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Career Advisor's Background and Career
Information
Name: Joan M. O'Brien, M.D.
Career Advisor for: Ophthalmology
Title(s): Professor-In-Residence
Best way to contact (e-mail, phone?): obrienjo@vision.ucsf.edu
Undergraduate & Graduate Degrees/Institutions: UCSF Medical
School, Fellowship in Ocular Oncology; Harvard Medical School, Fellowship
in Ocular Pathology; Harvard Medical School, Residency in Ophthalmology;
Dartmouth Medical School, M.H., M.D.; Bryn Mawr College, Post-B.A./Pre-Med;
Middlebury College, B.A.
Clinical Interests/Duties: Ocular Oncology, Pediatric Oncology
Research Interests/Duties: Retinoblastoma, Ocular Melanoma, Genetic
Risk Assessment in Cancer, Ocular and CNS Lymphoma
Personal Notes or Comments: Our department is very happy to have
students at any level of their career spend time with us, either in clinical
practice or research.
1. What can students do in the 1st and 2nd years to explore and/or
prepare for this career? An elective is offered by Dr. Douglas Fredrick
in the second year, which can be used by students as an introduction to
Ophthalmology. Any student with free time in the first or second year
is welcome to meet with myself, as Career Advisor, and I will set up an
elective in their free time to be with any ophthalmologist in our department
or in the community, depending on the student's particular clinical interests.
We can also arrange a summer research program if the student has either
a clinical or basic science research interest, or an interest in World
Health.
2. What common variations exist in the length/content of residency
programs for this career? Training in this career involves performing
an internship in Internal Medicine, Surgery, or a Transitional Year, followed
generally by three years of Ophthalmology residency. There are some 4-year
residency programs, but they are in the great minority. In terms of content
residency programs, the content of teaching is quite similar in all programs.
As in all surgical subspecialties, the volume of surgery made available
to residents may vary from program to program, and this is an important
consideration in determining where a student trains.
3. What common variations exist in this career after training?
Many ophthalmologists pursue fellowship training after their initial training
in Ophthalmology. Fellowships may be one or two years, and provide subspecialty
training in areas such as Ocular Pathology, Oculo-Plastics, Retina, Cornea,
Glaucoma, Ocular Oncology, or other fields of interest. Many residents
go directly into practice as comprehensive ophthalmologists.
4. What is a typical work day for you (or someone else representative)?
Typical workdays start early for ophthalmologists if they are surgical
days, as the ophthalmologist should be in the operating room by approximately
7 a.m. to be sure that the patient is ready for surgery and has had all
their questions answered regarding a particular procedure. Ophthalmologists
also spend time in clinic, and those days may be variable depending on
the number of patients seen and the type of practice the ophthalmologist
is engaged in. Certain subspecialties such as Retina have a larger volume
of emergencies than other subspecialties. Many ophthalmologists who are
subspecialty trained also perform research and therefore have laboratories
or clinical research programs, which occupy other days of the week.
5. What is the "culture" of this career? Ophthalmologists
tend to be friendly and enjoy having students observe in clinic or in
the operating room. Many are microsurgeons and therefore very precise
in the way that they approach surgical techniques and surgical management
of patients. This often can be seen in their clinical management of patients
as well, where precision in the examination and the use of many clinical
and surgical instruments is important. Ophthalmologists in the operating
room work as a member of a larger team of anesthesiologists, nurses and
others. The typical ophthalmologist speaks quietly in the operating room
and gives guidance to residents in a quiet and fairly organized fashion,
since many procedures are taking place inside a patient's eye. Many ophthalmologists
at academic centers do perform research, as this is a common expectation
for academic ophthalmology. This research can be clinical or basic science
research. Ophthalmology is a specialty that reaches across other disciplines,
for example diagnosis of diabetic retinopathy may involve interactions
with endocrinologists, diagnosis of metasases to the eye may involve interactions
with radiation oncologists and hematologist-oncologists. The eye frequently
mirrors the status of other diseases and ophthalmologists may need to
be quite involved with primary care physicians when a patient is found
to be hypertensive, to have glaucoma (glaucoma drugs may interact with
other conditions such as COPD or heart block), or to have multiple sclerosis
that may present initially to the ophthalmologist.
6. How compatible is this career with raising a family? How is this
different for men and women? Although this career, like most surgical
subspecialties, was previously dominated by men, increasingly women are
entering the field and are finding it extremely compatible with raising
a family. Depending on the specialty or subspecialty, many ophthalmologists
have very regularly scheduled hours in the office and in the operating
room, and therefore can be involved in outside activities necessary to
raising children and to having a firm family commitment.
7. How important, individually, are each the following for admission
to a competitive program:
a.Extra-curricular/volunteer work? Many students do participate
in international work or extraccurricular activities in ophthalmology,
as do many ophthalmologists at academic institutions. This is, however,
a less important criterion than many of the others below.
b. Research/publications? Research in Ophthalmology or publications
in Ophthalmology, or in some related field, are expected by most Ophthalmology
residency programs.
c. Honors in third year? Honors in a third year are helpful in
applying in Ophthalmology, but are in no means required.
d. AOA? AOA has been found not to correlate in a significant
way with matching in Ophthalmology.
e. A sub-internship? A subinternship is performed by all students
at UCSF who are determined to pursue Ophthalmology as a career. This
is necessary not only to experience the field and to be certain that
it is the right field for the student, but also to have sufficient familiarity
with the faculty so that strong letters of support can be written.
f. An externship? An externship is not required, and is frequently
discouraged in Ophthalmology.
g. (Other important elements to the application?) Students are
often worried that unless they are at the very pinnacle of their class,
they will not match in Ophthalmology, but this is not experienced here
at UCSF. Students tend to match well in Ophthalmology, but they should
allow sufficient time to perform some research and a subinternship so
that they will have strong letters. Board scores are considered at some
programs, and are of less importance at others. Volunteer work, achievements
in music, sports, and other activities are also considered in the application
process.
8. What are the most important qualities or character traits for a
person in this field? Ophthalmologists tend to be very happy with
their chosen field. They must be willing, however, to give up the adrenaline-like
lifestyle of emergency medicine, general surgery, or many other fields
where life-and-death is the situation at issue. In Ophthalmology, a single
organ system is being evaluated, and the ophthalmologist must be willing
to confine themselves to this single organ system, although it has broad
implications for the health of the patient, and it has broad implications
for the patient's quality-of-life.
9. How competitive are the residency programs in this field? Because
of the small number of ophthalmologists, and the relatively small number
of spots in each residency program, the field is relatively competitive.
Nevertheless, UCSF students tend to do very well in the match process.
They should seek advice early on to optimize their application packet.
10. How competitive is the job market after residency? We have
not found that UCSF graduates have difficulty finding jobs after resident
training in Ophthalmology.
11. What programs would you consider to be in the 1st tier, 2nd tier,
and 3rd tier? There are approximately 15 or 20 programs that provide
excellent surgical volume and have an academically excellent surgical
program. There are many other programs that provide excellent training,
but would not be first tier. It is difficult to list all these programs,
as they change yearly based on the movement of surgeons from one program
to another. The best advice regarding this is given in our summer program
in preparation for residency application, which we run annually.
12. What resources (web, books, etc, besides the AMA and AAMC sites)
would you recommend for students interested in learning more about this
field? I believe the best resource available to UCSF students is UCSF
faculty, who are very interested in student education and will provide
many personal insights about the field to students who are interested
in pursuing Ophthalmology as a potential career option. el-e l
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