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How to Become an Ophthalmologist


Overview

Prescribing a new pair of glasses or testing a patient's 20/20 vision are typical services provided by an eye doctor, but it takes a specialist trained to execute a full spectrum of eye care to include the identification and treatment of serious eye diseases. Ophthalmologists not only carry out the daily tasks associated with the average eye doctor, but are also qualified to perform delicate eye surgery on patients, as well as manage more advanced and hard-to-diagnose eye conditions.

What is an Ophthalmologist?

An ophthalmologist is a physician who specializes in the medical and surgical care of the eyes and other systems related to vision. In addition to overseeing the prevention of eye disease and injury in patients, ophthalmologists also provide basic eye care, such as conducting routine eye exams and writing prescriptions for eyeglasses and contact lenses.

Ophthalmologists are primarily trained to:

  • Fully understand the anatomy, physiology and diseases related to the eyes.
  • Possess the knowledge and skill to identify and treat a wide range of eye problems, including common vision deficiencies, glaucoma, cataracts, and eye cancer.
  • Diagnose and treat eye conditions related to other diseases, such as diabetes.
  • Provide a wide range of eye services, ranging from conducting basic vision tests to performing complex eye surgery.
  • Determine a patient's need for medication, surgery, glasses and/or contact lenses

A primary care physician often refers a patient to see an ophthalmologist when he or she is experiencing decreased or distorted vision; double vision; flashes of light; floaters (black specks or 'strings'); bulging in one or both eyes; misalignment of eyes; chemical burns; and/or loss of peripheral vision. Constant eye pain or injuries to the eye are also matters that call for the expertise of an ophthalmologist. Surgery is also a skill that ophthalmologists learn which is oftentimes required to treat eye trauma, cataracts, glaucoma, crossed eyes, and other issues.

Some ophthalmologists pursue a sub-specialty which allows them to treat a greater range of eye and vision problems. For instance, an ophthalmologist who gains additional training in plastic surgery qualifies to treat patients with drooping eyelids. It's this diversity in treatment that often makes the path of learning to become an ophthalmologist a challenging - yet highly rewarding one.

While an ophthalmologist is specially trained to address all aspects of eye care, some of the initial actions he or she will take when seeing a new patient is inquire about current symptoms, review their medical history, and perform an eye examination. During the eye exam, the physician will test and assess the following: visual alertness;  eyelid health and function; coordination of eye muscles; the eye's response to light; peripheral vision; pressure inside the eye; as well as take a look at the front lens, cornea and iris. They also check for a patient's need to use eyeglasses or contact lenses as a way to correct or improve his or her vision.

In many cases, an ophthalmologist is able to prevent vision loss and blindness with early detection and treatment of conditions such as glaucoma, eye disease associated with diabetes, crossed eyes, and some forms of macular degeneration.

In regards to eye doctors, ophthalmologists are often confused with optometrists, who typically serve as a primary health provider for average vision issues and annual checkups. However, there are a few factors that set these two types of medical school trained doctors apart.

As stated earlier, ophthalmologists perform all of the same functions as an optometrist, but since they specialize in vision care and the eyes, they are also qualified to diagnose and treat complicated eye problems. An ophthalmologist additionally undergoes more training related to the medical aspect of eye care, which allows them to perform surgeries on patients. It is the ophthalmologist who is called upon to repair retinal damage, or execute the very popular Lasik surgery which eliminates the need to wear glasses or contact lenses. Unlike optometrists, ophthalmologists prescribe a broader range of medications to patients.

There is also a difference in pay between the two eye doctors, as an ophthalmologist has the potential to make nearly three times as much as an optometrist, who earns a median yearly salary of $97,820, according to the U.S. Bureau of Labor Statistics.

Educational Track

A doctorate degree is the entry-level educational requirement for ophthalmologists.

Step by Step Educational Path of an Ophthalmologist

  1. Earn a bachelor's degree. There is a minimum requirement for students to gain acceptance into medical school to have completed at least three years of education at a college or university. However, the majority of medical students have an undergraduate or advanced degree. In order to fulfill future prerequisites, a student benefits from taking classes that include math and the sciences, such as physics, biology, and inorganic and organic chemistry.
  1. Apply to medical school. Those who wish to become an ophthalmologist must complete four years of medical school to obtain a doctor of medicine (M.D.) or doctor of osteopathy (D.O.) degree. The overall application process generally involves reviewing an applicant's overall GPA, extracurricular activities, volunteer experience, letters of recommendation, and MCAT (Medical College Admissions Test) scores.

In addition to measuring an individual's knowledge and understanding of the Physical Sciences and Biological Sciences, the MCAT examination also highlights Verbal Reasoning. An undergraduate typically takes this exam during his or her junior or senior year.

  1. Complete a medical school program. Anatomy, biochemistry, physiology, pathology, pharmacology, and psychology represent just some of the subjects that students learn during their first two years of medical school. During the remaining two years of training to become a physician, students learn how to care for patients within a medical environment, such as local hospitals and health clinics. Clinical rotations take place while under the supervision of experienced physicians, and involve many different specialties, such as pediatrics, psychiatry, obstetrics, and gynecology.
  1. Complete an internship and residency in ophthalmology. Upon graduating from medical school, the next step towards becoming an ophthalmologist is to pursue a one-year internship prior to completing a minimum of 3 years in an ophthalmology residency program. In the end, an ophthalmologist will be able to use their medical knowledge of the entire human body to help diagnose and treat conditions originating from another part of the body, which can have an effect on a patient's vision. This is one of the primary areas of training that differentiates an ophthalmologist from an optometrist.
  1. Obtain a license. In order to practice medicine in the United States, ophthalmologists must gain licensure from a state regulatory board by passing an exam and fulfilling state requirements. Following the completion of a residency, ophthalmologists can become licensed and immediately join the workforce, or choose to gain additional training in a subspecialty.
  1. Pursue a fellowship in a sub-specialty (optional). Fellowships allow ophthalmologists to gain specialized training in a specific area of eye care, which may include retina and vitreous diseases, glaucoma, plastic surgery, diseases of the corneas, or pediatric eye issues. Depending on the specialty and program requirements, this process can take one to three years to complete.
  1. Become board certified. Ophthalmologists also become board certified by passing a two-part exam generally administered by the American Board of Ophthalmology. When a physician passes this test, he or she earns the credentials of a board-certified ophthalmologist.

Career Path

From hospitals to the military, physicians specializing in eye care are hired to work in a wide range of employment settings.

Hospitals and health clinics hire ophthalmologists to become a part of their regular staff, and depending on the needs of the facility, a doctor might work as a full-time employee or come in a couple of days a week. In hospitals, ophthalmologists often treat trauma patients and those who have experienced a serious injury to the eye(s). Some eye specialists are hired by surgical centers to perform Lasik eye surgery, and other refractive procedures.

Health maintenance organizations (HMOs) blend some of the same characteristics found in a private practice and a hospital. Ophthalmologists who work from a HMO typically have his or her own office within a facility, and often work with other physicians within the organization to coordinate the care of a patient.

In the academic setting, colleges and universities hire ophthalmologists to educate and train the next generation of eye doctors. These educators may also keep regular office hours and see patients in need of emergency care.

Some ophthalmologists opt to pursue a career involving scientific research, and are hired by higher education institutions, pharmaceutical companies, and other industries to conduct studies on the causes and cures for eye diseases, as well as investigate issues related to vision problems.

Outside of a salaried position, ophthalmologists may join a private practice (either a single-specialty or multi-specialty group).

Employers hiring ophthalmologists typically seek the following qualities in a job candidate:

  • Demonstrates excellent manual dexterity, which is needed for treating such a small part of the human body.
  • Excellent communication skills; and the ability to provide accurate information about a patient's eye problem, as well as clearly explain the risks and benefits associated with available treatment options.
  • Pays close attention to detail, as one small mistake can lead to blindness.
  • Displays an interest in staying current on the latest trends, scientific research, and technological advancements related to the eye care industry.

Published articles or research also catches the attention of potential employers, as this shows that an ophthalmologist has an interest in educating their peers and playing a role in advancing the understanding, care, and treatment approaches related to the eyes. Being active in the community, such as participating in speaking engagements, teaching a night class, or presenting at a conference, are all extracurricular activities that tend to impress employers.

To increase the chances of being hired by an employer, the following also reads well on a job application:

  • Belonging to a society or association related to ophthalmology is highly recommended, as physicians not only have a chance to network with other medical professionals, but they also gain access to job leads, conferences, workshops, and other resources that can help boost a resume, experience, and the chances of getting hired by an employer. The American Academy of Ophthalmology is the largest national members-only association for eye doctors.
  • Demonstrating the pursuit of continuing education opportunities is another way to stand out to potential employers that are seeking job candidates who keep current in regards to the industry. For example, ophthalmologists who gain additional training and pursue a subspecialty can apply for employment within a wider scope of job openings.

According to the Medscape Physician Compensation Report (2014), ophthalmologists earn an average salary of $291,000 in the United States, which positions the average earnings of the occupation slightly above the middle of all other types of physicians. In 2013, Medscape's survey of ophthalmologists also revealed an increase of 5.3% regarding the overall compensation earned from the previous year [1].

Geography and employment setting both play an important role in the yearly earnings of an ophthalmologist in the U.S. According to Medscape, the highest salaries paid in 2013 for the occupation were found in the Great Lakes and Northwest regions with ophthalmologists making between $320,000 and $333,000. Those residing in the Southwest were identified as earning the lowest in the nation; they were paid an average yearly salary of $239,000.

In regards to the work environment and/or employer of an ophthalmologist, substantial income differentiations have been noted. Ophthalmologists who work in an office-based single specialty group practice tend to earn the highest salary, averaging $325,000 per year.

Other work environments and median annual salary figures of eye specialists to note:

  • Healthcare organizations - $315,000
  • Office-based multispecialty group practice – $309,000
  • Office-based solo practice - $291,000
  • Academic (nonhospital), research, military and government jobs - $208,000
  • Hospitals - $177,000
  • Outpatient clinics - $159,000

According to My Next Move (a partner of O*Net.com's AmericanJobCenter network), the job outlook for ophthalmologists is bright, with new employment opportunities very likely to emerge in the future due to the continued expansion of health care and related industries. An increasingly older adult population in the United States will also require advanced eye care, including procedures such as Lasik and cataracts surgery. In addition to those with advanced surgical training, certain ophthalmology specialists will also experience a greater demand for their particular expertise, in areas such as pediatrics and retinal care.

Starting a Private Practice…

To reap the benefits of enjoying greater freedom over patient decisions, a more flexible work schedule, and the potential to make more money, ophthalmologists may choose to establish their own medical business. The option to start a private practice is an especially appealing career move for ophthalmologists trained in a sub-specialty, as this means they can set up their own office to concentrate on treating patients with vision problems that are specifically associated with their area of expertise.

As stated earlier, enjoying a greater earning potential is one of the primary reasons an ophthalmologist may choose to start a private practice. According to Medscape, information representing 2013 revealed self-employed ophthalmologists earned much more ($338,000) than those in a salaried position ($224,000). [2]

With self-employment, instead of working in a hospital setting or driving to a clinic, an ophthalmologist works out of an office in a medical building or other site which contains rooms for examination and treatment, such as a space designated to performing eye surgeries.

It is important to note that starting a private practice does come with a few factors to consider:

1) Start-up costs, and possibly having to secure a loan. In addition to renting office space, an ophthalmologist's private practice must be outfitted with diagnostic equipment, office furnishings, and enough rooms to accommodate examinations, treatments, and surgery. Medical Management Associates, Inc. suggests that an ophthalmologist may need to have access to between $150,000 and $250,000 in order to get a private practice off of the ground.

2) Choosing a profitable area with low competition. While some doctors tap into a nest egg to fund a private practice, others must seek start-up financing from banks and other lending institutions. Additionally, ophthalmologists who plan to start a business in under-served markets with a shortage of eye doctors tend to appear more creditworthy to banks [3].

3) Insurance and other legal costs. In addition to malpractice insurance and legal costs, there are other fees and paperwork filings to submit before a physician can start seeing and treating patients.

4) Building a roster of patients, and attracting new ones. Depending on an ophthalmologist's work history, he or she may already have connected with a few patients or built a reputation within the medical community. At any rate, advertising, marketing and word-of-mouth will play an important role in attracting patients to a new private practice.

5) The overall financial risk of starting a business. As with any other entrepreneurial endeavor, there is the issue of debt and delayed financial reward. Medical Management Associates, Inc. also mentions that it now takes longer to get a new practice to produce a steady cash flow. In the past, it took about one year to see financial stability in the horizon, whereas now, an ophthalmologist might not see progress and growth until 18 to 24 months. This is an important factor that often discourages many from establishing a solo practice.

Although ophthalmologists working in private practice generally make more than salaried employees, they also have more paperwork on their hands, and are responsible for managing (and paying) staff which may include a receptionist, medical assistant, and/or nurse. There are also insurance companies to deal with and the stress of reimbursement claims.

To lighten the load, an increasing number of physicians are now choosing to merge their private practice with another, or become a part of a medical group. Some ophthalmologists also choose to co-treat patients and work in the same space with an optometrist.  The optometrist handles daily vision services and vision correction needs, such as eyeglass frames and prescription sunglasses, which allow the ophthalmologist to solely concentrate on performing surgical procedures if he or she wishes.

The career and educational path of learning to become an ophthalmologist requires at least eight years of post-graduate education and training. With the ability to diagnose and treat serious eye diseases and perform surgeries, such as Lasik, physicians enjoy a lucrative profession with plenty of opportunities to provide services through salaried positions and a private practice setting.

Additional Resources

  • American Academy of Ophthalmology 
  • American Association for Pediatric Ophthalmology
  • Pan-American Association of Ophthalmology
  • International Council of Ophthalmology
  • Association for Research in Vision and Ophthalmology 

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