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Most people entering optometry school have dreams of one day working in or owning a large Guggenheim type optometric practice stuffed full of designer merchandise, fancy instrumentation, and a waiting room full of patients eagerly awaiting you to diagnose their cool ocular pathology. Is this possible? Yes. Is it difficult? Sadly, Yes.
Most people also envision a scenario in which they graduate, join a practice with an old guy and slowly work there more as you grow and build the practice. Slowly over time, you buy in as the old guy fades away or perhaps s/he stays on and the two of you become partners. My experience, and that of a number of my collegues has been that this almost never works for a number of reasons.
The hardest part of that is finding an older doctor who wants the same thing as you do. Many times an older doctor will take on a young one and SAY they want a partner but what they really want is an associate doctor. The key to making something like that work is to spell out IN WRITING at the start the terms and conditions under which you will be given the right to buy in or buy the practice outright.
Many older doctors want to do this on a handshake type of arrangement. Come work for me for a couple of years, and if it works out, you can buy in they say. That sounds great in theory, and many unsuspecting young doctors jump at the chance, thinking that they will have the opportunity to buy into a great practice. Unfortunately, what happens more often than not is the new doctor starts working, takes over the undesirable hours, grows the practice and then in a couple of years when they want to buy in, the older doctor says Im not ready yet. In my experience, that means that the doctors WIFE isnt ready yet. What ends up happening is one of two things .the young doctor grows the office and now the seller wants MORE for the practice because its worth more and now the younger doctor is essentially spending a big chunk of money buying themselves or more often than not, the older doctor starts to make some really decent money off of the back of the young one and now there is less and less incentive for them to deal you in.
Most older doctors are (understandably) not willing to just sell out or partner with a new doctor. However, if they are SERIOUS about wanting a partner or a buyer for a practice, they should at the very least be willing to specify the terms under which they would allow the young doctor to buy in. For example .Young Doctor X will be allowed to buy in to the practice when their productions meets Y dollars or Z percentage of the practice income.
But even worse than this is the issue of medical insurance accessibility. I have harped on this issue ad nauseum for years on this and other forums and it can not be stressed enough that it is THIS issue that is going to make or break the vast majority of you allow me to explain ..
Even though there is a big number of people in the USA who dont have health insurance, and its a problem the fact is that the vast majority of patients do have medical insurance of some type. Some of these patients may also have corresponding dental or VISION riders which covers services related to dental or vision care that are not normally covered by medical insurance. Many of you out there may be covered by these supplemental dental or vision plans. In the vision arena, there are many of these types of plans such as VSP, Davis Vision, Eyemed, Spectera and a host of others.
If a patient presents to your office and needs care that is NOT of a routine nature, such as needing to be worked up for glaucoma, or diabetes, or for visual symptoms not related to refractive error, that visit and the testing that goes along with it needs to be submitted to their MEDICAL insurance carrier for reimbursement. The routine plans pay for a yearly, or bi-yearly visit but they dont cover any of the supplemental treatments or follow up care a patient may need outside of a routine well eye visit.
However, in many parts of the country, optometrists are NOT ABLE to participate in many medical plans. Some plans exclude all non-physician providers, some exclude just optometry. Yes folks, its legal, and yes it happens all over the place.
So if a patient with any sort of medical issue presents to your office, you can not treat them. You have to refer them out to a physician provider. (I should say, you CAN treat them, but you wont get paid for it) This is a DEATH SENTENCE for most private practices because when you see these patients and refer them out, it sends the patient the message that if you have ANYTHING wrong with your eye other than a need for glasses or contact lenses, then yours is not the office to go to. And where does this leave you? It leaves you essentially providing routine care to routine healthy patients and competing against commercial opticals for eyeglass and contact lens sales. There isnt anything wrong with that per se, but it essentially leaves you as an eyeglass merchant. If you want to be an eyeglass merchant, there is no reason to spend hundreds of thousands of dollars on 8-9 years of post secondary education. Just take a basic opticianry course at your local community college at open your eyeglass store.
So between this horrible medical insurance situation, and a lack of decent opportunities to enter private practice, what is a new graduate or young doctor to do?
Well the best advice I can offer you is the following:
If you have a particular city, state or area of the country that you want to practice in, then it is absolutely imperative that you find out if you can access medical plans in that area before you give any school of optometry one plug nickel. How do you do this? You can phone up a number of optometrists in the area and ask them if they are able to access plans .you can find out what the top 5 plans in that area are (usually through the state insurance commissioners office) and phone them up and ask if they are credentialing NEW optometrists onto their panel. If more than one of them says no, you may want to find another area to practice in or prepare yourself for a career filled with routine exams and selling glasses.
Finding the right practice to buy or join is incredibly difficult. Like I said before, most practices for sale are really little more than tired old optical shops with exam lanes in the back. Some of them are diamonds in the rough and can be fixed up but most new graduates or young doctors dont have the experience to tell which is which. Partnership opportunities are incredibly hard because the needs and desires of the young doctor are usually not coincident with those of the old.
I am incredibly lucky because I stumbled into a perfect situation. I now own a great office, in a great town, with a great partner, and I make big money but I struggled for YEARS to find it, and it even then, it just sort of fell into my lap. So Im pretty much the luckiest SOB as far as that goes.
The best suggestion I can give to young doctors is to do one of two things:
1) Find an area in which you can open cold. I think I spent far too much time dealing with small time thinkers and their told old optical shops. In my experience, the number of providers or commercial entities in an area matters little. The key is access to medical plans (see above) In fact, in some cases MORE competition can be better because if there are 5 dogs in a town, and youre the shining star, youll really excel. It will be as if none of those dogs are even around.
2) Find an office in which the old doctor wants to just flat out sell and be gone. The way that I did this was to look up the roster of licensees in my state, find all the guys who had been licensed for more than 30 years, cross referenced it with a list of towns I wanted to join and just starting calling people and asking them if they were thinking of selling. I finally got a hit.
So to reiterate, it is possible. I make huge money, working in a nice office, taking care of my patients to the extent my license allows. But its difficult to find an acceptable situation. You need to have a SPECIFIC plan of action long before you even think of entering school to be successful in this field .
Most people also envision a scenario in which they graduate, join a practice with an old guy and slowly work there more as you grow and build the practice. Slowly over time, you buy in as the old guy fades away or perhaps s/he stays on and the two of you become partners. My experience, and that of a number of my collegues has been that this almost never works for a number of reasons.
The hardest part of that is finding an older doctor who wants the same thing as you do. Many times an older doctor will take on a young one and SAY they want a partner but what they really want is an associate doctor. The key to making something like that work is to spell out IN WRITING at the start the terms and conditions under which you will be given the right to buy in or buy the practice outright.
Many older doctors want to do this on a handshake type of arrangement. Come work for me for a couple of years, and if it works out, you can buy in they say. That sounds great in theory, and many unsuspecting young doctors jump at the chance, thinking that they will have the opportunity to buy into a great practice. Unfortunately, what happens more often than not is the new doctor starts working, takes over the undesirable hours, grows the practice and then in a couple of years when they want to buy in, the older doctor says Im not ready yet. In my experience, that means that the doctors WIFE isnt ready yet. What ends up happening is one of two things .the young doctor grows the office and now the seller wants MORE for the practice because its worth more and now the younger doctor is essentially spending a big chunk of money buying themselves or more often than not, the older doctor starts to make some really decent money off of the back of the young one and now there is less and less incentive for them to deal you in.
Most older doctors are (understandably) not willing to just sell out or partner with a new doctor. However, if they are SERIOUS about wanting a partner or a buyer for a practice, they should at the very least be willing to specify the terms under which they would allow the young doctor to buy in. For example .Young Doctor X will be allowed to buy in to the practice when their productions meets Y dollars or Z percentage of the practice income.
But even worse than this is the issue of medical insurance accessibility. I have harped on this issue ad nauseum for years on this and other forums and it can not be stressed enough that it is THIS issue that is going to make or break the vast majority of you allow me to explain ..
Even though there is a big number of people in the USA who dont have health insurance, and its a problem the fact is that the vast majority of patients do have medical insurance of some type. Some of these patients may also have corresponding dental or VISION riders which covers services related to dental or vision care that are not normally covered by medical insurance. Many of you out there may be covered by these supplemental dental or vision plans. In the vision arena, there are many of these types of plans such as VSP, Davis Vision, Eyemed, Spectera and a host of others.
If a patient presents to your office and needs care that is NOT of a routine nature, such as needing to be worked up for glaucoma, or diabetes, or for visual symptoms not related to refractive error, that visit and the testing that goes along with it needs to be submitted to their MEDICAL insurance carrier for reimbursement. The routine plans pay for a yearly, or bi-yearly visit but they dont cover any of the supplemental treatments or follow up care a patient may need outside of a routine well eye visit.
However, in many parts of the country, optometrists are NOT ABLE to participate in many medical plans. Some plans exclude all non-physician providers, some exclude just optometry. Yes folks, its legal, and yes it happens all over the place.
So if a patient with any sort of medical issue presents to your office, you can not treat them. You have to refer them out to a physician provider. (I should say, you CAN treat them, but you wont get paid for it) This is a DEATH SENTENCE for most private practices because when you see these patients and refer them out, it sends the patient the message that if you have ANYTHING wrong with your eye other than a need for glasses or contact lenses, then yours is not the office to go to. And where does this leave you? It leaves you essentially providing routine care to routine healthy patients and competing against commercial opticals for eyeglass and contact lens sales. There isnt anything wrong with that per se, but it essentially leaves you as an eyeglass merchant. If you want to be an eyeglass merchant, there is no reason to spend hundreds of thousands of dollars on 8-9 years of post secondary education. Just take a basic opticianry course at your local community college at open your eyeglass store.
So between this horrible medical insurance situation, and a lack of decent opportunities to enter private practice, what is a new graduate or young doctor to do?
Well the best advice I can offer you is the following:
If you have a particular city, state or area of the country that you want to practice in, then it is absolutely imperative that you find out if you can access medical plans in that area before you give any school of optometry one plug nickel. How do you do this? You can phone up a number of optometrists in the area and ask them if they are able to access plans .you can find out what the top 5 plans in that area are (usually through the state insurance commissioners office) and phone them up and ask if they are credentialing NEW optometrists onto their panel. If more than one of them says no, you may want to find another area to practice in or prepare yourself for a career filled with routine exams and selling glasses.
Finding the right practice to buy or join is incredibly difficult. Like I said before, most practices for sale are really little more than tired old optical shops with exam lanes in the back. Some of them are diamonds in the rough and can be fixed up but most new graduates or young doctors dont have the experience to tell which is which. Partnership opportunities are incredibly hard because the needs and desires of the young doctor are usually not coincident with those of the old.
I am incredibly lucky because I stumbled into a perfect situation. I now own a great office, in a great town, with a great partner, and I make big money but I struggled for YEARS to find it, and it even then, it just sort of fell into my lap. So Im pretty much the luckiest SOB as far as that goes.
The best suggestion I can give to young doctors is to do one of two things:
1) Find an area in which you can open cold. I think I spent far too much time dealing with small time thinkers and their told old optical shops. In my experience, the number of providers or commercial entities in an area matters little. The key is access to medical plans (see above) In fact, in some cases MORE competition can be better because if there are 5 dogs in a town, and youre the shining star, youll really excel. It will be as if none of those dogs are even around.
2) Find an office in which the old doctor wants to just flat out sell and be gone. The way that I did this was to look up the roster of licensees in my state, find all the guys who had been licensed for more than 30 years, cross referenced it with a list of towns I wanted to join and just starting calling people and asking them if they were thinking of selling. I finally got a hit.
So to reiterate, it is possible. I make huge money, working in a nice office, taking care of my patients to the extent my license allows. But its difficult to find an acceptable situation. You need to have a SPECIFIC plan of action long before you even think of entering school to be successful in this field .
