Ophthalmology

[Jordan421]

I wanted to start a thread as there are very few threads out there for Ophthalmology PAs, and wanted to be a source of information for those interested.

I have been working in Ophtho for about 1.5 years, this was my first job out of school. This was not the specialty I was interested in coming out of school. I had zero experience. Initially it was ER or Surgery. But my wife got accepted into PA school shortly after I graduated. So I needed an 8-5 job while my wife was in PA school, and I took on the kids full time. I found it, sent resume, and hired on.

I graduated from the Interservice Physician Assistant program and we received about 10 classroom hours for Ophtho in school, and did a two week rotation in the field as well. This was my only experience, the hiring physicians understood this was going to be a learning curve. I spent the first 3 months shadowing and acting as pretty much a student. I spent the evenings study, reading, etc (I still do this quite a bit). I practiced slit lamp/fundus exams on the staff constantly.

After 3 mos, I had my own clinic starting with about 15 patients a day. My physician team made it very clear to me they would help with any patient at any time (I asked a lot of questions at first). Never one time, have they been bothered by questions/consults daily. Now I am down to a few a week.

I manage dry eyes, glaucoma, diabetic, macular degeneration, triages, preop/postop surgery, interpret ocular testing, etc.

Perform I&D for styes, remove corneal FB, remove periocular lesions, assist in blepharoplasty/ptosis repair, punctal plugs, punctal irrigation, conjunctiva and intravitreal injections.

Lots of cosmetics - botox, fillers, threads.

Currently working on getting approved to run lasers for glaucoma/diabetic management, pre-cataract surgery.

I see about 40-45 pts per day. I utilize 3 exam rooms, and have 3 scribes/work up techs. 90% of my notes are closed as I am walking out the room.

Pay: $225,000 (100K Salary, Monthly Bonus based on net receipts). I get 20% of -net receipts minus three times of my monthly cost to practice (10K*3=30K). My first year net receipts to practice approximately 990K. (Of note: my first 3 mos working while shadowing I accepted a 50% pay cut - basically a very fast paced mini fellowship).

PAs in Ophthalmology can bring a role that optometrists cannot necessarily fill (can be state dependent). I feel there could be a huge potential in growth in this field, if a supervising ophthalmologist is willing to take the time to train the PA.

I got very, very lucky with this being my first job. I love it, and have no plans to go elsewhere. I have a very supporting group of Physicians that treat me very well.

I am open for any questions about the field...

[LAWPA]

As a brand new Ophtho PA starting my first job, I appreciate this post. So far, my own early experience has been exactly as you described - I’m still in the “like a student” phase, with a clinic plan for moving to my own limited schedule with lots of backup available over the next couple months.

One question I would have is how in the heck is your monthly cost to practice only 10k?! Payroll/benefits for 3 technicians, other shared support staff, plus materials/facility costs, that just seems ludicrous! Based on your annual production figure, that’s an overhead cost ratio of ~12%!

 

[WinstonSLC]

On 11/15/2021 at 7:53 PM, Jordan421 said:

I wanted to start a thread as there are very few threads out there for Ophthalmology PAs, and wanted to be a source of information for those interested.

I have been working in Ophtho for about 1.5 years, this was my first job out of school. This was not the specialty I was interested in coming out of school. I had zero experience. Initially it was ER or Surgery. But my wife got accepted into PA school shortly after I graduated. So I needed an 8-5 job while my wife was in PA school, and I took on the kids full time. I found it, sent resume, and hired on.

I graduated from the Interservice Physician Assistant program and we received about 10 classroom hours for Ophtho in school, and did a two week rotation in the field as well. This was my only experience, the hiring physicians understood this was going to be a learning curve. I spent the first 3 months shadowing and acting as pretty much a student. I spent the evenings study, reading, etc (I still do this quite a bit). I practiced slit lamp/fundus exams on the staff constantly.

After 3 mos, I had my own clinic starting with about 15 patients a day. My physician team made it very clear to me they would help with any patient at any time (I asked a lot of questions at first). Never one time, have they been bothered by questions/consults daily. Now I am down to a few a week.

I manage dry eyes, glaucoma, diabetic, macular degeneration, triages, preop/postop surgery, interpret ocular testing, etc.

Perform I&D for styes, remove corneal FB, remove periocular lesions, assist in blepharoplasty/ptosis repair, punctal plugs, punctal irrigation, conjunctiva and intravitreal injections.

Lots of cosmetics - botox, fillers, threads.

Currently working on getting approved to run lasers for glaucoma/diabetic management, pre-cataract surgery.

I see about 40-45 pts per day. I utilize 3 exam rooms, and have 3 scribes/work up techs. 90% of my notes are closed as I am walking out the room.

Pay: $225,000 (100K Salary, Monthly Bonus based on net receipts). I get 20% of -net receipts minus three times of my monthly cost to practice (10K*3=30K). My first year net receipts to practice approximately 990K. (Of note: my first 3 mos working while shadowing I accepted a 50% pay cut - basically a very fast paced mini fellowship).

PAs in Ophthalmology can bring a role that optometrists cannot necessarily fill (can be state dependent). I feel there could be a huge potential in growth in this field, if a supervising ophthalmologist is willing to take the time to train the PA.

I got very, very lucky with this being my first job. I love it, and have no plans to go elsewhere. I have a very supporting group of Physicians that treat me very well.

I am open for any questions about the field...

You did IPAP but didn't go into the service afterwards? How did you go straight to a civilian job? Just need clarification. Ophthalmology sounds really interesting though

[kidpresentable]

This is awesome. I might be interested in trying to break into ophtho myself, but I never see postings, so I assume I’d have to do a lot of self-promotion. A couple questions I have:

Do you do injections for macular degeneration?

How would you respond if a hirer said, “We were really looking for a surgeon”?

[LAWPA]

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Do you do injections for macular degeneration?

Some PAs do perform intravitreal injections (IVI) for wet AMD, diabetic retinopathy, or other pathologies. Unfortunately many of these conditions require ongoing injections every X weeks on a tight schedule. IVI is relatively new (~2006) and has revolutionized retina practices - and PAs have been one of the methods for adjusting to the tremendous number of injections required.

Quote

How would you respond if a hirer said, “We were really looking for a surgeon”?

If a practice is busy enough to have another surgeon...well then it needs another surgeon. Hiring a PA doesn't change that. However, a trained PA can enable current surgeons to spend more time in the OR.

Quote

I never see postings, so I assume I’d have to do a lot of self-promotion.

Correct. Many ophtho practices will default to hiring optometrists if they look for non-physician providers. Looking for those job listings and reaching out to practices would be a more likely way to generate opportunities.

[Billdog29]

Thanks for sharing your experiences. I’m in my first year of PA school and worked ~2 yrs as an ophthalmic tech/scribe prior to PA school.  I loved the field and am very interested to get back into it. 
 

For those PAs and PA students interested in searching for employment/practice in this field, it seems it depends on 2 things:

1. A very supportive Ophthalmologist who understands the role a PA can play to expand her/his practice and who is willing to teach you. You need to find this physician - go network among them, ask your pharm rep connections who they know, ask your PCP and provider friends for an intro. 

2. Your willingness to take on more “schooling” and less pay for a while to learn the field. 
 

There is a real gap in this field in many states where Optometrists are not permitted to perform certain procedures. PAs can come in to help the Ophthalmologists expand their specialty by giving them more time to do it. 

I’d love to learn more from the Ophtho PAs out there about what their contracts look like - similar to the one mentioned above? Are you doing hospital consults too?