Feeling like a PROSTITUTE

[rpie]

I went to the optometrist yesterday for an exam & to get my Rx updated. Rachel & have only moved here relatively recently, and I typically go to Wal-Mart for most of my vision stuff. The one I went to had friendly people, and got things right as far as I could tell.

Yesterday I went to an independent chain (Eyeglass World is the name, I believe), and since I didn't have any referral sources I basically went based on a newspaper flyer a couple weeks back. I was *very* surprised at how unhappy everybody in the office appeared. My wife was in there last Friday, and she reported the same experience. The exam was $45--which then, it turns out, comes right back to me as a credit if I get my glasses there--and the sales staff were very high-pressure. It wasn't a pleasant experience, and I'm not going back.

One unfortunate trend from all three optometrists I've seen since starting dental school, is that when I answer them about what I do, they've all been very complimentary--I would almost say wistful--about dentistry and what a great field it is, despite not having much to say about their own field when I asked them about it. I usually change the subject since I'm never really sure how to respond to that, but I feel bad when that happens since I get the impression they're not especially satisfied with their careers, especially since I respect what they know and appreciate the help they're giving me (I'd be functionally blind without them!).

Now, I fully recognize my n of 3 means absolutely nothing, and maybe it really is just the corporate thing I'm seeing since I've never been to private practice, but that's my non-inflation-adjusted $0.02.

Bill, why not have your eye physical done by an OD in private practice? I would recommend finding an OD by looking at the providers on your major medical insurance. Note that some medical insurances sub-contract out their vision insurance through the commercial chains, so pay attention to their location. Also, be advised that in many cases vision insurance only covers a routine eye exam and materials. If you have an ocular medical condition your major medical insurance would cover those services. The point is; if your medical insurance does not have vision, you should still be able to find an OD that is listed as a medical provider.

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[Ben Chudner]

I might. I'm definitely not going back to EW (appropriate acronym, nein?). If private practice is going to cost more, though, I'd want some sort of referral before I just ring somebody out of the Yellow Pages.

Bill, is Indiana University School of Dentistry in Bloomington? If so, that is where the Indiana School of Optometry is. I bet the exam fees are not too high, and you may have some coverage as a student. You will there for a couple of hours, but you will have a very thorough eye exam.

 

[rpie]

Ken,

Thanks for the post. I think these issues are very important to students, as well as practicing docs. As you and I have discussed before, my path was quite a bit different than yours. Maybe I had the advantage of not practicing in an area like Los Angeles or New York. I have, however, seen older docs try to screw younger ones. Not just OD's, but OMD's do the same thing. As for the OD's, it's the ones that complain about corporate optometry that either refuse or are unable to offer a new grad a position that would keep them in private practice. In some of my upcomming talks, there will be both OD's and students. Hopefully, I can make the OD's realize that corporate will continue to get new grads as long as they continue the same tactics.

That being said, let me once again tell my story so that the other side is presented. After graduating from Berkeley, I did a residency in ocular disease at Bascom Palmer. After a year in Miami, my wife was ready to leave so we headed back to the west coast. We were both able to find jobs in Washington State so that's where we moved. I worked for an OMD practice for three years, before I realized I couldn't be an equal partner (not because I was an OD, but because I couldn't produce as much as a surgeon on the medical side). An opportunity came up to purchase an optometry practice sight unseen, meaning I had never worked there before. I knew the doctor and the reputation of the clinic, so that made things easier. I was able to secure financing from the SBA very easily because the doctor was goining to stay on as an employee and he was willing to carry a note for 20% of the purchase price. I bought the practice in August of 2001. The seller retired in August of 2004. I have just brought on another doctor part-time. I knew that I wasn't ready for a full-time employee (she is paid as an employee), so I contacted another doctor in the area that I knew was looking for a part-time doctor and we share her. This way both clinics have fulfilled a need for a part-time doc, and she works full-time between the two. By the way, we have no trouble getting on insurance panels, which I agree is the key to success for the future. Optical sales only represents about 30% of my revenue, with the majority comming from the medical side.

The morale of the story - there are some of us private docs that are willing to be fair to new grads.

Say Ben, I was wondering since you got into your practice in 8/01 how did 9/11 affect your practice and others in your area? We had about a 30% cancellation/rescheduling right after, and the income for the rest of the year was down about 20-25%. Talking with a few ODs and OMDs around the country there was a mix from no effect to some going into bankruptcy. One thing that was consistent with all docs was that they experienced a sudden drop of optical materials sales while, professional fees for medical treatment had little if any drop. The 20-25% drop in income is approximately what we make from our dispensary.

 

[jchod]

I'm 30 years old. I've worked in pharmacy, biotechnology and optometry. I found something I'm good at and love. I worked in it for a year and a half before going to OD school. I know EXACTLY what I'm getting into... I put myself through school and worked my ass off. I have great mentors both OD and OMD. I'll be fine... I spent a year running a front desk and coding insurance. I know how to bill .. and I know what they pay. I also know which plans are le poo.

Don't worry about cpw... she can take care of herself.

Keep that attitude and determination, and you'll do great things!! We need more like you. Good luck on boards!

 

[Ben Chudner]

Say Ben, I was wondering since you got into your practice in 8/01 how did 9/11 affect your practice and others in your area? We had about a 30% cancellation/rescheduling right after, and the income for the rest of the year was down about 20-25%. Talking with a few ODs and OMDs around the country there was a mix from no effect to some going into bankruptcy. One thing that was consistent with all docs was that they experienced a sudden drop of optical materials sales while, professional fees for medical treatment had little if any drop. The 20-25% drop in income is approximately what we make from our dispensary.

Talk about timing. On top of that, my office is located in a military town so you can imagine how tense it was around here. 30% cancellation/rescheduling sounds about right for that week. September of that year was down about 20% in collections. We bounced back in October and were only down about 9%, but by November we were up a little from the previous year. Fortunately, in January of 2002, I implemented a new fee schedule to increase reimbursements from several insurance companies. In 2002 I was up 23% in production and 12% in collection for the year.

In looking at the numbers a little more closely, I would agree that optical took the biggest hit in the months right after 9/11. I made an effort, however, when I first bought the practice to be less reliant on optical sales. In 2001, optical represented just over 40% of my revenue. So far in 2005 it only represents just over 30%. Maybe this is more due to economic factors rather than my efforts, but either way I would prefer to produce more on the medical side than the optical side. I feel that as the baby boomers age, there will be less of a demand for optical and more of a demand for medical, so that is how I am positioning my practice. I will always have an optical, but I am putting my efforts into growing my medical.

 

[KHE]

I'm 30 years old. I've worked in pharmacy, biotechnology and optometry. I found something I'm good at and love. I worked in it for a year and a half before going to OD school. I know EXACTLY what I'm getting into... I put myself through school and worked my ass off. I have great mentors both OD and OMD. I'll be fine... I spent a year running a front desk and coding insurance. I know how to bill .. and I know what they pay. I also know which plans are le poo.

Don't worry about cpw... she can take care of herself.

Yeah. I worked in a variety offices for 4 years too. I too "worked my ass off."

The issue is not knowing how to code, or bill, though those are obviously very important. You have to be assured that you will be able to be enrolled in these plans as well. You can NOT assume that because other ODs are on a panel that you can be too. I made that mistake.

 

[KHE]

Keep that attitude and determination, and you'll do great things!! We need more like you. Good luck on boards!

A "good attitude" and "determination" are noble qualities to have, but they are NOT enough.

Students....you need to formulate a SPECIFIC plan of what you want to do and you need to do it well before you graduate.

 

[KHE]

Say Ben, I was wondering since you got into your practice in 8/01 how did 9/11 affect your practice and others in your area? We had about a 30% cancellation/rescheduling right after, and the income for the rest of the year was down about 20-25%. Talking with a few ODs and OMDs around the country there was a mix from no effect to some going into bankruptcy. One thing that was consistent with all docs was that they experienced a sudden drop of optical materials sales while, professional fees for medical treatment had little if any drop. The 20-25% drop in income is approximately what we make from our dispensary.

In 8/01 I took a position as clinic director for a major refractice surgical center in Las Vegas. After 9/11, 300 000 people were laid off in Las Vegas. One month after that, the anthrax scare started up. Needless to say, no one was getting elective eye surgery since no one knew if the world was going to end or not, and the clinic folded in January of 2002.

 

[aphistis]

Bill, is Indiana University School of Dentistry in Bloomington? If so, that is where the Indiana School of Optometry is. I bet the exam fees are not too high, and you may have some coverage as a student. You will there for a couple of hours, but you will have a very thorough eye exam.

I wish, d'oh. IUSD is at IUPUI, so Bloomington would be quite a hike for an eye exam. If it was closer, I'd gladly go just for the karmic implications on my own patient base.

 

[rpie]

Talk about timing. On top of that, my office is located in a military town so you can imagine how tense it was around here. 30% cancellation/rescheduling sounds about right for that week. September of that year was down about 20% in collections. We bounced back in October and were only down about 9%, but by November we were up a little from the previous year. Fortunately, in January of 2002, I implemented a new fee schedule to increase reimbursements from several insurance companies. In 2002 I was up 23% in production and 12% in collection for the year.

In looking at the numbers a little more closely, I would agree that optical took the biggest hit in the months right after 9/11. I made an effort, however, when I first bought the practice to be less reliant on optical sales. In 2001, optical represented just over 40% of my revenue. So far in 2005 it only represents just over 30%. Maybe this is more due to economic factors rather than my efforts, but either way I would prefer to produce more on the medical side than the optical side. I feel that as the baby boomers age, there will be less of a demand for optical and more of a demand for medical, so that is how I am positioning my practice. I will always have an optical, but I am putting my efforts into growing my medical.

You are doing what we are doing by emphasizing services over materials. I think this is a key component to the survival of Optometry. Reading posts of people saying that Optometry is driven by the sales of materials may be true in some cases, but not in all. As you know there is very little profit in contacts, and as far as glasses, most vision insurance plans pay you the cost of materials, and allow you to charge minimal for extras. Yes, there are occasions where a patient will spend 3-400 bucks out of pocket for a pair of glasses in your dispensary but what we have found is that they are patients that have been coming to us over a length of time for their on going management of glaucoma, AMD etc. In the end, the amount of income generated form our dispensary is still about 20-25% of our revenue base. In private practice you have the ability to either emphasize materials or your services. I know a few OD’s do not have an optical dispensary and do well just on services, similar to what I believe JennyW does, and I also know of a few OD’s that are playing the “2 pair for 99 bucks” and the coupon game. In talking to the docs that play the 2 pairs for 99 bucks they are constantly complaining about how they get no respect, feel like a dial spinning tech. etc. and how hard they have to work in order to be able to make ends meet.

Anyway, I'm glad you made it thourgh the storm

 

[Ben Chudner]

Anyway, I'm glad you made it thourgh the storm

Ditto. It's nice to hear other success stories.

 

[jchod]

A "good attitude" and "determination" are noble qualities to have, but they are NOT enough.

Students....you need to formulate a SPECIFIC plan of what you want to do and you need to do it well before you graduate.

right . . . and . . .? At least for me, that point is opbvious. You can not do well at something if you have not defined your goals or your plan.

 

[wrx04]

What would you practicing docs recommend learning about above and beyond school? I'm gonna be starting Opt school in August and this forum, as well as seniordoc, has opened my eyes to the aspects of optometry that seem to be crucial in starting a successful practice. Would you recommend trying to get a job in a practice billing insurance? What would be the best way to prepare myself for running my own practice? Thanks alot for all your input.

 

[KHE]

What would you practicing docs recommend learning about above and beyond school? I'm gonna be starting Opt school in August and this forum, as well as seniordoc, has opened my eyes to the aspects of optometry that seem to be crucial in starting a successful practice. Would you recommend trying to get a job in a practice billing insurance? What would be the best way to prepare myself for running my own practice? Thanks alot for all your input.

Let me make a few suggestions...

I think its safe to say that most students out there envision running their own successful Guggenheim like practice filled with designer merchandise, and a waiting room full of cool and interesting ocular pathology....

If you are just starting out, I would just concentrate on doing as well in school as you possibly can for the first two years. Don't worry about all the stuff here and on seniordoc for the first two years.

But the second you are done with part I of the board exam, you need to really start doing some serious thinking and doing some serious pavement pounding. You have to research heavily the areas where you want to practice and you need to visit as many ODs and OMDs in that area as possible. And I don't just mean researching the number of ODs or OMDs, or Walmarts near by or the average income of the population. My experience was that these things matter very little. You need to research things like...

1) Can I be admitted onto managed care plans in that area? (if I so desire)

2) Is the area dominated by one or two managed care plans? If it is, do these pay well enough, or are they going to squeeze me like a turnip because they have such a large market share? Is the area dominated by a particular managed vision care plan like VSP or Eyemed?

3) Is the area dominated by one particular injustry or employer? For example, if the biggest employer in a particular area is a steel mill, what happens if the steel mill closes? (And going back to point #1, can you be admitted onto the managed care plan of that company?)

I would not try to get a job billing insurances. Billing them isn't the issue. Insurance billing can be confusing at first, but it's really not that hard to learn. The issue is "can I be admitted onto the panel in the first place?"


The only caveat to the above would be if you KNOW that you absolutely postively want to live in a certain area, and have no intention or willingness to move elsewhere, you should do this research long before you even start school. You don't want to get through school at find out that your chosen area is not a desireable one in which to practice. The notion that optometry can be "practiced anywhere because hey, everyone needs they're eyes checked" is not exacty true. If Microsoft employees have Blue Cross, and you can't be admitted onto Blue Cross, you might not want to open up an office in Redmond, WA. That's the kind of stuff you need to know if you are considering moving there.

 

[DrHopeless]

Many of you guys seem to be discontent with the profession. If you have to do it again would you?

 

[Ben Chudner]

1) Can I be admitted onto managed care plans in that area? (if I so desire)

Very important. In this world that is dominated by third party payors, it is hard to find patients willing to pay cash.

2) Is the area dominated by one or two managed care plans? If it is, do these pay well enough, or are they going to squeeze me like a turnip because they have such a large market share? Is the area dominated by a particular managed vision care plan like VSP or Eyemed?

This is hard to fully comprehend until you are in business. You need to determine how much your chair cost is per hour. For example if your overhead is $2000 per day (staff, utilities, rent, malpractice insurance, etc) and you see patients for 7 hours a day (9-5 with a one hour lunch), then you chair cost per hour is $285. If your patients all have VSP, and VSP only pays about $75 for an exam on average, then you need to see about 4 patients an hour just to cover your overhead. It's even worse for lower paying plans.

3) Is the area dominated by one particular injustry or employer? For example, if the biggest employer in a particular area is a steel mill, what happens if the steel mill closes? (And going back to point #1, can you be admitted onto the managed care plan of that company?)

This is important, but not specific to optometry.

I am not a big advocate of new grads opening up cold right out of school. I just don't think new grads are good enough doctors yet to be successful. Take time to improve your bedside manner and your diagnostic skills. Use your first job, or even jobs, to become a better optometrist. Once practicing optometry becomes second nature, then you are ready to learn how to run a successful business. This also allows you the opportunity to work in an area before owning a business there. You will be able to find out if you can get on insurance panels, if the area is doiminated by crappy insurance plans, etc. Ideally, you will be able to buy into the practice you are working at, although I don't know too many OD's that end up working for the first place they got a job.

 

[KHE]

Many of you guys seem to be discontent with the profession. If you have to do it again would you?

I think its very safe to say that I would NOT.

However, that doesn't mean I'm not grateful for the experience or that I hated going to work every day. It just became very obvious to me very quickly that I could not imagine myself sitting in a 10 X 10 dark room saying "which is better, one or two" for the next 30-40 years, so I left. But had I not had my degree in optometry, my teaching salary would not be nearly as high as it is. So in that sense, I am very fortunate.

 

[odstudent]

I think its very safe to say that I would NOT.

However, that doesn't mean I'm not grateful for the experience or that I hated going to work every day. It just became very obvious to me very quickly that I could not imagine myself sitting in a 10 X 10 dark room saying "which is better, one or two" for the next 30-40 years, so I left. But had I not had my degree in optometry, my teaching salary would not be nearly as high as it is. So in that sense, I am very fortunate.[/QUOTE


Before you started optometry school did you have any experience working for an optometrist? Didn't you know that was what you were going to be doing most of the time?

 

[rpie]

What would you practicing docs recommend learning about above and beyond school? I'm gonna be starting Opt school in August and this forum, as well as seniordoc, has opened my eyes to the aspects of optometry that seem to be crucial in starting a successful practice. Would you recommend trying to get a job in a practice billing insurance? What would be the best way to prepare myself for running my own practice? Thanks alot for all your input.

Gosh what a nice day yesterday was. We had the honor of having an acute angle closure patient come in first thing in the morning. The wonderful thing was he was so nauseated that he left his breakfast on our reception desk, and receptionist.


I think everyone needs to have a good idea of what mode of practice you want to go into. If you don’t want the headaches of running your own practice then look to either join a group practice or look into an HMO like Kaiser Permanente. Depending on your location Kaiser’s starting salary for OD’s are between 85-110 G’s a year. The down side to Kaiser is that it’s hard to get in so you may have to go part time for a while before being able to get a full time position. The positive is that you will be working along side the other health care providers. Should you desire to go into private practice, it is important to get on insurance plans, however I agree with Ben. A new grad starting cold may not be a wise choice.

One thing that many OD’s complain about is VSP. I understand why they are down on VSP because they do police you a lot. VPS does offer you consignment frames for your optical dispensary and now has a program to help financing a practice start up or purchase. Please note that I am not a VSP advocate, just a person that recommends using the resources that VSP offer. Another thing is that VSP has primary eye care coverage on certain plans so when a patient comes in with a medical condition you will be reimbursed for your services.

The difficult in getting on medical plans is probably dependant on your location; however this is not limited to OD’s, as I know some OMD’s that have not been able to get on certain insurance plans. An interesting point about patients that are on medical plans that exclude OD’s, we have noted that about 90% will also have VSP coverage for their vision insurance with the added primary eye care benefit.


There is young OD friendly docs out there. Depending on your situation I think you may find that group practices can be a little more flexible. We recently hired an OD couple (they introduced me to this site) that wanted to split a full time position between the 2 of them in order to care for their 4 young children. I can say that we are very pleased with the situation and hope that in the future they both consider going full time, and possibility full partner maybe.

 

[KHE]

Before you started optometry school did you have any experience working for an optometrist? Didn't you know that was what you were going to be doing most of the time?

Oh yes. I decided I wanted to be an OD when I was 14. I had worked for a number of different ODs throughout my high school and college careers. Like I said before I asked lots of questions but in retrospect, I asked the wrong ones.

 

[Eyegirl2k7]

One morning in clinic a fellow asked me where Suite 3 was because his eyes hurt and before I could answer him, he'd puked in the bucket he was holding. Aah, angle closure glaucoma. Lots of fun.

Eyegirl2k7.

 

[xmattODx]

If you don’t want the headaches of running your own practice then look to either join a group practice or look into an HMO like Kaiser Permanente. Depending on your location Kaiser’s starting salary for OD’s are between 85-110 G’s a year.

I don't think Kaiser really pays that much. I'm pretty sure you're looking at more like 55,000 or 60,000. At least in HI and the Pacific Northwest.

 

[hoosier1]

You will be expected to fulfill a certain qouta of patients everyday if you work for Kaiser

 

[stompy]

I don't think Kaiser really pays that much. I'm pretty sure you're looking at more like 55,000 or 60,000. At least in HI and the Pacific Northwest.

I know of someone who just got hired in the past year for roughly 77k....in Riverside, CA

 

[rpie]

I know of someone who just got hired in the past year for roughly 77k....in Riverside, CA

Good day Stompy how are you? I haven't notice any of your post lately.

The starting pay does vary depending on the location. One of our associates moved to the southeastern planes about 2 years back because her husband was opening his DVM practice. She took a job with Kaiser at 90 a year, and now she is in the process of finishing office space in her husbands practice so they will have a DVM / OD practice in one location. The thing about the patient quota, I was informed that it was instituted because there are docs that will always try to do the least amount of work.

I’m off to do some lectures and C/E over the next month so cheers to all.

 

[Abner Yokum]

The problem with optometry is that the vast majority of exams don't take much brains or expertise at all, which is why docs at Wal-Mart can cherry-pick these easy patients for a low in and out the door fee. Come on -- an ape can refract a myope or come up with an add, and most patients don't have any ocular disease. For the patients with a serious ocular disease problem, an ophthalmologist is probably a better option than an OD because medical insurance will pay for the care -- and unless the OD spends a lot of time treating disease, the MD's level of expertise is likely to be higher, not necessarily because of training, but just because he or she has more experience in this area. Face it, there's not much need for the ocular disease skills of an OD unless you live out in the boonies of North Dakota or Alaska, where no MD's in their right mind would want to practice, or unless you are a top of your class ocular disease junkie who does a prestigious disease residency and lands the rare job in a major metropolitan-area clinic that lets you use those skills. The rest of you will be spinning dials and occasionally writing an Rx for antihistamine drops. For whatever reason, many people (especially the ignorant yahoos, who make up a majority of Americans these days) now do perceive optometrists to be in about the same league as beauticians because so many of them practice in shopping malls, Costcos, and Wal-Marts. The genie was let out of the bottle long ago, and OD's are never going to have the prestige of real doctors again in the eyes of most consumers -- people don't read about what it takes to become an OD, all they know is that we're near the photo counter at the local Costco.

 

[stompy]

Good day Stompy how are you? I haven't notice any of your post lately.

Yep, I've instead been enjoying the discussion lately...(as well as reading up on optometrysucks forum on yahoo groups)


It's all very informative and interesting...it'll be quite a storm for me to sail through...let the games begin!

I'm about to start 1st year SUNY next month.

 

[HOLLYWOOD]

I know of someone who just got hired in the past year for roughly 77k....in Riverside, CA

I know someone who just got offered a job making $110,000 ... by jp morgan chase. He just graduated college.

 

[Ben Chudner]

The problem with optometry is that the vast majority of exams don't take much brains or expertise at all, which is why docs at Wal-Mart can cherry-pick these easy patients for a low in and out the door fee. Come on -- an ape can refract a myope or come up with an add, and most patients don't have any ocular disease. For the patients with a serious ocular disease problem, an ophthalmologist is probably a better option than an OD because medical insurance will pay for the care -- and unless the OD spends a lot of time treating disease, the MD's level of expertise is likely to be higher, not necessarily because of training, but just because he or she has more experience in this area. Face it, there's not much need for the ocular disease skills of an OD unless you live out in the boonies of North Dakota or Alaska, where no MD's in their right mind would want to practice, or unless you are a top of your class ocular disease junkie who does a prestigious disease residency and lands the rare job in a major metropolitan-area clinic that lets you use those skills. The rest of you will be spinning dials and occasionally writing an Rx for antihistamine drops. For whatever reason, many people (especially the ignorant yahoos, who make up a majority of Americans these days) now do perceive optometrists to be in about the same league as beauticians because so many of them practice in shopping malls, Costcos, and Wal-Marts. The genie was let out of the bottle long ago, and OD's are never going to have the prestige of real doctors again in the eyes of most consumers -- people don't read about what it takes to become an OD, all they know is that we're near the photo counter at the local Costco.

Thanks for the laugh. This is the funniest post I have seen in a while.

 

[SoxTown]

Thanks for the laugh. This is the funniest post I have seen in a while.

It made me chuckle too...

 

[KHE]

Thanks for the laugh. This is the funniest post I have seen in a while.

I failed to see the humor. Sadly, there's a lot of truth in what he said. Particularly the part about how we're perceived by the public.

 

[Ben Chudner]

I failed to see the humor. Sadly, there's a lot of truth in what he said. Particularly the part about how we're perceived by the public.

There is only truth in what he said for some of us. I believe perception is reality. In my office I have created a clinic that looks just as professional as the local OMD. I have the same equipment as the local OMD. I treat the same type of patients as the local OMD. In my office I am a "real doctor". My patients call me when they have a red eye, flashes of light, diplopia, unexplained ocular pain, or anything else that they need to call a "real doctor" for. I work closely with surgeons, and the retina specialist refers his patients to me for ongoing care after he has stabilized their condition. I even get referrals from MD's for diabetic eye exams. I don't refer out diabetes or glaucoma until it becomes surgical. I am tired of hearing all the complaining about how we are perceived. If OD's don't like how they are perceived, then either find a way to change that perception or quit. Corporate docs can choose this same path if they want. The optical in my office has no bearing on my patients' perception of me. It's they way I approach their care. There are no "7-4 out the door" exams (if those are the right numbers, Berkeley did not teach that type of exam). That is why I found the post funny, as I am sure other "real doctors" did.

And by the way, I practice in a suburb of Seattle with several OMD's in the area.

 

[KHE]

There is only truth in what he said for some of us. I believe perception is reality. In my office I have created a clinic that looks just as professional as the local OMD. I have the same equipment as the local OMD. I treat the same type of patients as the local OMD. In my office I am a "real doctor". My patients call me when they have a red eye, flashes of light, diplopia, unexplained ocular pain, or anything else that they need to call a "real doctor" for. I work closely with surgeons, and the retina specialist refers his patients to me for ongoing care after he has stabilized their condition. I even get referrals from MD's for diabetic eye exams. I don't refer out diabetes or glaucoma until it becomes surgical. I am tired of hearing all the complaining about how we are perceived. If OD's don't like how they are perceived, then either find a way to change that perception or quit. Corporate docs can choose this same path if they want. The optical in my office has no bearing on my patients' perception of me. It's they way I approach their care. There are no "7-4 out the door" exams (if those are the right numbers, Berkeley did not teach that type of exam). That is why I found the post funny, as I am sure other "real doctors" did.

And by the way, I practice in a suburb of Seattle with several OMD's in the area.

Good for you Ben, that you were able to build up a practice in the image that you wanted it.

But the point I was trying to make (and in retrospect I wasn't clear with it) was that commercial practice is not the only problem that creates this image of optometry.

Fact is, the vast majority of private practices out there are strip mall type practices which are essentially optical stores with exam lanes in the back, usually sandwiched in between a nail salon and a pizzeria. Yet these same docs will pat themselves on the back for being in "private practice" all the while deriding their commercial collegues. It doesn't make much sense.

Fact is, more than 85% of "private practices" out there get more than 50% of their revenue from material sales. How can anyone say with sincerity that that is a doctors office? Its essentially an optical store with a little side business doing exams. And if that's what 85% of the so called "private practices" out there are, then I really worry for the future of this profession. You might get the minority of your revenue from exam fees Ben, but the statistics show that you are in the minority.

And as I've said before, I've seen much more 7 and 4 and out the door in private offices. I've seen much more antiquated equipment in private offices. I've seen much more dusty BIOs in private offices and I've seen much more trying to convice 85 year old mac degen patients that they really really need AR coated polycarbonate progressives in private offices. I've seen much more unethical practices in private offices.

We can moan and groan about Costco, and Walmart and Lenscrafters, and 1800 contacts, and Pearle Vision and whatever. But "private practice" is just as much to blame for optometry's so called image problem than commercial practices, if not more so.

 

[Ben Chudner]

Good for you Ben, that you were able to build up a practice in the image that you wanted it.

But the point I was trying to make (and in retrospect I wasn't clear with it) was that commercial practice is not the only problem that creates this image of optometry.

Fact is, the vast majority of private practices out there are strip mall type practices which are essentially optical stores with exam lanes in the back, usually sandwiched in between a nail salon and a pizzeria. Yet these same docs will pat themselves on the back for being in "private practice" all the while deriding their commercial collegues. It doesn't make much sense.

Fact is, more than 85% of "private practices" out there get more than 50% of their revenue from material sales. How can anyone say with sincerity that that is a doctors office? Its essentially an optical store with a little side business doing exams. And if that's what 85% of the so called "private practices" out there are, then I really worry for the future of this profession. You might get the minority of your revenue from exam fees Ben, but the statistics show that you are in the minority.

And as I've said before, I've seen much more 7 and 4 and out the door in private offices. I've seen much more antiquated equipment in private offices. I've seen much more dusty BIOs in private offices and I've seen much more trying to convice 85 year old mac degen patients that they really really need AR coated polycarbonate progressives in private offices. I've seen much more unethical practices in private offices.

We can moan and groan about Costco, and Walmart and Lenscrafters, and 1800 contacts, and Pearle Vision and whatever. But "private practice" is just as much to blame for optometry's so called image problem than commercial practices, if not more so.

I can agree with all of that. I saw the same thing when I was looking for work. I have no beef with the corporate docs, because I do not compete with them. I'll bet if you look at the OD's complaining, they are the ones you describe. "Private practice" docs that essentially work next door to their optical in a strip mall. My point is that not all OD's have this image problem. The one's that do, are those same strip mall docs. I believe it's important for people like you who became unhappy with optometry to continue to post on the student forum. They need to understand issues that will affect them. I also believe it's equally important for people like me to post, so that the students have something to strive for - happiness within the profession.

 

[rpames]

Perhaps it is a difference of where you are located, but I have not seen many of the bad private practices that KHE has described.

Of course there are bad private ODs out there, but I also knew of a DDS who refused to sterilize his equipment after every patient. I knew of a DC who told every patient they needed to come back once a week for the rest of their lives, I knew a DVM who who charged for "diagnostic test" that did not exist. These docs were all in private offices, but my positive experiences with private docs still far outweighs these examples by a long shot.

I understand what KHE is saying, but I have not had the same experiences.

 

[John_Q]

Perhaps it is a difference of where you are located, but I have not seen many of the bad private practices that KHE has described.

Of course there are bad private ODs out there, but I also knew of a DDS who refused to sterilize his equipment after every patient. I knew of a DC who told every patient they needed to come back once a week for the rest of their lives, I knew a DVM who who charged for "diagnostic test" that did not exist. These docs were all in private offices, but my positive experiences with private docs still far outweighs these examples by a long shot.

I understand what KHE is saying, but I have not had the same experiences.

That's pretty gross if the doctor doesn't even sterlize the equipment between patients.

 

[ODhopeful]

I personally think the topic of this thread is not very nice toward prostitutes because they use their skills to earn a living just like anyone else. Like prostitution is a bad thing.......

 

[lnn2]

but I also knew of a DDS who refused to sterilize his equipment after every patient

Are you b****ting or blowing smoke up someone's @ss?! You're probably smart enough to know that it's a healthcare violation , to say the least! Don't they teach that in OD school?! Aseptic techniques and universal precaution?!
If that's true (I doubt it!) then it's a violation of OSHA, Dental Practice Act...You need to report that DDS to the Dental Board. His license would be suspended, even revoked, not to mention possible law suits.

 

[lnn2]

I personally think the topic of this thread is not very nice toward prostitutes because they use their skills to earn a living just like anyone else. Like prostitution is a bad thing.......

I agree. They have to work hard for the money too, making a honest living. just imagine how many popsicles they have eat per day for living!

 

[rpames]

Are you b****ting or blowing smoke up someone's @ss?! You're probably smart enough to know that it's a healthcare violation , to say the least! Don't they teach that in OD school?! Aseptic techniques and universal precaution?!
If that's true (I doubt it!) then it's a violation of OSHA, Dental Practice Act...You need to report that DDS to the Dental Board. His license would be suspended, even revoked, not to mention possible law suits.

I presume you are making this statement in shock of what that DDS was doing, or do you think I am just making things up? I assure you that nothing I post is ever just made up. And wether they teach us aseptic technique or not is totally irrelevant to the topic. But for the record, duh, what do think! That is why I posted it as an example of horrible medical practice.

By the way, I was told this by a family friend of mine and former hygienist of his who quit b/c of that disgusting practice.

 

[lnn2]

That's a shame! The hygienist has the moral, ethical obligation to report that DDS to the Dental Board.

 

[drbizzaro]

That's pretty gross if the doctor doesn't even sterlize the equipment between patients.

yeah that's disgusting... i know of classmates who pretended to clean stuff before practising on others, and never did! that's gross too!

 

[drbizzaro]

I presume you are making this statement in shock of what that DDS was doing, or do you think I am just making things up? I assure you that nothing I post is ever just made up. And wether they teach us aseptic technique or not is totally irrelevant to the topic. But for the record, duh, what do think! That is why I posted it as an example of horrible medical practice.

By the way, I was told this by a family friend of mine and former hygienist of his who quit b/c of that disgusting practice.

you should list their info here so we know not to go to him

 

[drbizzaro]

I personally think the topic of this thread is not very nice toward prostitutes because they use their skills to earn a living just like anyone else. Like prostitution is a bad thing.......

what's your opinion on drug dealing then? or extortion?

 

[Graham Lakkis]

Since I have now been practicing for over 10 years, I can look back at optometry from the perspective of a new graduate as well as a private practitioner. When starting my work career, I did not really know what type of practice I wanted or where it would lead me, but I was always adamant that I wanted to practice to the best of my training and ability. Although this can be done wherever you work, it is much easier in your own practice.

For the first 2 years out of school I worked for a chain store in a Mall. There were always instances where the optical store manager would say "We need to quickly fit in this customer (who didn't have an appointment) for a refraction, just skip the rest of the eye exam". Or "This customer doesn't want an exam, just bump up his add a little because he's having trouble reading the paper". Of course I never agreed, but that type of situation doesn't allow you to work to your maximum training. The equipment provided was also minimal, and the workspace was tiny (you could barely fit a second person in the exam room). That's why I started my own practice soon after.

As optometrists, we are in the top percentile of educational ability, and spending day after day doing repetetive and mundane work will quickly lead to boredom and disillusionment because we are not utilising our knowledge. However, if we do utilise all our abilities, and make every eye exam count, and make it the best that the patient has ever had, your practice will grow in leaps and bounds. I have had new patients comment that at their previous exams, the optometrist seemed bored, wasn't concentrating on what they said, or seemed unhappy to be there!

If you work in a commercial outlet, patients attend because of advertised sales, coupons or other marketing strategies. They usually don't know or care who the optometrist is. They are there for optical correction only. Can you imagine someone going to WalMart for foreign body removal, Day 1 cataract post-op, amaurosis fugax, or glaucoma care? These are all things seen daily in private practice, if you manage them as you were trained in the first place, and treat them well of course. Word quickly spreads through the community of the eye care you provide, and referrals come in from friends and relatives, work colleagues, family doctors and other optometrists.

That is the most rewarding aspect of optometry practice, where patients are coming to see YOU, because of the expert care YOU can provide them. These people become YOUR patients, and they return to see you year after year over their lifetimes. You become involved with their lives, their marriages, the children they have, and even their illness and death. Last week, the husband of one of my patients phoned me on the very day his wife finally succumbed to breast cancer, to tell me of her death! The patients become like family over the years, and even if they move out of the area, will continue to come and see whenever thay are in town. It is almost impossible to achieve this in a WalMart-type location, and although you may think the money is good initially, in my opinion it cannot sustain a satisfying professional career.

I realise that not everyone wants to have the responsibility of running their own practice, but this is where group practice is ideal. My wife is a dentist, and she works in a group practice with 2 other dentists, which has allowed her time off to have our 3 children, and now work 3.5 days a week. Recently 3 optometry colleagues have opened a new practice, and each of them works there for 2 days a week while still practicing at the university optometry clinic the rest of the time.

In private practice, if you enjoy your work, and do it to the best of your ability, the general public really can tell, and you will be rewarded with a long and satisfying professional career that you can recommend to your children.

 

[rpames]

In private practice, if you enjoy your work, and do it to the best of your ability, the general public really can tell, and you will be rewarded with a long and satisfying professional career that you can recommend to your children.

Great post! You have summed up what I have been trying to say for years.

 

[KHE]

I can't speak for the state of optometry in Australia, but I can assure you that the students and practitioners here in the USA also want to practice to the "best of their ability." Problem is, in a lot of areas ODs are not admitted onto medical insurance panels. So, sorry to say, the option to treat all those glaucoma cases and foreign body removals (of which there are actually very few) is not an option for many ODs. Therefore, they are reduced to retailing optical products which essentially puts them in direct competition with retailers.

Also, we REALLY need to get off this issue of private practitioners somehow being fine upstanding folks who care only for the welfare of their patients while corporate doctors are mere drones who are slaves to the corporate whims. I have said this repeatedly, I have worked in a number of both private and commercial practices on both the east and west coast. Yes, we have all had that experience in private practice where patients come and say "Wow! This is the best eye exam I've ever had!" Thing is, I heard it just as much when I worked commercial because I DID THE SAME EXAM. And the vast majority of the collegues that I knew in commercial did that too! I also heard this in commercial practice a lot: "Wow! This is so much nicer and more convenient. I went to see Dr. Smith on main street, and he just kept badgering me to get all kinds of expensive add ons and wouldn't give me my contact lens prescription." There are just as many doctors who are doing "7 and 4 and out the door" in private offices as commercial practices. I've seen it over and over again. And I don't know what its like in Australia, but in the commercial locations I worked in, the equipment was always new and modern and well maintained. In private offices, some of them were the same, but there was plenty of equipment that I saw that looked like it was the pride of world war II Germany, or had not been updated since the Carter adminstration.

Also, the notion of YOUR patients coming to YOUR practice to see YOU is a very tender notion, and it can be true as long as you take their insurance plan. When I worked in private practices we would have dozens of patients a month who would come to us as new patients and when we asked "How did you hear about our office?" They would say almost to a man "you are on my insurance plan." The might have said "and my friend Joe recommend you" which is very nice, and we're happy that Joe likes us, but the fact remains that if we were not on that patients insurance plan, he would NOT be in our office regardless of how much Joe sings our praises. We also had many patients every month who would request that we fax their records to another doctor. When we would phone and ask why, the reason was almost invariably this: "I really liked you guys, but we have new insurance and you are not on our plan now." This would happen with patients who had been seen in the office for 10, 20 or 30 years. And can you blame them? The number of patients who will pay out of pocket for services that they can get covered elsewhere is vanishingly small. Think about it! I only go to doctors who are on my health plan! Why would I expect my patients to be any different? Because I'm a "nice guy?" Let's be serious now. Health insurance is DAMN expensive. I'm not going to pay hundreds of dollars a month out of pocket for it and then use an out of network provider.

Students out there.....heed my warning. If you have any desire to do anything more than spin some dials for 35 years and fret daily about patients going to 1800 contacts or Lenscrafters (and I know all of you have this desire) then you must make DAMN sure that you can practice in an area where you can be admitted onto MEDICAL insurance panels. If you can not, then you will be relegated to sitting in a dark room all day saying "better one, or better two" and helping pre teens decide whether "turquoise" or "aqua" looks better on them and referring every pink eye and glaucoma suspect out to the friendly neighbourhood opthalmologist. Is that what you are hoping to do after 8 years of school and a couple of hundred grand of education?? I didn't think so.

Since I have now been practicing for over 10 years, I can look back at optometry from the perspective of a new graduate as well as a private practitioner. When starting my work career, I did not really know what type of practice I wanted or where it would lead me, but I was always adamant that I wanted to practice to the best of my training and ability. Although this can be done wherever you work, it is much easier in your own practice.

For the first 2 years out of school I worked for a chain store in a Mall. There were always instances where the optical store manager would say "We need to quickly fit in this customer (who didn't have an appointment) for a refraction, just skip the rest of the eye exam". Or "This customer doesn't want an exam, just bump up his add a little because he's having trouble reading the paper". Of course I never agreed, but that type of situation doesn't allow you to work to your maximum training. The equipment provided was also minimal, and the workspace was tiny (you could barely fit a second person in the exam room). That's why I started my own practice soon after.

As optometrists, we are in the top percentile of educational ability, and spending day after day doing repetetive and mundane work will quickly lead to boredom and disillusionment because we are not utilising our knowledge. However, if we do utilise all our abilities, and make every eye exam count, and make it the best that the patient has ever had, your practice will grow in leaps and bounds. I have had new patients comment that at their previous exams, the optometrist seemed bored, wasn't concentrating on what they said, or seemed unhappy to be there!

If you work in a commercial outlet, patients attend because of advertised sales, coupons or other marketing strategies. They usually don't know or care who the optometrist is. They are there for optical correction only. Can you imagine someone going to WalMart for foreign body removal, Day 1 cataract post-op, amaurosis fugax, or glaucoma care? These are all things seen daily in private practice, if you manage them as you were trained in the first place, and treat them well of course. Word quickly spreads through the community of the eye care you provide, and referrals come in from friends and relatives, work colleagues, family doctors and other optometrists.

That is the most rewarding aspect of optometry practice, where patients are coming to see YOU, because of the expert care YOU can provide them. These people become YOUR patients, and they return to see you year after year over their lifetimes. You become involved with their lives, their marriages, the children they have, and even their illness and death. Last week, the husband of one of my patients phoned me on the very day his wife finally succumbed to breast cancer, to tell me of her death! The patients become like family over the years, and even if they move out of the area, will continue to come and see whenever thay are in town. It is almost impossible to achieve this in a WalMart-type location, and although you may think the money is good initially, in my opinion it cannot sustain a satisfying professional career.

I realise that not everyone wants to have the responsibility of running their own practice, but this is where group practice is ideal. My wife is a dentist, and she works in a group practice with 2 other dentists, which has allowed her time off to have our 3 children, and now work 3.5 days a week. Recently 3 optometry colleagues have opened a new practice, and each of them works there for 2 days a week while still practicing at the university optometry clinic the rest of the time.

In private practice, if you enjoy your work, and do it to the best of your ability, the general public really can tell, and you will be rewarded with a long and satisfying professional career that you can recommend to your children.

 

[wrx04]

What determines whether you are admitted to a medical insurance plan or not? (or any type of insurance plan for that matter)

 

[KHE]

What determines whether you are admitted to a medical insurance plan or not? (or any type of insurance plan for that matter)

Sadly, nothing that you really have any control over.

In some parts of the country, ODs are welcomed onto plans with open arms, and the process simply involves filling out an application, having your credentials checked, and signing a contract.

Unfortunately, in other parts of the country, ODs are excluded from panels simply by virtue of the fact that they're an OD. Some plans "don't allow ODs." Some say they don't allow "any non-physician providers"

The WORST ones are the ones that allow ODs to bill for "routine" visits only. These are the patients that come to your office for care, but if they have anything wrong with them other than myopia, hyperopia, astigmatism, or presbyopia you will be referring that patient out. Or, you can treat them, but you will not be getting paid for it. And this type of thing can ruin the image of an office much more quickly than Walmart every could. If you have a patient with pink eye, and you have to send them out to an OMD or a GP, the message the patient gets is "If I have anything wrong with my eye other than a need for glasses, then this office is NOT the place to go."

In rare cases, if you keep badgering a plan and beg and plead long enough, they might admit you but will limit what diagnosis codes you can bill for. For example, after close to 10 months of pleading with one plan, I was able to be reimbursed for any conjunctivitis, but no glaucoma or FB removal or even uveitis. If a patient had one of these conditions, they were gone.

So again students, if you have any desire to do anything other than refract for 30 years, (and I know you all do) then you MUST be able to be admitted onto panels, and you should choose where you practice accordingly. Unfortunately, there really isn't any resource you can cansult. You just have to contact ODs and the OD societies in the cities and states where you are considering practice. Oddly, I found that the states that had the broadest scope of practice had the most restrictive plans. So do NOT elect to practice in a state simply virtue of the scope of practice. There's no point in having a license that says you can do whatever you want if you can't get paid for it.

 

[rpie]

Yep, I've instead been enjoying the discussion lately...(as well as reading up on optometrysucks forum on yahoo groups)


It's all very informative and interesting...it'll be quite a storm for me to sail through...let the games begin!

I'm about to start 1st year SUNY next month.

Congratulations on attending SUNY! Yes the optom suck board is a bit disturbing. However, I still feel that Optometry is what you make of it. Best of luck.