OD and OMDs should not be allowed to sell eyeglasses

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Optometrists and ophthalmologists should not be allowed to sell eyewear in their offices just as we can't sell medications on the premise that it's unethical to sell what you prescribe. Discuss.

Ban derms from selling creams and lotions then too.

Originally Posted by Tippytoe

Optometrists and ophthalmologists should not be allowed to sell eyewear in their offices just as we can't sell medications on the premise that it's unethical to sell what you prescribe. Discuss.

while your at it, you may as well ban any doctor from "selling" any procedures, or tests, also. It is the exact same conflict. I like to think that most docs subscribe to an ethos that avoids such a conflict, so I dont think your topic has any traction.

BTW some docs DO sell medications "on the premises".

Originally Posted by PBEA

BTW some docs DO sell medications "on the premises".

yes, a lot of rural GP doctors do

It has been my impression for the last 20 years that MDs and DOs can not or do not sell Rx medications. At least I've never been to an office that sold Rx meds. They write the Rx and the patient takes it to the pharmacy. This is law? State by state? To keep the docs ethical? I don't know.

Seems to be the same with glasses. Must have been a loophole somewhere along the way. Sure would be easier (on both me and the pt) if I could sell him some Xalatan and Refresh drops as needed.

Seems we should all either sell meds and glasses/CLs or not sell meds and glasses/CL. Makes no sense one over the other.

http://www.kevinmd.com/blog/2011/01/...dications.html

Of course in hindsight, it's all mute. The internet is taking the profit out of both anyway.

Originally Posted by Tippytoe

Seems we should all either sell meds and glasses/CLs or not sell meds and glasses/CL. Makes no sense one over the other.

http://www.kevinmd.com/blog/2011/01/...dications.html

Of course in hindsight, it's all mute. The internet is taking the profit out of both anyway.

I'll look into it when I go out to practice. If I can sell meds, glasses, CLs then I probably will. It is a special license given state by state and in rural areas to physicians that can demonstrate there is no other access near them.
https://docs.google.com/viewer?a=v&q...DXgMt3iBPAaZyw

It should be kept that way as urban doctors are more dissolute.

Originally Posted by Shnurek

I'll look into it when I go out to practice. If I can sell meds, glasses, CLs then I probably will. It is a special license given state by state and in rural areas to physicians that can demonstrate there is no other access near them.
https://docs.google.com/viewer?a=v&q...DXgMt3iBPAaZyw

It should be kept that way as urban doctors are more dissolute.

Perhaps true. But I'd think internet drug ordering would make that exception less viable, even wayyyy in the boondocks. And frankly, I'd probably rather have the patient yell at the pharmacist over that $150 little bottle of Tobradex than me. Not to mention the paperwork when they will want.......no DEMAND........ you to file it through their insurance. Your profit will probably be something like $3 per Rx in the end..

Originally Posted by Tippytoe

Optometrists and ophthalmologists should not be allowed to sell eyewear in their offices just as we can't sell medications on the premise that it's unethical to sell what you prescribe. Discuss.

OD and OMD should not be allowed to sell eyewear, yet retail opticals that hire people with very little training should be able to? This does not make any sense to me. I don't see anything unethical about the doctor selling " a product" if it is recommended to the patient that actually needs it or if the doctor thinks it will help the patient.

On the other hand, if the doctor just prescribes it and tries to force it upon the patient to increase their revenue when they know that that product is useless for the patient, then it becomes unethical.

The doctor can best make the necessary recommendation for the patient based on their visual/health condition and if you know you can provide them with the best product, the patient will be the winner and that's how it should be.

Originally Posted by NYCBlues

OD and OMD should not be allowed to sell eyewear, yet retail opticals that hire people with very little training should be able to? This does not make any sense to me. I don't see anything unethical about the doctor selling " a product" if it is recommended to the patient that actually needs it or if the doctor thinks it will help the patient.

On the other hand, if the doctor just prescribes it and tries to force it upon the patient to increase their revenue when they know that that product is useless for the patient, then it becomes unethical.

The doctor can best make the necessary recommendation for the patient based on their visual/health condition and if you know you can provide them with the best product, the patient will be the winner and that's how it should be.

Not intending to speak for another poster, I think what Tippytoe is getting at is the fact that many, if not all states, say it is illegal for ODs to sell prescription medications to patients. I can think of several states in which that's the case. (In fact, many even restrict free samples given to patients.) It is seemingly odd then, that we can sell all the glasses and CLs that we want since that is analogous to medication for refractive issues. There appears to be a conflict there. I doubt Tippytoe is calling for a grass-roots effort to ban optical sales in MD and OD offices, particularly in light of the fact that he owns his own office.

In my mind, the difference between the two is that medications, philosophically at least, are not intended to provide the doctor with profit; only to implement his/her treatment plan. Optical sales, on the other hand, is undoubtedly a profit stream, although with all of the changes going on, that's changing too.

Originally Posted by Tippytoe

Seems we should all either sell meds and glasses/CLs or not sell meds and glasses/CL. Makes no sense one over the other.

http://www.kevinmd.com/blog/2011/01/...dications.html

Of course in hindsight, it's all mute. The internet is taking the profit out of both anyway.

moot

Originally Posted by dinkus

moot

Ha, ha. Touché. I did mean moot and not the inablity to speak. The later is what I was looking for in a good looking wife .

Originally Posted by Tippytoe

Ha, ha. Touché. I did mean moot and not the inablity to speak. The later is what I was looking for in a good looking wife .

latter

Originally Posted by NYCBlues

OD and OMD should not be allowed to sell eyewear, yet retail opticals that hire people with very little training should be able to? This does not make any sense to me. I don't see anything unethical about the doctor selling " a product" if it is recommended to the patient that actually needs it or if the doctor thinks it will help the patient.

Easy. Opticianary would become an associate's degree. We would quit fighting them every step of the way to allow them to become licensed (some states are/some aren't now) and we would be reasonably sure of competent dispensing.

I'm not against eye docs selling eyewear. Just wonder how it came to be that we do that and not the meds we prescribe. What's the difference between one and the other. That's all.

I do know that MDs thought it highly unethical to sell anything but their services for most of the 20th century. It was even unethical (and maybe illegal?) for MDs and ODs to even advertise. Somewhere along the way, it because much less unethical and most every OMDs started selling glasses after cataract surgery fees were cut and now full page color yellow page ads are the norm.

So as with most things.........ethics are closely tied to money. When in doubt, follow the money trail. It'll lead you to the truth every time.

Originally Posted by Shnurek

latter

Double Touche. The latter over the former. Sometimes my real life takes more attention than the computer so gotta play with the kids now. Goodby..........or is that Good Bye.....or perhaps goodbye...........

But the real question is, which is it: Donut or Doughnut?

We should push to ban all the online retailers first.

Originally Posted by Tippytoe

It has been my impression for the last 20 years that MDs and DOs can not or do not sell Rx medications. At least I've never been to an office that sold Rx meds. They write the Rx and the patient takes it to the pharmacy. This is law? State by state? To keep the docs ethical? I don't know.

Seems to be the same with glasses. Must have been a loophole somewhere along the way. Sure would be easier (on both me and the pt) if I could sell him some Xalatan and Refresh drops as needed.

We have an ENT + ophtho office in town with its own mini-pharmacy - basically the top 15-20 drugs from each specialty.

I think an easy fix, and admittedly this isn't my own idea, would be to give every glasses/contact rx to the patient at the end of the exam. Its much easier to get glasses elsewhere that way as opposed to having to ask for it.

Originally Posted by Jason K

Optical sales, on the other hand, is undoubtedly a profit stream, although with all of the changes going on, that's changing too.

Originally Posted by Tippytoe

So as with most things.........ethics are closely tied to money. When in doubt, follow the money trail. It'll lead you to the truth every time.

The selling of glasses by doctors should have never been. It probably started off fine, and then went downhill unethical after that. I've filled in at many different settings and see just how needy & greedy doctors and staff have become. After examining a presbyope with a simple +1.00 OU Rx, the doctor and staff all are disgruntled by the fact that the patient simply wants readers. No fancy free-form PAL, no AR/transition/clip-on's etc. Just readers.

Or the patient who's glasses Rx changed by a 0.25 and simply is fine with their current pair.

Unfortunately, at this point in time, the largest portion of the majority of private practice ODs income is based on the sale of glasses. Take away the sales of glasses and almost 95% of private practices would shutter. IMHO, this should have never been allowed. We should be making the majority of our income based on service, not product. Sadly this is not the case for ODs and will unlikely never return back to a service based profession.

Originally Posted by Meibomian SxN

The selling of glasses by doctors should have never been. It probably started off fine, and then went downhill unethical after that. I've filled in at many different settings and see just how needy & greedy doctors and staff have become. After examining a presbyope with a simple +1.00 OU Rx, the doctor and staff all are disgruntled by the fact that the patient simply wants readers. No fancy free-form PAL, no AR/transition/clip-on's etc. Just readers.

Or the patient who's glasses Rx changed by a 0.25 and simply is fine with their current pair.

Unfortunately, at this point in time, the largest portion of the majority of private practice ODs income is based on the sale of glasses. Take away the sales of glasses and almost 95% of private practices would shutter. IMHO, this should have never been allowed. We should be making the majority of our income based on service, not product. Sadly this is not the case for ODs and will unlikely never return back to a service based profession.

while there are exceptions, what you describe is not "the rule". If it does happen, that kind of behaviour is more likely to be found in the mall, IMO. Regardless of who does it, the same thing can be found in any doctors office (MD, dentist, OD, etc) when prescribing other kinds of treatments, and as such the sale of spectacles is not unique.

I think the polar opposite of your argument is to say that ODs or OMDs should not be allowed to associate, work for, or lease space from a retail corporation (like lenscrafters, walmart, etc). If there was any conflict of interest to be found, you are sure to find it in those settings.

Originally Posted by PBEA

while there are exceptions, what you describe is not "the rule". If it does happen, that kind of behaviour is more likely to be found in the mall, IMO. Regardless of who does it, the same thing can be found in any doctors office (MD, dentist, OD, etc) when prescribing other kinds of treatments, and as such the sale of spectacles is not unique.

I think the polar opposite of your argument is to say that ODs or OMDs should not be allowed to associate, work for, or lease space from a retail corporation (like lenscrafters, walmart, etc). If there was any conflict of interest to be found, you are sure to find it in those settings.

This is true. I stopped going to a dentist because they refused to listen to me and were constantly trying to upsell me on things I clearly don't need. I don't mind the initial sales pitch, every business (and salesperson) deserves the opportunity to make money, but stop pestering me.

After I had my braces taken off at 14, I had my canine teeth filed down to be flush with the rest of my teeth (incisors?) and my ortho had this in my chart and his office was downstairs from said annoying dentist. Annoying dentist and hygienist were clearly trying to get me to buy a $400 night guard since I "grind my teeth at night" which dental ins doesn't cover. This i politely declined at visit 1 and was documented. 5 visits go by and they are still annoying me. I finally give up and switch dentists. He does my exam, says at the end, "keep doing what you're doing, see you in 6 months" I ask new dentist (who is FABULOUS), "Do I have a teeth grinding problem?" and he says there was no evidence of this. Without me mentioning I had them cosmetically filed, he said they looked fine, but the fact that I told him that made more sense in retrospect.

The point of this rant was that I understand that there are some people who are probably post op Lasik patients who maybe need readers and just get their 1 year checks and +1.50s from CVS work fine. They don't need $400 PALs. The same mom who might be a -3.00 who develops -0.50 of cyl in one eye but has 2 kids in college and is paying cash for her exam and glasses probably won't get a new pair today. This is the kind of stuff that I think that is being debated. The reason I left that office was because of pushy salespeople.

Ya, salespeople (some doctors) are annoying in a lot of places. My dental insurance didn't cover composite fillings in my posterior teeth so he asked if he can do both for $75 each. I was like hell no, stick to what the insurance pays you for. Do the amalgam.

Or when I went to my local OD and the optician tried to upsell me by getting a new frame and AR lenses. I'm like listen, if you keep upselling me after I'd told you that I am going to be an optometry student (this was before I started 1st year) I will just ask for my Rx and walk away. So she finally calmed down and I just asked simply for my lenses to be replaced. Its the sad truth but unfortunately many Doctors of all types are trying things to keep their income high. Such as dermatologists selling lotions and creams and MDs selling vitamins. Or when my dad went to the Audiologist with a hearing aid he got from them. It was broken so they tried to get him to buy a new $3000 hearing aid. My dad simply paid $200 or so to get it repaired. So many scammers.

Jason K is right that there is a lot of crap you have to wade through when you bill medical insurance but every MD/DO has to wade through it also so its just a fact of life.

Also, I'm sure this is more of an augmented phenomenon in dog-eat-dog big cities like NYC.

Originally Posted by VA Hopeful Dr

We have an ENT + ophtho office in town with its own mini-pharmacy - basically the top 15-20 drugs from each specialty.

I think an easy fix, and admittedly this isn't my own idea, would be to give every glasses/contact rx to the patient at the end of the exam. Its much easier to get glasses elsewhere that way as opposed to having to ask for it.

It's actually already the law. An OD or OMD is supposed to give you your eyeglass Rx at the completion of the exam without you ever asking. Most don't bother and it's rarely enforced. It's about like being a car dealer and giving every customer that walks up to you an ad to a rival car dealership. Just not good business sense (while being questionalby ethical at the same time). We are in the optical business after all (at least for a few more years).

I must admit I freely give out spec Rxs because I don't want to strong-arm any person that doesn't really want to buy my quality and service. You can tell the Walmart "customer" from a mile away.

BTW, contact lenses are a slightly different story. You are entiltled to the CL Rx only after the fitting is complete.....and this is usually after a 1 week follow-up exam is performed (unless you get it done at a commercial place where they probably don't even look at a CL on your eye). Of course at the Army hospital where I externed, we just make up a CL rx and wrote it down for the patient and told them to get a F/U "somewhere" down the line. Wink, wink.

FEDERAL TRADE COMMISSION
PART 456--OPHTHALMIC PRACTICE RULES--


Sec. 456.2 Separation of examination and dispensing.

It is an unfair act or practice for an ophthalmologist or optometrist to:

(a) Fail to provide to the patient one copy of the patient's prescription immediately after the eye examination is completed.

Provided: An ophthalmologist or optometrist may refuse to give the patient a copy of the patient's prescription until the patient has paid for the eye examination, but only if that ophthalmologist or optometrist would have required immediate payment from that patient had the examination revealed that no ophthalmic goods were required;

(b) Condition the availability of an eye examination to any person on a requirement that the patient agree to purchase any ophthalmic goods from the ophthalmologist or optometrist;

(c) Charge the patient any fee in addition to the ophthalmologist's or optometrist's examination fee as a condition to releasing the prescription to the patient. Provided: An ophthalmologist or optometrist may charge an additional fee for verifying ophthalmic goods dispensed by another seller when the additional fee is imposed at the time the verification is performed; or

(d) Place on the prescription, or require the patient to sign, or deliver to the patient a form or notice waiving or disclaiming the liability or responsibility of the ophthalmologist or optometrist for the accuracy of the eye examination or the accuracy of the ophthalmic goods and services dispensed by another seller.

Revised as of January 1, 1999]
From the U.S. Government Printing Office via GPO Access

http://www.ftc.gov/opa/2004/10/ALT143-contact.pdf

Its true. It is the law but its enforced about as much as gas stations selling colored contact lenses.

Originally Posted by Shnurek

Jason K is right that there is a lot of crap you have to wade through when you bill medical insurance but every MD/DO has to wade through it also so its just a fact of life.

You're neglecting one small detail. ODs cannot see the volume of patients that MDs/DOs enjoy. We're lucky to get 12 patients through the door each day and even if we billed medical on every one of those patients, you're talking about a bunch of level 3 and maybe a few level 4 office visit reimbursements and scattered tests here and there. It's not going to be a cash cow. MDs/DOs don't have the same problem getting patients in the door. If anything, they sometimes have to close their practices to new patients since they're "full." If you see 40 - 50 patients per day and you bill office visits for all of them, along with additional testing, you're going to be doing a lot better than an OD who's getting $40 per patient to see a bunch of EyeMed, VSP, and Optum patients with a few Medicare visits billed to "dry eye" here and there. Wake up, dude - optometry is not medicine, not even close. If MDs were trying to survive on seeing 10-12 patients per day, they'd be in the same boat, but the fact is, they're not.

Jason K, you say a lot of interesting things but with great exaggeration. You are the bottom of the barrel of optometry. You work commercial for around 80k a year and you took out 180k or whatever it was in loans. You'd be the last person I'd look up to/take advice from, sorry.

Originally Posted by Shnurek

Jason K, you say a lot of interesting things but with great exaggeration. You are the bottom of the barrel of optometry. You work commercial for around 80k a year and you took out 180k or whatever it was in loans. You'd be the last person I'd look up to/take advice from, sorry.

I actually laughed out loud when I read this. Shnurek, I make more money than the average OD does in my position. I have no idea where you came up with the 80K figure from. All I can tell you is that I make more money than you ever will as an OD - be sure of that. And watch what you say about "commercial optometry." It's your future and that of your classmates so by crapping on it, you're inadvertently trashing your own desitny.

I think, as others have mentioned, you need to take a break from posting. Read up on the topics you profess expertise on and then you might not constantly get shot down for making ridiculous comments. It does make for good entertainment, I'll give you that.

I can't wait until reality comes crashing down all around you. Since I know your name, who knows, I might even have a first hand look at it.

I see you edited your post to take out the personal threat. But in any case I don't go around in my free time trashing my own profession. If it didn't work out for you then too bad, it doesn't work out for everyone. Use your free time to gain extra income or to think of business ideas or whatever. Its great that you tell students not to dive head first into a profession that may require you to take out $200,000 in 6.8% or so of student loans. But you take it to such an extreme level where people may think they absolutely will never get a good job when they graduate. Which is in one way not such a bad thing because this profession was built on self-employment. "If you do not take risks then you will not make money" as they say, and you will end up in commercial. The way I see it is that you complain more than you provide solutions to the problem. Look at KHE. He was down the hole many hundreds of thousands of dollars but he partnered in and at least now he is happy even though he may still be in debt.

According to http://www.bls.gov/ooh/Healthcare/Optometrists.htm Optometry is increasing in size 33% in the next 10 years. You see ophthalmologists letting ODs join their professional groups, helping them with laser cataract surgery and scope of practice expanding on one end while we are holding the turf that the opticians desperately want on the other end, aka commercial or refracting optometry. I see this is a good thing and there will be more diversity with what you can do with your OD degree.

In any case, I promote optometry. It may be in an unorthodox way but I'm not your generic push-over nerdy student. If you look over the wikipedia editing history as in this link you can see all the contributions I have made. http://en.wikipedia.org/w/index.php?...action=history Sure I screw up sometimes in interpreting a statistic, such as that pie chart only being of those students that actually accepted offers, and I openly admitted that I made a mistake unlike hanging onto things and diverting the topic like many other people like to do.

Its great that you think you know my name. People on ODWire trash talk each other with their full names in view. I have asked the moderators here whether I should tone down the things I say but they just told me that no matter what I say, ophthalmologists will always look down on us so there is no point in censoring me.

Originally Posted by Shnurek

You are the bottom of the barrel of optometry.

What was that you were saying about "personal threats?"

Originally Posted by Shnurek

I see you edited your post to take out the personal threat.

What on Earth are you talking about here? I edit my posts all the time and there was nothing regarding any personal attack that prompted any edit.

Originally Posted by Shnurek

But in any case I don't go around in my free time trashing my own profession.

When you trash commercial optometry, you’re trashing your own future. You’re just too clueless to realize it.

Originally Posted by Shnurek

If it didn't work out for you then too bad, it doesn't work out for everyone. Use your free time to gain extra income or to think of business ideas or whatever.

Already taken care of, chief. I’m less than half time as an OD now. I don’t want to be part of a profession that will essentially be dead in 10 – 15 years, at least as we know it now.

Originally Posted by Shnurek

Its great that you tell students not to dive head first into a profession that may require you to take out $200,000 in 6.8% or so of student loans. But you take it to such an extreme level where people may think they absolutely will never get a good job when they graduate. Which is in one way not such a bad thing because this profession was built on self-employment. "If you do not take risks then you will not make money" as they say, and you will end up in commercial.

There is intelligent risk and there is idiotic risk. Jumping off a cliff without a parachute is an example of idiotic risk. Entering optometry, at a time when there are twice as many practitioners as there are respectable jobs, is another example of idiotic risk. I’ve never claimed that absolutely no one will find respectable work after graduation. What I’ve been saying all along is, very few will land in respectable spots – as in a handful per class. The rest of the class will go on to pollute and further sink the profession. You, my good man, will be part of that second group, you just don’t realize it yet.

Originally Posted by Shnurek

The way I see it is that you complain more than you provide solutions to the problem. Look at KHE. He was down the hole many hundreds of thousands of dollars but he partnered in and at least now he is happy even though he may still be in debt.

Starving actor’s father: Son, I think it’s great that you want to be a Hollywood superstar, but the reality is, very few actors ever make it to the big leagues. Most actors scrape by, but there just aren’t that many spots for big stars to fill.

Clueless son: Dad, you’re crazy and you don’t know anything. I just saw Mel Gibson on the street. He was in a Ferrari and everything. There’s no reason I can’t be Mel Gibson, become incredibly wealthy, lose my mind, and start carrying on about anti-Semitic views - No reason at all.

Originally Posted by Shnurek

According to http://www.bls.gov/ooh/Healthcare/Optometrists.htm Optometry is increasing in size 33% in the next 10 years. You see ophthalmologists letting ODs join their professional groups, helping them with laser cataract surgery and scope of practice expanding on one end while we are holding the turf that the opticians desperately want on the other end, aka commercial or refracting optometry. I see this is a good thing and there will be more diversity with what you can do with your OD degree.

Oh my god, seriously? You and Emily haven’t learned your lessons yet? You might as well come on here and say that Barry Obama announced that the economy is fully recovered, so we can all stop worrying. The BLS is a bunch of “data” collected by government workers. All of the optometry data are taken from AOA biased sources. That you don’t understand that is demonstrative of your total lack of understanding of what you’re in for.

Originally Posted by Shnurek

In any case, I promote optometry. It may be in an unorthodox way but I'm not your generic push-over nerdy student. If you look over the wikipedia editing history as in this link you can see all the contributions I have made.

This is why open source editing on Wikipedia should not be allowed.

Originally Posted by Shnurek

People on ODWire trash talk each other with their full names in view. I have asked the moderators here whether I should tone down the things I say but they just told me that no matter what I say, ophthalmologists will always look down on us so there is no point in censoring me.

I’m not following your random, nonsense, stream of thought here. A perfect place to end.

Here is just reason # 1 out of 20 that optometry is doomed as we know it.

Patient: "Lets see, I could spend $8 to get frames at Wal-mart, who will offer me a money back guarantee for any reason even if I just don't like the color after 3 months or my baby-daddy beat me and broke the old ones. (The eye exam inside ghetto-mart is $45).

OR I can get my frames from my OD for $200 (plus lenses) with only a 1 yr manufacture breakage warranty.

$8 vs $200. Tough choice.

Hmmmmm.....what to do what to do?!

Random red eyes and glaucoma suspects by themselves just won't sustain 50,000 (and growing fast) Optometrists. It just won't no matter what kind of math you use.

Two things I like about Jason K - he reads and replies to everything I say and he warns future students to come into a profession that requires usually 150k-200k worth of loans to graduate when the median income is only 95,000. Btw, I'd sooner move to rural Montana or something than go commercial. I'm crazy like that. I would do it.

Is there an oversupply? Yes, in most professions there is. Is something being done about it? Somewhat. The Step 3 of the board exam was switched to North Carolina so everyone has the same objective testing environment. Teachers are now not allowed to mention the word boards to students at all to not give them a fair advantage about what could be on the test. Boards are getting harder and more clinical to restrict some students from getting licensure. State licensing exams are beefing up too.

If you guys have any ideas about what to do about it, it would be awesome to hear it.

Originally Posted by Shnurek

Two things I like about Jason K - he reads and replies to everything I say and he warns future students to come into a profession that requires usually 150k-200k worth of loans to graduate when the median income is only 95,000.

Shnurek, if I responded to everything you say on here, I'd never leave my computer terminal. The reason I respond to many of your posts is because they are filled with outright nonsense that can be misleading to people who are considering the profession. For what it's worth, the 95K figure applies to all CURRENTLY practicing ODs, not future ones. You're entering an optometric world that will not be paying 95K for much of anything. I'd plan on a terminal income in the 70s or 80s as that's likely the most you'll ever be making as an OD, even in commercial.

Originally Posted by Shnurek

Btw, I'd sooner move to rural Montana or something than go commercial. I'm crazy like that. I would do it.

Good luck with that. You'll be going commercial, almost guaranteed. You just don't see it yet. You will, though. Montana has Walmarts so you might be fine in that regard.

Originally Posted by Shnurek

Is there an oversupply? Yes, in most professions there is. Is something being done about it? Somewhat. The Step 3 of the board exam was switched to North Carolina so everyone has the same objective testing environment. Teachers are now not allowed to mention the word boards to students at all to not give them a fair advantage about what could be on the test. Boards are getting harder and more clinical to restrict some students from getting licensure. State licensing exams are beefing up too.

Oversupply is one of the underlying factors that has produced the many OTHER reasons that optometry is sinking. If you remove the oversupply, which will never happen in your lifetime, the other problems will still be there. You're in over your head, you just don't know it. That's your problem, Shnurek, you think you know everything and in reality, everything you know is based on fantasy.

Originally Posted by Shnurek

If you guys have any ideas about what to do about it, it would be awesome to hear it.

That's the problem. There is NOTHING we can do. It's far beyond our control at this point. There were some things that were tried in the distant past. ODs created our own vision 'insurance' plan called VSP. Unfortuantely it's grown into a moster and left ODs out in the pasture to fend for ourselves. We fought for medication rights (in the 70's and 80's) while giving away our optical business at the same time (or more accurately, it was taken away). Past ODs got fat and happy on 300% mark-up on glasses too stupid to realize that sooner or later, MBA corps will figure out what a gold mine we had and jump all over it. THIS has taken place full-force now.

Factoid: If ODs in past years had insisted on making their money on services and charged at cost (or close to it) for optical goods, we would not be on the Titanic right now. But that road was paved long before most of you were even born.

- We can not stop more schools from opening (Illegal restraint of trade).
- We can not stop more commercial entities from moving into the optical arena (free country-free market).
- We can not stop on-line retailers from selling optical goods (you can get Viagra and Propecia on-line from overseas so no problem for Acuvues).
- We can not (legally) form a union so we can not strong-arm insurance companies or the gov't into fair pay for services
- We can not charge any more than allowed by xyz insurance company.
- We can't invent any more procedures to do on the eyes in the hopes of increasing revenue.
- We can't expect to suddenly "find" more eye disease to compensate for the 50% loss of optical revenue.
- We can not expect the cost of business to decrease.
- We can not expect other MDs to refer to us before thinking about their OMD colleagues first.
- We can not beat 1-800 contacts and every other on-line venue in prices.
- We can not beat Walmart (many mom-n-pop's have tried and failed).

So few things are really in our control. It's not 1978 any more. We can have the most awesome practice we can afford with great staff and excellent service. We can have excellent training and the best equipment. But it's all a numbers game. Patients/ODs/reimbursement = Outcome.

My "solution" (and others), while not favorable to you and other students, is to think long and hard about other fields. Even other health care fields that are in a better position to weather the economic and political storms. Optometry just ain't one of them. At some point you have to quit saying, "It's all what I can make of it and the glass is half full" and say " Actually the glass is, in fact, half empty and I think I will retreat, regroup and come back smarter and stronger with a better plan".

Again, I wouldn't say it if I didn't fully believe it. I've been successful and I'm set. But the future is not the past. ODs are typewriters in a world about to blossom with computers.

More automation is further driving the nails in the coffin. Things that are already taking place like:

- Retinal photos of diabetics taken in family doc offices and beamed to retinal docs to read (skipping ODs altogether).

- Streamlined office efficiency while increasing the number of pts each OD can see will futher exacerbate the oversupply problem. Used to be, in the 1970's each OD would see one patient every hour (and sell him $300 glasses- cash purchase). Then, in the 1980's, it was one pt every half hour (with an eyeglass sale and $400 conventional wear contact lenses and fit). Now it's one patient every 10 minutes (5 if your in commercial), $40 pay from the insurance company next month (after 3 re-filings and 4 phone calls) and give the patient a copy of their spec and CL rx to take to Walmart. Totally different world. Things really started going downhill in the 1990's with commercial entities and the internet coming together to form the perfect storm to kill optometry.

See, today you will have to see about 11 patients to make the same money Dr. OD did in 1985 with one patient ($40 exam and $400 glasses and CLs).

Optometry belongs in the commercial sector. We can learn all about disease, vision therapy, lasik etc etc. But at the end of the day optometry has a very very limited scope. Almost every patient an OD sees just wants to get their prescription and shop around for glasses or contacts to find the cheapest deal possible. And can you honestly blame them?

As soon as ODs try to do anything beside refraction they are slapped on the wrist by the medical community. This profession was build on doing refractions and selling glasses. The selling part is gone and what left is only refractions. What an OD does 90% of the time is perfect fit for retail setting. Patient (I mean customer) gets a free 5 min exam with cheap glasses so they are happy, Walmart is happy as long as exam lasts 4-5 min and nobody cares about the OD.

This profession was a gold mine in the 80s and early 90s, the OD that I shadowed practiced during these times and she cleaned up well, very well. Likelihood of me repeating that is a big fat zero. If you want to know Optometry's future just look at Pharmacy, oversupply and commercial.

Originally Posted by Tippytoe

See, today you will have to see about 11 patients to make the same money Dr. OD did in 1985 with one patient ($40 exam and $400 glasses and CLs).

Um, no. If that's the case, you're doing something horribly, horribly wrong.

Originally Posted by eyestrain

Um, no. If that's the case, you're doing something horribly, horribly wrong.

I agree! Almost everyone needs a pair of glasses. And almost everyone can be convinced to purchase at your location.

I also agree... Jason K and Tippytoe have a tendency to overstate a little although I agree with many of their points.

Originally Posted by drbizzaro

I agree! Almost everyone needs a pair of glasses. And almost everyone can be convinced to purchase at your location.

The online retain optical industry is expanding exponentially for a reason – patients are making use of it at an increasing rate and generating huge profits for them. This is America – the free market should dictate who lives and who dies. Unfortunately, the private OD, particularly the solo private OD, is set to dry up because there’s a way to get what he offers at a much cheaper price, sent right to the customers’ door. We can fight this all we want. We can say “Hey, it’s up to you to convince your patient to buy from you…” and that’s absolutely true, but it does not change the reality that the forces are in motion and there’s only so much we can do about it. We’re just fighting it. How long can we resist? Indefinitely? I think not. Have you been in a Blockbuster Video lately? Those bare shelves, giant used movie bins full of $3 videos, and stores with 1 person staffing the store, are not what we saw 10 years ago. Have you been to a Tower Records lately? When MP3 players came out in the late 90s, I’m sure the Tower execs were not too worried, but less than 8 years later, they were at home in their boxers looking for work on Monster. Why? Because people found they could get the same product (digital music) at a much lower price online. No lines, no sales people to deal with, no sales tax, just what they want – digital music. The same thing will happen in optometry - guaranteed. The trend started in the last couple of years. It will gain momentum, especially as younger folks, for whom the internet is second nature, move up into middle age. Right now, there’s a significant portion of the population that does not feel comfortable buying things online. That will change. In 20 years or so, virtually everyone will be an “online” person. I don’t think twice about buying things on Amazon. My father won’t even consider it.

So, say what you will about the concern over online retailers, but I think they spell the final nail in the coffin for the private solo OD. It’s just a matter of time before the air in the room runs out. It might take a few years, maybe even a decade, but it will happen. History repeats itself and we’ve already seen what happens when the same market forces are exerted on other industries. Optometry has not ever bothered to insulate itself or form any kind of barrier to these forces so it too will perish, at least as we know it today. Sorry if that view is thought to be exaggerated, but I think it’s very blunt and very accurate.

Originally Posted by drbizzaro

I agree! Almost everyone needs a pair of glasses. And almost everyone can be convinced to purchase at your location.

"Almost anyone can be convinced to purchase at your location". Yikes. I guess I could also "convince" them to buy some vitamins, some jewelery and some Amyway products while I'm at it.

I'm not in the profession to convince any patient to do anything. That's what used car dealers (and Lasik surgeons) do. I'm not very good at convincing my patient (whom I've worked hard to gain their trust) to pay 400% more to buy glasses from me when they can get equal or equivalent glasses elsewhere much, MUCH cheaper. If they ask, I tell them the truth. It's that Golden Rule thing. I wish I didn't have a conscience and could do some of the things some ODs and OMDs do day in and day out. I'd just rather to be able to sleep well at night and look my kids in the eyes as an honest business man and doctor. I concentrate much harder at doing a good eye exam and treating their eye problems than selling glasses.

Commercial entities ARE in business to convince customers to buy something. That's their ONE AND ONLY concern. That is the great disconnect between the professional optometrist and the opto-whore spinning and grinning for a paycheck

And almost everyone needs a pair of glasses?? What world do you live in? Most people don't need glasses.
And many that do only need OTC readers. I'm in the USA, btw.

Originally Posted by eyestrain

Um, no. If that's the case, you're doing something horribly, horribly wrong.

Where did I go wrong? Working in America's Best, doing $40 exams, you will make $440 doing eleven exams. In the 1980's, there was no America's Best (or Walmart or Lenscrafters etc....) and a conventional contact lens fit and supply was around $400 and the exam was around $40. Glasses were held hostage in the OD office probably another $250.

So one exam 1987 = $440 CL + $250 for glasses (minus expenses of course)
11 EyeWorldMart Express exams today - $440 (minus expenses)

Is my math wrong? I'm not talking about private practice. Those of us lucky enough to still be in private practice are dinosaurs. The future, for sure, is commercial for most of our current students.

Originally Posted by tippytoe

"almost anyone can be convinced to purchase at your location". Yikes. I guess i could also "convince" them to buy some vitamins, some jewelery and some amyway products while i'm at it.

I'm not in the profession to convince any patient to do anything. That's what used car dealers (and lasik surgeons) do. I'm not very good at convincing my patient (whom i've worked hard to gain their trust) to pay 400% more to buy glasses from me when they can get equal or equivalent glasses elsewhere much, much cheaper. If they ask, i tell them the truth. It's that golden rule thing. I wish i didn't have a conscience and could do some of the things some ods and omds do day in and day out. I'd just rather to be able to sleep well at night and look my kids in the eyes as an honest business man and doctor. I concentrate much harder at doing a good eye exam and treating their eye problems than selling glasses.

Commercial entities are in business to convince customers to buy something. That's their one and only concern. That is the great disconnect between the professional optometrist and the opto-whore spinning and grinning for a paycheck

and almost everyone needs a pair of glasses?? What world do you live in? Most people don't need glasses.
And many that do only need otc readers. I'm in the usa, btw.

what a great post.

Originally Posted by Jason K

The online retain optical industry is expanding exponentially for a reason – patients are making use of it at an increasing rate and generating huge profits for them. This is America – the free market should dictate who lives and who dies. Unfortunately, the private OD, particularly the solo private OD, is set to dry up because there’s a way to get what he offers at a much cheaper price, sent right to the customers’ door. We can fight this all we want. We can say “Hey, it’s up to you to convince your patient to buy from you…” and that’s absolutely true, but it does not change the reality that the forces are in motion and there’s only so much we can do about it. We’re just fighting it. How long can we resist? Indefinitely? I think not. Have you been in a Blockbuster Video lately? Those bare shelves, giant used movie bins full of $3 videos, and stores with 1 person staffing the store, are not what we saw 10 years ago. Have you been to a Tower Records lately? When MP3 players came out in the late 90s, I’m sure the Tower execs were not too worried, but less than 8 years later, they were at home in their boxers looking for work on Monster. Why? Because people found they could get the same product (digital music) at a much lower price online. No lines, no sales people to deal with, no sales tax, just what they want – digital music. The same thing will happen in optometry - guaranteed. The trend started in the last couple of years. It will gain momentum, especially as younger folks, for whom the internet is second nature, move up into middle age. Right now, there’s a significant portion of the population that does not feel comfortable buying things online. That will change. In 20 years or so, virtually everyone will be an “online” person. I don’t think twice about buying things on Amazon. My father won’t even consider it.

So, say what you will about the concern over online retailers, but I think they spell the final nail in the coffin for the private solo OD. It’s just a matter of time before the air in the room runs out. It might take a few years, maybe even a decade, but it will happen. History repeats itself and we’ve already seen what happens when the same market forces are exerted on other industries. Optometry has not ever bothered to insulate itself or form any kind of barrier to these forces so it too will perish, at least as we know it today. Sorry if that view is thought to be exaggerated, but I think it’s very blunt and very accurate.

you keep suggesting that the "private OD" is doomed, etc, but I think that corporate retail optical is at least as much at risk, if not more so. Private ODs tend to try and diversify a bit more, whereas the corporate setting is very limited. Higher exam fees, reduced dispensary overhead, etc and PP optometry should be very sustainable. Sure some private ODs try and be like wallyworld with low fees and low quality, etc and they might likely fall by the wayside. However, contrast that with the one trick pony that is the corporate optical, the downward pressure on exam fees, the relentless focus on material sales, excessively high overhead (well positioned in the mall) and that makes for a recipe for failure. IMO, people DONT need optical materials that often and as such it makes zero sense to build your entire business model around that idea (like the mall). IF the internet captures a larger portion of the optical market (very big IF) then its likely to crush the mallmart optical who is already at operating with thin margins. The first to go will be loss leader "exam" and the requisite OD, that much you can count on. They can better use that 10 by 10 jail cell to house a federal prisoner or maybe the mall security threats, and make WAYYYYY more money (lol).

Personally Ive pushed my office to become more reliant on exam services and have structured the office economics that way. 10 years + with this model and still going strong. No reason other ODs cant do it, they just need to stay away from the wallyworld mentality. I dont "sell" anything, I prescribe things, and people are free to purchase materials elsewhere. Ive seen the "online thing" come for some time now and I gotta say I think that it is wildly overstated. Sure they have some traction, but the market percentage they have is flat and likely to stay there. Given the very weak position that coastal contacts and others are in (leveraged to the hilt, with crazy returns, bottoming out stock, etc) they are lucky they arent bankrupt already as they have been running a loss for at least a full year. Hard to deliver such a high maintenance, custom and personalized product that often requires hands on care, through the internet of all places . Well them's the breaks, and those companies are learning the hard way. Even deregulation wont help much.

Whats wrong with working hard and being creative in order to convey to patients that staying with you (professional services or materials) is a a win win. I am 5 years out, have never practiced in the "golden years" of optometry, yet do very well. It's a crazy concept, but I don't even have to be unethical to do it. Again while I agree with oversupply and some other points Jason and Tippy make there is a big paint brush in their hands. One is biased toward his/her own personal experiences, anyone should understand this. Speaking about the demise of PP optometry like it is gospel truth shows a lack of a certain amount of perspective. Nothing is for sure.

Originally Posted by east

Whats wrong with working hard and being creative in order to convey to patients that staying with you (professional services or materials) is a a win win. I am 5 years out, have never practiced in the "golden years" of optometry, yet do very well. It's a crazy concept, but I don't even have to be unethical to do it. Again while I agree with oversupply and some other points Jason and Tippy make there is a big paint brush in their hands. One is biased toward his/her own personal experiences, anyone should understand this. Speaking about the demise of PP optometry like it is gospel truth shows a lack of a certain amount of perspective. Nothing is for sure.

I've said this before, but I don't speak only from my experience. My experience is what caused me to delve deeply into the inner workings of the profession and what's going wrong with it, but I'm looking at things from the standpoint of where things will be going in the future. Market forces are in place and we can't change that. We've seen what happens in other industries when the same type of forces are exerted without an organized opposition to counterbalance. Can ODs individually resist what's going on? Sure - and it might delay the inevitable, but eventually, the market will decide who stays alive and who falls by the wayside. There will always be those patients who are willing to pay extra for better service. The question is, are there enough of those patients around to keep the ever-growing number of ODs in business? I don't think so. What separates us from pharmacy is the ability to charge for our services, but those services have been devalued to the point that they will probably never recover. Some ODs are able to focus on services and compete with the expanding commercial monster, but most aren't doing it or are not able to do it. Most ODs in private practice offer, essentially, the same thing that is offered at Walmart, but in a more respectable setting with nicer shelves (in some cases). Could they change? Maybe. Will they change? Probably not - and that's reality. What matters is not what could happen, it's what will happen.

There are too many forces working against the private OD, some of which are out there working against all private practice doctors, MDs, DOs, DDSs - everyone. We're on the bottom of the reimbursement/pay scale so who's going to be the first to go?

I think it's great that you're in your position. If there were more people out there in your spot, I wouldn't be on here. But as I've said many times, for every "OD success story," there's 20 more out there working in a box as an IC at 4 or 5 different locations. The flooding of the system can't go on indefinitely without a collapse taking place somewhere. Unfortunately, I believe that collapse will hit private ODs first, then commercial ODs. As long as the oversupply valve is left open, the system will be heading towards failure. There's just no other way. If you see it differently, that's fine, but there will be thousands of excess future ODs who will pay the price if you're wrong.

Originally Posted by Jason K

You're neglecting one small detail. ODs cannot see the volume of patients that MDs/DOs enjoy. We're lucky to get 12 patients through the door each day and even if we billed medical on every one of those patients, you're talking about a bunch of level 3 and maybe a few level 4 office visit reimbursements and scattered tests here and there. It's not going to be a cash cow. MDs/DOs don't have the same problem getting patients in the door. If anything, they sometimes have to close their practices to new patients since they're "full." If you see 40 - 50 patients per day and you bill office visits for all of them, along with additional testing, you're going to be doing a lot better than an OD who's getting $40 per patient to see a bunch of EyeMed, VSP, and Optum patients with a few Medicare visits billed to "dry eye" here and there. Wake up, dude - optometry is not medicine, not even close. If MDs were trying to survive on seeing 10-12 patients per day, they'd be in the same boat, but the fact is, they're not.

I'm curious why this is, Jason. The optometrists I've spent time with over the years (I actually thought about becoming an optometrist, at one point) all seemed to have fairly low volume relative to your average ophthalmologist. Is this another facet of the oversupply? Are there other factors?

From the ODs that I shadowed, the ones in urban saturated areas do have low volume. But ones in small towns or in places they are actually needed have high volume. http://cms.revoptom.com/index.asp?page=2_1079.htm

Optometry is more conducive to a small town/rural setting and apart from the high financial cost of getting the degree this is an important point students must know. I know that special someone who is going to jump on me about how I'm just a first year and I don't know anything. That is why I sourced my argument. Plus look at the scope of practice laws, the ability to get onto medical panels and a 10% Medicare pay bonus. The more rural you get, the better it is for optometry.

Originally Posted by Visionary

I'm curious why this is, Jason. The optometrists I've spent time with over the years (I actually thought about becoming an optometrist, at one point) all seemed to have fairly low volume relative to your average ophthalmologist. Is this another facet of the oversupply? Are there other factors?

I am not Jason (don't have the Chuck Norris street-cred) but I'll chime in. ODs never have the volume of ophthalmolgists for a number of reasons.

1. OMDs get referrals from their colleague MDs (and lots of them). ODs, no matter how good, don't get the referrals 'by default' like OMDs do.

As a general rule, OMDs are assumed competent until proven otherwise while ODs are assumed incompetent until proven otherwise.

2. OMDs get referrals from ODs. Almost never goes the other way around.
3. Many people believe in the theory that they might as well go to the top of the food chain instead of going to one doc and then having to be refered to another. (I did this with a health problem.....went straight to Duke instead of messing around with my local docs).
4. Many people believe OMDs are smarter since they have more schooling.
5. OMDs are taught to recall better (shorter intervals, repeat visits, etc...) and taught to work with techs. ODs are taught to do a 2 hour eye exam on every person by themselves (no kidding).
6. OMDs can do everything the OD can do and much more. For this reason, they not only get the initial patient, but the patient's family members as well. It's the one-stop-shopping they like.
7. The entire profession of optometry was modeled from the beginning as a thorough visual exam followed by the selling of eyewear. One patient per hour with 'customized care'.

These days, ODs are a watered down version of an eye doctor. Good enough for most people who simply need a refraction and a cursory look at the eye or a shot-gun approach with Tobradex.

Optometry is, once again, a made up/legislatively purchased profession.

Originally Posted by Shnurek

From the ODs that I shadowed, the ones in urban saturated areas do have low volume. But ones in small towns or in places they are actually needed have high volume. http://cms.revoptom.com/index.asp?page=2_1079.htm

Hmm....I just checked out the Review of Optometry article you cited. # 1 on the list of "small town" oportunties is Raleigh/Durham/Chapel Hill, also known as the Research Triangle area. Population is close to 2 MILLION with the greatest concentration of PhDs in the world I believe.

Not exactly 'rural'. As a matter of fact, most of the places they list aren't consider rural by most people outside of NYC or LA.

For the record, I did extern at a large OD owned rural clinic in NC. He had a huge volume practice at the time. Problem is, in his rural area (as most probably) there were no jobs. 75% of the population was on some form of welfare. So he became the welfare KING of eye exam. Made his money on high volume, low-priced exams (and using free optometry student labor in the form of 4th year externs).

Flash forward to 2011 and the state, under budget crisis, cut welfare eye exams for all adults. This immediately cut his practice about 50%. He's hurting. His wife left him. His kids hate him for making them grow up in a little welfare town with nothing to do and no prospects. True story.

Moral: Rural areas are rural for a reason. No one wants to live there!

ouch

Originally Posted by Tippytoe

ODs are a watered down version of an eye doctor. Good enough for most people who simply need a refraction an cursory look at the eye.

Optometry is, once again, a made up/legislatively purchased profession.

wow, you and jason sound like two peas in a pod. Seriously if optometry was only what you describe I would have left long ago. While some of what you say does occur, it is by no means a "universal truth". Your perspective is limited, as is Jasons, by your own experience. I'll be the first to admit optometry has many challenges, but it is and has always been what you make of it (like anything else). If you want to go and spin and grin at the local refractohut then its YOU who is making that choice, if you want the challenge of private practice and offer the full scope of your license then its YOU who is making that choice.