Ophthalmology Career Pros & Cons: Is It Right for You?

Are you considering a career as an ophthalmologist? With so many specialties to choose from and your future on the line, it’s one of the most challenging decisions medical students have to make.

This guide will cover the pros and cons of becoming an ophthalmologist, from the massive patient volume to the high success rates of cataract surgery and grateful patients.

There are so many different factors to account for when choosing a specialty, including how many years you’ll spend in training, whether or not you’ll perform procedures, the level of patient interaction you’ll have, your practice setting, the people you’ll work with, your work-life balance, how much you’re paid, and more.

This series offers a comprehensive look into the career of an ophthalmologist through the eyes of Dr. Kevin Jubbal. He outlines the factors he considered and why he ultimately did not choose ophthalmology as his specialty. That said, rest assured that this guide presents both sides of the story, outlining the pros and cons of pursuing a career in ophthalmology.

For a completely objective and unbiased look at ophthalmology, including more details into the daily life of an ophthalmologist and the exact steps to take to become one, also check out our guide to How to Become an Ophthalmologist (So You Want to Be…)

Ophthalmology Pros — What I Liked

1 | It’s Procedural

If you like surgery, you get to do surgery, even if some surgeons from more traditional surgical specialties don’t consider it true surgery.

The bread-and-butter procedures are short. The average cataract surgery is 30 minutes in residency and 12 minutes in private practice. There are definitely longer procedures, especially in retina, glaucoma, and oculoplastics, but most are quite quick, and the surgeries are highly successful.

The procedures are also quite precise and involve numerous small details. If you’ve watched this or my personal channel before, you know I’m a fan of precision.

Since the procedures are all comparatively simple and outpatient, there are no inpatient admissions.

If you enjoy working with your hands, then this is not a bad gig. You get grateful patients, perform a number of faster procedures, and since they’re usually quite successful, you also feel highly accomplished and like you’re making a difference in many patients’ lives.

2 | The Patients Are Highly Motivated

Patients know how much they value their vision—it’s generally the #1 most valued sense people have. So when they see it threatened, they care and they want to make changes as soon as possible.

But try telling a patient they need to exercise and cut back on red meat to lower their blood pressure and cholesterol. Preventative measures like these are more abstract, so it’s harder for patients to follow through on healthy lifestyle choices.

Not only are patients more motivated, but the vast majority are also grateful. Imagine you can’t see well, and then after a routine cataract surgery, your vision is suddenly brighter, more vibrant, and crisper. Making such an immediate and profound difference in the lives of your patients is a definite win for ophthalmology.

3 | It’s a Consult Service

As a consult service, you’ll see a lot of patients and new presentations, which means there are more learning opportunities and generally more going on. It’s fast-paced and exciting.

On the other hand, when you admit to your own service, it can sometimes be quite frustrating because the daily inpatient note frequently becomes stagnant, with little to no change in your day-to-day activities.

4 | Excellent Lifestyle

There’s a reason this is one of the ROAD specialties, even though that acronym is a bit outdated.

The lifestyle is mostly outpatient, with regular 9-to-5 hours. You can also adjust between the clinic and surgery over the course of your career. Emergencies are rare, especially if you avoid retina surgery. If you do get into surgical retina, though, you’ll have to deal with occasional emergent add-on cases, like retinal detachments, but even these can generally wait until the next morning.

However, while it provides a strong work-life balance, it’s important to keep in mind that you’ll still see a lot of patients over the course of a workday.

The compensation is also excellent at nearly $470,000. With a retina or oculoplastics fellowship, you can also make much more if that’s a primary motivator.

Keep in mind that lifestyle is variable based on the practice setting, and we’re discussing averages. If you’re in private practice, then it’s typically a 9-to-5 schedule. But if you’re doing retina at a large academic center, you’ll face longer hours and more emergencies.

5 | Plenty of Flexibility

You can work hard, grind it out, and get fairly compensated, or you can take it easy, work 30-35 hours mid-career, and earn between $300,000 and $350,000.

If you prefer less procedural work, consider neuro-ophthalmology; if you want a more cash-based practice, opt for oculoplastics.

6 | High Job Satisfaction

Job satisfaction in ophthalmology consistently ranks toward the top in surveys. That’s the result of a combination of many factors we’ve already discussed, such as highly grateful patients who make you feel like you’re making a meaningful impact, a great lifestyle that doesn’t usually come with too much stress, and good pay.

7 | Anatomy

Eyes are incredible and have their own complex set of physiology and pathophysiology.

They’re also clean organs. For comparison, consider colorectal surgery.

The practice of ophthalmology is more dependent on the physical exam compared to most other specialties.

New treatments and technologies are constantly being developed, such as Ocular Coherence Tomography (OCT), which utilizes near-infrared technology to produce cross-sectional images of a patient’s retina, visualizing each layer independently and measuring their thickness.

However, I also appreciate that there is a continuation and appreciation for the tradition of Pseudoexfoliation syndrome, more commonly known as PEX.

PEX is a systemic age-related disorder identified by the deposition of abnormal proteins, pseudoexfoliative material, often described as flakes or crumbs, in the eye. These proteins build up on the lens and iris, as well as within the trabecular meshwork, leading to complications like glaucoma and cataracts.

PEX is typically diagnosed by observing these deposits on the lens and iris using a slit lamp. By doing this, ophthalmologists can directly observe the optic nerve, also known as cranial nerve II, and the retina, which are both parts of the central nervous system (CNS).

Seeing that, along with direct visualization of blood vessels, provides a window into systemic function or dysfunction. Sometimes, ocular findings can be the first indication of other systemic issues, allowing you to alert the appropriate clinicians to the patient’s condition.

You don’t have to go as thoroughly into the history, and it only takes a couple of minutes. And most of the other information you need can be found in the physical.

The downside of this reliance on the PEX is that in the future, telemedicine will be limited for ophthalmology.

8 | Training

The training is also shorter than in other surgical specialties. Residency lasts four years, while most others last five or more.

Fellowship is also optional, and most only last a year.

The exceptions are oculoplastics and surgical retina, which are both two years.

Oculoplastics is a two-year fellowship specializing in the treatment of orbital diseases and adnexal structures, including the eyelids, tear drainage system, and facial structures. It includes both aesthetic and reconstructive surgeries.

Surgical retina primarily focuses on treating retinal diseases, including diabetic retinopathy and retinal detachments.

Ophthalmology Cons — What I Didn’t Like

1 | Procedures

While I like that ophthalmology is procedural, the actual procedures leave something to be desired.

For anyone who has done surgery, you can sometimes feel like ophthalmology isn’t quite as exciting.

In the hospital, you’ll even hear surgeons in other specialties say that ophthalmology isn’t “real surgery.” Of course, that’s not what any ophthalmologist would say, but from my perspective, I completed a one-month ophthalmology rotation and did not find the procedures to be particularly fulfilling.

2 | Clinic vs Procedure Balance

Ophthalmology has a lot of clinic, and if you want to spend the majority of your time operating, there are other avenues in medicine that give you more OR time and less clinic time.

For example, the average cataract surgeon requires 2.5-3 full clinic days per week to maintain a full, relatively busy operating room schedule.

Part of this is because the procedures are so fast. While coronary artery bypass surgery usually takes about 3 to 6 hours, cataract surgery only takes about 12 minutes in private practice.

After a while, you can build a referral base specifically for surgery, but that will take a considerable amount of time.

Additionally, you will perform several procedures in the clinic, such as laser treatments or injections, but only you can decide how exciting those are for you.

3 | Too Specialized

Some joke that ophthalmology makes you a bit of an “eye dentist” in that you’re separated from the rest of medicine.

You learned all this incredible medicine in medical school, and sure, you’re understanding the interconnection of the body with the eyes for things like diabetes, but for the most part, you’re just isolated to the eyes.

Whereas most of medicine is moving towards incorporating teams, you won’t be as deeply involved in coordinated care, apart from the occasional consult to rheumatology, neurology, endocrinology, and, of course, the patient’s PCP.

4 | Bread and Butter

The bread and butter of the specialty is the management of chronic diseases, such as glaucoma, age-related macular degeneration (AMD), diabetic retinopathy, keratoconus, Fuch’s dystrophy, idiopathic intracranial hypertension, and so on.

Many of these things can be a bit tedious, but the silver lining is that patients will be incredibly grateful after cataract surgery.

5 | Patient Volume

And it’s not only the tedium of the bread and butter procedures, but the volume. While you can have a consult service for inpatient, most of ophthalmology is outpatient, so you’re going through an extremely high number of patients per day.

Seeing 30 to 50 patients can leave you feeling quite busy and rushed, so although the lifestyle is more laid-back than neurosurgery, for example, you’ll be on your feet and moving between the hours of 9 to 5.

6 | Physical Exam

I still think the emphasis on the physical exam is mostly a pro, but keep in mind that in certain situations, this will be a con. There are many patients who will make examining their eyes more difficult.

The drunk person in the emergency department is an obvious example, but many patients understandably feel uncomfortable with people poking around near their eyes. This will compound your stress when you’re already falling behind in the clinic.

7 | Mid-level Encroachment

You might be confused because PA and NP don’t meddle with ophthalmology. However, optometrists do, and the push for them to perform more procedures, such as laser treatments, minor surgeries, and injections, is an area where they’ve made progress.

After my experience in medical school and plastic surgery residency, I have developed an appreciation for the necessity of robust training to ensure patient safety.

While mid-levels are valuable team members, that’s when they’re adhering to their scope. When greed motivates some of them to demand greater scope and overestimate their competence, a fine example of the Dunning-Kruger effect, then the value drops. It’s not optometrists vs. ophthalmologists, but rather what’s safest for the patient.

I’m rather outspoken about anti-mid-level creep, as are most physicians. Shout out to the Physicians for Patient Protection (PPP), who are carrying out this important mission and advocating for patient safety.

I discussed the impact and research behind mid-level encroachment in a previous guide.

9 | Anatomy

If you prefer variety, there are other surgical specialties that can offer it to you. For example, plastic surgery has an insane variety when it comes to anatomy, as they operate from head to toe.

With ophthalmology, you’re focusing exclusively on the eyes. And while the eyes are extremely fascinating and are, of course, affected by systemic diseases like diabetes, it’s not the same as performing surgery in different regions of the body.

Some people value variety, while others prefer a more focused approach to anatomy. For me, I like variety in my day-to-day.

Should You Choose Ophthalmology?

So, should you become an ophthalmologist?

It depends on what you’re looking for!

There are pros and cons to every specialty, and what’s important is figuring out what makes you want to jump out of bed in the morning and what you are willing to put up with. What challenges are you willing to tolerate, and what upsides make you want to jump up and down on Oprah’s couch?

If you like quick, meticulous procedures, excellent compensation, a healthy work-life balance, working with constantly evolving, cutting-edge technology, and grateful patients, ophthalmology could be a good fit.

However, you may have to see dozens of patients a day, the bread-and-butter conditions and procedures can be tedious, doctors in other surgical specialties may look down on you, and the specialty is exclusively focused on the eyes, which doesn’t leave much room for variety.

Ultimately, it comes down to your own personal preferences.

If you want to learn more about ophthalmology, check out So You Want to Be an Ophthalmologist.