Ophthalmology

It has been a while as I have been working long, long hours on ophthalmology. I find it fairly interesting but I do not think that I would like to spend my entire life in the limited field of ophthalmology. Let me explain. Basically we do clinic hours all day long from 8:00 am to 8:00 pm on wednesdays we do minor procedures in the afternoon. These include minor surgeries on or around the eyes like mole removals and eye lifts (cosmetic and out of medical necessity). Also we do removal of different lesions on the eyeball itself. On Fridays we do surgery in the afternoon evenings. These include retina, corneal surgeries, cataract removal, and other complex eye surgeries. 

Basically ophthalmology has a narrow scope of pathology and the patients also fit into a narrow category. By the time a patient comes to see an ophthalmologist besides basic check ups they have serious disease. These are patients with glaucoma, end stage diabetes macular degeneration, and on the milder side cataracts. For more serious procedures a corneal or retinal specialist is required which is additional training beyond general ophthalmology and limits the practice even further. Also the training in ophthalmology is not very applicable to day to living. If someone goes down on a plane or in public an ophthalmologist would not be the best equipped to handle the situation unless it involved trauma to the eye and even then many  other fields are also trained in managing trauma to the eye. Another issue that ophthalmology is facing is the turf war that optometry has been fighting. Optometrists are lobbying and trying to encroach on the practice of ophthalmology. Often the public is unaware of the differences which adds to the issue. Obviously there are many areas of ophthalmology that optometrists will never be able to touch due to the fact that they did not go to medical school and they can't do surgery.

What do I like about ophthalmology and why is it a competitive field? Well it is all about pay and lifestyle. A practicing ophthalmologist has very light hours and rarely emergency calls in the evening. Also they make decent money but this has been declining over the past several years. Ophthalmologists were one of the highest paid specialties in the 80's and early 90's but the reimbursement has dropped significantly where today they do well and better than average but they are certainly not one of the higher paid specialties anymore. Another good thing about ophthalmology is that it is procedure based and there is some surgery involved in their work. Also they get to sit during surgery which is nice. The surgeries are obviously confined to the eyes. 

I like doing this rotation and it has been interesting to learn and see what ophthalmologist do. I have become proficient at doing eye exams, glaucoma screening, dilating eyes and using the slit lamp to examine eyes. It is actually not that difficult once you get the hang of it and it is not to complicated to see the pathology that affects the eye. You are looking at a very small area and so any disease sticks out well. You look at the blood vessels in the back of the eye, the lens, the cornea, retina, optic disc, optic nerve. I have also done a few ultrasounds on eyeballs to detect retina detachment.