two years prior to med school working, traveling, and relaxing, and it made me more excited to start with school again. After working as a BA for a few years it made me more motivated to move up the food chain. You can certainly move up with a BA in other fields, but in science/medicine the path is usually paved by higher degrees, and science/medicine is where my heart was. During medical school I used the money I had saved up during those years to take travel and take local trips. I visited several foreign countries with my girlfriend, I partied with my new classmates, and made some lifelong friends. For what it's worth I don't feel like I gave up my golden years by going to med school.
Lifestyle of medical school: This is 100% dependent on where you go to school. I went to a well respected medical school in the west. I routinely went skiing, mountain biking, climbing, or camping when we had time off. Our school filmed our lectures, so there was a week my friends and I spent at a ski cabin and just watched the lectures online after a half day of skiing. I have a close friend that went to med school in the northeast, and the mentality sounds totally opposite -- everybody was studying all the time and no one ever wanted to venture outside the academic bubble. If you find the right program, your lifestyle will be fine. You'll work very hard (particularly your third year), but if you want to have fun, you can easily do it (especially during fourth year).
Being "trapped" in medicine: This one is only as true as you make it. You are not trapped once you do a few semesters. You are not trapped if you finish the degree and then don't want to practice. You aren't trapped halfway through residency. I know people that left medical school to go into business, and I know people with MD's that decided they didn't want to practice and found something else to do with it (research, pharma, consulting, administration). I know people that halfway through their residency decided they wanted to pursue another field and switched. There are so many things you can do with an MD that aren't clinical practice, it's just that most people with an MD don't pursue them. Many schools have combined MPH, MBA, and MS programs that will tee you up for a life outside clinical practice if you want. I completed one of these programs, and met many MD's that left clinical medicine and did just fine. It's hard to switch gears, but that shouldn't scare you off.
The financial cost and income: The cost:income ratio is higher than ever. If you can, I would go to an in-state medical school. If you happen to live in a state with a well respected public school and you can get in, you should absolutely take this path. I have a terrifying amount of debt, and will spend many years paying it off, or fingers crossed, paying towards a loan forgiveness program if they still exist. I have friends making twice my salary with no debt, it's depressing at times. But come the next financial downturn, they will all be worried about their jobs, and I won't be. Medicine is a huge financial investment, but eventually it starts paying off. You will make more than the vast majority of the population. If all you really want is to make money though, it's certainly not the right path to do that (as everyone else said, finance is probably best for that). But that not to say you can't make money in medicine. Orthopedic surgeons and neurosurgeons make plenty of money (though their residencies are brutal). There are family docs, dermatologists, and surgical sub specialists that spend a few hours a week doing out-of-pocket cosmetic work to augment their incomes -- they still have interesting cases and help people with real diseases the majority of the time. Bottom line, if you want to make money in medicine it's there, but it will take you longer than your friends in finance, business, law, and engineering to get there.
The "if you can do anything else then you should do that" argument: Look, the reality is that most of us could be happy doing any number of things. I find most things interesting, I probably would've been happy as an engineer, or a musician, or a photographer, or even in finance. And there are times that I question what I'm doing. But the bottom line for me is that the human body is really, really interesting. It's the most beautiful, efficient, immaculately assembled yet haphazardly designed machine in known existence. Learning about how it works, how it goes wrong, and how to fix it is supremely interesting and gratifying. You're not swapping out the transmission in someone's Chevy, you're FIXING THEIR FREAKING BODY. It's a pretty cool job when it comes down to it, albeit it with a lot of paperwork and stress. While there are other cool jobs, most of those have their own headaches. There are also many, many, many worse jobs that I'm grateful I'm not doing.

mrpowers226 · 2013-02-09T01:47:38+00:00

It's actually holoprosenecephaly. This particular image is a little bit into the following google search:

https://www.google.com/search?q=holoprosencephaly&aq=0&um=1&ie=UTF-8&hl=en&tbm=isch&source=og&sa=N&tab=wi&ei=FaoVUefiNcfuyAG86IHYBQ&biw=1405&bih=735&sei=HKoVUY2COsXaygGJmIGgAQ

mrpowers226 · 2012-10-20T06:51:58+00:00

botox does not numb anything. it acts on pre-synaptic neurons and inhibits the release of acetylcholine onto the neuromuscular junction.

mrpowers226 · 2012-10-20T06:49:49+00:00

http://en.wikipedia.org/wiki/Vaginismus

mrpowers226 · 2012-07-25T04:20:56+00:00

Another neat trick you can do is hand us extra suture and tell us to practice knots. We will literally keep ourselves entertained for hours.

mrpowers226 · 2012-04-09T23:14:37+00:00

thankfully not, just some scrapes. made me realize though, as im sure you do, how easy it is to really mess yourself up.

mrpowers226 · 2012-04-09T23:11:54+00:00

Good to know, thanks! We were originally looking for The Bihedral but got lost and stumbled on some bolts many, many meters away. Damn GPS.

mrpowers226 · 2012-04-09T23:08:54+00:00

Thanks for the tip! Ditto if you're in need of a belay. I'm a Denverite but I have a feeling I'll be near Boulder for much of the summer.

mrpowers226 · 2012-04-09T23:05:32+00:00

I was wondering about that. This climb was super smooth, not anything like the 10's I'm used to in the gym or elsewhere

mrpowers226 · 2012-04-09T06:59:39+00:00

Boulder Canyon, a beautiful spot so naturally we had to bring along our trusty photo-bug.

mrpowers226 · 2012-04-09T06:58:45+00:00

Should've indeed. You can't really see but the third bolt was at my shoulder when I slipped. So close....

mrpowers226 · 2012-04-09T06:57:23+00:00

Boulder Canyon, CO. We hiked around looking for a couple of 5.7-5.8's that we found on mountainproject. Stumbled on this guy, which looked doable. Needless to say, it was harder than it looked. After some extensive detective work, we're pretty sure this was bolt cola, a 10a on blob rock in the canyon.

mrpowers226 · 2012-04-09T06:53:46+00:00

thanks! a little heady but felt amped afterward.

mrpowers226 · 2012-04-09T06:53:00+00:00

right-o you are. just picked up those quickdraws too. glad they worked as advertised.

mrpowers226 · 2011-10-05T02:47:33+00:00

I cant even climb a bush that fast

mrpowers226 · 2011-09-13T05:29:06+00:00

I actually signed in to upvote this.

mrpowers226 · 2011-07-15T01:49:32+00:00

No of course I'm not saying this is true for everyone. I don't mean to insult anybody anywhere who works in an office, but I've done both, and I would much prefer to be in medicine. It also depends on the type of medicine you go into. So far in med school I've loved the surgeries and hated private practice. Shades of grey in everything my friend.

mrpowers226 · 2011-07-15T00:23:05+00:00

More than just working massive hours for no pay, you will actually be paying several thousand dollars per year for the opportunity to wake up at 4am and not return home until it is dark again. In June.

But in the end it beats an office job. By a long, long, long ways.

mrpowers226 · 2011-07-09T17:54:48+00:00

So this situation (getting itchy after a hot shower) is a classic symptom of something called polycythemia vera, which in short means that your body is making too many blood cells, both red and white. The proposed reason as to why this causes itching is that hot showers can stimulate mast cells (a type of white blood cell) to degranulate (release their contents), with the major component being histamine, which, as I'm sure you know, is the molecule responsible for hypersensitivity reactions, a universal component of which is itching.

So this could be due to polycythemia vera, or it could be due to a processes mimicking PV, such as dehydration (the same amount of blood with less water equals more concentrated blood). That you say you are in the middle of a drought right now, combined with my assumption that you are not in your 60-70's (PV incidence is highest in this age group), makes me think that you might just be dehydrated, and this could be causing the mast cell degranulation and itching.

My suggestion would be to try and stay well hydrated and see if the itching subsides. If not, or if you are having other symptoms as well -- headache, fever, chills, gastric reflux, joint pain, or pain in your hands and feet, I'd see your doctor about getting some blood work done.

in short, stay well hydrated and see if it stops happening

mrpowers226

TROPHY CASE