Ophthalmology Job Search, Part 1: Opportunities & How to Find Them

Introduction

After years of college, medical school, residency, and possibly fellowship, most ophthalmology trainees are understandably eager to begin their work life. However, those years of training typically do not prepare the candidate for the nuances of the job search process. This three-part series will dive deep into this process, with a focus on non-academic positions:

• The first article will focus on the types of jobs available to ophthalmologists and the means available to locate opportunities.
  
  
• The second article will touch on strategies for communicating with practices and the interview process.
  
  
• The third and final article will discuss the contract negotiation process, the onboarding process, and how to establish oneself in the community. 

With that said, let’s dive in.

Types of Jobs

A quick Google search will yield numerous articles that describe the various employment opportunities available to ophthalmologists. Although one can classify these in several ways, one useful way to categorize them is by practice size:   



Practice size correlates reasonably well with several key characteristics, mostly due to social and financial reasons, and remains a decent proxy for matching one’s personality and goals to a practice.  “Smaller” in this context suggests less than approximately 20 providers. On the contrary, “larger” suggests more than 20 providers, though typical private equity (PE)-owned practices employ well over 40 physicians, and hospital and academic departments can grow to just as large.

What can I expect with a smaller practice?

Smaller practices afford greater autonomy, schedule flexibility, and a more destructured and fluid corporate climate. Expect to have a closer and more direct relationship with administration and the practice owner(s). Disadvantages include poorer benefits (a smaller practice is less able to negotiate favorable benefits compared to a larger enterprise), lower likelihood of offering the latest gadgets and technologies (due to lesser economies of scale), and less job security. Expect to be your own marketer and advocate by attending local meetings, cold calling community doctors, or visiting referring practices, which can be seen as either a thrill or a nuisance depending on your perspective.

What can I expect with a larger practice?

A larger practice offers greater job security, typically excellent benefits, and a structured and formal corporate environment. This may come at the expense of autonomy and independence, and possibly at the expense of feeling like a “cog in a wheel” or losing a sense of personal brand at the expense of the enterprise’s brand. Due to economies of scale, one can expect more of the latest technologies and possibly less pressure to see high patient volumes or increase collections. Larger practices often contain committees that oversee, for example, physician recruitment, technology purchases, etc., allowing a young ophthalmologist the opportunity to become formally involved in practice management.

Academic practices do not entirely abide by this paradigm, because there exist other priorities and revenue streams aside from clinical work (such as research activities, education, and philanthropic donations). However, in general, one can expect a reasonably similar paradigm to that of a hospital practice.

What are the expectations regarding income?

Most important to note is that starting salaries are far less important than income growth and potential, which are the key factors to assess in a prospective practice. Solo practice offers an extreme example of low starting income, though extremely high potential for growth. Hospital practices sit at the other extreme, with higher starting salaries, but low potential for growth. Group practices and PE-owned practices occupy the middle ground. Academic practices do not fit well into this income paradigm. However, bear in mind that starting salaries vary wildly based on geography, supply and demand, and even negotiation skills, and it is the income growth potential that parallels practice type.

To summarize, in a smaller practice, you will veer closer to “being your own boss,” and there may be more of a “sky's the limit” mentality with income, though with fewer trimmings, such as administrative support, job security, and advanced gadgets. On the contrary, in a larger practice, one will have access to all the trimmings provided to you by a corporation, though at the expense of autonomy, independence, and personal brand. PE-owned enterprises vary, as well, with some functioning more as a conglomerate of smaller practices that each retain their identity, and others functioning as monolithic brands. The former may offer a hybrid between a smaller and larger practice.

Finding the Job

In the internet age, there is no shortage of means by which a candidate can search for employment. Though not exclusive, the following list details the most common means:

• Recruiting Firms
• AAO & subspecialty societies
• LinkedIn, Doximity, JAMA
• Google Search
• Word of Mouth

How can I identify academic positions?

All of the aforementioned means are commonly used to advertise postings for private practice, though many academic positions are disseminated either exclusively through word of mouth or advertised via AAO or subspecialty society websites. Academic positions are best explored by contacting your residency and/or fellowship mentors, who may be indispensable in locating academic opportunities and securing initial lines of communication with prospective employers.

How can I identify private practice positions?

In the private practice realm, recruiting firms and online postings are far more common. As you complete your training, you will likely be contacted by various ophthalmology recruiting firms. Such firms retain deep roots in ophthalmology communities and often have insider knowledge regarding the local practices. The firms will typically request an updated CV and then probe your particular clinical interests, geographic preferences, and even personal matters such as your marital status, etc. They will then present you with a list of prospective practices and seek your feedback on where they should send your CV. It is important to be firm regarding which practices you would like your CV sent to - one does not want his or her CV “circulating around” the local community out of their control. Despite your attempts to rein in recruiting firms, it is possible for your information to end up in unwanted hands, as various candidates can attest to receiving cold calls and text messages from employers to whom they never sent a CV. Overall, understand that by sending out your CV, you do lose a bit of control. It is also true that recruiters will likely receive a commission if you sign with a practice through them. However, this is money that the practice owner(s) have committed to spending, and it does not necessarily imply that your income will be affected.

Professional society websites are a second popular means of locating job opportunities. Websites such as LinkedIn, Doximity, and JAMA would also fall into this category, though the greater “bang for your buck” would be on the ophthalmology-specific websites. Finally, a simple Google Search can lead to job opportunities. Practices typically advertise basic information about the position, clinical volumes, and occasionally expected salary.

Practice size is also a reasonable marker of how practices will be advertised. Advertisements on society and journal websites are typically those of larger practices, who have the capital to maintain an advertisement on websites and often contain internal recruiting departments to seek out candidates.  In contrast, smaller practices typically advertise themselves through recruiters, who understand the local community and its needs best.  Bear this in mind as you navigate the job search process.

What are the next steps?

After identifying prospective practices, it is best to create tiers representing one’s interest, ranging from “dream jobs” to “would be somewhat satisfactory.” Contact practices within a tier, starting with “dream jobs” and work down the tiers as you hear back. Do not contact all the practices at once - as mentioned before, one worst case scenario is that a CV circulates throughout the community beyond control, creating the perception that the candidate is merely mass-contacting practices without doing due diligence to find a good fit. In addition, remember that you will only be taking one position, so by being selective with the number of practices whom you contact, you ultimately decrease the chances of burning bridges.

Overall, the ability to identify prospective practices and employers has never been easier. However, with greater ease of access comes a greater need to sort through these practices. In the next article, we will pick up with a focus on communicating with prospective practices, the pre-interview phone or Zoom call, and in-person interviews.