Ophthalmology has been one of the fastest growing specialties in the world. The advances in the field in the last three decades has been astounding. In the early 1980s, a cataract surgery required a 10 day hospital stay with a few nylon/steel sutures to the eye and yet have sub-optimal visual outcomes. Today the same cataract surgery can be done as a day care procedure of about 10 minutes duration with just topical anesthesia (anesthetic in the form of eye drops), through a pinhole probe and no sutures at all. The post operative outcomes have risen to give patients 6/6 vision and sometimes they don’t even need spectacles after surgery.
Today the field has expanded into sub-specialized eye care with many sub-specialists in
These are some questions you need to answer to yourself first before deciding on what to do after residency :
Where will you be practicing- a major city or small town ?
Are you really interested to become a sub-specialist or you are just following the herd?
Do you want to work in a medical college or in a private eye hospital or a charitable hospital ?
Whether you want to have your own set up or you prefer to have a salaried job or you want to be on your own working in several hospitals ?
Whether finances are a problem and you need to immediately start earning after your residency?
These above questions are very important for your career path.
If you are going to be working in a small town an exclusive sub-specialty practice will be difficult if not impossible. If you are going to be practicing in a metropolitan city a single Ophthalmologist clinic is not going to be a viable option because the initial investment required to attract patients is too high. Ophthalmology is a machine intensive field so unless you can invest a large amount of money opening your own eye hospital is tough especially in a big city.
Make sure you know what you want to do by the end of residency
General Ophthalmology is a viable option if you want to start earning soon as you finish residency. Income wise it’s not going to matter a lot in the long run. Doing a sub-specialty sometimes restricts income avenues as well as it takes longer to train. Good fellowships in India pay poorly and that would not even be enough to take care of yourself. Remember that the longer you train, the longer it is before you can start practice.
Doing a Sub-speciality has it’s pros and cons. Practicing a subspecialty like Retina requires expensive equipment for diagnostic and treatment purposes which are available only in big eye hospitals. Oculoplasty is a completely referral based practice because people usually do not know about this subspecialty. For a Cornea practice the support of good in house Eye bank is the most important requisite. A lot of the Sub-speciality practice is possible only in big hospitals who can afford to spend on infrastructure, high end machines and have enough patients to justify the expenditure. If you do general Ophthalmology and cataract surgery along with your sub-speciality practice, your sub-speciality practice can get diluted. If you are a retina surgeon doing cataract surgery, you may not get many referrals from cataract surgeons. This is especially true in big cities in the south of India.
By the end of your residency, one should be able to do a cataract surgery independently- ideally Phacoemulsification too. That really is the basic minimum in an Ophthalmology residency. Unfortunately 80% of Ophthalmologists who clear their final year exams in India are not trained enough in this basic surgery independently. If you haven’t been taught in that institute, don’t stick around hoping you’ll get training someday. Don’t waste your time. Move to different places and do fellowships to learn cataract surgery. There are just too many centers in India to learn cataract surgery from. It takes more time and effort but that’s just required.
If you were reasonably trained in in cataract surgery during residency it is important that you either get better at that or start sub-specialty training in good institutes. I was lucky that my institute (RIO- Kolkata) gave me very good training in all sub-specialties of Ophthalmology. I was not keen on doing only cataract surgery for a living and was keen to add more variety to my work.
I wanted to sub-specialize either in Oculoplasty or Cornea & Refractive Surgery. Eventually I ended up doing both fellowships. I did not plan it that way but it so happened by fate.
If you were reasonably trained in in cataract surgery during residency it is important that you either get better at that or start sub-specialty training in good institutes. Try to get into the best fellowships available and be willing to work hard for it. If you want a good fellowship and did not get through in the first round of interviews in the fellowship of your choice don’t settle for less. Say you want to do Retina in a premier institute and you didn’t get through the interviews- Try to get a research position or a clinical observer position in the same institute instead of joining some underpaying job. Show them that you are genuinely interested in working there. Get involved and make some sacrifices.