Medical Journey, Ophthalmology, Pediatric Ophthalmology

How to Choose a Specialty: Why I Chose Ophthalmology

I always knew I wanted to be a doctor.  My mother is a physician and ever since middle school, I knew I wanted to help others as she did.  

I entered medical school thinking that I was either going to specialize in Pediatric Oncology, Peds Cardiology or Child Psychiatry (like my mom). I remember my mom specifically telling me that she didn’t forsee psychiatry in my future, but of course, told me to give all rotations a chance. I always knew I wanted to work with children, so a Pediatric subspecialty seemed like a natural choice. The thing is choosing a specialty is as much dependent upon your personality and finding the right fit, as it is your interest. I love kids, but as I progressed through medical school, I came to realize I am the kind of person who likes a very definite beginning and end to a diagnosis and plan. I like to be able to DO something to fix a problem and I am a bit impatient. All of those traits meant that child psychiatry, with the investment into years of therapy before seeing a change, was not meant for me! (Mom was right, but don’t tell her that!). I also came to realize, for better or worse, that I have a surgical personality. As I rotated through General Pediatrics, I also came to the conclusion that it too was not meant for me.  I didn’t feel invigorated by the well child visits or flu appointments. Pediatric cardiology require completing a 3 year residency in General Pediatrics first, and I quickly realized that was not going to be the right choice for me.

Dr. Rupa Wong

I had never considered a surgical subspecialty and had no clue what an ophthalmologist did.  Since I had perfect vision, I had never seen an eye doctor and truth be told, I barely knew the difference between an optometrist vs ophthalmologist.  I was lucky that my medical school required we each choose a 4 week elective in surgical subspecialties. We could do one entire month in just one specialty or separate them and do 4 one week electives.  Open to us were choices like orthopedics, urology, plastic surgery, etc. I chose to do a 2 week rotation in ophtho and a 2 week rotation ENT in my 3rd year and had a hard time deciding between the two.

A friend gave me excellent advice to “make sure I enjoyed the most mundane aspect of the field”. Every day is not cataract and strabismus surgery in ophtho, could I handle dispensing glasses and monitoring glaucoma medically? If you like even the most boring, day to day aspect of the field, then that’s the right one for you.

I loved the precision of ophthalmology, that I could immediately fix a patient’s vision and enable the to see better, whether it was through glasses or surgery.  And, though I know now that ophthalmology is known as a field with a “better” lifestyle, that did not really enter my thought process when choosing it.  I think if you choose a specialty based on the hours or the pay, 10 years from now (which is where I am in my career now), you will feel burnt out and the money and easy hours won’t be worth it.  You have to truly love what you do to to make it worth the sacrifice.

Here’s what I loved:

  • Clinic and surgery – In ophthalmology, you get to actually develop a relationship with patients, because unlike many other surgical subspecialties, you are in clinic a lot. I love surgery, but it’s the interactions with patients that drew me to medicine.
  • Precise, bloodless surgery which restores sight! Honestly, can’t get better than that
  • Manifestation of systemic diseases in the eye – It is amazing to be the first one to diagnose a patient with diabetes or even a rare syndrome, like Marfan’s, based on their eye exam.  I’ve done both!

I was hooked!  During my 4 year of medical school, I was lucky enough to receive a scholarship to do a rotation in Chennai, Indian in pediatric ophthalmology. I worked with an ophthalmologist who had actually done residency and fellowship in the U.S. and then had gone back to India to practice. She was such a mentor to me and really helped solidify my goal of becoming a peds ophthalmologist.

Ophthalmology is a 3 year residency after a one year internship.  The internship can be either a year of Preliminary Medicine, Preliminary Surgery or a Transitional Year, in which you rotate through many different subspecialties.  I chose to do a Transitional Year because I wanted the experience of rotating through fields like Dermatology and Rheumatology, which can impact the eyes. The match for the internship year and the residency is separate.  After residency, there are numerous fellowship choices for Ophthalmology, though hardly any of them are board certified. This means that, unlike, say Cardiology, or Gastroenterology, you don’t take Boards in your subspecialty area, just in Ophthlamology.  It also means that the pay is way less for fellowship than residency and some fellowships are even UNPAID!!

 

The fellowship for Peds is combined – so it’s in Pediatric Ophthalmology/Adult Strabismus. So, in addition to learning about pediatric eye conditions – congenital glaucoma, infantile cataracts, and blocked tear ducts,  I also learned the latest techniques of adjustable suture strabismus surgery for adults. This allows me to help adults with thyroid eye disease, cranial nerve palsies or even just re-operations from strabismus when they were a child. Some of the areas of ophthalmology are extremely specialized, I love Peds ophtho/strabismus, because it remains general, but just pertains to kids.  I’m not only dealing with the retina or cornea or glaucoma – I do all of that.  I perform laser retinal surgeries for retinopathy of prematurity, remove infantile cataracts and also do strabismus surgery on kids and adults.

 

When I moved to Hawaii, my chairman, David Hunter, said “You will be the adult strabismus surgery expert.”  I didn’t want that initially. Adult strabismus surgery is much more challenging than strabismus surgery on kids. Adults have double vision from their strabismus, so surgery has to truly be perfect in order to eliminate it. That amount of pressure when I was just starting out scared me! But, as I have grown in experience and confidence, I relish these surgeries – I see each case as an opportunity to make a real difference!

One of my happy adult strabismus patients

I still feel as passionately about this field 17 years later as I did when I was a 3rd year med student!  I truly think that choosing the right specialty, what aligns with your personality, really helps to avoid physician burn out.  Sure, there are so many daily hurdles – like endless electronic medical charting, insurance prior authorizations, and denials to deal with that contribute to physician dissatisfaction with their jobs.  But, I can hold on to the fact that I receive notes like these from my pediatric patients.<a

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