Ophthalmologist

Ophthalmologists are medically trained doctors who blend medicine and surgery along with cutting edge technology to treat and prevent eye conditions

As an ophthalmologist you'll have specialist skills in the diagnosis, treatment, management and prevention of diseases of the eye and visual system. You'll deal with a range of conditions, including cataracts, glaucoma, squints, eye injuries, infectious eye diseases and degenerative conditions resulting from ageing. You'll manage patients of all ages, from premature babies to the elderly, with acute and long-term eye conditions.

You may work in a variety of settings including outpatient clinics, operating theatres where you'll conduct surgery, laser eye surgery clinics and community clinics. There's also a limited amount of ward-based work available.

You can also work as a medical ophthalmologist if you're trained in general medicine as well as ophthalmology. As a medical ophthalmologist, you'll manage eye disorders that are specifically related to whole-body disease, such as diabetes, multiple sclerosis and stroke. You'll treat the patient as a whole - not just their eye condition.

Responsibilities

Ophthalmology is a blend of both medicine and surgery. As an ophthalmologist you'll need to:

• assess and examine patients in order to make a diagnosis
• manage ophthalmic conditions, taking into account both the medical and psychological aspects of patient care
• manage busy general outpatient clinics, emergency eye clinics and specialist clinics
• do occasional ward rounds (most ophthalmic patients have day surgery and don't stay in hospital overnight)
• work as part of a multidisciplinary team that includes optometrists, orthoptists and nurses, as well as with specialists such as neurologists, ENT (ear, nose and throat) surgeons, paediatricians and geneticists
• operate equipment such as ophthalmoscopes, slit lamps and lenses
• carry out eye surgery using, for example, an operating microscope or laser surgery
• provide advice and reassurance to patients and family members
• educate patients to help them understand their medical condition
• handle legal documentation for the certification of patients as blind or partially sighted
• support health promotion and disease prevention activities.

If you work as a medical ophthalmologist, you will also have expertise in immunosuppression, neurology or in immunosuppression, neurology or cardiovascular medicine, and will manage areas such as diabetes retinal screening programmes. You may also use therapeutic procedures, such as laser therapy and intraocular injections.

As a consultant ophthalmologist you'll also need to:

• teach and train junior doctors and other healthcare professionals and lead members of the ophthalmology team
• get involved in research
• manage resources and practice development or lead on specific aspects of care.

Salary

• The basic starting salary for junior hospital doctor trainees at foundation training level is £28,808 in the first year, rising to £33,345 in the second year.
• As a trainee at specialty level you can earn between £39,467 and £53,077. Salaries for specialty doctors range from £45,124 to £77,519.
• The salary for consultants starts at £84,559 rising to £114,003 depending on length of service.

Allowances are paid for working nights, weekends and being on call. You also get extra pay for any hours over 40 per week. You'll automatically be enrolled on the NHS pension scheme.

Once you are a consultant, you may apply for local and national Clinical Excellence Awards (England and Wales) and you may also be able to supplement your salary by working in private practice.

Figures relate to the pay and conditions of medical doctors within the NHS. Rates will differ in private practice.

Income data from NHS Health Careers. Figures may differ outside of England, and are intended as a guide only

Working hours

Ophthalmology typically has routine hours of 9am to 5pm. You may need to work extra hours, especially as a junior doctor but out of hours work is generally light when compared to other specialties. You may be on an on-call rota for small periods of time. Night work, however, is unusual.

In addition to full-time work, there are opportunities for part-time work and job sharing. Staff, associate specialist and specialty (SAS) doctors often work in outpatient departments on a sessional basis or part time, combining ophthalmology with general practice. Consultants in community eye care may also work in GP practices.

What to expect

• You'll spend a lot of your time working in outpatient clinics. Many patients will require follow-up appointments for an ongoing condition. You'll usually have two or three operating sessions each week (at consultant level) to cover procedures such as cataract surgery. You can also work in community or primary care settings.
• You'll work closely with other members of the eye care team such as hospital doctors, ophthalmic nurses, orthoptists, optometrists and ocular prosthetists.
• Jobs are available throughout the UK and competition for consultant posts is high. There are also opportunities to work abroad.
• Recent new developments in technology and treatments mean that it's an exciting time to be an ophthalmologist and it can be a very rewarding career as patient satisfaction is often high. It can, however, be challenging when helping people who are losing or have lost their sight.
• You may need to travel to attend international meetings, see international patients or operate in other countries.

Qualifications

To become an ophthalmologist, you'll first need to complete a degree in medicine recognised by the General Medical Council (GMC). This usually takes a minimum of five years to complete, although if you've already got a degree in a subject other than medicine (usually a 2:1 or above), you can apply for a four-year accelerated medical graduate entry programme (GEP). Although many medical schools require a health-related degree for the GEP, this isn't always the case.

Following graduation you'll enter foundation training in UK hospitals, which lasts two years. After the first year of training you'll become a fully-registered medical practitioner. During these two years you'll work in a hospital as a junior doctor on a rotational basis in different departments, which may include ophthalmology. See MSC - Foundation Programme for more information.

To find out more about these initial stages of training and the qualifications required, see hospital doctor.

Once you have passed the foundation training you can apply for ophthalmologist specialist training (OST), which normally takes seven years to complete and involves the stages of ST1 to ST7. You'll also need to complete the Fellowship in Ophthalmology (FRCOphth) examinations from the Royal College of Ophthalmologists (RCOphth) before the end of your training.

During your training you’ll gain the general clinical skills of an ophthalmologist and basic knowledge of conditions covered by the specialty. This may include working in general and specialist clinics, casualty work and theatre sessions. You'll also become proficient in assessing patients for glasses and will gain your Refraction Certificate, and will go on to cover more advanced techniques such as laser technology.

Once you've successfully completed the full seven years, you'll be awarded the Certificate of Completion of Training (CCT) and can then join the specialty register and begin applying for consultant posts. See the RCOphth for full details on education and training.

For information on training to become a medical ophthalmologist, see the Joint Royal Colleges of Physicians Training Board.

Skills

You'll need to have:

• communication skills, including empathy and sensitivity
• good stereoscopic vision and professional health requirements in line with the GMC
• manual dexterity and good hand-eye coordination
• diagnostic skills to determine the type of disease or condition, its severity and extent
• excellent problem-solving and clinical decision-making skills
• the ability to work alone and as part of a multidisciplinary team
• leadership skills
• the ability to work under pressure
• organisational, time management and planning skills
• familiarity with research methods and a willingness to keep up to date with advances in treatments and technology.

Work experience

Entry to medical school is competitive and you'll need to do some work experience or a placement in areas relevant to medicine to get a place. This could be through work experience at your local hospital, GP surgery or nursing home, or through work shadowing a doctor. This experience shows your commitment to becoming a doctor and provides insight into the physical and emotional demands of working in medicine.

While studying medicine, choose ophthalmology as a component/special study module and consider an elective placement in ophthalmology in the UK or abroad. You can also join the British Undergraduate Ophthalmology Society (BUOS) which gives access to resources and a chance to network.

Visit your local eye hospital or department and speak to ophthalmic staff to find out more about the role and any opportunities to gain practical experience. Undertaking voluntary work with an eye charity also provides useful experience and will help you get a feel for vision impairment from the patient's perspective.

A limited number of prizes and awards are offered to undergraduates to help fund electives in ophthalmology. Check with your medical school for individual medical school awards or see the RCOphth website for details of what it offers.

Employers

The majority of ophthalmologists are employed by the NHS. Some work for private hospital companies and there are increasing numbers of ophthalmologists working as laser eye surgeons in the private sector.

Some consultants also undertake a wide range of pro bono work for the Royal Colleges (e.g. RCOphth), the National Institute for Health and Care Excellence (NICE) and other government bodies.

There are also opportunities to work overseas, where there is high demand for primary care and medical ophthalmologists.

It is also possible to become a medical representative for pharmaceutical companies or companies dealing with ophthalmic instruments.

There are also opportunities to work for the armed forces.

Look for job vacancies at:

• BMJ Careers
• Jobs.ac.uk - academic and research jobs
• Jobs.hscni.net (Northern Ireland)
• NHS Jobs (England and Wales)
• NHS Scotland Recruitment

Vacancies are also listed on the websites of private hospitals - see Private Healthcare UK for a list.

Professional development

As a qualified ophthalmologist, you'll need to continue learning and developing your skills and knowledge throughout your career. Continuing professional development (CPD) is essential if you want to remain on the GMC register. CPD activities can include attending courses, conferences, meetings and workshops, as well as undertaking research and peer-reviewing journal papers.

You can also carry out training in a specific area to gain a sub-specialism. Specialist areas can include:

• cataract and refractive surgery
• glaucoma treatment
• paediatric ophthalmology
• medical or surgical retina ophthalmology
• neuro-ophthalmology.

Medical ophthalmologists tend to specialise in areas such as diabetes, neuro-ophthalmology, ocular inflammatory disease and medical retinal disease.

Skills training courses are provided by organisations such as:

• Moorfields Eye Hospital
• Royal College of Ophthalmologists (RCOphth)
• The Royal Society of Medicine (RSM)

If you wish to integrate more formal teaching into your work, search for qualifications in medical education.

Career prospects

The majority of ophthalmologists become consultants. Competition for consultant posts is strong and there are many applicants for each post. You’re able to apply for consultant roles six months prior to you achieving your Certificate of Completion of Training (CCT) so start to look early.

As a consultant you'll gradually gain more experience in your clinical duties and take on more responsibilities. You'll be responsible for all the patients in your care and will also supervise and train junior doctors.

With experience, there are some opportunities to move into managerial roles, initially as a clinical lead (a lead consultant for a team), then as a clinical director (a lead consultant for a department) and later on as a medical director (a lead consultant for a hospital trust).

If you don't want to become a consultant, or are unable to work as one, you can work as an SAS (Specialist and Associate Specialist) doctor. The type of work you do will depend on your interests and experience and you may perform surgery, as well as do outpatient work. You're likely to have fewer management responsibilities in this role but may run departments such as diabetic retinal screening services. The working hours of an SAS doctor tend to be more regular than those of a consultant.

There are also opportunities to follow a career as an academic ophthalmologist. You'll usually take a higher degree during your training and also carry out a lot of research through fellowships.

If you're interested in teaching future doctors, you may become a director of medical education, training programme director or associate dean in charge of the entire training programme.

There are also opportunities to work in the private sector or abroad.