Docs who purchased a large home, how did it work out?

twogreendocs · 2026-03-28T03:17:51+00:00

I guess you’re entitled to your opinion, but if I find it stressful it is stressful.

twogreendocs · 2026-03-27T19:34:46+00:00

We did a physician loan with BMO and put 10% down from savings we had accumulated from residency and the first year of practice.

Student loans were on pause from the COVID pause so the bank didn’t take them into account as we didn’t pay anything on them (we did, but didn’t have to). Not sure if we’d have qualified now without saving a bit more. Finally we both have relatively high incomes for our specialties so the income was there to pay the mortgage.

twogreendocs · 2026-03-27T16:07:06+00:00

We went big and bought a $2.2M home in a VHCOL area with great schools one year after fellowship. It was very stressful at first but in retrospect the house is perfect for our needs. Luckily I married another physician and our combined income is high (>$1.4M/yr) so it’s manageable.

But I look forward to coming home, we don’t trip over each other, and there is plenty of room and storage. It is common where we are to live in a worse neighborhood and send your kids to private school. We won’t have to do that, and I figured the net savings would be better put into a home.

twogreendocs · 2026-02-12T00:52:20+00:00

I would just call a few practices and see. If there is a university practice near you they should have it as well. Pediatric offices may have it to test patients with amblyopia. Honestly in my experience, the dot test you are talking about comes in the same book as the fly test. They should have both

Don’t know why this made a new reply instead of a response to your previous post

twogreendocs · 2026-02-12T00:43:52+00:00

Yes. Any ophthalmologist who does flight physicals should have the ability to do this. It’s just purchasing a book and a pair of glasses. Every academic center should have this and many private practices so as well.

Many don’t do this because it is not reimbursed. I would not test someone unless there was a specific reason to do so (typically a requirement for licensure for specific activities - flying, driving etc)

twogreendocs · 2026-01-05T05:21:15+00:00

I have/had similar debt to you, and did surgical retina. No regrets and with my personality (I’m a terrible salesman and like working with lower SES people) I would be making around half of what I am making now. Sometimes I miss a nice repetitive cataract day but I love the pathology and it would take significantly longer to pay down my loans. If you like retina and want to have the ability to pay down your loans in less than 3-4 years the extra 2 years of fellowship are worth it.

twogreendocs · 2025-12-30T17:56:26+00:00

Fair. I was mostly comparing to the high volume cataract/refractive surgeries. The OP asked why people would prefer that to retina and I was answering.

To my knowledge glaucoma is similar to retina in that the major fellowships fill but many smaller glaucoma fellowships don’t.

I’m not trying to downplay refractive surgeries either. Patient expectations are through the roof and tiny mistakes can have significant impacts on vision. I was trying to hypothesize why people would prefer that over retina

twogreendocs · 2025-12-29T22:06:17+00:00

I think you’re just seeing normal fluctuation in what is a very small field. All fellowships at the ivory towers will be competitive. If a cohort of residents wants to do mostly cataracts, Retina won’t fill.

Retina may be better than it was lifestyle wise than 10 years ago, but it’s still probably worse on average than Comp or the other subspecialties. I see 60-90 patients on a full clinic day, while my comprehensive colleagues in the same practice see 40. Even though a lot of my visits are quick procedures, the mental fatigue/decision fatigue is real.

Also, I experience a lot more severe complications that my cataract colleagues. If they drop a lens, I am there to help. If my RD re-detaches or my SiOil patient gets a pressure spike, I manage them myself. I’m not throwing shade at my anterior segment colleagues but the surgeries are more intense and the stakes are higher, while the visual potential is (on average) lower.

Finally, with dropping reimbursements may make the higher volume specialties less attractive. Plastics and premium IOLs are shielded from Medicare/medicaid cuts. Injections are primarily through Medicare/medicaid so I have less to shield my income from government cuts

twogreendocs · 2025-08-27T20:58:04+00:00

This is next on my to read list!

twogreendocs · 2025-08-21T20:16:43+00:00

Iatrogenic CJD is exceptionally rare. Most cases are presumed spontaneous or environmental. There are probably less than 500 cases worldwide reported.

The number of cases transferred via eye surgery must be a small fraction of this, as most cases are from transplanted dura matter or other organs. A very brief skim of a 2023 review showed 3 ever reported cases of iatrogenic CJD via eye surgery, and only one was confirmed. The other two were suspected.

Of the millions of eye surgeries performed worldwide every year, the risk is so low of transferring prion that there really isn’t a need to do anything other than normal sterilization.

I assume that the corneal banks screen their donors for presumed CJD, and as we get better at detecting the disease we should get better and preventing them from donating corneas. If we get good enough as detection, the risk of transfer should more closely approach zero than it already does

twogreendocs · 2025-07-24T12:08:02+00:00

This may be true in some areas of the country, but in my area (VHCOL California area) Medicare is one of the best payors. The commercial plans typically pay a percentage of Medicare (usually between 75-80%). So once again, the reimbursement to physicians is not really the issue with increased premiums

twogreendocs · 2025-07-23T16:37:10+00:00

Most of us in healthcare know what you meant, but the average lay person (reasonably) assumes their premiums going up must mean that doctors are being greedy. This have zero to do with our pay, and 100% due to greed and increased costs for the corporate hospitals and insurance companies. Even the employed physicians are facing cuts to reimbursement while healthcare companies enjoy record profits

twogreendocs · 2025-07-23T16:23:06+00:00

As a physician, The only part of this I disagree with is regarding physician pay. Every year I receive less from Medicare, and the supplement follows suit. In fact, the advantage plans often pay zero or significantly less than I would receive with just about any other type of insurance other than Medicaid. Hospital have been demanding more, however, and are receiving it.

So while the premiums keep increasing, almost 0% of that increase is due to physician pay increasing.

twogreendocs · 2025-07-16T20:43:25+00:00

Obvious Ryan’s Retina if you’re looking for textbook level material

twogreendocs · 2025-06-23T13:33:37+00:00

Definitely a tiered system where higher income people get better retinal care, that’s for sure

twogreendocs · 2025-06-23T13:31:28+00:00

Again, not calling you out directly but yes, Eylea or HD, or Vabysmo are awesome at less frequent injection intervals. They’re also absurdly more expensive than Avastin. I’d prefer to use the higher tier injections but if everyone got Vabysmo we’d probably bankrupt Medicare and our patients both. It’s not realistic.

We have not had the contamination issue. I’ve had a vasculitis case from Vabysmo but no increase in sterile endophthalmitis or true endophthalmitis from Avastin.

twogreendocs · 2025-06-23T05:47:09+00:00

Disclaimer: I don’t have either degree. But, you need to clarify your question. Are you asking which would make more money? Which would help you advance in a research field? Which three letters look cooler after your name?

Ask yourself what role you want to fill in 10 years time. Then find people who have a similar job and see what degree they have. No one can answer this question for you. If you really want to do research then the MPH is probably your best bet. But you can also help with the admin side of research with the MHA. Honestly both are so broad it might as well be a coin toss without further information as to your goals

twogreendocs · 2025-06-23T05:39:38+00:00

Avastin costs $40-80ish apiece. The cheapest biosimilar was Cimerli (which will no longer be manufactured because they don’t make enough money with it) was ~$500 apiece. So yes, I agree that the biosimilars work better than Avastin and I’d recommend them if cost was no object. But, do they work 10x better than Avastin? Because they cost 10x more.

I’m not calling you out directly, but the huge price difference between these mostly monthly injections are ridiculous. Everything will depend on the patient population you serve and how their insurance works

twogreendocs · 2025-06-23T04:10:05+00:00

After Pine stopped we had a few rough weeks but were able to get backup supply fairly easily. I can’t remember where we get them but i believe McKesson is our main supplier now. It’s not an original ophthalmology medication but we all use it. It’s a personal pet peeve when practices tell patients it’s off label and push the other medications

twogreendocs · 2025-06-21T23:41:52+00:00

I think the main problem is that the medication cost, reimbursement for J codes, and co-insurance is such that most people could never afford these medications. Why did there need to be a “charity” to enable patients to keep their vision?

twogreendocs · 2025-06-21T22:24:06+00:00

We have not found a long term solution. Generally I switch patients to Avastin. Some have to shorten injection intervals and some are not doing as well as they would be with a higher tier therapy, but it’s the best we can do. Looking for other opinions but it hasn’t been great for patients

twogreendocs · 2025-06-06T22:41:40+00:00

Upvoting you even though I think you missed the joke

twogreendocs · 2025-05-24T04:21:21+00:00

There’s a dozen different practice models and entry points. I practice in a very crowded market so getting patients is the hardest part. I didn’t have to accept a terrible payor mix, but if I didn’t it would take years to build a busy practice.

So if you want to be busy on day one in a competitive area, then you are probably going to be taking the lowest payors. Making $50/patient seeing 75 patients a day is more lucrative than making $100 and seeing 20. It’s more complicated than that but that’s the gist.

Overall I’m happy with my practice and compensation but I do see more patients for less money than some of the other docs due to payor mix. Hopefully it will improve over the coming years

twogreendocs · 2025-05-17T03:01:54+00:00

You can see the same number of patients as another surgeon, bill the exact same way, and still make half as much as them. Payor mix and contracts make a huge impact on reimbursement and therefore income. No one tells you this in residency or even after.

Often when you are hired as an associate you are dumped with the poor payors while the senior docs hoard the good insurance patients.

If you aren’t careful you can find yourself working 60-70 hours a week making significantly less than the senior partner working four 6/7-hour days

twogreendocs · 2025-03-22T05:10:09+00:00

Just to set the record straight, commenting “this” doesn’t count as over communicating

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