Ophthalmologist

As an ophthalmologist you'll have specialist skills in the diagnosis, treatment, management and prevention of diseases of the eyes and visual system. You'll deal with a range of conditions, including cataracts, glaucoma, squints, eye injuries, infectious eye diseases and age-related macular degeneration. Your work will be a blend of medicine and surgery.

You'll manage patients of all ages, from premature babies to the elderly, with acute and long-term eye conditions. You could work within:

• outpatient clinics - which may be for general, acute or specialty conditions
• specialist operating theatres - for eye surgery such as cataract removal
• treatment clinics - such as laser eye surgery.

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

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
• conduct ward rounds when needed (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 equipment such as surgical microscopes or laser systems
• provide advice, information 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.

If you work as a medical ophthalmologist, you'll manage areas such as diabetic eye screening programmes. You may also use therapeutic procedures, such as laser therapy and intravitreal injections.

As a consultant ophthalmologist you'll also need to:

• teach and train resident 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 salary during foundation training in England is £38,831 to £44,439. Salaries for doctors starting their specialist training range from £52,656 to £73,992.
• As a speciality doctor, you'll earn between £61,542 and £99,216. Salaries for specialist grade doctors range from £100,870 to £111,441.
• Salaries for newly qualified consultants start at £109,725, rising to £145,478, depending on the length of your service.

Resident doctors (formerly known as junior doctors) will earn a basic salary, plus pay for any hours over 40 per week, a pay enhancement for working nights, a weekend allowance and an availability allowance if you're on call.

High-cost supplements are available to doctors working in London. You'll automatically be enrolled in the NHS pension scheme, but you can opt out.

Consultants in England and Wales may apply for local Clinical Excellence Awards and national Clinical Impact Awards. You should also be paid more if you take on extra responsibilities in, for example, management or education. In Scotland, you can apply for discretionary points. Consultants are also able to supplement their salary by working in private practice.

Figures relate to the pay and conditions of medical doctors within the NHS, which is the largest employer of ophthalmologists in the UK.

Salary bands differ across the four countries of the UK. Pay negotiation happens annually at different times, so salaries will change when each country agrees their new pay award. Check your country's pay scales for doctors for the most up-to-date NHS salary information on the BMA website.

Income data from NHS Health Careers - Pay for doctors. Figures are intended as a guide only.

Working hours

During training you may need to work some additional hours, but out-of-hours commitments are generally lighter than in many other medical specialties. You might be part of an on-call rota to cover eye emergencies, although night work is uncommon.

As well as full-time roles, there are opportunities for part-time work and job sharing.

What to expect

• You'll spend much of your time working in outpatient clinics, often seeing patients with long-term conditions. At consultant level, you'll usually have two or three operating sessions a week for procedures such as cataract surgery. Some roles also involve community or primary care work.
• 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 across the UK, although competition for specialty training posts is high due to the ratio of applicants to available posts. There may also be opportunities to work abroad.
• Advances in imaging, laser treatments and surgical techniques mean ophthalmology is a rapidly developing specialty with access to cutting-edge technology.
• The role can be highly rewarding as patients often experience immediate improvements, but it can also be emotionally challenging when supporting people who are losing, or have lost, their sight.

Qualifications

To become an ophthalmologist, you must first complete a degree in medicine recognised by the General Medical Council (GMC). This usually takes five to six years, or four years on an accelerated graduate-entry programme if you already have a relevant degree (normally a 2:1 or above in a science-related subject). The British Medical Association (BMA) provides advice on applying to medical school as a graduate.

Some universities offer foundation or gateway courses with an additional year to help widen access to medicine - see the Medical Schools Council (MSC) for more information.

After graduating, you'll complete the two-year paid UK Foundation Programme, rotating through six placements in different specialties, which may include ophthalmology. After the first year, you'll gain full GMC registration. On completion of the programme, you'll receive the Foundation Programme Certificate of Completion (FPCC).

Next, you'll apply for ophthalmic specialist training (OST), which normally takes seven years to complete (ST1 to ST7). Entry into OST at ST1 is competitive and there are more applicants than places available, so you'll need a strong application that shows your commitment to ophthalmology. Check competition rates for specialty training.

During OST, you'll develop core clinical and surgical skills, which may include experience in general and specialist clinics, emergency eye care and theatre sessions. You'll use simulation training early in the programme to develop competence in microsurgery techniques before operating on patients.

In the later stages of training, you'll focus on one or more specialist areas such as glaucoma, medical retina or paediatric ophthalmology. You must also pass the Fellowship in Ophthalmology (FRCOphth) examinations from the Royal College of Ophthalmologists (RCOphth) before the end of your training.

After completing OST and passing all the required exams, you'll be awarded the Certificate of Completion of Training (CCT). You can then join the GMC specialist register and apply for consultant posts. See the RCOphth for full details on education and training.

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

Skills

You'll need to have:

• communication skills, to explain diagnoses and treatment plans to patients and their families, and to work effectively with colleagues
• excellent hand-eye coordination, binocular vision and stereopsis (3D depth perception)
• manual dexterity to carry out fine, precise surgical work
• diagnostic skills to determine the type, severity and extent of an eye condition or disease
• excellent problem-solving and clinical decision-making skills
• strong leadership and teamwork skills
• emotional resilience and the ability to maintain high standards of care when working under pressure
• organisational and planning skills
• time and resource management skills
• familiarity with research methods and a commitment to keeping up to date with advances in treatments and technology through continuing professional development.

Work experience

When applying to do a medical degree, you'll be expected to show that you understand what a career in medicine involves. This can be through paid or voluntary work experience at your local hospital, hospice, GP surgery or nursing home, or through work shadowing a doctor. Such experience demonstrates your commitment to becoming a doctor and provides insight into the physical and emotional demands of working in medicine.

Virtual work experience accepted by medical schools is available through Medic Mentor, which also offers free mentoring. You can also gain insight by watching documentaries, listening to healthcare podcasts or reading articles. What matters most is reflecting on what you've learned about patient care and the realities of medical practice.

At medical school, choose ophthalmology as a component or special study module and consider an elective placement in the UK or abroad. You can also join the British Undergraduate Ophthalmology Society (BUOS), which provides access to resources and networking opportunities.

Try to arrange a visit to your local eye hospital or department to speak with ophthalmic staff and explore opportunities for practical experience. Volunteering with an eye charity can also help you understand vision impairment from the patient's perspective.

During your two-year foundation training, aim to secure an ophthalmology rotation. If that isn't possible, try to arrange a taster session with your local ophthalmology team to gain further insight into the specialty.

Find out more about the different kinds of work experience and internships that are available.

Employers

Jobs are available in NHS and private hospitals, as well as with private laser eye treatment centres.

There may also be opportunities to work for professional or regulatory bodies such as the Royal College of Ophthalmologists (RCOphth), the National Institute for Health and Care Excellence (NICE) and other government bodies. Some ophthalmologists also work in universities or research institutions, or with eye-health charities and non-profit organisations.

You may also work overseas, where there is demand for primary care and medical ophthalmologists. Another option is to become a medical representative for pharmaceutical companies or manufacturers of ophthalmic instruments.

Look for job vacancies at:

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

Individual trusts and hospitals may advertise vacancies on their websites. Vacancies are also listed on the websites of private hospitals or laser eye clinics.

Professional development

Once qualified, you'll be expected to continue learning throughout your career. Continuing professional development (CPD) is essential if you want to remain on the GMC register. You'll need to keep a record of your CPD activities for annual appraisal and GMC revalidation, which takes place every five years.

CPD activities can include attending courses, conferences, meetings and workshops, as well as participating in audits, contributing to teaching or engaging in research and quality improvement projects.

Skills training courses and events are provided by organisations such as:

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

Additional postgraduate qualifications are valued, particularly if you wish to integrate teaching, management or research into your career. Search postgraduate courses in medical education. It's also possible to integrate research into your clinical training to become a clinical academic. Find out more about academic ophthalmology.

Career prospects

As a consultant, you'll gain further clinical experience and take on more responsibility, with opportunities to progress into leadership roles such as lead consultant, clinical director or medical director. Many consultants also contribute to national organisations, professional bodies and guideline committees.

If you decide not to pursue a consultant post, or prefer a more structured working pattern, you can work as a speciality, associate specialist and specialist (SAS) doctor. SAS doctors may carry out surgery and outpatient work, often with fewer management duties, and may run services such as diabetic retinal screening.

If you'd like to pursue research or an academic career, it's important to start early, often during Foundation Training, by applying for an academic clinical fellowship or completing a higher degree such as an MD or PhD.

If you're interested in teaching, there are opportunities to train medical students, resident doctors and other healthcare professionals. You could become an educational supervisor and progress into roles such as training programme director or director of medical education.

As well as working for the NHS, there are opportunities in private hospitals, independent treatment centres or private clinics, or to establish your own practice. It's also possible to combine NHS work with private practice.