Matt Price here, a photographer from Mid Florida Eye Center, a private practice in Mt. Dora, Florida. I'm been taking ophthalmic photos (SD-OCT, fundus photography, fluorescein/ICG angiograms) for the past three years. I've been a longtime lurker on the site and forums and finally was able to join the OPS and join the discussion.

I wanted to use my first forum post as not only an introduction to the community, but also to get some information from my fellow photographers in the industry. I've only ever worked in one ophthalmic practice, so I have no idea how my job and photo output compares to my peers, so I thought I would ask everyone to post their experience, specific to retina clinic;

     1. How many patients does your retina doctor see on a typical day?

     2. How many fluorescein and/or ICG angiograms do you perform on a typical day?

     3. How many OCTs do you perform on a typical day?

I'm not looking for concrete numbers, just a feel for what the average day is like for my fellow photographers.

Thanks in advance for participating and I look forward to interacting with you all in the forums!

Matt

Welcome to the OPS! The first thing that comes to my mind when I read your post is... when are you allowed to use the bathroom?

It's amazing that, given the fact we all do relatively the same tasks (give or take), there can be a wide variation in how an office or clinic runs.  Go to any Academy meeting and chat with fellow imagers and you will be surprised at the differences.

I can tell you that where I work, we do not do anywhere near the numbers you mention. Like most other imagers you've read about while lurking out there, our FA numbers have dropped off with the increased usage of SD-OCT. My gut feeling is that the FA numbers your present seem a bit on the high side (percentage wise) and your OCT a bit on the low side.  Maybe those numbers will slowly transition around sometime in your future. You never know. My guess is, most replies will report lower numbers than yours, unless there are multiple cameras, docs, and imagers involved.

Either way, with the number of FA's you do, you should have NO problem collecting your CRA portfolio!

Gary

Anyone who's contributed multiple posts to the OPS blog is much more than a lurker here. Glad to see you officially joined our member community - welcome aboard!

I have a few questions for you:

1. Do you have multiple cameras that you jump back & forth between?
   
2. Do you do your own injections?
   
3. Do you do late photos on your angiograms?
   
4. Do you juggle patients in/out (start the next angiogram while waiting for lates on the previous patient)? 
   
5. Do you explain/consent patients for angiograms or does someone else do that before the patient gets to you?

All of these factors & more can effect how many you can reasonably do in a day. For years I've covered an angiography clinic at a different hospital where we do a high volume session, but it's set up like an assembly line (no color photos, 5 min lates, etc). Other personnel will workup/consent/start IV & bring the patient into the camera room. I don't move much from the seat & just shoot one FA after another. Any complications can slow that process way down however. But even there, our angiogram numbers have dwindled significantly in recent years.

One final question: do you get lunch? Gary already beat me to the first question that came to mind (Do you get to pee? ;-)

Barb

When the original post went live, there was a second paragraph after the questions with the OPs daily stats.

It looks like there were some edits done today and that paragraph is now gone.

Now as to your sanity...i'm not crazy enuf to comment on that.  ;)

j-

It seems that the numbers have magically disappeared from my response as well. Hmmm.... how did that happen? ;-)

Too bad they are gone. It kind of defeats the original intent/purpose of this thread. I thought it was a really good topic for discussion. I doubt anyone will respond to the original questions now.

As a forum moderator, I can easily delete this entire thread if anyone is uncomfortable with what was originally posted. Just say the word and it's gone...

I work at an academic institution, as do Gary and Tim. Moran has ALL ophthalmology sub-specialties supported, including neuro-ophthalmology and oculoplastics.  The imaging department does primarily all kinds of imaging of the posterior pole and nerve, and slit lamp photos.  Much cornea related imaging like pachymetry and topography is done in the cornea suites - not by us.

There are five imagers in our imaging department, and each is able to do all kind of imaging - though I must admit that we have 2 superstars at RetCam and Bioptigen imaging of kiddies  in the OR or NBICU- not me.

Our department's experience is that SD-OCT is the most common procedure performed, either macular scans and RNFL scans, followed by color photos, and fundus autofluorescence quickly growing in frequency.

We never do an angiographic procedures unless some kind of color imaging has been done within a week or so of the angiogram, and with a uveitis specialist, we do more ICG procedures than many practices who do not have that subspecialty.  Our Risk Management department wants licensed medical personnel (nurses or docs in training) to do our procedure injections, and we each consent our individual patients. We do all the data entry, escort the patients, and at the end, load all the images into the review software.

As we have physicians who are researchers as well, we often do SD-OCT + FAF + IR, then add FP, and sometimes do the whole gamut including FA, and ICG.  We will share patient imaging to help with patient flow, if convenient, but usually the same imager does all the ordered procedures.

When we are busy, we feel we are VERY busy - sometime over 100 procedures a day - but our norm is more like 75 procedures a day.  Before EMR, the doctors' patient loads were larger, and our numbers were more like 85-90 procedures today.

I hope that gives you a frame of reference.  Some folks say they rarely do angiograms anymore - we still do both but 12 would be a busy day.

Would love to hear more from imagers working in private practices!

Paula

Indeed welcome!

I currently work at a very large multi specialist practice in Indianapolis (I have worked also in university and small practices).  I currently cover our only 'established' satellite office (i.e the others are very small and are visited irregularly).  I have one retina doctor in our office everyday and he is my only responsibility).  I do all escorting, consenting, IVs, exporting to EMR.  We utilize almost exclusively our Spectralis for all studies (OCT/FA, no ICG).  There is an old Stratus I use some days for maybe a dozen studies.  That instrument's totals are included below.

 Daily numbers:  fairly concrete, docs see 40-60 patients a day, I perform 15-30 OCT per day, FAs (includes IR/RF/AF) 6-15.  So my numbers are drawn from the assumption that any angio patient is very likely also getting OCT while at the Spectralis. I am not required to personally track exact amounts, but as a satellite office I do report monthly what I have tracked as time permits.  Our mother ship is able to track those numbers precisely. 

As a wise OPS member just mentioned to me via email, being an imager isn't as fun as it use to be, it is much now about the numbers since the instruments have advanced so much, since injections and OCT have become so common place.  Patient care seems to have improved  with injections, and the numbers of aging patients who need retinal care is growing.  Both really good things for our jobs and paychecks - but my neck/shoulder/wrists repetitive motion concerns are real . .  

Stuart

1. Our retina doc sees about 27-30 patients a day.

2. We average about 3-5 fluorescein angiograms per week; some days I have none and some days I have 5!

3. I scan on average 30-40 patients a day.

@Tim B.

1. We have the Spectralis HRA/OCT  and a Topcon TRC 50VT color fundus camera. I only use the Topcon for a study we are participating in that requires color fundus photos. I miss color photography!

2. I do not do my own injections. 

3. I do 5 minute lates as a rule, but occasionally the situation warrants 10 minute lates.

4. hahahaha....but really, if it is a repeat angiogram, I do the OCT while I wait for the 5 minute mark. Sometimes moving the patients from one chair to another takes longer than it does to do the testing.

5. It has taken me 3 hours to reply to this post between patients.

@Paula

I work in a private practice that has 7 ophthalmologists; 1 medical retina, 1 occulopastic, and 5 anterior segment docs. We scan all of our premium lens patients; I have a pre-set for this and it is quick and easy. All macular scans are accompanied by auto fluorescence photos. Depending on the disease, I might do red-free photos as well. When scanning the optic nerve head, I typically will take red-free photos if the patient is dilated. If the patient has optic nerve head drusen, they get auto fluorescence photos.

We still do FAs at the onset of NVAMD treatment, then repeat after 3 or 4 treatments; PDR patients; CSCR; vascular occlusion and I'm sure a few other things that don't come to mind right now. We do ICG for patients that will have PDT for NVAMD or CSCR. 

I explain the testing procedures and obtain consent. We have 2 computers in the retina clinic linked to mine so that makes it a little quicker for me to put "representative" photos into the patient EHR, but the Dr. has access to all the photos; for the other 6 doctors, well....it's a little more work.

When i was working at a university it seems that I was super busy and that we did every test to every patient, but I swear I think I'm even busier now with OCT alone than I was with the additional dark room duties. I saw close to 6000 patients this past year and boy am I tired!

Thanks so much for taking the time to respond. Let's keep this rolling! I find it very interesting to compare my experiences with those of my fellow imagers!

 Matt