then some attorney general would take a big, wet juicy bite out of our ass, and call it anti-trust. You should be aware that doctors have no rights and usually have no leverage. Health insurance companies, on the other hand, have all the leverage in the world, AND are exempt from the monopolization of their industry. They have a get out of jail free card (courtesy of the us gov). In other words they can fix fees, collude with other insureres, and generally act in an anti-competitive fashion. I laugh when people whine about "obamacare", wake up people, we have been in a de facto stat of "socialized" medicine for at least 10 years, probably much longer. Vision plans are the worst of the bunch, if any lay observer were to examine the reimbursement for these plans they would fall over laughing. You make more money cutting hair, then "selling glasses", or providing half-assed "vision" exams.
do you regret going into optometry?
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then some attorney general would take a big, wet juicy bite out of our ass, and call it anti-trust. You should be aware that doctors have no rights and usually have no leverage. Health insurance companies, on the other hand, have all the leverage in the world, AND are exempt from the monopolization of their industry. They have a get out of jail free card (courtesy of the us gov). In other words they can fix fees, collude with other insureres, and generally act in an anti-competitive fashion. I laugh when people whine about "obamacare", wake up people, we have been in a de facto stat of "socialized" medicine for at least 10 years, probably much longer. Vision plans are the worst of the bunch, if any lay observer were to examine the reimbursement for these plans they would fall over laughing. You make more money cutting hair, then "selling glasses", or providing half-assed "vision" exams.
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Yup. That's what happened to those Orthopods that stopped taking medicare.
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If you really want to be into this kind of field , you must love people in this profession. Besides it is really unprofessional with you if you are into a work that you don't like the people in it. Cope up with the things around you. 
You define THAT as unprofessional?
This is unprofessional:
At one of our Halloween parties in optometry school, some optometry students showed up dressed as a slaver and slave, complete with dark makeup and a rope around the slave's neck. The hospital who'd leased out the facility to the optometry school that night refused to host us after that. It was a big scandal at the time.
Some fourth year Mormon students, who had clinic together, got in trouble for selling Amway to patients.
One of the fourth-year students told us that during one one of his clinic rotations, the Attending OD ripped up the exam form in front of the patient, told the student "This is c**p!"and ordered the student to redo exam because he didn't believe in the 21 point eye exam. There were allegations of sexual harassment of female students by this same doctor. Nothing was done by the optometry school to address this issue. I know they were aware of it because I inquired about it.
I got my first job because an OD was caught with a half-empty bottle of whiskey behind his exam chair. He had been telling staff and patients that he smelled of alcohol because he was using lots of Listerine for gingivitis. He went into rehab and retired. I took his place. I was really judgmental of him at the time, but looking back, I can understand why he needed that bottle.
An OD I worked for was about to buy a lease from another OD until I told her that selling a "lease" is somewhat unkosher, business-wise. I explained to her that buying a lease is like sharing a room in an apartment with someone, both of you paying rent. When the person vacates he asks you to pay him to buy the rental contract. You end up paying him plus rent to those who owned the apartment! I told her to tell the real lessor what was going on and if she was going to buy anything from the other OD that it would be something tangible, like patient records, so that at least she could write if off on her taxes. Well, the lessor wasn't too happy about it and I saved her $30,000 dollars! We've been buds ever since!
On the same note, my buddy was having patients recite the Sinner's Prayer when doing near visual acuity testing. I checked into it to see if it was legal to mix business and religion, and it was, so I just let it go. But proselytizing at work is probably unprofessional -- on the same line as selling Amway to patients.
My buddy had warned me about an OD in the area who had cheated her out of pay. She'd filled in for him one weekend and when she met him to get her paycheck, he threw it at her out the window of his sports car and drove away laughing hysterically and yelling, "S**ks to be you. HA, ha ha!!!" She opened the envelope and he'd paid her for HALF of what they'd agreed upon.
An optician told me about an OD he worked for who repackaged sample contact lenses into bottles and sold them at a hefty profit! Never got caught. Luckily, most lenses no longer come in bottles.
After I signed an employee contract with an Opthalmology clinic I was invited by the MD owner to a baseball game to "get to know each other." His son came with us. The son left to get some stuff for the hot dogs. He returned with ketchup. When the MD realized his son forgot the napkins, he reached behind my back and slaped his son on the back of the head really hard. He called him STUPID for forgetting the napkins and to go get them RIGHT NOW. Had I had this meeting before signing the contract, I'd have declined the job. Yes, performing child abuse in front of colleagues might be considered unprofessional. Patients LOVED this guy, by the way. He was totally different at work.
A few weeks after the above incident, I got a patients file on my desk with a sticky note attached to the surgery center form we ODs and COTs regularly filled out for the MD's. It regarded cataract surgery. On the note was scribbled, "Are you stupid? What do you think I am, an idiot? Do you want the surgery center people to think we're stupid, or something?" It was in reference to the patients an acuity entry, which I'd filled-in correctly. I was shocked at this note and I looked over at the MD boss of mine, who I shared an office with, and said, "Did you write this? He looked at it and said, "Um. Yeah." I said, "Do you care to explain?" I was genuinely mad and shocked. He said, "I was just having a really bad day. I'm sorry. We want you to write ---- in that space." This same practice was involved in Medicare fraud. Fraud and telling a colleage she's stupid is unprofessional. After this encounter, I'd earned his RESPECT and he never talked down to me again.
This same practice wrote off a yacht on their taxes. Add tax fraud to the list. Thank goodness I only worked a year for these people.
I was asked to do procedures that were beyond the scope of my license. The MD I worked for had me drive out to a remote clinic to see his 1-day post-ops so that he could have a long weekend. If any patients had pressures over 40, I was told to do anterior chamber paracentesis (Thats when you stick a needle into the eye and drain fluid out). . I told my boss I didn't feel comfortable with it ... I mean ... I'd be doing it for the first time alone and totally unsupervised. He said he'd talk me through it over-the-phone if I needed to do it and to not worry. He said, "You just go in through the port incision." I felt it was inappropriate of him to ask that of me. Plus, almost ALL MD's see their own 1-day posts just for the very reason that they can catch problems early and it's their job! Anyway, the highest IOP I ever came across on those days was 35. I gave the patient Diamox and some topicals. I don't know what I'd have done had I really needed to do ACH paracentesis. I'd have been really, really scared of Iris prolapse.
A several years ago, when I first came to my present location, I did an exam on a young teen who failed a school vision screening. Her script was pl-0.75X90 on each eye. A week later, the mother storms in furious because she had her daughter re-examined by the OD down the street who had badmouthed me and said my prescription was "way off." Neither script had yet been filled. I wanted to know what the script was in case the kid was a type I diabetic. Mom didn't have the script. I called the other OD and told his staff to pull him out of an eye exam if he was unavailable. He got on the line and told me the script he wrote was -0.5D sph OU. I said, "So you basically wrote a spherical equivalent of my script and told the mother it was way off? You had me thinking the kid was diabetic! Don't do it again. Good bye, doctor." I hung up on him and I haven't heard from him since. He's been miraculously quiet over the years. It's unprofessional to engage in negative advertising. If you can avoid badmouthing another OD, do so. (The reason for the second exam is because the school nurse recommended the other doctor, me being new and unknown at that time).
It's also unprofessional to treat commercially employed OD's badly. Every time I go to a CE meeting, someone says something rude to me regarding my method of employment. The truth is that I do the same thing they do for half the price and that is what angers them. Much of this profession is all about the $$$. Many OD's become strangely self-righteous once they open their own private practice -- yet those same OD's worked commercial optometry to pay of their student loans! I've been doing the same eye exam for 14 years at varying locations. Probably the worst exams I did were at an ophthalomology clinic because I had a tech doing half of my exam. Presently, I spend 30 min to one hour per patient and everyone gets a field exam and I do dilation as needed. My $50 dollar eye exam is actually better than my $120 dollar eye exam, in truth. I do it all myself. No techs.
Opticians can treat you badly, too. I had one manager try to tell me to prescribe everyone two pairs of glasses. "Everyone can use a +0.5D reader," he said. I said, "No, everyone can't." I asked him, "Are you a sales person?" He said, "Yeah." I said, "Then sell glasses. Leave the eye exams to me. I prescribe what people need and nothing else." He said, "Well, Dr XXX was cool and he used to do that!" I said, "I prefer being uncool."
A different optician told me one day that I needed to change people's prescriptions more so that they'd order glasses. I told him, "I'll prescribe what I get. No promises."
Opticians are not to tell you how to practice. In fact other OD's are not to tell you how to practice. In fact, no one can tell you how to practice except the board of optometry in your state.
You can't trust other ODs either. I worked at a corporate location where one OD private contractor conspired to steal the contracted OD's practice! There were secret meetings with the optical staff, who would behave badly toward the contracted OD and well toward the private contractor. This employed OD also told the corporation he'd sign a 7-day per week contract if they'd only give him the lease to this store. In order not to lose his store the contracted OD gave up a location his wife (also an OD) was working part-time and gave it to this greedy OD. His wife worked her husband's location part time. I know all this because I was the second private contractor who was just a fly on the wall. As a part of the deal, the corporation offered me my own store. Being a slime-ball is unprofessional and trying to steal someone's practice is just wrong. That's part of the risk of working a commercial location. A private contractor filling in at a private practice owned by an OD could not steal that practice. But I've also heard of people in such situations secretly photocopying patient files and downloading addresses of patients off the computer in order to build their own practice they were planning to open in the same area.
One OD was publically flogged by the Board of Optometry (if you do anything bad in our state it's published in the board's quarterly newsletter) for having s*x with teenage girl patients in the back seat of his car. I believe his license was revoked.
Another OD was flogged for doing a inadequate eye exams, substituting fundus photography for his retinal exam. His license was suspended.
Another fill-in OD who worked at the optical before I took over the lease used to see 40 patients a day by himself with no techs. Inadequate eye exams are unprofessional.
So, what do you think. Is not having a natural affection for people in general, my accused unprofessional behavior, really so unprofessional?
Now, you may understand why I have a negative view of my profession and you might be able to appreciate how a shy person in this profession can get eaten alive! I had to force myself out of my shell in many instances, or else I'd have been nothing more than a human carpet.
And maybe it's unprofessional of me to air dirty laundry, but I have to be completely fair to those seeking employment in this profession. You're taking on a tremendously long and expensive education. You deserve an completely raw and un-sugarcoated description of real-life optometry. If you still want to do it, then do it. I hate to be the one to tell the little ones there is no Santa Claus, but I'm sure you appreciate the truth.
On the same note, these problems are not limited to optometry. I roomed with a Podiatry resident who told me, "Podiatrists eat their young." And I know things are NASTY in medicine. Even opthalmologists attack one another!
I have also come across some really nice, honest ODs who are trying to do good in the world. But again, they've all been taken advantage of by "the others."
Just remember that you need a cheerful, outgoing and people-seeking personality that is as wise as a tortoise and as aggressive as a pit-viper. If you're shy and not the most talkative person and if you're a bookworm and if you can't handle confrontations, then don't go into optometry.
Oh, this is so incredibly naive.
In any health profession, it's best if you have the ability to talk to others and if you LIKE doing so. The only health profession I can think of that you might be able to get away with that sort of conversation would be a Proctologist, mostly because patients expect you to be an a-ho*e anyway. ;-)
Seriously though, if you do that, patients with hate you and make your life a nightmare!
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How about just using an O-Scope? You can't tell depth with that, and field is so limited. I would take a fundus photo over an O-scope everyday. Personally, I like using a 90D lens to view the posterior pole.
How about advertising Optos as an alternative to dilating drops. "You can avoid dilating now for an Optos image for $40?" Charging a fee for dilating in any instance is unethical. Its part of a 92004 or 92014. There is NO separate procedural code for DILATION. All of this is unethical.
I agree with a lot of the comments you made. BUT in no way in he** would I have stuck a needle in if the pressure was over 40. If you're not licensed to do that it can be considered assault if something goes even more wrong. Some jobs are not just not worth it.
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I don't really understand your rational here.
You will be spending time with the patient once a year so how bad can it really get ?
After reading your previous post, it saddens me to see how OD's treat each other. Whats going on!? May I ask which state those stories originated from?
Thanks.
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All of this isn't up to you. The decision is made by the Board of Optometry in your state. They, not you, will decide what constitutes the minimums of a proper retinal exam.
In the case of this OD, they felt fundus photography alone to be an inadequate retinal exam.
My opinion is that a scanning laser ophthalmoscope might substitute for a direct or indirect view ... but again, check with your state board first! You alone do not have the authority to make such a decision. Plus ... I'm uncertain the optos can give you a really sharp look at the macula. The best lens for that is a 78 or 90D.
This incident took place over a decade ago and who knows what I'd have done. I was just a kid.
Today, were I in the exact same situation (out-of-town remote clinic emergency), I probably would do anterior chamber paracentesis on a 1-day post-cataract patient who had monster IOPs, because I can. I'm licensed to do injectables, where back then I was not. Plus, the original hole is already present on the eye. Also, Good Samaritan Law would apply.
It wouldn't be the first treatment I'd turn to. It would be the last after exhausting Diamox and all the topicals. I wouldn't do ant chamber para in any other circumstance, such as an angle closure. The MD's might, but me, no. That's cowboy stuff and cowboys get sued!
You will be spending time with the patient once a year so how bad can it really get ?
An optometrist is like a hairdresser on steroids. Patients don't just expect an eye exam, they expect you to entertain them while you do it. Think of a hairdresser and how hairdressers are able to quickly make a connection with their clients. When I get my haircut, I watch and listen carefully. Those women are the grandmasters of social interaction and I'm amazed at how they pull it off!
If you just say "uh huh" and "yeah" as your patient interaction (besides reciting instructions) the patients will get angry at you. They'll ask you, "Are you having a bad day?" and if you say yes, they'll say, "Well, It's not my fault." Never say yes. Or they'll ask, "Do you like your job?" Never say no. Say yes or they'll get anxious. Or they'll say, "You don't say much, do you?" Or, "Is there something serious wrong with my eyes?" I mean, as socially inept as I am, even I have better social skills than that! You must speak in more than one-word sentences in order to compete in this profession. You'll never see the patient more than once if don't, so forget about their returning for their one-year visit. They'll have moved on.
If you are socially inept, take some acting classes and fake it. It does work. You'll never be as slick as the naturals, but it'll make your life much more comfortable. Or you can take some seminars on customer service. Those help as well.
Sorry. Can't disclose location because I was told to "never under any circumstance reveal the inner workings of this office to anyone" on my last day at the MD's office. The way it was said sounded like a threat. They scared the living ##### out of me.
I figure that because over a decade has passed, and 3 out of 4 of the doctors in that practice has quit or was let go, and that their business entity, as it was, no longer exists, It's relatively safe to disclose a small bit of what happened there, but I still won't reveal the state because it might reveal their identity.
I returned to commercial optometry after that because I figured that if such a prestigious group of people were so corrupt that everyone, including private OD's, must be corrupt. These MD's were amongst the finest surgeons in the world. I was recruited because I was a good diagnostician. I had about six months experience as a practicing OD when I joined this group (no residency). I was barely 26 when I started working for them. I was very naive and innocent. This group was so good that at least 2 of the 9 doctors that were part of the whole group were doing FDA investigational studies for various ocular devices. I was employed by a of sub-group of eye doctors who shared a larger building, surgery suite and optical. They also rotated and shared the satellite clinics. This was probably the second most prestigious eye place in the entire state and I was amazed that I got a job there. It started out as a dream job. But boy, it didn't end up that way.
I haven't worked for an MD or an OD ever since because I didn't want to be put back into a similar situation.
My advice to young OD's would be to tell any prospective employer that if there is any sort of fraud being conducted in the practice, be it tax fraud or insurance fraud, that you'll quit. Tell them you'll not take part in such things and that if they're presently doing anything fraudulent, ask them not to hire you. That would be the only way I'd work for another OD or MD.
As a private contractor, you probably won't run across that sort of thing and you needn't worry about it so much.
The best way would be to open a practice stone-cold. That way, your destiny is in your own hands, well, until ObamaCare ties them.
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I don't really understand your rational here.
You will be spending time with the patient once a year so how bad can it really get ?
After reading your previous post, it saddens me to see how OD's treat each other. Whats going on!? May I ask which state those stories originated from?
Thanks.
You'll be spending time with THAT patient MAYBE once a year. More than that if they have something going on. But if you'd rather spend 40+ hours a week in awkward silence with your patients, go for it.
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Well, I mean when I go to my eye doctor, I don't really start a conversation with him. I find it awkward to bother him. I went to an Ophthalmologist for a recent eye exam, and he did start a conversation with me, asking things like what I will be studying etc. thing pertaining to school, though. It was a much better experience, and I do believe if you can connect with the patient, that would make the od more memorable.
Maybe its just me, but how many of you believe if the OD, rather than the patient, starts the conversation, the OD will be more memorable in the patients eyes?
There should definitely be some verbal exchangement going on between patient and doctor, but in a profesionally setting such as an exam room, you can't really talk your mind. I think the OD must maintain a professional atmosphere, because after it isn't a hair salon. This is what probably gets some OD's nervous, when talking to patients, because they do not know what to really say- it may be appropriate, but nevertheless, unprofessional.
Its funny how some folks are in a good mood when going to their Eye doctor, but when it comes time to see an MD or a Dentist, the expressions on their faces reeks of depression.
Maybe its just me, but how many of you believe if the OD, rather than the patient, starts the conversation, the OD will be more memorable in the patients eyes?
There should definitely be some verbal exchangement going on between patient and doctor, but in a profesionally setting such as an exam room, you can't really talk your mind. I think the OD must maintain a professional atmosphere, because after it isn't a hair salon. This is what probably gets some OD's nervous, when talking to patients, because they do not know what to really say- it may be appropriate, but nevertheless, unprofessional.
Its funny how some folks are in a good mood when going to their Eye doctor, but when it comes time to see an MD or a Dentist, the expressions on their faces reeks of depression.
Sorry I got you guys off topic.
About regretting going into a profession: I'd hate to be an ophthalmologist right now. Medicare, as some result of ObamaCare (don't know specifics), has lowered its reimbursement for cataract surgery again.
In 2008 the reimbursement was a pathetic $626.15 per eye for the standard uncomplicated procedure. The average list price for the IOL was $325 in the US, about $200 in Canada. (not multifocal).
In 2010, Medicare lowered the reimbursement even more (don't know exact numbers) and has suspended payments to physicians.
After the cost of the IOL, the ancillary staff, the fees for using as surgical facility and malpractice insurance the ophthalmologists will be doing this procedure for free very soon, or worse, they'll be operating in the red. I feel sorry for them.
They'd make more money now fitting contact lenses and selling glasses ... being optometrists!
About regretting going into a profession: I'd hate to be an ophthalmologist right now. Medicare, as some result of ObamaCare (don't know specifics), has lowered its reimbursement for cataract surgery again.
In 2008 the reimbursement was a pathetic $626.15 per eye for the standard uncomplicated procedure. The average list price for the IOL was $325 in the US, about $200 in Canada. (not multifocal).
In 2010, Medicare lowered the reimbursement even more (don't know exact numbers) and has suspended payments to physicians.
After the cost of the IOL, the ancillary staff, the fees for using as surgical facility and malpractice insurance the ophthalmologists will be doing this procedure for free very soon, or worse, they'll be operating in the red. I feel sorry for them.
They'd make more money now fitting contact lenses and selling glasses ... being optometrists!
While you are free to turn down insurance plans, you won't have many pts. Eyemed and vsp pays $35 to $65/exam and requires you discount the optical about 40%. And these are the better insurance programs. You have to buy frames , office equipment etc. even if you go the medical route, there is not enough path to make ends meet unless you are comfortable over diagnosing disease and overcharging insurance companies. Look at the trends: we get paid much less now that 30 years ago, not even after correcting for inflation. Even a 2 year sonar tech gets paid more than a lot of optoms. Nurses get paid more, I love my job, and am one of the lucky few to have a good job. But if I was 10 years younger, I would go back to school. Ok. Don't believe me, you soon will.
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Laura,
It's always nice to have practicing doctors on the forums but it would be helpful if you stopped reviving forums that are several years old.
It's always nice to have practicing doctors on the forums but it would be helpful if you stopped reviving forums that are several years old.
