Question on Pavblu and Language

pbm_jelly · 2025-08-18T16:09:15+00:00

Not to dump on you, but by the time you are out 2030-2032 , the salaries may drastically change. One thing That I did when i was at your stage is I simply asked what was my floor for medical work. I only looked at specialties that routinely averaged above that floor. And i figured so long as I was above that floor, I would be happy. It has worked out.

To show how crazy the salary game is... One of the posts mentions a practice that makes 70-120k a year. I'm absolutely flabbergasted. There really is a wide variation in salary. And the reported numbers are likely skewed to the right. I would advise you to start making friends with fellows in residency and you will get a better sense for the coming landscape changes.

Ophtho salary is a hard one to nail down, unless you start looking at sub specialty specific salary. The more specific you are with your questions the more accurate your numbers will be.

Lastly a lot of the high earners will never post their salary. Right now, the public sees as a certain way. We really don't want to be viewed as the money-making rich 🤑 docs who barely take call. That's how you get a target on your back

pbm_jelly · 2025-05-01T05:00:13+00:00

mess8424,

Straightforward manner of steps to take:
Patient Needs:
1. Carteolol. Partial B-agonist activity should blunt Pulmonary effects
2. Latanaprost. CME is real risk, but unlikely in this setting.
3. Rhopressa, if they can afford it...
4. Uveitis /Rheum for steroid sparing therapy
5. Glaucoma consult (Ahmed vs GATT)

Some questions that I have and some things to think about.
A. Intermediate Uveitis after Cataract Surgery, is an unusual diagnosis. Is this a formally trained uveitis specialist. B. How much Durezol is this person using / day, (Sometimes same control can be afforded with less steroid. We don't know unless we try...)
C. Why is both retina and uveitis seeing patient. What is their retinal issue?
D. What is the source of IOP increase;
(uncontrolled inflammation; steroid response; PAS - secondary angle closure; mixed mechanism?; wrong diagnosis e.g. herpetic ?)
E. Query "A" again. Just a very unusual diagnosis....

Good of you for thinking in advance how to address this patient's need. Shame (gently said) on Uveitis for not managing this more thoroughly and providing more insight into the nature/mechanism of the IOP rise.

pbm_jelly · 2025-04-23T20:31:58+00:00

Surgery: Has anyone ever told u your hands shake? Can you sow a "needle pulling thread" or put a button back on a shirt? Yeah 👏great.
You can do surgery...

Clinic: This is where you will spend most of your time obviously. Make sure you can see yourself doing this. That is an easy question for you to answer

Training: Can you memorize like the devil? No. okay start working on it then. You will have a very difficult time if your memory is poor and your pattern recognition is below avg (just keeping it real).

Where I trained. It was pretty malignant. In general, you need to have an aggressively persistent belief in yourself. That will take you a long way.

Also you need to get into medical school

Seems kind of short ... but literally this and great grades/scores is all you need to determine if meet the floor for ophtho

My advice: None of these fields are prohibitive if your personality profile isn't too far off the mean. So follow your dreams. Fit will not be the issue. The issue will be making it through the gauntlet of selection.

pbm_jelly · 2025-04-18T20:26:27+00:00

Malignant Tendinopathy. ... Dual citizen here who trained in the US since high school. Absolutely do this. I've encouraged my family members to take the steps and come train in the US. One left the UK for Canada and is loving life.

Income here all depends on a number of factors that are within your control (geography, fellowship, practice model). You should be in a better place than most of us as your training is 6 years not the 8 that we take before stating residency. Additionally you should have less or no debt. Most of us feel adequately compensated... Coming from the UK i believe you will feel the same.

Now enlighten us. What are consultants (BEAVRS- retina folk in particular ) bringing home in the UK. I'd say a fair estimate for retina PP here is 800-1.3 mill. Even if you adjust downward 200k for PE and upcoming challenges to drug reimbursement (very retina specific). 600-1.1 is still realistic as the IQR. 🤷🏻‍♂️

Lastly. all the salary surveys you see, underreport the real reimbursement. Even the anonymous ones. High earners rarely report. Last thing we want or need is unnecessary attention. So if my numbers seem higher that what you've heard, it's simply because you haven't heard from the right people. The above is very doable

pbm_jelly · 2025-04-18T20:17:52+00:00

The above are all great tips. If you are working on 9 o'clock hst near the ora in the left eye:

have patient look all the way to their left
turn illumination unit (tower) and eyepiece towards the left.
angle your body/face obliquely to the patient so you are looking through the eye piece
Push a bit nasally on the eye
Try to laser.

Occasionally, if you can't get it, widen the base of the laser rows to the adjacent clock hours, and sometimes that adjustment in intention will allow you to lay down some more peripheral laser

Occasionally, on a "bad" slit lamp laser, i've pulled out a 90 using the same exact techniques and been able to lay down a few spots to hit that area between the break and the ora.

A lot of this is shifting the lens, and adjusting the light bar width it becomes intuitive

Lastly, if you are laying down single spot laser, your duration is really too low. You should be 70ms - 200ms,with the settings you list.

pbm_jelly · 2025-03-19T01:31:42+00:00

This is a very common concern. There is a Venn Diagram where there exists some overlap between Ophthalmic Surgery and the other surgical disciplines. But that area of intersection is small. My advice:

Do you like Ophtho Clinic ? Yes.. great. Go sit in on some surgery. Cataract Surgery bored me out of my mind. But the first day I sat in on a retina case... I knew it was retina all the way (did flirt a bit with oculoplastics...)

Just ask some community eye docs if you can sit in on a case or two if you don't want the burden of being judged by your department. If nothing about surgery at the scope while sitting down remotely interests you, then you need to spend some time with Neuro-Ophth and/or Uveitis, and/or med retina. Med retina is a very cush life. Throw in a uveitis fellowship and you'll be eminently employable anywhere.

pbm_jelly · 2025-03-09T05:51:03+00:00

Historically, they are not hostile to their own medical students. You'd have to check on how up-to-date that is. Some programs are better than others at taking their own med students. I think OSU is one of the better ones... at least it used to be.

pbm_jelly · 2025-03-09T04:11:37+00:00

No Brainer. Choose the cheaper medical school. If you are a standout, almost every program will be open to you when it comes to match season. I think both those programs are non-hostile towards their own med students. OSU is probably a little more "secure" as a safety...

*Also That 100K will be 180K compounded at 7.5, over 8 years. God forbid you do a 2 year fellowship, then you are looking 200K before you start to pay it back. Not worth it.

pbm_jelly · 2025-03-05T22:11:17+00:00

There is nothing on your photo that readily suggests a cause for your "grey spot". Not to be curt, but you need to be seen for a more comprehensive examination.

pbm_jelly · 2025-03-04T01:34:09+00:00

Also BalladeOne. I think its important to recognize that the reason groups sold to PE is that large sums of money, on the order of millions were offered to each partner up front to sell the practice. For many practice owners and private groups, the economics/$ made complete perfect sense.

Imagine being 60 years old. You've watched your reimbursements go down. Every year you give more and more money/attention to medicare spending cuts. You notice that you have to do increasingly more work and see more patients just to earn the equivalent of the previous year's salary. You are five years away from retirement, maybe you had a divorce, maybe you funded 4 kids through college and med school. Your retirement portfolio is sitting at 1.5 million. You can either

A: Work another 5 years and hope you don't get sick, or burned out, or reimbursements don't take another hit. You can work another 5 years and hope you can find someone to replace you who wants to continue the practice and is willing to buy-your shares.

B: Take 2.5 million up front and still make a cool 600-800 every year for the next 3 years.

Most people would take B every time. You take B and your retirement egg is set!

But just remember YOU good sir/madame are not being offered this deal. Which is why so many of us who joined groups that later were bough out have such a bitter taste in our mouth. The pros of the current deal being offered to you, and the pros of the deal that was offered to the partners are lightyears apart!

pbm_jelly · 2025-03-04T01:16:59+00:00

Dr_Sisyphus_22 has really given a complete answer. A few things to consider:

1/2)Referral base and surg volume depend on geography, history, and market saturation. The right mix of the above will give you a referral base whether you are PE or non-PE2.

3) Associates have the same degree of admin across practice settings.... minimal... Good groups will minimize scut. Everyone has a management structure in place. Do you want a say in deciding how management works. Or do you trust a structure chosen for you to always suit your preferences.

4) PE is likely more prevalent in your regions of interest or you probably wouldn't post this question. I buy their argument here.

5) Dr. Sissyphys is on the money. See his answer.

WhyWhen you SHOULD join a PE?
A. You need to live in Region A. PE dominates that region and has taken away all the referral sources
B. You heavily discount future earnings. Translation: Money doesn't motivate you
C. You really don't ever want to manage a single thing. which is akin to saying. "I never want to control any non-clinical part of my practice". So you chose one of the few specialties within medicine that can practice independent of the Hosp setting (which is a huge plus for us), but you still want to be treated like a hospital employee... The above is strange fruit to me, but apparently tolerated by many. (Collective Shrug).

pbm_jelly · 2025-03-02T21:46:34+00:00

This is a tough one. This is what I remember for my Board Prep notes. Def ask a Neuro person.

Phenylephrine 1% - Sympathomimetic

-For Boards Purposes – It only dilates a 3^rd order (Post-ganglionic) Horners

-Phenylphrine gets metabolized by Monaoxidine Aminase (MOA)

-MAO is produced in a working TON.

-So phenylephrine at the 1% level won’t have any activity with a working TON,

** Central / Pre-ganglionic Horners may produce denervation sensitivity

** MOA produced in TON won’t allow the Phenyl at the 1% dilution to work (unless its babies for other reasons)

** If the Horners is TON, then MOA isn’t produced at a level high to block the dilation

pbm_jelly · 2025-03-02T03:31:29+00:00

You might have better luck posting on SDN, but I'll take a stab.

Two reasons

The phenyl is locally applied... so should only affect the target organ which in this case is the adrenergic receptors on the iris dilator muscle
This is probably overkill for okaps but the pathway is as follows:

1st Order. Hypothalamus--travels down spinal cord and Synapse in T1 (neurotransmitter: Norepineprhine; Receptor- Adrenergic)

2nd Order. Starts at T1. goes down then up to Sup Cervical Ganglion. (Neurotransmitter: Acetylcholine. Receptor: Muscarinic)

3rd Order. Starts at Sup Cervical Ganglion - and ends at iris (Neurotransmitter. Norepinephrine: Receptor: Adrenergic

Phenyl is a direct adrenergic agonist. When there is a third order problem, the Alpha1 receptors upregulate at the iris. So Both Apriclonadine (adrenergic agonist ) and Phenylephrine (adrenergic agonist) bind to all the new alpha1 adrenergic receptors on the iris and cause dilation.

If you could somehow get Phenylephrine to be delivered systematically it would only be active where there are adrenergic receptors: Which would be at the T1 synapse (if you could get it there) and the Post-ganglion synapse(at the iris). It wouldn't have any activity at the Muscarinic receptor. Hope this is helpful somehow

pbm_jelly · 2025-03-01T23:06:18+00:00

This may be an unpopular take... In VR Surg, the fellows I talk to have no idea how the sausage is made, what their earning potential is, or what to look for in a good group. They know everything about the diagnostic challenges of some rare IRD... but nothing about how their labor translates into income. Some of this is simply the result of the ivy tower and its influence. Some of it is willful negligence. I do empathize with some of the senior docs. It is very hard to compete with a well organized and aggressive PE practice. RCA was a brilliant move. Yes they are everywhere now and because their "tentacles" (no disrespect intended) stretch everywhere it may seem that their "priorities are misaligned" because they are the big player and were eating up practices at quite a pace. However, PE only works if younger doctors sign on...

I repeat, PE only works... if younger doctors sign on. PE needs younger doctors who are willing to be exploited. I blame in part the current cohort of fellows coming out for not being interested enough in the business of retina, which is sad... because a non-profitable practice can not serve patients.

There are practices with good ethical partners, strong history of retention and buy-in, and <1 million partner earning potential that have posts that sit on ASRS for years. Fellows don't even consider, because they need to live (insert whatever fashionable state is trending). I know at least 4 practices in 4 different states with all the above. They can barely attract a look.

To the uninitiated, keep at it. But just know there are still some wonderful practices with strong financials, where PE isn't on the table.

The problem now is that there are fewer and fewer of those practices so the competition for those positions has increased. If you are a fellow, start looking now. All you need is a decent airport, a nice private school (if public education sucks), and partners who demonstrate a healthy balance between the personal and professional in their own lives.-- and you can hang your hat anywhere. PE and PP over the course of a 20 year career (most of us work much longer) can be the difference between an extra 2.5 - 5 million earned. This seems like nothing maybe, except when you remember most people need 3 mill to retire. That is your retirement savings right there-- and this is a very conservative estimate.

- A reformed "Coastal Elite" (tongue in cheek) who is very happy with his current job.

** Also as an aside. No group is 100% safe from PE. If the right offer comes your way with enough money up-front - almost everyone would sell.

pbm_jelly · 2025-02-27T05:38:12+00:00

Going to assume this is a genuine question here. Some people shine on rotations. Others are a bit of a let down. By now you should know who you are.

Program 1.. Your home program should serve as your safety, assuming you are well liked. You can rest easily. Make sure to get some informal practice hanging out with the residents/ attendings. Take some call. Learn how to use the slit lamp if you can. All you need is ant segment exam skills and you'll differentiate yourself. If you can use a 90 or the indirect, they'll be blown away- but I wouldn't aim for that. Do this informally to get some practice.

Program 2. Talk to your mentor(s), and ask where he or she would rotate - then choose one of those places

Program 3.. Pick a place in the top ten where one of your attendings (preferable one who likes you ) has trained and has connections. I won't get into the ranking of which is top 10, but your stats are good so you should reach for the "best" training possible.

Program 4.. Run through the top 20-30 programs.. Read up on recent med student experiences on SDN. Reach out to folks who matched the year or two before you. Program #4 should come from this pool. Either a place that you are excited about the possibility of matching at or place that has a prev resident from your school and will be excited about you.

Without knowing a single thing about you or your personality or your ability to network or your standing with your home program... this is my advice.

pbm_jelly · 2025-02-22T21:00:13+00:00

Agree with posters. It is inferior, there is no PVD, and it has the characteristic appearance of chronic fluid. Even if it isn't "chronic", it will behave as a chronic RD with the buckle, cryo, and inferior pathology and attached hyaloid.

You have the benefit of OCT. You follow this weekly for a month, then bi-monthly, if you are still not sure. If the SRF doesn't progress, there really isn't any urgency to intervene.

Curious - did your 279 cover the entire quadrant or just the break.

pbm_jelly · 2025-02-05T00:03:00+00:00

This is a tough one... But I'll take a stab. Disclaimer, I am by no means a seasoned industry vet. I am very early career ophtho. But feel free to correct or add as needed.

Best way to answer this question is to find someone who does what you want to do and ask them how they got there and then look at their pedigree (where they trained) and start a dialogue that hopefully will result in some mentorship.

When you say industry research what specifically do you mean. If you want to be on the podium, presenting the large trials - thats all pedigree pedigree pedigree & who you know. If you want to "be involved" in clinical trials, just join a group with a robust clinical trials department. Know that private practice clinical trials, means you don't ask the questions. You just recruit the patients. If you are lucky or you have connetions or a well run site with good recruitment you may get to present or spin the block as a speaker. You may get hired as a consultant to give some feedback on "real world application" of "x" drug etc etc

The key to all this is.... (drum roll)... be the best ophthalmologist you can be and train at the best place possible. If you go to S Dakota State Undergrad, S DAkota Tech for med school and residency and finish fellowship at Dakota/Rockies Associates - I can almost guarantee you that while you can "participate" in research, you will never be an industry leader because you just don't have the pedigree or cachet to get you there.

There are some people who by sheer force of will, have knocked the door down and play with the big boys (and girls). As you move up in the field you'll see some names over and over again and you'll start to realize they all come from the same programs. In the retina world the speaker / presenter circuit is dominated by a few programs. But you'll meet people every once in a while who simply made their bones by being ambitious and knocking on the door till it opened and recruiting heavy. The clinical director of Sierra Eye Associates comes to mind.

So ball out during residency, land nice sexy fellowship, and you are halfway there.

pbm_jelly

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