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.
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.
BTW some docs DO sell medications "on the premises".
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/doctors-profit-dispensing-medications.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=cache:AidGPCWKse4J:www.dhp.virginia.gov/Pharmacy/guidelines/110-29%2520Physician%2520dispensing%2520guidance%25202-2011.doc+rural+doctors+selling+drugs&hl=en&gl=us&pid=bl&srcid=ADGEESgzKrjGDN6XlPDo0LrLF8GINbYVxy_YQiQhPPLs5vW1ns69l6UnlELx2rrFda7JF8X_tlCPgYpMJpfX4t2wQ21lXVYnXDcl8zLlqkssCWtUTyWLL3gXSmaDCl6tlKIOThrem9hB&sig=AHIEtbSuLOuiuccdP16eDXgMt3iBPAaZyw
It should be kept that way as urban doctors are more dissolute.
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.
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/doctors-profit-dispensing-medications.html
Of course in hindsight, it's all mute. The internet is taking the profit out of both anyway.
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 .
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.
latter
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.
Optical sales, on the other hand, is undoubtedly a profit stream, although with all of the changes going on, that's changing too.
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.
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.
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.
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.
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.
Shnurek said:You are the bottom of the barrel of optometry.
Shnurek said:I see you edited your post to take out the personal threat.
Shnurek said:But in any case I don't go around in my free time trashing my own profession.
Shnurek said: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.
Shnurek said: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.
Shnurek said: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.
Shnurek said: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.
Shnurek said: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.
Shnurek said: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.
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.
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.
I agree! Almost everyone needs a pair of glasses. And almost everyone can be convinced to purchase at your location.
I agree! Almost everyone needs a pair of glasses. And almost everyone can be convinced to purchase at your location.
Um, no. If that's the case, you're doing something horribly, horribly wrong.
"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-***** 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.
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 theres 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, its up to you to convince your patient to buy from you and thats absolutely true, but it does not change the reality that the forces are in motion and theres only so much we can do about it. Were 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, Im 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, theres 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 dont think twice about buying things on Amazon. My father wont 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. Its 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 weve 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 its very blunt and very accurate.
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.
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
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.