optometry in turmoil

[optcom]

I came across this. check it out

http://www.secointernational.com/jobsite/

I just took 2 from them, and there are more.

General comment
State: Multiple
Type: Corporate Practice Positions Avaiable
Contact: Disgruntled
Additional Info: I work in an area where corporate optometry rules the industry. Private optometrists are becoming more and more rare and it looks as if the same trend is beginning in many other places. State laws to prevent optometrists from being employed by corporations may not be the answer as ultimately the OD chooses to sign the lease without negotiating. The high cost of our education is also partly to blame, but as long as people are willing to pay the fees for school then they (schools) will continue to rake the money in. A union may be a good idea but it would probably be best to organize it through the AOA since it is an already established network

We should start a union to stop these corporations from controlling our fees, hours, etc. It's sad that OD's can't stand up and unite to fight for our own right to practice as we wish. Are we all just a bunch of no backbone sell outs? And its true, the AOA and our schools who continually pump on 100 OD's a year all with 150k loans are selling us out too. We need a union! Factory workers have unions to protect them against unfair corporate rule. But we don't. Why is that?

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Members don't see this ad.

 

[r_salis]

I'm not sure that a few anonymous postings on a job board constitutes "turmoil" -- just looks like some unhappy people to me.

 

[optcom]

Does anyone who actually working in the field have any say about it? SUNY2007 is too busy taking notes and getting ready for tests. I don't think you knows what's going on.

Real optometrist please post something real, not just promotion speech. We need truth.

 

[Richard_Hom]

Dear optcom and future colleagues,

I'm not particularly situated as my other colleagues are, but I can say that there is a "kernel" of truth in what the anonyous poster had mentioned.

The turmoil is really based upon the work of Charles Prentice who is the first "professional optometrist" who around the turn of the 20th Century set out to offer ophthalmic services outside of a jewelry store. Well, it's been a tumultous 100 years since Mr. Prentice established the "modern definition" of optometry.

Because of this legacy of jewelry stores in the optical trade, there has always been a parallel characterization of optometry. In my opinion, the greatest financial return still rests in the sale of optical products. Corporations have recognized this and have used their skill and resources to accentuate this part of optometry.

Ergo, the "fight" to achieve professional recognition from the public and other professions. It's now 2003, and the parallel characterizationh of optometry still exists and to some extent even more enhanced. There is a turmoil but I feel that one would be hard pressed to agree which one.

For example, there are disagreements in the areas of behavorial vision and its efficacy, the utility of optometrists performing surgical procedures, and the use of advanced technology to diagnose and manage eye problems.

In summary, I don't think it is far fetched for this anonymous poster to say what was said. I believe that the profession itself has still a ways to go to correctly portray optometrist which will not be a trivial task.

Regards,
Richard Hom,OD,FAAO

Originally posted by optcom
Does anyone who actually working in the field have any say about it? SUNY2007 is too busy taking notes and getting ready for tests. I don't think you knows what's going on.

Real optometrist please post something real, not just promotion speech. We need truth.

 

[optcom]

Dr. Hom, thanks for the input, you always make a car wreck look like a fender bender.

Everyone has a different goal in life. For me personally I won't want to be in a profession that is limited not by personal ability but legislature. I gusee others are happy with contacts and glasses, with artificial tears mixed in sometimes.

 

[TomOD]

Optcom,

I'm a private OD that has been out of school for 3 years. I have a private practice that is doing outstanding and I make great money already..........and expect to continue to grow larger and more profitable each year.

I see 10-20 patients per day and sell, on average, one pair of glasses per day.

Some OD's (and OMD's) are lazy. Some are unethical and try to sell everybody that walks into their office, glasses (or refractive surgery or tell everyone they need cataract surgery in the case of some OMD's).

On the whole, Optometry is whatever you want it to be. Find the right community in a good state and you can practice "medical" optometry as I do...........and enjoy a good living without having to worry about every eyeglass chainstore in the area.

There are a few limations (ie. surgery) which becomes irrelavent. I'm busy enough as it is without doing surgery.

The few times I do get frustrated is in a sitation like today. I had a elderly lady with cataracts and an epiretinal membrane over her left eye macula causing distortion.

I sent her to a very good retinal Ophthalmologist but not before sending a detailed letter along with scanning laser photographs CLEARLY showed the membrane. Also the lady was scheduled for cataract surgery with another Ophthalmologist.

A note from the retinal Ophthalmologist doesn't mention anything about the epiretinal membrane (only a fiticious diagnosis of macular degeneration). I go by the office (friendly people) to check to see if he even received my note and copys of the scans. It is not in the record and a tech has to find it in the drawer somewhere. He never even read it and didn't have a clue why she was there.

The patient returned to my office for her post-op cataract care. The surgeon noted in his 1 day post-op notes that she has a small corneal abrasion and folds in decemet's membrane (of the cornea). When I see her 10 day's later at her first post op visit, she is seeing 20/40 with a great amount of corneal edema, folds, and a "fragile cornea".

I took care of this woman (debrided cornea and bandage CL) and she will be okay. BUT I doubt her vision will be any better than 20/30 (it was 20/40 before the surgery).

Had the Opthalmologist listened to me and reviewed my notes, even briefly, I think we'd all be happier. They could have done a combined vitrectomy and cataract surgery (as they did on one of my other patients a few months ago).

This is what gets frustrating...........that you have to rely on other to take care of YOUR patients. Sometimes they are less competent than you............sometimes not! Most fields are like this though. I sent a patient to a pediatrican for mild allergies and she sent him to an allergist??

Sorry for the long-winded response. Many OD's would have simply "pushed this patient along" to the OMD, and tried to get another warm body in the chair to sell some glasses to.

I get alot of OD and OMD reject patients when they get tired of dealing with them......ARMD, glaucoma, corneal problems, blepharitis, etc..... OD's want glasses sales and contact lenses and OMD's want surgerical candidates.

All the rest of the patients (the other 80%) are eager for a good OD to come to the calling............at least in my experience.

So you can be many things in Optometry..........from refractionist at Costco to a "real doctor" making your living off of services you provide.

Good luck.

 

[optcom]

Tom,

It?s always a pleasure reading your posts. I think you have a good thing going there and wish you more success. But I don?t think most optometrists live in a state that allows much medical eye care. Most of them are locked in by vision plan which requires OD doing a comprehensive eye care without the appropriate reimbursement. They call it vision plan so that they could just pay you very little. Patient thinks that we are only checking their vision since it?s called vision plan. Medical eye care is carved out and OD cannot participate. Vision insurance does not pay for medical eye care even if you render your service. Not every OD is able to or wants to move to your state, or you will be out of business too.

BTW, if you were a retinal ophthalmologist, you could take care of the lady right there without send her out and having her going back and forth.

 

[TomOD]

I disagree with your first statement. It does depend on where you are and what enviroment your in. Most states allow OD's to treat a wide range of ocular disease. Insurance is a different matter.

But I still say that any OD that wanted to could have a thriving practice treating eye disease (as well as doing eye exams and selling eyewear).

I find, usually, the OD's that tell me it's impossible simply haven't been trained in the insurance game.

We have many "vision plans" in my area including VSP, Cole, EyeMed and the like. I simply do not participate in any plan that does not allow me to treat medical problems. They don't pay well and are an insult. I charge Medicare allowable exam fee $120 for a comprehensive exam.

This chart shows prescribing privilages state by state. It is expanding all the time.

http://www.aoanet.org/advocacy/prescriptive-chart.asp

Your last statement about the retinal Ophthalmologist is true. That was my point. There is a limit to what OD's can do. But in reality, this retinal OMD has an artifical limit, set by the group he is in, and the number of patients he see. He can legally treat anything, but, in his words, "wouldn't touch a cataract because it's been 20 years since he has done a cataract surgery". He is very limited (but very good) at what he does now.

Medicare is the best plan there is. They pay well and allow OD's to bill most procedures. Alot of other 3rd parties take their lead.

 

[optcom]

Tom,

You may treat, but if you are not reimbursed, I don't think you will be too happy. I am just curious how do you get on most insurance panels and involved with medical eye care(not just vision plan). Most ODs I talked to find it is very difficult to do so.

The comments about retinal OMD is right, he or she may not want to do a catract removal, but the option is still there, unlike ODs, don't even dream about it.

 

[TomOD]

Perhaps I am very lucky or just just in the right place at the right time. I accept basically 5 insurance plans: Medicare, Medicaid, BCBS, United Health Care, and Tricare (my only vision plan....I was mistaking before, I do accept one vision plan).

There are a few other random plans that we get paid for but are not on their "panel". Also, thanks to my very hard work and diligence, we see quite a few 'workers comp" patients from local business.

Many plans reimburse anyone. Some, you know, require you to be on their panel. I am reimbursed for everything from comprehensive eye exams (92004 and 99_ _ _ codes) to punctal plugs, D&I, Corneal, conj, and lid FB removals, cyst removals, chalazion injections, stromal puncture, epilation, ect..........and of course, visual fields, scanning laser, retinal photos, anterior segment photos. The list is long. I bill them AND get paid for them every day.

I understand all states are different. We have been able to get on just about any insurance panel we have requested. Some requires a little sweet-talking.

What state are you in Optcom? Maybe that will help us understand your situation better.

 

[optcom]

Tom,

good for you. I wish other states take the lead from yours. I am in VA and it's managed care heaven.

 

[TomOD]

Optom,

Specifically, what 3rd parties are you having trouble participating in?

Do they just flatly refuse your application? And, have you enlisted your state society for help?

 

[Richard_Hom]

Dear optcom,

Medical panels will accept optometrists in the following circumstances (non-inclusive):

1. If you have ophthalmology and/or primary care medicine support.

2. If there are inadequate eye care resources nearby.

3. Medical plans cannot reject you because you're an optometrist(?), but they can reject you because they're not looking for your specialty. Ergo, you have to look like an "medical" ophthalmologist in order to be accepted. This means no low vision, no behavioral vision, no spectacles, etc. This would be straight "medical optometry/ophthalmology"

4. Hospital privileges. If you have privileges anywhere, this can politically facilitate your entry to a medical panel.

5. The deal is to be accepted through their medical plan rather than the vision plan (obvious, but still lost on a lot of folks).

Richard

 

[optcom]

Dear Tom and Richard,

I believe its champus, tricare, BCBS that I have difficulty with them. I love to do more medical eye care and really enjoyed it from time to time. But the reality of not on panel and forced to take vision plan really make it difficult. I feel I am using only 5% of my capacity.

There are plenty OMDs around. When I called, I asked specifically 'medical eye plan'. I was still being told ODs are not allowed. Maybe I need to tape the conversation next time.

Thanks for all the input.

BTW Tom, how did you afford to get all the necessary instruments, if you don't mind me asking.

 

[TomOD]

A bank loan. I borrowed about $100,000 the day I got my license. It took a little sweet talking to the banker (and a good business loan) but she gave in.

Also, as an aside, we were not allowed on Tricare for the first year because it was a "closed" panel. It took about 3 months of persuasion with us getting patients with Tricare insurance writing them letters and calling to convince them that we had people that wanted to see us. They finally gave in. In reality, Tricare is probably the worst plan I take. Reimbursement is on $64 and they allow no medical treatment. Every problem has to be referred to the local Army hospital.

I do understand your situation though. We have one hospital based plan that covers our entire hospital system employees from janitors to doctors that will not let OD's on .

They tell us they DO have OD's on their panel but only the 2 that work at the Ophthalmology referral center. I'm still working to convince them..........it's been 3 years.

I am surprised that you have so much trouble with BCBS though. Our problem here (and maybe elsewhere) is that there is something like 100 different BCBS plans. Some of the PPO won't let us on but most, I think will. We just basically have to call every time a BCBS patient want's to be seen.

We spend alot of time on the phone.

 

[Richard_Hom]

Dear Tom and optcom,

I'm reflecting on Tom's statement regarding BCBS. If BCBS is your Medicare carrier, you're almost in already. However, there are circumstances where BCBS may only be the administrator and not the actual plan. This may be an ERISA health plan which is the most "anti-OD" of them all.

As Tom says, anything connected with an ophthalmology center, will most likely get on a system.

I cannot talk completely about my situation, but I would presume this. If you can demonstrate that you're not giving refractive care as your primary emphasis and can "join" the medical staff of any local hospital (see prior post), then your chances will be improved.

Originally posted by TomOD
"...They tell us they DO have OD's on their panel but only the 2 that work at the Ophthalmology referral center. I'm still working to convince them..........it's been 3 years....I am surprised that you have so much trouble with BCBS though. "...

Regards,
Richard

 

[rose13]

Tom, Richard, and Optcom:

Thanks for your frankness. I am still considering optometry for next fall, and your experiences with the insurance companies, and Tom's experience with the retina patient, have given me something more to think about. With that being said, do any of you feel that you should have given more consideration to pursuing the OMD/ODO route in instead (not for the fiscal rewards, but for fewer limitations)?

Thanks,

 

[TomOD]

No,

I spent 4 years in the Marine Corp (as a grunt) following high school and didn't want to "post-pone" my life any more.

I'm perfectly happy being an OD.

 

[Richard_Hom]

Dear rose13,

If I had wanted to go to medical school, I wouldn't have wanted to be an ophthalmologist. First, I didn't want to nor do I intent to do intraocular surgery. I wouldn't mind doing external surgery such as chalazions, cysts, or debridement of the cornea by either a blade or a laser.

If I had wanted to go to medical school I would have wanted to be the "country general practitioner".

But aside, I was fresh out of school and several ophthalmologists (chief of ophthalmology at an HMO, professor of retinas at a top 10 ophthalmology residency program, numerous private practice ophthalmologists) asked me this and I my frequent answer that they couldn't reliably retort was: "...Gee...I went to 4 years of professional school and you went to 7-8 years and you and I end up seeing the same patients, doing the same thing to these patients 90% of the time. Why would I want to go to medical school then ophthalmology residency. I liked what I did then and I like what I do now.

I see these obstacles as temporary and movable. I've always said that if you didn't like what you did you have to go out and either redesign your job/situation or find another career. So, I've lived those words. I'm not saying that I'm any where near where I want to be financially, but that is what I wanted. I wanted happiness in what I wanted in my work. And I pretty much have all of what I wanted.

HTH in deciding what is important in choosing a profession. TomOD might have a different path but I imagine that he and I are making our own path the way we want to practice.

Regards,
Richard

Originally posted by rose13
Tom, Richard, and Optcom:

Thanks for your frankness. I am still considering optometry for next fall, and your experiences with the insurance companies, and Tom's experience with the retina patient, have given me something more to think about. With that being said, do any of you feel that you should have given more consideration to pursuing the OMD/ODO route in instead (not for the fiscal rewards, but for fewer limitations)?

Thanks,

 

[optcom]

Dear Richard and Tom:

Thanks for the info. I will try it again this week. I would've went back to med school so that I could be a full care provider. I did have classmate went for OMD degree. Too bad I am too old for it. There are so many other stuff that needs to be cared for.

I will keep you posted on my progress.

 

[TomOD]

We do have 3 OD/OMD in my area. Guys that went back to Med school.

One is a pediatric/strab specialistist (the only one in 100 miles). One is a general Ophthalmologist with a group practice after leaving the military. And the 3rd is in the Army.

It's doable but like Richard said, is seems alot of useless work for a little more expanded privaleges.

But that's just my opinion. I've never asked them if they thought it was worth it.

We also have a OD turned Internist in another city. Also, we have a Vet turned OB/Gyn???!!!

 

[Caffeinated]

I have 2 friends that went back to med school after a few years in optometry. One just started his residency in ENT, and the other is finishing a general surgery residency. Born to cut, I guess.

Originally posted by TomOD
We do have 3 OD/OMD in my area. Guys that went back to Med school.

One is a pediatric/strab specialistist (the only one in 100 miles). One is a general Ophthalmologist with a group practice after leaving the military. And the 3rd is in the Army.

It's doable but like Richard said, is seems alot of useless work for a little more expanded privaleges.

But that's just my opinion. I've never asked them if they thought it was worth it.

We also have a OD turned Internist in another city. Also, we have a Vet turned OB/Gyn???!!!