Americas Best Contacts and Eyeglasses pay

[EyeStudent]

Can any current or former OD's of Americas Best Contacts and Eyeglasses state when the company post a salary amount, if that amount is gross or net? They advertised at my school starting pay of $115,000. I figure if i'm able to make $8,000 a month ( thats $96,000 a year) after taxes, i'll pay 1,600 towards student loans, $400 for a car loan, $1,500 for mortgage and property taxes, $800 groceries, $150 phone bill, cable internet $150, $250 health ins. That leaves $3,150 to save or for disposable income ( or payback more of the student loans). I'm sure i'm missing other expenses i will be needing to pay, but $8,000 a month sounds good to a 3rd yr student right now.

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[Jibslider]

Sounds pretty good doesn't it... How does seeing a patient every 7 minutes sound? You know that BIO thing and all of that ocular disease stuff you learned? Well, you'll never get a chance to PROPERLY evaluate the health of your patients eyes working (like a dog) at a place like that. Trust me, you don't want to work there.

Go shadow an OD that works at AB.

Is working at AB better than making zero dollars and living in the gutter? Yes... but just barely.

 

[Jason K]

Is working at AB better than making zero dollars and living in the gutter? Yes... but just barely.

Very well said. There's a reason they offer high salaries to naive new grads - it's a hell hole. The "exam in 7 minutes" is absolutely NOT an exaggeration. EyeStudent, here's what to expect. You'll be told during your interview that you'll be scheduled for 8 patients an hour to start. Then you'll clear your throat and say "What, you mean 8 patients for the morning, right?" At which time, your interviewer, who will probably be wearing an outfit that would have been in fashion when Blossom was on TV, will reply "No, it's 8 per hour....don't worry, you get used to it really quickly." You'll also be told "Hey, no worries big fella, you can practice to the full extent of your training. You wanna do glaucoma, no problem! You wanna do kone fits? No problem! You wanna do corneal transplants with a dull butter knife and some thread from an old dress sock? No problem! You can do it all! What they really mean is, "We don't care about eyes, we just want you to sell our garbage glasses and old, outdated CLs. But you CAN do it all, as long as you see around 60 patients per day for "full exams" and "contact lens fittings."

I know one classmate who worked there for a year right out of school. In addition to telling me she routinely cried in her car on the way home from work, she told me the only way she could keep up was to simply throw the patient behind the phoropter with the autorefraction in place, spin the wheel like a contestant on the Price is Right, and then pull the patient out...simply writing down what was on the autorefraction printout. She rarely refracted anyone and just used the phoropter for show.

JB, I don't think anyone on here will understand what we're talking about so I will ditto your advice to go shadow an AB doc for a whole day. The whoooooooole day....not just 5 minutes in the back of the exam room, or a quick lunch in the back office.....the whole enchilada from 9:00 to midnight, or whenever it is that they close. Actually, maybe they never close, who knows?

Given the state of optometry these days, I'd say if you're a new grad and you have no other choice, you might just have to suck it up and do it, but I don't know a single OD who's lasted in an AB position for more than a about 18 months. It's a total burnout situation from day one.

This highlights the problems that lay ahead for new ODs. Right now, AB is a "last resort" for many people. In a couple of years, when the new schools start graduating hundreds more ODs on top of the hundreds we already can't support entering the workforce, then we're really going to see some ODs acting like starving castaways on some deserted island. Good times, baby...good times.

 

[Meibomian SxN]

Very well said. There's a reason they offer high salaries to naive new grads - it's a hell hole. The "exam in 7 minutes" is absolutely NOT an exaggeration. EyeStudent, here's what to expect. You'll be told during your interview that you'll be scheduled for 8 patients an hour to start. Then you'll clear your throat and say "What, you mean 8 patients for the morning, right?" At which time, your interviewer, who will probably be wearing an outfit that would have been in fashion when Blossom was on TV, will reply "No, it's 8 per hour....don't worry, you get used to it really quickly." You'll also be told "Hey, no worries big fella, you can practice to the full extent of your training. You wanna do glaucoma, no problem! You wanna do kone fits? No problem! You wanna do corneal transplants with a dull butter knife and some thread from an old dress sock? No problem! You can do it all! What they really mean is, "We don't care about eyes, we just want you to sell our garbage glasses and old, outdated CLs. But you CAN do it all, as long as you see around 60 patients per day for "full exams" and "contact lens fittings."

I know one classmate who worked there for a year right out of school. In addition to telling me she routinely cried in her car on the way home from work, she told me the only way she could keep up was to simply throw the patient behind the phoropter with the autorefraction in place, spin the wheel like a contestant on the Price is Right, and then pull the patient out...simply writing down what was on the autorefraction printout. She rarely refracted anyone and just used the phoropter for show.

JB, I don't think anyone on here will understand what we're talking about so I will ditto your advice to go shadow an AB doc for a whole day. The whoooooooole day....not just 5 minutes in the back of the exam room, or a quick lunch in the back office.....the whole enchilada from 9:00 to midnight, or whenever it is that they close. Actually, maybe they never close, who knows?

Given the state of optometry these days, I'd say if you're a new grad and you have no other choice, you might just have to suck it up and do it, but I don't know a single OD who's lasted in an AB position for more than a about 18 months. It's a total burnout situation from day one.

This highlights the problems that lay ahead for new ODs. Right now, AB is a "last resort" for many people. In a couple of years, when the new schools start graduating hundreds more ODs on top of the hundreds we already can't support entering the workforce, then we're really going to see some ODs acting like starving castaways on some deserted island. Good times, baby...good times.

+1

If that's all you can find, then so be it. But I don't have too many friends who have stayed there past 3yrs. And I know of 2 who have been sued already and another got a reprimand from the board. So that's what you get for $115k/yr.

 

[Shnurek]

I knew of an ophtho that just used auto-refractions for calculating cataract IOLs, glasses and contacts. But he had a great personality and no patient ever cared.

 

[JMK2005]

I knew of an ophtho that just used auto-refractions for calculating cataract IOLs, glasses and contacts. But he had a great personality and no patient ever cared.

are you saying that's good practice?

 

[Shnurek]

are you saying that's good practice?

no

 

[blazenmadison]

Can any current or former OD's of Americas Best Contacts and Eyeglasses state when the company post a salary amount, if that amount is gross or net? They advertised at my school starting pay of $115,000. I figure if i'm able to make $8,000 a month ( thats $96,000 a year) after taxes, i'll pay 1,600 towards student loans, $400 for a car loan, $1,500 for mortgage and property taxes, $800 groceries, $150 phone bill, cable internet $150, $250 health ins. That leaves $3,150 to save or for disposable income ( or payback more of the student loans). I'm sure i'm missing other expenses i will be needing to pay, but $8,000 a month sounds good to a 3rd yr student right now.

I think you're underestimating the taxes. You would make about $6700 after taxes if you live in a state where there is no state income tax like (Tennessee, Texas, Arizona, etc.). Otherwise factor in another 3-5% for state income tax.

Try ADP's after tax salary calculator
http://www.adp.com/tools-and-resour...l-calculators/salary-paycheck-calculator.aspx

I think you are better off grabbing a Wal-Mart or Lenscrafter lease if you want to do retail optometry. Avoid Sams Club/Costco membership driven retail optometry because they are typically low volume.

 

[Tippytoe]

Try ADP's after tax salary calculator
http://www.adp.com/tools-and-resour...-calculators/salary-paycheck-calculator.aspxI

I love that calculator. Plug in $80,000 (reasonable starting OD salary) and as a single person in North Carolina (for example), your take home is $4,500/month. Not bad at all.

But subtract (at least) $1,500 for school loans every month and you're at $3,000 (starting to get near teachers/garbage man income now). Still not bad. (btw,$150,000 loan comes out to $1,700/month and a $200,000 school loan comes out to $2,300/month)
Check out: http://www.finaid.org/calculators/loanpayments.phtml/

Get a new Toyota Camry for $500/month and a house for $1,500/month (modest house) and you're left with $1,000 per month for everything else.

So good news, your not starving and you have a car and a house. Bad news, after gas and food, you probably won't even have enough left to buy yourself health insurance much less invest in your future (Roth IRA, Simple IRA, etc....). Hope you don't want to have kids. They can be kind of expensive. And unfortunately, social security likely won't be around when you guys get old.

It's gonna be a tough life for you. Sorry.

 

[ChokherOD]

Please don't be discouraged by all the negative comments from this forum (Esp. Jason K). After you graduate, you've to start somewhere so don't be scared by all the negativity. It is not so bad as a OD in AB. There are days it gets very busy and you may have to see 3-4 patient in 1 hour, but there may be a day you will be seeing about 5-10 patient throughout the whole day which is not bad at all. OD spent as much time as they need to unless there are 5 other patients waiting to see the OD. It is a different experience for everybody and not everyone cries on their way to home.Work load depends on the location you work at. You're right about the salary range.

 

[yollusyollus]

My salary is exactly $100,000. There are 6 paid holidays, two of which are floating (labor and memorial day), five PTO days, and five vacation days.

About working here: I'm a new grad. You get a 3 day orientation in which an area doctor comes in and does your paperwork and shows you their system.

My normal exam takes about 10 minutes. They have full-page paper charts for new patients and half-page paper charts for follow-ups and repeat patients. The tech fills in almost all of the paperwork for me except the signature and exam findings. a typical exam goes like this:

1) I go into the tech room and look at the chart while the patient is having VA, autorefraction, and NCT performed. This lets me know the patient's name and gives me a chance to look at the pre-filled medical/eyeglass history so I don't dick around wasting time with that during the actual exam.

2) I say hi to the patient and tell them to take a seat and ask them what they're in for. 90% of the time its glasses or contacts, 9% of the time its due to some sort of conjunctivitis/CL abuse red eye/anterior seg issue and 1% of the time is for driving tests and DFEs for diabetes. This part usually takes 1-2 minutes, meanwhile I am using hand sanitizer on my hands, alcoholing off the equipment, and filling out the rest of the chart including signing it.

3) I do subjective refraction preceded by retinoscopy via skiascopy bars if the patient is too young, too old, has weird autorefraction findings, or if there's any reason to distrust the autofraction / old glasses. Skaiscopy bars are faster than the phoropter, and I actually spent considerable time while in optometry school (extra time) learning to use them quickly so I can complete retinoscopy in about 20 seconds on both eyes on nearly anyone. Refractive sequence takes about 3 minutes, 1 minute if its a simple young myope, maybe 4 minutes if they're old, non english speaker, or deaf or old.

4) Pupils, EOM, cover test and NPC, direct ophthalmoscopy, and monocular indirect ophthalmoscopy using transilluminator and 20D lens is about 1 minute.

5) Slit lamp and 90D fundus exam in about 1 minute. This part and the consultation is postponed if I dilate or cycloplege.

6) Consultation for 2 minutes in which I explain the findings, write out contact lens prescriptions if needed, attempt to push PALs, UV/AR coatings to make the manager happy, talk about warm compresses, AT, and zatidor (where I live zatidor is very very important....) and trial framing if the prescription is weird. If I have to trial frame I put the thing together while doing consultation, and they walk around with them

Dilation: here's the thing at America's Best, they want to sell FDT exams and the general manager's bonus is in part dependant on FDT exams sold (it is about an 8% contribution to their score). Dilations are $20 BUT if they purchase an FDT, the dilation is free. Hence, the general manager has abolustely nothing against me performing more dilations.

In general, I dilate all patients over 45 and any kid with any hint of refractive weirdness gets cyclopleged. Total dilation rate for me personally is about 70%. The least dilated segment is the 20-40 year old problem free population. On a slow day I see 20 exams, average day about 30, and busy days are 40 or so. I do dilate a little less and trial frame a little less when it gets extremely busy. My personal remake rate is about 1%, company average is 8% currently.

Referrals, disease, and other "cool stuff": I treat all anterior seg stuff and anything posterior gets sent to the ophthalmologist. Reason is that the office doesn't have a 24-2 capable screener, OCT, camera, etc and no SKU codes to charge for them. The past month I have treated and followed up 3 ulcers, numerous CL related red eyes, 2 uveitis, and fitted five RGPs, two of which were bitorics on high cylinder corneas.

My overall rating of the experience: pretty much what I expected out of school. The pay is approxmiately $400 a day which is on par with what most fill in jobs in the area pay. The stress level is very low since I'm idle about 30% of the time, and the patients are generally pretty nice. I got my job through a school interview.

Why I think many optometrists have a beef with america's best: I think people simply don't have the physical skill to do the exam fast enough so they spend a lot of time dicking around with technical issues and it cuts into consultation time, which is where you have your fun and make your money. A simple example is that lots of people can't get undilated 90D views quickly on a small pupil, do retinoscopy fast enough, perform monocular indirect, or ask history questions efficiently. In addition, training the techs well will go far.

 

[yollusyollus]

Sorry for the double post.

Some more information about America's Best that may inform you:

The pay anywhere that I looked is approximately $400 a day, give or take, for the physical labor of doing optometry. There is very little variation in this number and it will probably decrease a little over time as more grads are pumped out.

I'm on pretty good terms with the store's general manager and look at the production numbers daily. The thing which the manager is judged most heavily on is "net controllable contribution dollars" which represents, net of all costs including doctor payroll, staff payroll, remakes, the rent, electricity, and staplers, blah blah, how much profit is funnelled to the national vision entity. A typical non peak month in the store I work at, this number is approximately $27,000. Therefore, if you actually OWNED THE PLACE as a private office operating in a similar fashion as America's best, this would be approximately what you would make in addition to your doctor salary of $9000 or so. This is why private offices generate approximately $300k income/year if run properly.

Only difference is a lot of their patients get brought in by the 69.95 2 pair ads that are everywhere. Private office can replicate this but much more slowly via internal marketing. Their average unit sale is about $250, with average pair being about $102. This isn't too far off from most private offices due to their well trained optical staff.

You could probably duplicate America's best as a private office fairly easily except your lab costs are going to be a bit higher since they have a centralized lab and a couple extra ones in Mexico and Hong Kong, and volume growth would be lower since you dont have national advertising.

The weakness their place has in comparision with a private office is customer service. They have standardized training protocols and hire mostly college-aged people that aren't in college, with a core of 2-4 lifers that are certified oppticians doing it their whole lives. There of course is a lot of turnover in the low level receptionist / tech positions and this leads to longer patient wait times, low customer service skills, etc. This is how a private office would beat out America's Best since by virtue of how they run and how they hire and how their staff training is.

Of course, as a private office you'd have a similar problem. Basically, it amounts to this: you want someone as receptionist and optician, a person as nice, smart, well educated, well groomed, and communicative and focused on customer happines as you are as the doctor. Problem is that if they WERE all those qualities, they wouldnt be sitting at your desk being your receptionist, right? They'd probably be in college or getting a better job. That's the problem: trying to get good customer service out of basically ****ty raw materials, and is the eternal staffing challenge for low level positions. If I was in charge I'd pay $20+ an hour for quality lifers, but I'm not running the show here and such lifers are in short supply.

 

[EyeStudent]

Thanks for the responses everyone, especially yollusyollus. Yollusyollus, thanx for all the info. I feel like a big downside of working in corporate is that you have to deal with workers who are less qualified than you, and that would somewhat drain me. But saying that, everything you described about the work day is something I could live with( except for the 40 pt busy day wow, i might cry in my car after that day,jk). I have no idea yet where I am going to be working after the next yr when I send out my resumes to Private Practitioner Offices, OMD offices, and Commercial practices. What I enjoy the most, even though I have not done alot of exams as intern, is not only evaluating the retina with a 90D during indirect ophthalmoscopy, and dilating patients, as well as examining the cornea for infiltrates and SPK, inverting the lids looking for papilla or GPC, TBUTs for dry eye, checking for staining etc.. is just talking to patients and learning about their lives. I hope Jason K, its not true that OD's just read off the autorefractor, that would a waste of a very expensive education. That optometrist should have known what she was getting herself into. I knew when i began optometry school that it is a saturated field, but coming from a family who owns a gas station ( where i worked summers 16 hr shifts) and we could barely pay rent from month to month, optometry looks great! If i do go into Americas Best Contacts and Eyeglasses, i will expect to bust my butt in seeing alot of patients and doing quick exams, and not complain about it, and collect my check.

 

[EyeStudent]

I didn't mean to sound like i just enjoy evaluating the ocular health of patients. I do like refracting as well, i guess i like everything right now, i'll probably be jaded of optometry in ten yrs. I appreciate the insight ChokerOD.

 

[yollusyollus]

The biggest problem with working corporate is that you don't get any cut of the optical revenues. The reason why I exist for the company is because most people, out of convenience or tradition, get their eye exams at the same place that they purchase their glasses. Therefore, if they have an optometrist in the back WITH THE ABILITY to spew out prescriptions, troubleshoot contacts, and fix problems with glasses that the opticians can't fix, it greatly improves their patient flow. But I have no illusions that I contribute anything to their bottom line DIRECTLY.

However, it's not like you're a ton different at a private office either. A large amount of the money is made in the optical. There does not exist cash pay patients that give you $200 for a contact lens exam just because you're awesome, and if there were, there won't be after Obamacare takes effect and nearly everyone has some sort of insurance.

Starting a private office costs money and time. I ran my own caluculations which are fairly detailed, based on walk-throughs of several offices. The startup cost for a decently equipped office that looks reasonably nice with a frame lineup of about 400 frames is at least $120k including a few months of working capital. Yes, I know you can start one for $60k and have read all the optometric management articles (all 530 or so of them in their archive) but if you are realistically expecting your office to not look like **** then you need to spend a little more.

One idea would actually to open directly adjacent to an existing and extremely busy corporate location and attempt to beat them where they're the weakest (customer service). You get to basically utilize their national advertising since anyone walking into their store will see yours, but if you can do better than them, you will win.

Anyway, about the salary thing: the highest salary I've heard for America's Best was $120,000 starting in North Carolina. It is high because it's very difficult and expensive to get licensed in NC. Average is a little over $100k. Lenscrafters is paying about $45 an hour these days but the problem is that they often don't give you a full week so you are not at full utilization. One place that you can work at to gain extra days is Pearle Vision since they have 7-day leases and their docs are always looking for fill-ins.


By the way, regarding the person that JasonK mentioned that cries everyday after prescribing off the autorefractor: such a person is unsuited for any job and is best suited to stay home and live off welfare. Optometry is trivially easy compared to the vast majority of jobs requiring a doctorate level education and in a truly free market should probably be compensated about 60k or so. Getting paid 100k/yr for the actual work of doing optometry is more than fair. Where the real money is, however, is owning the whole store.

 

[yollusyollus]

For your budgetary concerns, here is my own experience.

After optometry school I owed about $50000. I attended one of the more expensive private schools in the country. This was the result of 1) no undergrad debt due to full scholarship 2) working 30hr/week during undergrad and investing all of the cash 3) large scholarship in optometry school paying about a third the tuition 4) working 40 hr week during optometry school 5) having kids early so I had food stamps and medicaid throughout school. The debt will be paid off by the end of this year. Disclaimer: I am an asian male under 30 years old. None of the scholarships were due to being black or mexican or female or gay or Navajo or whatever, all of them were fully based on academic merit.

My current rent in a nice one bedroom is about 800 bucks a month, water and internet and electric is less than $150 total, gas about $150 a month, food for the family about $700 (I buy good food, its important) so overall including random unexpected things about $2000 a month for living expenses for a family of 4. My wife doesn't work.

Advice for keeping your debt low: Basically, you need to work more, play less, and buy less stuff. Very simple. Work more, and you have more money to invest. Study harder and you'll get scholarships so school is way cheaper. Get on welfare because if you don't take that money, some obese diabetic dude who needs his fourth bypass surgery and sixth treatment of PRP is gonna use it up in about 2 months, or they'll spend it on one missile to blow up some $4 hut in afganistan. Buy less stuff since none of it will make you happy. For happiness, get a religion, play video games, spend time with your family, and eat sushi buffets (I'm not religious but through oberservation it seems to make a lot of people happy). None of that costs too much money. Buying a ton of shiny crap is ******ed. Stop overpaying for food at Whole Foods, shop at the mexican supermarket. Their food is cheaper and better quality.

As for investing, start a Roth IRA early, starting using the 401k after you graduate. If you wind up working in any self-employed capacity, start a solo 401k or SEP IRA and stick all your money into that.. the cap is much higher than with employed 401k. Use broad index funds preferably from vanguard or fidelity, go read the bogleheads.org forums. Do not play penny stocks, buy whole life insurance, day trade ETFs, or do any of that ******ed ****. Read some good investing books by academics such as Burton Malkiel and the stuff by Fama and French, and Bogle's books.

Do not do income based repayment under the assumption that you'l be waiting for the 25 year loan forgiveness or stretch your repayment period to 30 years unless you have some critical reason to do so. Do some math on excel and you'll see its pretty dumb. You should also realize that they tax all of the forgiven amount as income in the year that it happens, meaning a humongous tax bill somewhere down the line.

The key thing is probably to realize that most of the best things in life aside from sushi buffets are either inexpensive or free. At least don't blow your cash soon after graduating thinking your a "doctor". Hint: everyone's got a Phd or other variety of doctorate now. Nobody DOESNT have one. It's not special, and optometry school is very easy to get into so its not exacrly a mark of intelligence either. Even nurses are doctors now, and so is the chiropractor, the occupational therapist, the unemployed Ph.d in Women's Studies working at starbucks, and everyone else who goes through college and gets some grad school after realizing that undergrad is worthless. Don't think there's a vast gulf separating you from the receptionist.... if that receptionist was to take some easy pre-reqs at the community college, get about a 3.0+ gpa, will easily go to optometry school and be your equal... so its not that special. You should eat the same food she does, and stop bitching about earning only 100k or about having to see some more patients. She works just as hard as you and makes probably 25k a year. At least at my location, I KNOW the reception is working harder than me and so are all the opticians. It's not a bad deal....

 

[Jason K]

I hope Jason K, its not true that OD's just read off the autorefractor, that would a waste of a very expensive education.

Unfortunately, it is true. When you see 60 or more patients per day, you don't have the luxury of a 5 minute refraction. Our optometric hero, who's been working at AB for a couple of months and sounds like he's working at an AB location in northern Alaska, might be singing tales of glee from inside a well-known optometric garbage dump, but it doesn't change the reality of what AB is and what it stands for. I suspect if you met an inmate from a federal penitentiary who said "Hey, man, it ain't all that bad...I get free food, clothes, and free rent. Sure, the showers can get kind of rough here and there, but you know, you just take it for what it is and move on," you might still think twice about asking to be his cellmate in D block.

And yes, you're right, she should have known, but she didn't just like you do not. You might think you do, but you have no clue. You can't know, you're not even in school yet. You have a picture formulated in your head of what optometry is and will be, but sadly, it's a warped view that does not constrain itself to reality.

It's up to you, chief. You can listen to the general consensus among practicing ODs out there, that the field is crammed full of practitioners, the new schools will continue to hurt the profession, and the future for new ODs now is grim. Or, you can listen to a guy who's been out of school a few months, who has yet to fully realize who he's actually working for, and is telling a story that contradicts the sentiments of every person I've ever known who has even driven by an AB location.

If you can honestly tell yourself that you'll be happy working in an environment that has you doing very little, if any ocular health assessment/management, 1 minute refractions, and peddling Chinese plastic frames all day for $10/pair, then by all means, optometry might be just what you're after. The optometry of the future, at least in the US, will be just that.

 

[yollusyollus]

Unfortunately, it is true. When you see 60 or more patients per day, you don't have the luxury of a 5 minute refraction. Our optometric hero, who's been working at AB for a couple of months and sounds like he's working at an AB location in northern Alaska, might be singing tales of glee from inside a well-known optometric garbage dump, but it doesn't change the reality of what AB is and what it stands for. I suspect if you met an inmate from a federal penitentiary who said "Hey, man, it ain't all that bad...I get free food, clothes, and free rent. Sure, the showers can get kind of rough here and there, but you know, you just take it for what it is and move on," you might still think twice about asking to be his cellmate in D block.

And yes, you're right, she should have known, but she didn't just like you do not. You might think you do, but you have no clue. You can't know, you're not even in school yet. You have a picture formulated in your head of what optometry is and will be, but sadly, it's a warped view that does not constrain itself to reality.

It's up to you, chief. You can listen to the general consensus among practicing ODs out there, that the field is crammed full of practitioners, the new schools will continue to hurt the profession, and the future for new ODs now is grim. Or, you can listen to a guy who's been out of school a few months, who has yet to fully realize who he's actually working for, and is telling a story that contradicts the sentiments of every person I've ever known who has even driven by an AB location.

If you can honestly tell yourself that you'll be happy working in an environment that has you doing very little, if any ocular health assessment/management, 1 minute refractions, and peddling Chinese plastic frames all day for $10/pair, then by all means, optometry might be just what you're after. The optometry of the future, at least in the US, will be just that.

Cool story bro. You sound pretty dumb man, go be a writer and work at starbucks. Sounds like you're not a fan of free information exchange and prefer to bitch all the time.

I'd simply like to tell people of my personal experience and of practioners I have personally met, and asked them of their compensation and so forth. Your mileage may vary, I'm telling people objectively how many minutes I spend on refractions and how much money I make and how much debt I have and so forth. I don't work in Alaska by the way, I work in a place with a current temperature of 70 degrees and a climate similar to coastal oregon.

The scheduling system at America's Best potentially allows up to 8 patients to be scheduled an hour (2 per 15 minute slot). This may occasionally happen but bear in mind, they have an optical to run as well, and their opticians cannot also deal with 8 patients an hour. In general they try to schedule it so approximately four patients show up per hour and only follow-ups overlap with the 15 minute segments that are devoted to full exams. I have spoken with all of the optometrists in my area (I can view their schedules as well, actually) and nobody has exceeded 40 patients per day for a while (it's rare, usually caused by a 2-optometrist store having one of them call in sick), most see about as many as I see which is 20-30.

I have a difficult time understanding your 60 patients-per-day comment. Have you personally worked there or known anyone who worked there, or are you talking out of your ass? I don't see how it would be a wise business decision from the chain's point of view to overwork their opticians to that degree, since by definition everyone that sees the optometrist must see the receptionist, the optician, the tech, and everyone else. You're telling me that the MBAs who run the corporate office, similar to the MBAs that run REI sporting goods or Safeway, think its a good idea to completely understaff their office at every level of service?

As for the Chinese plastic frames, their frames are actually derived predominantly overstock or out-of season lines made in the US, with an average cost of $3-5. They are made of the same materials and same screws as pretty much every other frame out there. Thought you knew that?

I don't really understand your "doing very little ocular health assessement", let me ask you, how much are you expecting to do? Treat glaucoma and corneal ulcers all day? Glaucoma treatment is fairly easy compared to troubleshooting glasses. All you gotta do is run more OCTs, more visual fields, take photo, and hand out more alphagan/travatan/timolol, and refer when it finally requires an SLT or trab or whatever. Ulcer: apply antibiotics. Do a lot of follow ups. Add steroids when epthelial defect has cleared. Wow, so intellectual... its not that hard. It's just a job man, similar to most other jobs that involve... work.

Your excessive criticism of corporate optometry is kind of weird. Corporate optometry is simply what private offices are when they get big enough to become chains. How would you behave differently if you are a practice owner?

 

[Jibslider]

... is not only evaluating the retina with a 90D during indirect ophthalmoscopy, and dilating patients, as well as examining the cornea for infiltrates and SPK, inverting the lids looking for papilla or GPC, TBUTs for dry eye, checking for staining etc.. is just talking to patients and learning about their lives. ...

Yes, seeing return patients and forming those relationships is the most rewarding part of our job for me. If this is important to you, ask yourself if you feel like you can make that bond AND do your high quality exam in 7-10 minutes.

The truth is, at AB the doctor-patient relationship doesn't matter. Most of those patients are not there for YOUR exam or personality, they are there for the cheap terrible contacts and the "free eye exam".

You can work at AB and SEE (not examine in my opinion) 40+ patients and work hard for your paycheck, OR you could work SMARTER for your paycheck and enjoy your day.

 

[Jibslider]

...
I don't really understand your "doing very little ocular health assessement", let me ask you, how much are you expecting to do? Treat glaucoma and corneal ulcers all day? Glaucoma treatment is fairly easy compared to troubleshooting glasses. All you gotta do is run more OCTs, more visual fields, take photo, and hand out more alphagan/travatan/timolol, and refer when it finally requires an SLT or trab or whatever. Ulcer: apply antibiotics. Do a lot of follow ups. Add steroids when epthelial defect has cleared. Wow, so intellectual... its not that hard. It's just a job man, similar to most other jobs that involve... work.

Yikes. I hope that you take Glaucoma a little more seriously than you make it sound. Throwing tests and drops at patients repeatedly while their glaucoma progresses until they need a referral "or whatever" isn't good eye care

 

[yollusyollus]

Yikes. I hope that you take Glaucoma a little more seriously than you make it sound. Throwing tests and drops at patients repeatedly while their glaucoma progresses until they need a referral "or whatever" isn't good eye care

Yeah, throwing drops and tests at them until it can't be controlled is EXACTLY what you should be doing before referring to glaucoma specialist opthalmologist. Whats the alternative.... NOT throwing the drops at them? NOT doing the tests...?

 

[yollusyollus]

Yes, seeing return patients and forming those relationships is the most rewarding part of our job for me. If this is important to you, ask yourself if you feel like you can make that bond AND do your high quality exam in 7-10 minutes.

The truth is, at AB the doctor-patient relationship doesn't matter. Most of those patients are not there for YOUR exam or personality, they are there for the cheap terrible contacts and the "free eye exam".

You can work at AB and SEE (not examine in my opinion) 40+ patients and work hard for your paycheck, OR you could work SMARTER for your paycheck and enjoy your day.

You got a good point there. That people go AB to get cheap glasses/CLs, not for the doc or the manager or anyone else in there. People go to McDonalds for their cheap burger. Same thing. I'm sure you get more repeat patients as a private doc. Personally, it don't care whether they're repeats or not, but thats just me.

However, I'm not under the impression that people go to Outback Steakhouse because their waiter last year was awesome, either. I don't think the patients care about their optometrist or dentist that much. I sure don't care about my dentist that much, nor the mechanic that fixes my car. I actually go to dentist thats about as high end and prviate-practice-y as you can get, and I like him. BUT... 99% of the reason im there is for the service. Even if patients like me, they don't like me enough to come visit me randomly when its not for eye care. Thats what actual friends/family are for.

I don't work that hard at AB. The opticians work at least twice as hard and make less than half as much. Most days I walk away feeling I didn't do much at all. Again, thats just me, I already posted exactly what I do and how much of it I do. I also know that what I do is more thorough than most private OR corporate docs.

 

[Tippytoe]

I think the AB optometrist here speaks for himself and shows what kind of person you have to be to be a commerical refractionist. He/She seems to fit right in to that kind of sloppy "eye care".

Any place that charges patients (or customers where he is working) money to dilate really doesn't care about eye health. It's a penalty to patients and an incentive to get them to NOT to agree to dilate so they can move glasses faster. Also it's 100% UNETHICAL.

I've met many Walmart ODs that were Gung-Ho for a year or so. Then they got burned out, fired and at my doors begging for a job. It's pitiful when you see an OD with a wife and children practically on their knees looking for part-time work because XYZ-mart kicked them out when 30 day's notice. Then again, I do know of one Walmart OD that has been there for over 10 years (has 5 leases with slave ODs working for him). His only problem is keeping ODs. They come and go. (Moral is: It's good to be the king!)

I'll ask our AB OD to be sure to come back and post next summer and we'll see if he still likes it..........if he's still working there. No matter what he says, 1000's of ODs can't be wrong. The consensus is: America's Best is the worst working enviroment for ODs.

 

[Jason K]

I have a difficult time understanding your 60 patients-per-day comment.

Then apparently, you haven't been to the annual AB barbeque. Ask around, hoss - 60 pts per day is not even a full book.

Have you personally worked there or known anyone who worked there, or are you talking out of your ass?

I haven't worked there - that's why I don't have herpes. Yes, I know several people who work there. All of them would need counseling if they read any of your posts, so I won't subject them to the punishment.

I don't see how it would be a wise business decision from the chain's point of view to overwork their opticians to that degree, since by definition everyone that sees the optometrist must see the receptionist, the optician, the tech, and everyone else. You're telling me that the MBAs who run the corporate office, similar to the MBAs that run REI sporting goods or Safeway, think its a good idea to completely understaff their office at every level of service?

Here on planet earth, where more than one technician can work in an optical, AB is free to have one slave in the exam room, with multiple opticians outside waiting to feed. I'm shocked you don't realize that. Also, believe it or not, it isn't terribly difficult for one person to stand behind a register and say "Thank you for your money. See you next year." Despite that fact, many locations have two registers with......wait for it......two cashiers.

I don't really understand your "doing very little ocular health assessement", let me ask you, how much are you expecting to do? Treat glaucoma and corneal ulcers all day?

Oh, man - you are a new OD program's dream student.

Glaucoma treatment is fairly easy compared to troubleshooting glasses.

..........(cricket chirps).....Wow........I'd normally have something witty to say here, but....I'm speechless.

All you gotta do is run more OCTs, more visual fields, take photo, and hand out more alphagan/travatan/timolol, and refer when it finally requires an SLT or trab or whatever.

this just keeps getting better....it's like an Amtrack running toward a brick wall.

Ulcer: apply antibiotics. Do a lot of follow ups. Add steroids when epthelial defect has cleared.

Ok, I suspected that you had once worked for CLDoc [correction - mclem], but now I know it's true. How's life after the lawsuit? Still throwing antibiotics on anything opaque that affects the cornea?

Your excessive criticism of corporate optometry is kind of weird. Corporate optometry is simply what private offices are when they get big enough to become chains. How would you behave differently if you are a practice owner?

No, my ocular-health-disregarding friend, commercial optometry is not "simply what private offices are when they get big enough..." Commercial optometry exists for one reason: to sell materials. Private practice optometry is not run by MBAs, so it exists to provide eye care to patients. Regardless of that fact, optometry will soon be "all commercial" anyway, so it really doesn't matter.

Wow, so intellectual... its not that hard. It's just a job man, similar to most other jobs that involve... work.

Wow (again). Tippytoe is dead on - you ARE in the perfect spot for yourself. Kudos, big fella, I thought I'd never find the holy grail of garbage optometry, but you're the real deal. I won't be surprised if AB is quietly collecting samples of your DNA to clone you for their minions.

 

[blazenmadison]

America's Best.

PROS:
1)Good starting Salary
2)Benefits/Vacation
3)Job right out of school

CONS:
1)Work Saturdays (that goes for most corporate places and some private practices now)
2)Rotating schedule, you could be "floating" around different stores within X radius
3)No authority over staff hiring and you're accountable to a H.S. educated manager
4)Exams are basically refractions in 5 minutes allowing you to miss ocular pathology and being sued (dilation is not mandatory)
6)You are limited to contact lens choices like Biomedics and Acuvue 2 because of the cost
7)You are shunned by the local optometric community because you are that "guy" that devalues our eye exams. (Free eye exams for purchase of eyeglasses!) Unfortunately, you will encounter a few ODs that will report you to the board for petty stuff like not having your license displayed while practicing or your name is not on the door or you forgot to put "Optometrist" next to your Dr. XYZ name on prescriptions.
8)If you are "slow" or not producing enough income for their style of practice, then you will lose your job. I know an OD that dilated most everyone and did glaucoma work-ups and was warned by corporate to stop being a "doctor". He ended up being fired by giving patients the proper care.
9)You're going to be too dependent on this 'stable' income to leave
10)Your resume won't be very impressive if you plan on trying to find a better position

At the end of the day, you have to make a living, so a job is better than no job!

 

[yollusyollus]

I think the AB optometrist here speaks for himself and shows what kind of person you have to be to be a commerical refractionist. He/She seems to fit right in to that kind of sloppy "eye care".

Any place that charges patients (or customers where he is working) money to dilate really doesn't care about eye health. It's a penalty to patients and an incentive to get them to NOT to agree to dilate so they can move glasses faster. Also it's 100% UNETHICAL.

I've met many Walmart ODs that were Gung-Ho for a year or so. Then they got burned out, fired and at my doors begging for a job. It's pitiful when you see an OD with a wife and children practically on their knees looking for part-time work because XYZ-mart kicked them out when 30 day's notice. Then again, I do know of one Walmart OD that has been there for over 10 years (has 5 leases with slave ODs working for him). His only problem is keeping ODs. They come and go. (Moral is: It's good to be the king!)

I'll ask our AB OD to be sure to come back and post next summer and we'll see if he still likes it..........if he's still working there. No matter what he says, 1000's of ODs can't be wrong. The consensus is: America's Best is the worst working enviroment for ODs.

You mad?

Funny why you talk as if you've made it and are having the time of your life with all these OD's on their knees (weird fantasy buddy....) in front of you. Here's the truth man: you sore that other people can practice optometry in settings you don't fit into. That's fine. Whats not fine is that you feel free to judge the quality of other's eyecare without any personal experience in that mode of practice. Have you ever worked at an AB location or received an eye exam there?

Here's another truth: Your clinical skills probably suck ass if you think doing a proper health exam requires 30 minutes minimum. Learn some skills son.... stop adding negativity to the forums and go read some Kanski.

Fact: I was offered 2 residency spots and 1 fellowship prior to the ORMS match. One such location has a two word name and the names start with a B and a P. My NBEO scores are 700+ across the board and I went through optometry school while working full time and having kids. Don't try to judge my skills buddy. You probably are one of those folks who thinks its some sort of massive achievement to finish opto school, and that assessing the optic nerve is the pinnacle of intellectual achievement. Guess what: it's not. I turned all of that down to work at AB since it paid more and involves less bull****.

I'm here to tell people my pay, my exam sequence, how many I see a day, and what the general manager cares about, since this will help optometry grads find a job. You are doing nothing but looking like a gigantic idiot. Anyone who has further questions about AB I will answer them as straightforwardly as possible. Not even saying that AB is the best place to work... but you have to develop your own system to provide eyecare in such a setting.

 

[yollusyollus]

Then apparently, you haven't been to the annual AB barbeque. Ask around, hoss - 60 pts per day is not even a full book.

I haven't worked there - that's why I don't have herpes. Yes, I know several people who work there. All of them would need counseling if they read any of your posts, so I won't subject them to the punishment.


Here on planet earth, where more than one technician can work in an optical, AB is free to have one slave in the exam room, with multiple opticians outside waiting to feed. I'm shocked you don't realize that. Also, believe it or not, it isn't terribly difficult for one person to stand behind a register and say "Thank you for your money. See you next year." Despite that fact, many locations have two registers with......wait for it......two cashiers.


Oh, man - you are a new OD program's dream student.


..........(cricket chirps).....Wow........I'd normally have something witty to say here, but....I'm speechless.


this just keeps getting better....it's like an Amtrack running toward a brick wall.


Ok, I suspected that you had once worked for CLDoc, but now I know it's true. How's life after the lawsuit? Still throwing antibiotics on anything opaque that affects the cornea?


No, my ocular-health-disregarding friend, commercial optometry is not "simply what private offices are when they get big enough..." Commercial optometry exists for one reason: to sell materials. Private practice optometry is not run by MBAs, so it exists to provide eye care to patients. Regardless of that fact, optometry will soon be "all commercial" anyway, so it really doesn't matter.


Wow (again). Tippytoe is dead on - you ARE in the perfect spot for yourself. Kudos, big fella, I thought I'd never find the holy grail of garbage optometry, but you're the real deal. I won't be surprised if AB is quietly collecting samples of your DNA to clone you for their minions.

There is no annual AB barbeque. There's a CE event that provides about 45 credits and its usually in Texas. I've seen plenty of schedules. They don't involve seeing 60. My schedule today was fairly full with 48 total appointments and I saw 32 patients, 20 of which were full exams and the rest were follow ups and red eye/CL troubleshooting. Booked != Show. I hope you realize that.

Looks from what you write that you've never worked in a real optometry practice. Opticians do a lot more than say thank you for your money. If you are under that impression I suggest doing some shadowing and consulting your local pre-optometry club since you have never actually done eye exams.

Commericial optometry exists to sell materials. Yes, thats true. Private practice exists to.... what? Sell balloons? Or are you living somewhere where patients routinely come to your office with a large variety of ocular pathology just because all the local opthalmologists refer the patients to you? Stop trolling dude....

Here's another little factoid for you if you actually care to learn anything since you obviously seem to know everything already: The optometrist is about as important as the receptionist in terms of total practice perception. That is it say, pretty important, but not the whole picture. It does not make America's Best a lot of money if they constantly doing remakes due to poor optometry being performed and sucking up staff and optometrist time.

Although their mission in life is not to make optometrists as happy as possible, it does behoove them to at least allow enough time for optometrists of VERY AVERAGE competence to complete a decent refraction and some semblance of health exam, or the store stands to lose in a malpractice suit as well (never knew that did you? read your malpractice policy lately?). Tell me, I posted my exam sequence above and also my dilate rate of 70%.... what are you doing better than me?

 

[Jason K]

Opticians do a lot more than say thank you for your money.

Not at America's Best, they don't. Everywhere else, I'd agree, and never stated otherwise.

Commericial optometry exists to sell materials. Yes, thats true. Private practice exists to.... what? Sell balloons?

I don't remember too many people in my OD class saying "I can't wait to get out and sell matierlas!" Private practice is built on eye care, commercial is not. If you don't see that, you need to try working in one for a while.

Although their mission in life is not to make optometrists as happy as possible, it does behoove them to at least allow enough time for optometrists of VERY AVERAGE competence to complete a decent refraction and some semblance of health exam, or the store stands to lose in a malpractice suit as well (never knew that did you? read your malpractice policy lately?). Tell me, I posted my exam sequence above and also my dilate rate of 70%.... what are you doing better than me?

Listen, my very average friend, if you think you can come on this board and state that you can do a reputable ophthalmologic examination in 7 minutes, you must take all these people for idiots. You can satisfy the requirements for an eye exam, it doesn't mean you're doing reputable work. Keep trying, you can't make a diamond out of a pile of feces, no matter how hard you try. You're putting forth excellent effort, though, I must admit.

 

[yollusyollus]

Not at America's Best, they don't. Everywhere else, I'd agree, and never stated otherwise.




I don't remember too many people in my OD class saying "I can't wait to get out and sell matierlas!" Private practice is built on eye care, commercial is not. If you don't see that, you need to try working in one for a while.




Listen, my very average friend, if you think you can come on this board and state that you can do a reputable ophthalmologic examination in 7 minutes, you must take all these people for idiots. You can satisfy the requirements for an eye exam, it doesn't mean you're doing reputable work. Keep trying, you can't make a diamond out of a pile of feces, no matter how hard you try. You're putting forth excellent effort, though, I must admit.

Look son, for all your voluminous (ooh lookit that a big word, do I get points now??) writing, learn to read. I have outlined my exam sequence as above. I take 10 minutes on a routine patient without dilation, not 7. If I dilate it takes about 2 more minutes mostly because of explaining what the drops do and having them walk in and out of the room. Even if I don't dilate I obtain three views of the fundus via direct, monocular indirect, and 90D opthalmoscopy, allowing for viewing at all magification levels and views to about the mid-periphery on an average patient with average pupils.

Although AB has no OCT or threshold field machine, with the equipment that I have my exams are as thorough or more thorough than most private docs. I utilize several binocular refraction techniques including the Turville infinity balance (yes, I have the equipment for that. I made it myself). I use a Borish card (my own) and my remake rate is 1%. Do you even know what that stuff is? You do realize that the reason anyone comes to the optometrist is 95% to see better, right? At least, its possible to refine your refractive skills to a high level utilizing a high volume environment like AB.

Funny now, Jack Copeland managed to invent the streak retinoscope while working at a dock examining non-english-speakers 40 pts/day. That, in fact, is how he developed his skills to a high level. Are you telling me he's a sub-par and not up to your standards?

I'm not saying all AB docs do this. They don't. However, with the proper technique it is more than possible to give thorough exams in that environment.

 

[Jason K]

Look son, for all your voluminous (ooh lookit that a big word, do I get points now??) writing, learn to read. I have outlined my exam sequence as above. I take 10 minutes on a routine patient without dilation, not 7. If I dilate it takes about 2 more minutes mostly because of explaining what the drops do and having them walk in and out of the room. Even if I don't dilate I obtain three views of the fundus via direct, monocular indirect, and 90D opthalmoscopy, allowing for viewing at all magification levels and views to about the mid-periphery on an average patient with average pupils.

Although AB has no OCT or threshold field machine, with the equipment that I have my exams are as thorough or more thorough than most private docs. I utilize several binocular refraction techniques including the Turville infinity balance (yes, I have the equipment for that. I made it myself). I use a Borish card (my own) and my remake rate is 1%. Do you even know what that stuff is? You do realize that the reason anyone comes to the optometrist is 95% to see better, right? At least, its possible to refine your refractive skills to a high level utilizing a high volume environment like AB.

Funny now, Jack Copeland managed to invent the streak retinoscope while working at a dock examining non-english-speakers 40 pts/day. That, in fact, is how he developed his skills to a high level. Are you telling me he's a sub-par and not up to your standards?

I'm not saying all AB docs do this. They don't. However, with the proper technique it is more than possible to give thorough exams in that environment.

You gave yourself away with the MIO comment. Do you really expect us ODs to believe you whip out a direct, a 90D, and an MIO on each undilated patient....in a 10 minute sequence?? An M - I - O??? Really, dude?

Now I know you're a student - and I have a pretty good idea which one. Jesus, I can't even believe I wasted a couple of posts on you. Please go back to your studying now.

And for the record, voluminous really isn't a big word.

 

[KHE]

Although AB has no OCT or threshold field machine, with the equipment that I have my exams are as thorough or more thorough than most private docs. I utilize several binocular refraction techniques including the Turville infinity balance (yes, I have the equipment for that. I made it myself). I use a Borish card (my own) and my remake rate is 1%. Do you even know what that stuff is? You do realize that the reason anyone comes to the optometrist is 95% to see better, right? At least, its possible to refine your refractive skills to a high level utilizing a high volume environment like AB.

I actually snarfed my orange juice out my nose when I read that. Next, this guy is going to tell us how he created his own leaf room in an unused supply closet to help prescribe size lenses to his monocular aphakes.

Funny now, Jack Copeland managed to invent the streak retinoscope while working at a dock examining non-english-speakers 40 pts/day. That, in fact, is how he developed his skills to a high level. Are you telling me he's a sub-par and not up to your standards?

I would say Dr. Copeland is below my standards because he's been dead for probably 40 or 50 years now.

 

[Tippytoe]

You mad?

You're funny man. That's for giving us so many laughs. Really. It's awesome to have a nutball like you to lighten our day.

Unfortuantely, I am the man you will never be. I am a successful PRIVATE PRACTICE OD that does and says what he pleases. I have no boss to bow to. I have no authority telling me what contact lenses to fit. I have no high school graduate telling me what hours I must have my office open. I have no one telling me I'm not selling enough glasses.

I don't work Saturdays or Sunday. I'm off every day by 4:30. I take Wednesday off completely. Yep, I work 4 days per week........actually 3 1/2 and make more $$ than you are chief. So nope, I'm not mad. Maybe sad. Sad that you feel you need to prostitute yourself to make a buck. Sad you are not man enough (or woman enough...whoever you are) to be a real doctor and open up a private practice.

If your going to be in a crappy profession like optometry, at least try to make the best of it. But you'll be alright cause you tell yourself it's all good. But we know late at night, when you can't sleep, you dream of one day having a private practice to call your own. A day you won't have to be yelled at for leaving at 7 pm when a late straggler walks in for an eye exam. A day you won't miss every one of your kids baseball games. A day you can actually have a 2 day weekend.

But................sound like you got it all figured out. And again, thanks for the laughs.

P.S. Oh yea, I just saw the MIO comment. You do know that is a very old piece of equipment. People search for them online. They are antiques. That last guy I saw use one was an OD that was about 78 years old and he had had it since school.

 

[xmattODx]

You should re-read. He doesn't use a real MIO. He uses a poor man's MIO (don't really know why) a transilluminator and 20 D.

 

[Tippytoe]

You should re-read. He doesn't use a real MIO. He uses a poor man's MIO (don't really know why) a transilluminator and 20 D.

I didn't see that. He proudly claims he uses 3 viewing techniques to view the posterior pole. One is plenty. He's leaving out that little area we call the peripheral retina and not viewing it at all. It's kinda important. He says he dilates 70% of his patient. IMPOSSIBLE, I say. You just can't fit all that in in 10 minutes. Little things like tumors and tears can occur there. But I guess they don't if he never looks. . It's akin to your dentist only looking at your front teeth because "that's all people really see anyway".

Charging someone extra for dilation is about like your PCP charging extra for a prostate exam. "What you wanna stick a finger in my a_ _ and you want me to pay you extra to do it". No thanks. Same with dilation. It's not a pleasant experience for most people. It should be included in a comprehensive eye exam with the pt having the option to decline. .

Then says he doesn't even have a visual field instrument. That alone shows he's little more than a refracting optician. You can not practice eyecare in 2012 without an automated visual field. That means he's either missing alot of stuff or simply referring everything out to an OMD (I'm assuming he doesn't refer out to a real OD that has the equipment---ODs don't refer to other ODs as a rule). He also has no retinal camera, no corneal topographer, no pachymeter, no OCT, no b-scan, no slit-lamp/ant seg camera...........you know......all the stuff that it takes to treat eye problems after the refraction.

I propose I could train a high school graduate to do his job in 3 months. I'd call him an optican and he would be perfectly suited to perform adequete (albiet sloppy) eye exams at Americas Best. For real.

The thing this poster has going for him is that when he misses something, and he will miss something important, the customers do not think he as a real doctor so they might not bother to sue him. After all, you don't get the brightest bulbs in commercial practice. Yes I've worked commercial. Lots of people with missing teeth and dirty diapers (and not just the babies) .

But again, we don't have to prove it here. Anyone that is interested, find an America's Best location and spend a couple of days in that zoo. You'll see what we are talking about.

 

[Jason K]

I utilize several binocular refraction techniques including the Turville infinity balance (yes, I have the equipment for that. I made it myself). I use a Borish card (my own) and my remake rate is 1%.

When you get out of 1st year, I recommend putting your building skills to the test. I've heard you can make a a combo HFA/OCT out of a "Speak and Spell," a Toshiba Blackstripe vacuum tube television, an "Easy-Bake-Oven," a large white mixing bowl, and a Thigh-Master (the original, by Susan Sommers, not the imitations), so long as you know what you're doing. I got all the way through the assembly phase, but the wiring was just too much for me. You also might try making an original gangster version of the retinoscope - none of these electronic models that are for pansies, go for the flame variety that operated by candle light.

I say, have at it. When you do finally graduate, America's Worst will likely be your only option. The only difficulty will be in convincing them that you want to use all home-made equipment. I think they'll sign on, not sure.

I'm assuming you guys just covered the history of refraction or something - way too many references to ancient ophthalmic devices and refraction techniques that probably haven't seen the inside of an exam room since the 1950s.

 

[CL Doc]

When you get out of 1st year, I recommend putting your building skills to the test. I've heard you can make a a combo HFA/OCT out of a "Speak and Spell," a Toshiba Blackstripe vacuum tube television, an "Easy-Bake-Oven," a large white mixing bowl, and a Thigh-Master (the original, by Susan Sommers, not the imitations), so long as you know what you're doing. I got all the way through the assembly phase, but the wiring was just too much for me. You also might try making an original gangster version of the retinoscope - none of these electronic models that are for pansies, go for the flame variety that operated by candle light.

I say, have at it. When you do finally graduate, America's Worst will likely be your only option. The only difficulty will be in convincing them that you want to use all home-made equipment. I think they'll sign on, not sure.

I'm assuming you guys just covered the history of refraction or something - way too many references to ancient ophthalmic devices and refraction techniques that probably haven't seen the inside of an exam room since the 1950s.

Ha ha...too funny. I can't find my Turville septum anywhere. Maybe cause I haven't done the TIB since my second year of optometry school.

There's no reason to waste good money on an expensive camera. I remember making a pinhole camera out if a shoebox when I was in optics lab.

 

[yollusyollus]

I actually snarfed my orange juice out my nose when I read that. Next, this guy is going to tell us how he created his own leaf room in an unused supply closet to help prescribe size lenses to his monocular aphakes.



I would say Dr. Copeland is below my standards because he's been dead for probably 40 or 50 years now.

Size lenses aren't any good for monocular aphakes, and you don't use a leaf room to prescribe that either... you use an eikonometer. Nice try at name-dropping the leaf room though in order to show everyone that you remember something from optometry school...

Aside from that, you can spend $15 dollars at Bernell.com to assemble your own eikonometer. I happen to have one in the office just for kicks.

 

[Jason K]

Size lenses aren't any good for monocular aphakes, and you don't use a leaf room to prescribe that either... you use an eikonometer. Nice try at name-dropping the leaf room though in order to show everyone that you remember something from optometry school...

Aside from that, you can spend $15 dollars at Bernell.com to assemble your own eikonometer. I happen to have one in the office just for kicks.

Dude, we all know you're a 1st year OD student - shouldn't you be cramming for the History of Refraction test you have coming up? Have you given any thought to the HFA/OCT combo I mentioned - I think you might jet be the guy to put it together.

 

[yollusyollus]

I didn't see that. He proudly claims he uses 3 viewing techniques to view the posterior pole. One is plenty. He's leaving out that little area we call the peripheral retina and not viewing it at all. It's kinda important. He says he dilates 70% of his patient. IMPOSSIBLE, I say. You just can't fit all that in in 10 minutes. Little things like tumors and tears can occur there. But I guess they don't if he never looks. . It's akin to your dentist only looking at your front teeth because "that's all people really see anyway".

Charging someone extra for dilation is about like your PCP charging extra for a prostate exam. "What you wanna stick a finger in my a_ _ and you want me to pay you extra to do it". No thanks. Same with dilation. It's not a pleasant experience for most people. It should be included in a comprehensive eye exam with the pt having the option to decline. .

Then says he doesn't even have a visual field instrument. That alone shows he's little more than a refracting optician. You can not practice eyecare in 2012 without an automated visual field. That means he's either missing alot of stuff or simply referring everything out to an OMD (I'm assuming he doesn't refer out to a real OD that has the equipment---ODs don't refer to other ODs as a rule). He also has no retinal camera, no corneal topographer, no pachymeter, no OCT, no b-scan, no slit-lamp/ant seg camera...........you know......all the stuff that it takes to treat eye problems after the refraction.

I propose I could train a high school graduate to do his job in 3 months. I'd call him an optican and he would be perfectly suited to perform adequete (albiet sloppy) eye exams at Americas Best. For real.

The thing this poster has going for him is that when he misses something, and he will miss something important, the customers do not think he as a real doctor so they might not bother to sue him. After all, you don't get the brightest bulbs in commercial practice. Yes I've worked commercial. Lots of people with missing teeth and dirty diapers (and not just the babies) .

But again, we don't have to prove it here. Anyone that is interested, find an America's Best location and spend a couple of days in that zoo. You'll see what we are talking about.

Boy, you are hilarious. I'm not going to even comment on the "I are successful private practice OD/second coming of Jesus" chest beating you have up there. Tell me honestly, do YOU have a B-scan in your office? A refrigerator full of various agars? LOL.

Just to educate the non-*****s who might be reading this, none of that stuff TippyToe mentions is necessary for the vast majority of practice and if you did in fact buy it as a new grad starting out in private practice you are financially ******ed.

Anterior seg camera: go to costco and purchase a Rebel 3 digital camera and the best 35mm macro lens you can find, plus a short stand. There, you've pretty much got the best anterior segment camera money can buy.

Posterior camera: There's a Panoptic Iphone attachment for taking photos. There's not much illumination, so using a a beam splitter with a high intensity parabolic-mirror plano light source facing downward over the beam splitter (both can be bought from Edmund Optical for about $1000) in front of the aforementioned macro lens will allow high quality fundus photo to be taken.

Pachymeter: buy your own. It's like $500 for a used one. I have one.

Topographer: nice to have, but you can live without it if you don't do Ortho-K. Can diagnose and fit pellucid, cones, and all the other stuff by doing peripheral keratometry. Takes some extra time, but do you think people weren't aware of those conditions before topographers were widespread?

Finally, tell me how an OCT allows you to "treat" eye problems. how much glaucoma do you see a year? Oh wait, you have the OCT to run scans on every isolated drusen you see so you can collect $80 from medicare. Nice move, leech.

If you're going to get all crazy with the equipment, do YOU have the ganglion cell mapper software? Confocal microscope to make sure you don't miss that one fungal keratitis you'll see in your life (and that's from the powerpoints from optometry school)? Oh wait, real(tm) optometrists have MRIs in their office too and employ radiologists to read the scans. What a joke dude.

Moral of the story: If you're a new grad and need money and don't have a bunch of fancy equipment where you work, you use your brain a little bit and do what you can with what you have by learning a bit more from those optics classes you paid so much tuition for. There's nothing admirable about soiling your panties and throwing up your hands in helplessness because you don't have an MRI, CAT scan, a fridge stocked with culture media, and your old OD school prof on the phone to help you through every non 20/20 patient.

 

[Jason K]

Can diagnose and fit pellucid, cones, and all the other stuff by doing peripheral keratometry. Takes some extra time, but do you think people weren't aware of those conditions before topographers were widespread?

Peripheral K's?? Are you kidding me? Irregular cornea fitting is done with diagnostic lenses, even if you have a topographer, ThunderBuns. Have you been interviewing a doc who graduated when cave-paintings were in fashion? This stuff is hilaaaaaarious!!! I'm just picturing you in your exam room with a home-made keratometer saying "Hey, just a few more minutes, I need to measure every square mm of your corneas, I'm almost there...." Little piece of advice....get a couple of Rose K fitting sets. You probably don't know what a Rose K diagnostic set is or what it looks like, but when you're a big 3rd year, you might get your hands on one.

You just need to give it up, dude. You've been called out and you're going down in flames with each successive, ridiculous post. They're amazingly entertaining, though.

 

[yollusyollus]

When you get out of 1st year, I recommend putting your building skills to the test. I've heard you can make a a combo HFA/OCT out of a "Speak and Spell," a Toshiba Blackstripe vacuum tube television, an "Easy-Bake-Oven," a large white mixing bowl, and a Thigh-Master (the original, by Susan Sommers, not the imitations), so long as you know what you're doing. I got all the way through the assembly phase, but the wiring was just too much for me. You also might try making an original gangster version of the retinoscope - none of these electronic models that are for pansies, go for the flame variety that operated by candle light.

I say, have at it. When you do finally graduate, America's Worst will likely be your only option. The only difficulty will be in convincing them that you want to use all home-made equipment. I think they'll sign on, not sure.

I'm assuming you guys just covered the history of refraction or something - way too many references to ancient ophthalmic devices and refraction techniques that probably haven't seen the inside of an exam room since the 1950s.

You aren't an optometrist, are you? There is no history of refraction class in any optometry school.

By the way, have you heard of the Panoptic opthalmoscope? IT IS AN MIO, SON. Do you even know how modern opthalmic equipment works? I assume that if you are in fact an optometrist you learned the bare minimum necessary to pass your courses and have no idea how to change the bulb on your slit lamp.

Lets hear your remake rate, buddy. Binocular refraction outdated? LOL. Looks like you can't even refract as well as an America's Best doc. Ever heard of convergence torsion and how if you took that into account your remake rate on first time progressive wearers would go down dramatically? I'm sure a "real doctor" like yourself would not concern yourself too much with the vision science literature... after all, you're busy running MRIs on all the optic neuritis that gets referred to your office by the local neuro-opthalmologist.

 

[yollusyollus]

Peripheral K's?? Are you kidding me? Irregular cornea fitting is done with diagnostic lenses, ThunderBuns. Have you been interviewing a doc who graduated when cave-paintings were in fashion?

Peripheral K's? Hilaaaaaarious!!! You just need to give it up, dude. You've been called out and you're going down in flames with each successive, ridiculous post. They're amazingly entertaining, though.

Review your notes please... someone's failed their first cornea test. You diagnose pellucid with diagnostic lenses? LOLLLLLLLLLL.

Nice one. I'll let you keep talking and let the laughs continue....

Btw, I've noticed that you'ev edited your post above to mention Rose K fitting sets. Why would I need a "couple" of them? Let me guess, you have two because you do nothing but fit cones all day and go through the lenses so fast the replacements don't come back in time. (Also noticed that you've edited the post containing your NBEO scores to be "mid to low 700s" instead of "mid 600s to low 700s". I'll let that one go, lol....).

I don't have one... I use piggyback lenses if a simple RGP doesn't work, on cones in America's best. America's best customers don't have much money or insurance. Of course, you wouldn't understand that Rose K lenses cost the patient hundreds of dollars.... since you, being privledged, do not serve the poor folks... only rich ones, with optic neuritis, which also have insurances that reimburse well for MRIs. Such is the life of a "real doctor"....

 

[CL Doc]

Review your notes please... someone's failed their first cornea test. You diagnose pellucid with diagnostic lenses? LOLLLLLLLLLL.

Nice one. I'll let you keep talking and let the laughs continue....

If one were practicing on the cheap, the way to evaluate the peripheral cornea would be to use a placido disc, not peripheral k readings. Much quicker.

We had a photokeratoscope when I was a student that took a polaroid of the reflected rings.

You can also buy an attachment for a slit lamp cheap that does the same thing.

However, I wouldn't try billing medicare for topography with that.

 

[Jason K]

Review your notes please... someone's failed their first cornea test. You diagnose pellucid with diagnostic lenses? LOLLLLLLLLLL.

There's a difference between "diagnosing" and "fitting." You need to read more carefully. By all means, though - keep trying. It's a amusing.

Btw, I've noticed that you'ev edited your post above to mention Rose K fitting sets. Why would I need a "couple" of them? Let me guess, you have two because you do nothing but fit cones all day and go through the lenses so fast the replacements don't come back in time. (Also noticed that you've edited the post containing your NBEO scores to be "mid to low 700s" instead of "mid 600s to low 700s". I'll let that one go, lol....).

You've gone out of control here, stud-muffin. Are you hallucinating now that you've been exposed as a rouge student, impersonating an OD? I have no idea what you're talking about. No one has edited anything regarding NBEO scores - again, please take to reading more carefully. Please use quotes to demonstrate your cluelessness. Pull those quotes out, hoss - let's see you put your money where your mouth is.

 

[yollusyollus]

There's a difference between "diagnosing" and "fitting." You need to read more carefully. By all means, though - keep trying. It's a amusing.




You've gone out of control here, stud-muffin. Are you hallucinating now that you've been exposed as a rouge student, impersonating an OD? I have no idea what you're talking about. No one has edited anything regarding NBEO scores - again, please take to reading more carefully. Please use quotes to demonstrate your cluelessness. Pull those quotes out, hoss - let's see you put your money where your mouth is.

It's "a amusing" alright. A "rouge" student sure has you wringing your panties in desperation. Seems like your English skills are deteriorating rapidly as is your credibility. I haven't seen a clever metaphor for quite a while now... forgot to take your ADHD meds?

Honest, admit it dude. You're probably a Real Optometrist that did pretty crappy in school, did a residency, and expected to be an opthalmologist afterward, but became disappointed when only corporate positions materialized. Afterward, you obtained a Rose K fitting set and spent your "hot wife"'s parent's money filling your Private Office(tm) with an OCT, topographer, confocal microscope, and UBM, and sitting there bitching in your office alone with no patients on SDN about how optometry is dead since you can't make the lease payments and not getting laid since your wife (she's female, right?) is pissed off cause her parents are on her back about her incompetent deadbeat husband (your a dude, right?).

Nice talking to you kiddo. Anyone else have any serious questions about America's Best? Not saying its for everyone. Just telling you the straight facts about how I do my exams and how much money I make.

 

[CL Doc]

You aren't an optometrist, are you? There is no history of refraction class in any optometry school.

By the way, have you heard of the Panoptic opthalmoscope? IT IS AN MIO, SON. Do you even know how modern opthalmic equipment works? I assume that if you are in fact an optometrist you learned the bare minimum necessary to pass your courses and have no idea how to change the bulb on your slit lamp.

Lets hear your remake rate, buddy. Binocular refraction outdated? LOL. Looks like you can't even refract as well as an America's Best doc. Ever heard of convergence torsion and how if you took that into account your remake rate on first time progressive wearers would go down dramatically? I'm sure a "real doctor" like yourself would not concern yourself too much with the vision science literature... after all, you're busy running MRIs on all the optic neuritis that gets referred to your office by the local neuro-opthalmologist.

Where did you go to school?

 

[Jason K]

It's "a amusing" alright. A "rouge" student sure has you wringing your panties in desperation. Seems like your English skills are deteriorating rapidly as is your credibility. I haven't seen a clever metaphor for quite a while now... forgot to take your ADHD meds?

Still waiting for those quotes - what's the matter there, TombRaider - having trouble finding something?

Funny that you haven't once denied that you actually are a student - I think it's pretty obvious to all at this point. You've got home-made exam room equipment, you do binocular refractions and 12 different posterior seg examinations on every patient, you dilate 70% of your patients in an optical environment? Do you really think we're that clueless? You reek of a 1st year student who's gone haywire with his academic info.

You're going to have to stop, wait another few weeks (at least) and then come up with another fictitious screen name to use. You're in the middle of an online inferno that you can't get out of now. I don't think we've heard such ridiculous claims since the imemily era. By all means, though - keep going with it, it's cute to read your attempts to sound like someone with clinical experience. You had me going for a few posts, but it all fell apart for you soon enough.

Also, ask your next poor CL patient to pull out their phone. My usual medicaid patient has a $700 iphone and car with rims that cost more than car itself. Rose K lenses are not all that pricey - do your homework. People spend more on an annual supply of DD lenses (those are daily disposables, but the way - you probably haven't gotten to those yet.) Keep trying, little man - keep trying.

 

[yollusyollus]

Still waiting for those quotes - what's the matter there, TombRaider - having trouble finding something?

Funny that you haven't once denied that you actually are a student - I think it's pretty obvious to all at this point. You've got home-made exam room equipment, you do binocular refractions and 12 different posterior seg examinations on every patient, you dilate 70% of your patients in an optical environment? Do you really think we're that clueless? You reek of a 1st year student who's gone haywire with his academic info.

You're going to have to stop, wait another few weeks (at least) and then come up with another fictitious screen name to use. You're in the middle of an online inferno that you can't get out of now. I don't think we've heard such ridiculous claims since the imemily era. By all means, though - keep going with it, it's cute to read your attempts to sound like someone with clinical experience. You had me going for a few posts, but it all fell apart for you soon enough.

Also, ask your next poor CL patient to pull out there phone. My usual medicaid patient has a $700 iphone and car with rims that cost more than car itself. Rose K lenses are not all that pricey - do your homework. People spend more on an annual supply of DD lenses (those are daily disposables, but the way - you probably haven't gotten to those yet.) Keep trying, little man - keep trying.

Let me break it down for you son.

First, it's not possible to quote stuff that you've changed if I didn't copy it down beforehand. I'm not that obsessed over you. The reverse doesn't seem to be true. Post a screenshot of your NBEO score display. Mine will go up as soon as yours does. Feel free to black the name out.

It takes about 1 minute to apply dilation drops to someone, explain what they do and walk them out of the room. It takes another minute to call them back in and get them seated. It takes about 2 minutes to view the periphery / posterior pole. If your exam flow is halfway decent this will add a whole... five minutes? To your exam sequence. Have you not performed optometry outside a school setting? Let me guess, your eye exams take 2.5 hours and are finished up by asking your attending, "so where was that cataract you were talking about?"

It takes about 20 seconds to view the nerve and macula of both eyes using a direct scope, and adds maybe 30 seconds to slit lamp to do undilated 90D. It takes about 2 minutes to do undilated MIO views to the mid-periphery on a average-cooperativity patient. ITS NOT THAT HARD BRO. I believe there's an advantage to seeing things at all magnifications, and it adds nearly nothing to my exam time. Tell me, how long does it take for YOU TO DO YOUR POSTERIOR EXAMS? Leme guess, peek with a 90D that takes 10 minutes because you can't get a view on 10mm pupils?

Again, let me break it down for you again: the manager at AB gets bonused on FDTs. They cost $15. FDTs are free if the patient dilates. It's A LOT EASIER for me to talk a patient into spending $15 on dilating than for the tech to talk someone into shelling out $15 for something that she can't explain that well. Hence, the manager LOVES THAT I DILATE. CAN THIS NOT BE MORE CLEAR TO YOU?

About home made exam room equipment: it's cheap, it works, and it works because I understand how it's built. I've used that eikonometer a few times. My homemade fundus camera is pretty ****ing awesome. Not ashamed of it, buddy.

Signing off for the night. I feel that I've gotten significantly stupider since speaking with you.

 

[CMM83]

This is just classic optometry.

 

[Shnurek]

This is just classic optometry.

lol

yollus, I'm guessing you ignored my initial warning not to argue with this Jason person. Do you feel better now that you wasted a part of your life on this person?