Choosing Between Academic and Private Practice for DO Ophthalmology Residencies

Understanding Your Career Fork in the Road as a DO Ophthalmologist

Finishing an ophthalmology residency as a DO graduate is a major milestone—but it also opens a high‑stakes question: academic vs private practice. For DO graduates, this decision sometimes feels even more complicated, given historical biases, the structure of the ophtho match, and differing cultures in academic medicine vs community practice.

This article will walk you through how to compare academic medicine and private practice specifically as a DO graduate in ophthalmology, including:

• Day‑to‑day work differences
• Compensation structures and lifestyle
• Teaching, research, and promotion expectations
• How each path impacts long‑term career options
• Practical steps to evaluate and choose what fits you best

Throughout, we’ll keep the focus on your unique vantage point as a DO graduate entering the ophthalmology residency and post‑residency job market, and how to strategically position yourself for the career you want.

---

1. Big-Picture Overview: Academic vs Private Practice in Ophthalmology

What “Academic” Really Means in Ophthalmology

An academic ophthalmology position is usually based in:

• University medical centers
• Teaching hospitals
• VA systems with strong educational ties
• Large non-university systems that sponsor residencies/fellowships (“quasi-academic”)

Core features:

• Tripartite mission: patient care, teaching, research
• Involvement with residents and medical students (and sometimes fellows)
• Emphasis on scholarly productivity (publications, presentations, grants—varying by institution)
• Often a formal academic title: Assistant/Associate/Full Professor
• More exposure to complex and tertiary referrals, rare diseases, and advanced surgeries

What “Private Practice” Really Means

Private practice in ophthalmology is a spectrum. You might work in:

• Solo or small group practices
• Large multi-specialty eye groups
• Private equity–backed practices
• Community-based, non-academic hospital–employed positions

Core features:

• Primary goal is clinical efficiency and financial sustainability
• Minimal or no formal teaching/research requirements
• Focus on high-quality, high-volume clinical care and surgery
• Greater emphasis on business fundamentals (productivity, revenue, overhead, marketing)
• Often more direct control over workflow, staffing, and growth strategy

Where DO Graduates Fit In

The unified ACGME system has greatly expanded opportunities for DO graduates in ophthalmology. For the DO graduate residency path, this means:

• More integrated programs and less fragmentation
• Better access to both academic and community training sites
• Increasing normalization of DOs in academic ophthalmology departments

Yet, DO graduates still may encounter:

• Occasional bias or assumptions about training background
• Fewer DO mentors in high‑level academic leadership roles
• Perceptions that research-heavy academic tracks are more “MD‑dominated”

The reality: DO status is not a barrier to either path—but you must be deliberate in how you position yourself during residency and early career.

---

2. Day-to-Day Life: How Your Work Will Actually Look

Clinical Workload and Patient Mix

Academic Ophthalmology:

• Often a mix of general and subspecialty care, depending on your role
• More complex cases and referrals—uveitis, advanced glaucoma, complex retinal disease, pediatric pathology, oncology, etc.
• Clinic templates may be less dense to allow for teaching and documentation, but complexity per patient is often higher
• Patients may be underserved, underinsured, or medically complex; VA populations are common
• More multidisciplinary collaboration (neurology, rheumatology, neurosurgery, oncology)

Private Practice:

• Strong emphasis on efficiency and volume
• High proportion of bread-and-butter ophthalmology—cataracts, refractive issues, common retinal disease, glaucoma management, minor lid issues
• More insured and elective care depending on the practice model and payer mix
• Laser and surgical days may dominate your schedule, especially in high-volume cataract/refractive practices
• Less time per patient but more control over appointment structure in some practices

Teaching and Education

Academic:

• Regular involvement in:
  • Resident clinics and OR supervision
  • Didactics: lectures, journal clubs, wetlabs
  • Medical student teaching, skills labs, OSCEs, and mentoring
• Your teaching evaluations often impact promotion and contract renewals
• Heavy exposure to learners improves your own knowledge and communication skills
• Many DOs find this especially rewarding, given osteopathic training’s emphasis on whole-patient teaching and mentorship

Private Practice:

• Teaching is usually:
  • Occasional: precepting rotating residents or students
  • Informal: staff training, patient education, community talks
• Most practices do not expect formal teaching roles
• Could be more structured if the practice partners with a residency or optometry school, but that’s variable

Research and Scholarly Work

Academic:

• Depending on your track:
  • Clinical track: primarily clinical with some expectation of publications, QI, or educational scholarship
  • Research track: protected time, grant-writing, significant pressure for productivity
• In ophthalmology, research often includes:
  • Clinical trials (e.g., retina, glaucoma, cornea)
  • Outcomes research, imaging, surgical techniques
  • Educational research, health disparities, public health in eye care
• As a DO graduate, a strong research portfolio from residency or fellowship can erase any perceived disadvantage and showcase your academic potential

Private Practice:

• Research is optional and often:
  • Industry-sponsored trials (esp. retina, glaucoma, cornea)
  • Outcomes/quality projects led internally
• Publishing is not commonly required
• Room to keep a research “side gig” if you enjoy it, but it must coexist with productivity demands

---

3. Money, Lifestyle, and Job Security: Tradeoffs That Matter

Compensation Models

Ophthalmology is generally well-compensated, but academic vs private practice differs significantly.

Academic Compensation:

• Usually lower base salary than private practice, especially early on
• Often includes:
  • Base salary + small incentive or bonus structure
  • Benefits: strong retirement packages, health insurance, CME funds, tuition discounts for family
  • More predictable income, less reliant on RVU extremes
• Subspecialties (e.g., retina) may still do very well—even in academic centers—but usually trail private practice equivalents
• Geographic variation is large; some academic centers in lower‑cost areas are more competitive

Private Practice Compensation:

• Often higher earning potential, especially after partnership
• Common structures:
  • Salary + productivity bonus (based on collections or RVUs)
  • Straight productivity after a ramp-up period
  • Buy-in to partnership: ownership share, profits, ancillary revenue (ASCs, optical shops, lasers)
• Private equity models may offer:
  • Attractive initial salary and signing bonuses
  • Equity packages, but with complex and sometimes limiting long-term implications
• Wide variation across markets; high-volume cataract surgeons and retina specialists often have top-end earning potential

Lifestyle and Work-Hours

Academic Lifestyle:

• Often more predictable hours and built-in structure:
  • Clinic and OR block schedules set by department
  • Protected academic time (varies widely)
• Call:
  • Typically shared across a faculty group
  • May involve supervising residents on call
  • VA positions often lighter on call
• Vacation is usually standardized (e.g., 4–6 weeks) and predictable
• Administrative demands (committees, meetings) can encroach on personal time

Private Practice Lifestyle:

• Can be excellent but more variable:
  • Highly efficient practices may allow fewer clinic days with high income
  • Others may expect extended hours, weekend work, frequent OR block use
• Call:
  • Community call (for local hospitals) can be light or heavy, depending on region
  • Some high-volume practices have sophisticated call-sharing networks
• Vacation is negotiable but tied to:
  • Productivity expectations
  • Partner norms (if everyone works 48 weeks, you probably will too)

Job Stability and Long-Term Security

Academic:

• Benefits of:
  • Institutional backing, large health systems, university funding
  • Some positions with tenure-track or long-term contracts
• Risks:
  • Budget cuts, leadership changes, shifting priorities
  • Pressure for RVUs even in academic environments
• That said, academic departments always need clinical workhorses—ophthalmologists are rarely “unemployed” for long

Private Practice:

• Benefits:
  • Direct control over your patient base and clinical reputation
  • Ownership and equity can provide long-term security
• Risks:
  • Market competition, shifting referral patterns
  • Private equity acquisitions changing culture and expectations
  • Overhead increases, payer changes, and policy shifts

As a DO graduate, the security of an academic medicine career can be appealing if you’re concerned about market variability, while the earning and autonomy potential of private practice may suit entrepreneurial personalities.

---

4. Academic Medicine Career for a DO Ophthalmologist

Advantages of Academic Ophthalmology for DO Graduates

1. Teaching and Mentorship

   • If you enjoyed teaching as a resident—helping juniors with slit lamp technique, walking a student through fundus findings—academic practice magnifies that.
   • As a DO, your training in holistic care and patient communication often translates well into being an effective educator.

2. Credibility and Visibility

   • Academic settings can provide:
     • High-impact titles (Assistant Professor, Director of Service, Program Director)
     • Visibility through conferences, publications, national committee work
   • Helpful if you plan a leadership career or want to shape training for future osteopathic ophthalmologists.

3. Complex Cases and Subspecialization

   • Tertiary referrals and rare pathology keep your skills sharpened and challenged.
   • Ideal if you are fellowship-trained in:
     • Retina
     • Cornea and external disease
     • Glaucoma
     • Pediatric ophthalmology/strabismus
     • Oculoplastics
   • You may also have access to specialized equipment and resources that private practices may not invest in.

4. Pathway to National Roles

   • Academic track facilitates:
     • Participation in clinical trials
     • Leadership roles in major societies (AAO, subspecialty societies)
     • Influence on guidelines, policy, and residency education

Challenges and How to Navigate Them as a DO

1. Breaking into Academic Culture

   • Some academic centers still have few DO faculty in ophthalmology. You may need to:
     • Demonstrate strong ophtho match credentials: solid residency training, strong surgical log, good letters from known faculty
     • Build a research and teaching portfolio during residency/fellowship
     • Network actively at conferences and through mentors

2. Promotion and Tenure Pressures

   • Expectations vary, but many require:
     • Regular publications
     • National presentations
     • Documented educational contributions
   • Strategy:
     • Begin research projects in PGY‑2/3
     • Collaborate with established researchers
     • Track teaching efforts and build a teaching portfolio

3. Lower Relative Compensation

   • To make this sustainable:
     • Choose a cost-of-living area that makes the salary comfortable
     • Understand your benefits package in detail (retirement matching, loan repayment, childcare, etc.)
     • Negotiate protected time realistically—too little and you’ll burn out; too much and you’ll struggle to meet clinical demands.

Who Tends to Thrive in Academic Ophthalmology?

You’re likely to thrive in academic medicine if you:

• Genuinely enjoy teaching and mentoring
• Find complex, rare, or system-level problems stimulating
• Are comfortable with committee work and institutional politics
• Want to pursue leadership, research, or educational innovation
• Value stability and long-term institutional affiliation

---

5. Private Practice Ophthalmology: Autonomy, Volume, and Business

Advantages of Private Practice for DO Ophthalmologists

1. Higher Income Potential

   • Particularly strong in:
     • High-volume cataract and refractive practices
     • Retina practices with busy injection and surgical schedules
   • Partnership and ownership can lead to significant wealth over time.

2. Clinical and Operational Autonomy

   • You often have more influence over:
     • Scheduling patterns
     • Staffing models
     • Technology investments (lasers, imaging, premium IOLs)
   • You can shape the patient experience according to your values.

3. Geographic Flexibility

   • Private practices exist everywhere—from urban centers to rural communities.
   • Easier to choose location based on:
     • Family needs
     • Spouse/partner career
     • Lifestyle (coastal, mountains, smaller cities, etc.)

4. Entrepreneurial Satisfaction

   • For those interested in business, you can:
     • Develop new service lines (aesthetic oculoplastics, optical shops, surgery centers)
     • Lead marketing and community outreach
     • Influence the culture and growth trajectory of the practice

Challenges of Private Practice—and Solutions

1. Financial and Productivity Pressure

   • RVU or collections-based expectations can be intense.
   • For a new DO graduate:
     • Seek transparency: ask for historical volumes, payer mix, and ramp-up expectations.
     • Negotiate a realistic guaranteed salary period as you build your patient base.

2. Business Complexity

   • Running or owning a practice requires:
     • Understanding overhead, staffing, billing, and compliance
     • Managing HR issues and practice culture
   • If this is new to you:
     • Consider mentorship from senior partners or formal coursework (MBA lite, CME business courses).
     • Read industry resources on ophthalmology practice management.

3. Risk of Culture Misalignment

   • Some practices may prioritize:
     • Speed over patient education
     • Aggressive upselling of premium services
     • Minimal time for complex or underserved patients
   • Your osteopathic principles (whole-person, patient-centered care) may clash if the culture is misaligned.
   • During interviews, watch how partners speak about patients, staff, and each other.

Private Equity: A Special Case

Many ophthalmology practices are now owned or affiliated with private equity (PE) firms.

Potential Pros:

• Attractive starting salaries and sign-on bonuses
• Administrative burdens handled by a management company
• Sometimes access to better technology or negotiation power with payers

Potential Cons:

• Pressure to increase production and cut costs
• Limited control over future practice decisions
• Changing partner track models and uncertain exit strategies

As a DO graduate, it’s crucial to:

• Obtain the full contract and PE agreement details
• Ask current physicians candidly about changes post-acquisition
• Consider how this aligns with your long-term vision and values

---

6. Choosing Your Path: Practical Steps and Hybrid Options

Self-Assessment: What Actually Matters to You?

Before fixating on “academic vs private practice,” ask:

• How important is income relative to time and flexibility?
• Do I feel energized by teaching and research, or do these feel like obligations?
• Do I enjoy complex tertiary cases, or prefer to be highly efficient with common problems?
• How much risk and responsibility am I willing to take on for the sake of autonomy?
• Where do I see myself in 10–15 years—running a practice, leading a department, or balancing both?

This is the core of choosing career path medicine: aligning your personality, values, and long-term goals with the structural realities of each environment.

Use Residency and Fellowship Strategically

Whether you’re still in the osteopathic residency match process or finishing training, use your time to experiment and gather data.

For academic medicine career–curious DO residents:

• Seek:
  • Research projects (clinical or educational)
  • Teaching roles (lectures, small groups, OSCEs)
  • Mentors with academic appointments who can advocate for you
• Aim to:
  • Present at national meetings (AAO, subspecialty societies)
  • Publish at least a few meaningful papers or case series
  • Build a CV that answers the question: “Why academic?”

For private practice–leaning DO residents:

• Focus on:
  • Surgical excellence and efficiency (cataract, retina, whatever your niche)
  • Understanding practice operations during community rotations
  • Learning coding and billing basics
• Ask attendings about:
  • Compensation models
  • Partner track timelines
  • What they would do differently if starting over

Explore Hybrid and “Best of Both Worlds” Options

The choice isn’t always binary. Hybrid models include:

1. Academic-Community Partnerships

   • You may be employed by a private group but:
     • Teach residents occasionally
     • Have adjunct faculty status at a medical school
   • You get clinical volume plus academic involvement.

2. Part-Time Academic, Part-Time Private Practice

   • Less common but increasingly seen:
     • Some ophthalmologists hold a portion of their FTE in academia (e.g., 0.3–0.5) and the rest in private practice.
   • Requires careful negotiation and good will from both sides.

3. VA or Government Systems with Academic Involvement

   • VA positions often:
     • Have academic titles through affiliated universities
     • Offer teaching opportunities with less pure research pressure
   • Good option if you want stable hours, benefits, and some academic engagement.

4. Private Practice with Strong Teaching Culture

   • Some large eye groups:
     • Host residents or fellows
     • Encourage physicians to teach and attend conferences
   • You can have a mostly community practice with a strong educational role.

How to Evaluate Specific Job Offers

Create a structured checklist when comparing offers:

1. Clinical Scope and Daily Life

• What is the expected clinic volume and case mix?
• How much OR time, and how quickly can I build my surgical volume?
• Are there subspecialty opportunities aligned with my training?

2. Teaching and Research (if desired)

• Will I have residents, fellows, or students?
• Is protected time real or just theoretical?
• Are there startup resources for research or educational projects?

3. Compensation and Benefits

• Base salary, bonus formula, and expected total compensation in years 1–3
• Retirement match, disability, malpractice coverage (claims vs occurrence)
• CME funds and time, relocation assistance, loan repayment options

4. Culture and Mentorship

• How do physicians talk about each other and leadership?
• Are there DO ophthalmologists already thriving there?
• Is there a clear path for career development (promotion or partnership)?

5. Long-Term Viability

• For academic positions: department stability, leadership support, realistic expectations
• For private practices: payer mix, referral base, succession planning, private equity involvement

---

FAQ: Academic vs Private Practice for DO Graduate in Ophthalmology

1. As a DO graduate, am I at a disadvantage for an academic ophthalmology career?
Not inherently. While some departments historically had fewer DO faculty, the landscape is changing rapidly. If you demonstrate strong clinical skills, engage in research or scholarly activity, and build relationships with mentors, your DO degree is unlikely to be a true barrier. A well-crafted CV and evidence of academic potential during residency/fellowship matter far more than the letters after your name.

2. Can I switch from academic to private practice (or vice versa) later in my career?
Yes, but each transition has challenges. Academic to private practice requires adapting to higher volume and business-oriented metrics; private to academic may require rebuilding your scholarly activity and teaching profile. If you anticipate switching, maintain some involvement in both worlds—for example, doing occasional teaching while in private practice or maintaining strong surgical numbers while academic.

3. Which path is better financially in the long run—academic or private practice?
For most ophthalmologists, private practice—especially with partnership or ownership—offers higher lifetime earning potential. Academic compensation is generally lower but more stable, with strong benefits and less direct financial risk. The “better” path depends on your financial goals, risk tolerance, and how much you value non-monetary aspects like teaching, complex cases, and institutional affiliation.

4. How early in residency should I decide between academic and private practice?
You do not need to decide on day one, but you should start exploring intentionally by mid-residency. Use PGY‑2 and PGY‑3 to try research, teaching, and community rotations; by late PGY‑3/early PGY‑4, having a working preference will help you target fellowships, mentors, and job searches appropriately. Remember that your first job need not lock you in permanently, but a clear direction will make the transition from residency to practice smoother.

---

Choosing between academic and private practice as a DO graduate in ophthalmology is less about what you “should” do and more about who you are, how you want to spend your days, and what kind of impact you want over a 30‑year career. With honest self-reflection, strategic use of residency and fellowship, and careful evaluation of specific jobs, you can build a deeply satisfying career—whether in the halls of academia, the flow of private practice, or a thoughtful combination of both.