3 reasons not to listen to Baby Boomer optometrists

[IandI]

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"It will never be as good as it was in the past.”
Too many students and new optometrists are hearing an undercurrent of pessimism and “Chicken Little” messages that the sky is falling. Many Baby Boomers prefer the old days and are concerned for The future of optometry. In many ways this is a huge advantage for the next generation of optometrists. As Carol Dweck, PhD. describes in her book Mindset: The New Psychology of Success, there are two kinds of thinking about people and life: fixed and growth. The growth individual sees change as an opportunity to grow and make things better than they were before. Someone with a fixed mindset sees the world as having arrived and one must continue to build upon things of the past.

Not all Baby Boomer optometrists have a doom and gloom outlook for the future of our profession. However, many will say in casual conversation that the best was in the past. As Dweck says, those who have a growth mindset are those people who will excel in their line of work, in their parenting and personal life, and be the most fulfilled. I would have to agree and here are 3 reasons to embrace a growth mindset and not listen to the baby boomer generation.

1. Optometry/ophthalmology relations – Right now is the best time to be practicing optometry in healthcare. The younger generation of optometrists are graduating alongside their ophthalmology peers with the knowledge and abilityto medically treat the eye. Respect for optometry has grown exponentially over the past 20 years and more optometrists and ophthalmologists are working as a team to treat and manage eye disease. One of my best friends has been changing the mindset of ophthalmology residents for almost 10 years by leading them in clinical care and shaping them to see optometry as their equals. He embraced the growth mindset by educating ophthalmology students about optometry.
2. Medical model – With many Americans on the verge of receiving some type of eye care coverages through the government, the growing practice will experience an influx of patients. The fixed mindset will say that we are just having to see more patients and receive a lower reimbursement. This is true if we continue practicing in a model that was successful for the past 30 years. However, the next generation has an opportunity to thrive under these new conditions when the medical model is embraced. The medical model will allow for greater delegation and may resemble something similar to what dentists or orthodontists have been doing for years. The sky is falling for those who refuse to change the way they have practiced for the past 20 years despite the changing climate. For the next generation of optometrists the future looks bright under the medical model.
3. Ambitions – The Baby Boomer optometrists are a product of the generation that endured the Great Depression. They watched their parents go through very difficult times and the Baby Boomers were determined to not let that happen to them. They redefined the workaholic mentality. Work, work, work, work. . . retire. Good or bad, the next generation of optometrists do not embrace this mindset. They don’t necessarily need the highest paying jobs. What they desire are jobs that will give them freedom to live now. With the changing scope of healthcare, there is some allure to taxing the rich and government healthcare. The next generation believes this will create an opportunity for more time off. Instead of working like their parents did, they will work to the point in the year where time off is more intriguing than the amount of net dollars they will see in their pocket once they hit the upper-tiered tax brackets.

Now don’t get me wrong, there is much wisdom that comes from the mouth of those Baby Boomer optometrists. The take-home point for the next generation of optometrists is to be selective on how deep you wade into the waters of Baby Boomer nostalgia. Embrace the future of optometry with a growth mindset: We can grow, we can make tomorrow better than today, and the best years are yet to come.

 

[Optometry Master]

Keep reading that psychology nonsense. I'm not a baby-boomer. I'm in my early 40's and can tell you that Optometry is on a quick downward spiral. There will NOT be a great influx of new patients from Obamacare. Just won't happen. The vast majority of 40+ patients are already in the eye care system. Kids will continue to go to OMDs because their MD pediatricians and school will refer them there as they are still viewed as "real doctors".

Ambition has little to do with reality. You can be gung-ho at selling typewriters to everyone in the world but you will fail because it's an outdated device. No matter what Dr. Phil tells you.

ODs and OMDs will NEVER greatly work happily together because they are COMPETITORs. No matter what anyone thinks, MONEY is a dividing source and as more and more useless Optometry schools open, OD's fee will go down and down and down further pissing off OMDs who keep their fees up high.

The 'medical model' has been followed by a great number of ODs in states such as West Virginia, Oklahoma and North Carolina among others for over 30 years. The 70 year old ODs you speak off probably don't do as much medical care as they should. But that's certainly not the majority of todays ODs.

I appreciate you trying to put a 'happy spin' things. But the numberS do not lie. 4-5 new OD school pumping out an extra 600 new ODs per year (in addition to the previous 2,000 per yr), trouble finding decent employment, proliferation of commercial optical joints with ODs begging to work them for peanuts. And most importantly, stagnant or even declining income of ODs over the past 10+ years.

 

[KHE]

I have some issues with this posting.

Yes, it certainly is possible to make a good living in optometry and the medical model certainly needs to be part of it but the "medical model" won't save optometry. Most optometrists have, as another poster said, incorporated the medical model into their practices years ago. In essence, we've already been doing it for decades. So yes, there are a few older docs in the twilight of their careers who could probably do a bit more but there is not a massive amount of medical model patients out there yearning for optometric services if only they could just find the right doc to give it to them.

As far as Obamacare goes, whatever people think of Obamacare, it will not save optometry. Simply think about it......the USA has 320 million people. Of those, 30, 40 million are uninsured. That means 280, 290 million people ARE insured and as such, have access to optometric care.

The average optometrist sees 1.1 patients per hour. That number has been constant for over 10 years now. Even if every single uninsured patient signed up for Obamacare and if every single one of them got an eye exam next year and every single one of them got it from an optometrist (none of which is all that likely) , you would see at best, the average patient load rise about 10% to 1.2 patients per hour. That hardly sounds like optometric nirvana to me.

Lastly, even uninsured patients have access to optometric care. Optometric care is not expensive. You can get an "eye exam" in most parts of the country for about what it costs to change your oil. You can get glasses and contact lenses for next to nothing.

So I don't particularly see that article as being all that helpful.

 

[drumstix]

Lastly, even uninsured patients have access to optometric care. Optometric care is not expensive. You can get an "eye exam" in most parts of the country for about what it costs to change your oil. You can get glasses and contact lenses for next to nothing.

here's what "next to nothing" gets you:

GLASSES:

CONTACTS:

 

[mclem222]

I read the first post and all I will say is that there are a lot of Gen x, millenials along with Baby boomers who are dissatisfied with optometry. I refer to that post as the "ostrich head in the sand" mentality. Remember when airline pilots made tons of money and had tons of respect? Or when veterinarians were paid well? Or the times when someone was a pharmacist it meant they had a good living running their own store? Well those days are over… I am not exactly sure what is in store for optometry, but to believe that it is necessarily going to be the same financial payback as the 90s or 80s is in a fantasy world. to ignore that 1800 contacts, Warby parker or online sales and the $19.99 "eye exam" is not going to change our field tremendously is ignoring the basics. Instead of focusing on the psychology, I would focus on the facts:

1. Yes ODs have been doing medical for a long time. No…our knowledge is not the same as an OMD. I know we all really reallllly wish it was but it isn't. How do I know? My brother is an OMD and his training was vastly different than mine. Not that I can't manage basic glaucoma or traumatic iritis but a patient has pauciarticular JRA with eye involvement and a swollen nerve, he needs to see an OMD. We aren't going to take over the medical. Period

2. The advent of commercial has degraded our profession. This is no different than CVS for pharmacists. We lost the autonomy on that one guys and with that comes all the control.

3. The online sales have eaten into our profits from optical …..BIGTIME. To think it hasn't is a joke.

4. In terms of not needing money…tell that to an OD student I had who is 180K in debt and is about to take a job with an OMD for 75K. How long is that going to take to pay off, paying $1200 a month?…about 15 years…If you make 75K you are getting 4-5K a month.. Do the math…Let me tell you something your grandpa should've told you "You need money to enjoy your time off." Staring at the bird feeder or going on hikes is only so much fun.

YES I Agree with all change brings opportunity but sometimes when there is a change and the ability to change out of a field is difficult, it can economically devastate a generation of workers. For example, when automation changed the auto industry, a whole generation of workers were put out of work. Yes, you could argue, they could go into computing or programming and work on automation but is that realistic? Maybe with their kids but not that generation. What happened when all the Hair cutterys and Roadside Buzzcut stores started popping up? Yes the local town barber was putt out of work. He could work at a hair cuttery but his income dropped significantly. What about when online sales of airline tickets destroyed the travel agent industry? Does anyone on this site buy plane tickets from a travel agent? Yes you could argue.."Well Mr Travel agent that is opportunity! You could get into web design and create websites for trips and airlines.!" The flaw here is that once people have invested in a job, it is hard or difficult to change at age 30,40,50 to something else. We all have a finite number of working years (60 max lets say). To reset at a certain age because an industry drastically changes is possible but extremely difficult. In all the examples I have cited, I am sure many travel agents, factory line worker, barber etc.. wish they were in a different field when the all the changes occurred in their job to put them out of work.

By the logic of the original poster, Detroit and Cleveland should've been hotbeds of opportunity when the auto and steel industries in the US drastically changed. Hmmm…not a lot of people moving there to take advantage of all the "opportunity from change".

A lot of times on this site, pre-optometry or optometry students post counter arguments to what the established ODs post about doom and gloom in optometry. Yeah…it really hurts when you are currently investing in something and people are saying its a bad idea. It hurts a lot. But instead of fighting it think "Hmmm why are people saying this?" Most doctors and people love to say "I love what I do" Instead of blaming the individuals try to research if there is merit. And don't listen to people who are not doing what you plan on doing. If you want to do commercial optometry ask someone who is actually doing commercial optometry how they like it. Not your professor who talked to some people at a meeting or was told something by a friend. Or if you want to start a practice, find out from a recent graduate who started a practice how that went…In that search if you find out that only two people started a practice out of 100 in the last class, one in waterloo, arkansas and the other in Columbia, Georgia it may tell you something. It may not be doom and gloom but the writings of a student who has zero experience is meaningless in my mind. It is all pontification and "psychology" analysis.

Think people and use you brain..not emotions just because you "really" want something to be a certain way.

 

[20DOC20]

I'm working as an associate in a private practice that's been established for 30 years and it seems as if we're losing money. The state-sponsored plan pays around $35 for an exam and we do 2 patients per hour. Hardware is reimbursed at wholesale, state-run lab. And VSP reimburses around 80 for an exam and a most of those patients are walking with out with their Rx's. We make a little off the glasses, but average glasses sale is billed out for 350 and we get, at best, reimbursed 50% of that and remainder is uncollectable (capped).

We have three employees: one optician, one tech, one receptionist and one OD. I'm not sure if we're generating enough revenue to cover our salaries.

I am worried about the future of private practice optometry because if you want to succeed, you need to bill out for ancillary tests such as fundus photos, fields, gdx-vcc etc ... If you do that too much, you flag an audit. You also risk making the patient angry.

I suspect there are a lot of docs out there who deliberately overdiagnose "glaucoma suspect" in order to have the opportunity to regularly bill out, on a long-term basis, ancillary procedures. Private practice docs are pushed into abusive, if not fraudulent, practice management strategies. If were resorted to doing that to keep the practice doors open, then there's something really wrong with our system.

And boy, Medicare's now wise to all of this and they're cracking down. I advise never to cheat on insurance billing because they'll fine you and you can goto jail for it, for up to 3 years.

Personally, I refuse to do anything illegal and as a result, the revenues I'm generating for this practice are lower than my predecessor's production.

I'm not a baby-boomer, but really, you should have respect for your elders. A wise man learns from his own mistakes, but a smart man learns from the mistakes of others.

 

[KHE]

I'm working as an associate in a private practice that's been established for 30 years and it seems as if we're losing money. The state-sponsored plan pays around $35 for an exam and we do 2 patients per hour. Hardware is reimbursed at wholesale, state-run lab. And VSP reimburses around 80 for an exam and a most of those patients are walking with out with their Rx's. We make a little off the glasses, but average glasses sale is billed out for 350 and we get, at best, reimbursed 50% of that and remainder is uncollectable (capped).

We have three employees: one optician, one tech, one receptionist and one OD. I'm not sure if we're generating enough revenue to cover our salaries.

I am worried about the future of private practice optometry because if you want to succeed, you need to bill out for ancillary tests such as fundus photos, fields, gdx-vcc etc ... If you do that too much, you flag an audit. You also risk making the patient angry.

I suspect there are a lot of docs out there who deliberately overdiagnose "glaucoma suspect" in order to have the opportunity to regularly bill out, on a long-term basis, ancillary procedures. Private practice docs are pushed into abusive, if not fraudulent, practice management strategies. If were resorted to doing that to keep the practice doors open, then there's something really wrong with our system.

And boy, Medicare's now wise to all of this and they're cracking down. I advise never to cheat on insurance billing because they'll fine you and you can goto jail for it, for up to 3 years.

Personally, I refuse to do anything illegal and as a result, the revenues I'm generating for this practice are lower than my predecessor's production.

I'm not a baby-boomer, but really, you should have respect for your elders. A wise man learns from his own mistakes, but a smart man learns from the mistakes of others.

Something is really not right here.

$350 for an eyeglass ticket is painfully low. Either you or your optician is not doing your jobs correctly. "most" of your VSP patients are walking out the door? That right there sets of huge alarm bells.

Are you the only doctor in this practice or is the owner present there as well? If so, it makes no sense that a two doctor practice would have only one optician, one tech and one receptionist. That's a sign of a practice that really only needs one doctor.

Regarding glaucoma suspects, the incidence of glaucoma in the general population is approximately 6%. It would seem to reason then that patients classified as glaucoma suspect would be higher than that. What percentage of your patients do you think are glaucoma suspects?

 

[Optometry Master]

Something is really not right here.

$350 for an eyeglass ticket is painfully low. Either you or your optician is not doing your jobs correctly. "most" of your VSP patients are walking out the door? That right there sets of huge alarm bells.

I disagree. In my neck of the woods, $350 for glasses is on the HIGH END. We don't try to milk every penny we can from people. Patients now KNOW they can go to Zennis online (or whatever it's called) and get a NICE complete pair of glasses for $6.95. Nice glasses from Wal-mart for $49.95. They may not be "Mercedes quality" according to us. But they are plenty good for the majority of people. In fact, on those rare occasions I do sell a $350 pair of glasses, I wonder inside about the patient's sanity. There are a few isolated pockets in America you can still get away selling over-priced eyewear. But those places are fast, fast becoming a fairytale.

 

[KHE]

I disagree. In my neck of the woods, $350 for glasses is on the HIGH END. We don't try to milk every penny we can from people. Patients now KNOW they can go to Zennis online (or whatever it's called) and get a NICE complete pair of glasses for $6.95. Nice glasses from Wal-mart for $49.95. They may not be "Mercedes quality" according to us. But they are plenty good for the majority of people. In fact, on those rare occasions I do sell a $350 pair of glasses, I wonder inside about the patient's sanity. There are a few isolated pockets in America you can still get away selling over-priced eyewear. But those places are fast, fast becoming a fairytale.

So you're saying no one in your area has an iPhone because everyone knows you can still get flip phones for free?

No one wears $200 Air Jordans because you can go to Payless and get sneakers for $25?

No one eats at a nice restaurant because everyone knows you can go to Applebees and spend $14 for an entree?

The key is a properly trained staff who can provide education. Every 6 months, I meet with a group of other doctors from all over the country to compare notes. Many of these doctors practice in rural, low income areas. The average average revenue for a pair of glasses was well over $400.

 

[opto2be]

Wow, I've never heard of anyone paying more than $400 for a pair of glasses. KHE, are you reimbursed at that amount or is that what you bill?

I think tangibility is also an important factor. The difference between an iPhone and a flip phone is clearly tangible to the consumer. But is the difference between a cheap and expensive pair of glasses tangible in the same way?

 

[KHE]

Wow, I've never heard of anyone paying more than $400 for a pair of glasses. KHE, are you reimbursed at that amount or is that what you bill?

I think tangibility is also an important factor. The difference between an iPhone and a flip phone is clearly tangible to the consumer. But is the difference between a cheap and expensive pair of glasses tangible in the same way?

No, of course it's not tangible in the same way. That's why a trained staff and patient education is so important. People aren't going to spend $500 on a pair of glasses (or anything really) on a whim. So if your office is structured to "get them in and get them out" you're not going to do well in this area. It takes a few minutes to explain WHY the high end progressive you sell is different than the $79 one at Costco. It takes a few minutes of time to explain WHY the high end A/R coating that you use is better than the crap-0-la at Walmart is better.

The other thing is that you need to stop viewing Walmart and Costco and Zenni as your competition. Those people aren't who you're competing with. You're competing with the jewelry store, the travel agent, the purse store, the shoe store for the person's disposable income. So you have to take the time, show them, explain to them the differences and why your practice is the value added proposition.

Does it work every time? Of course not. Some people simply don't care. Some people are loyal to Walmart or whatever they perceive to be the "lowest price." But many people are more than willing to spend disposable income on a quality pair of eye wear if you educate them on the difference.

 

[thiaeyemd]

Interesting points here. I would say one thing that may play a role with the glasses and its prices. I do know from the ophthalmology point of view things like Botox, Lasik and refractive lenses are only purchased by individuals at a certain income level. For example, Allergan has researched it and found that if you practice in an area where the mean income is less than 70K, it will be very difficult if not impossible to develop a botox practice. People just can't afford it no matter how good it is. The same is true for refractive lenses which is more analagous to glasses in that there are several options and patients are getting the cataract surgery anyway like they are getting the glasses. I would guess the mean glasses price really depends on the income level of the area where one practices. That being said, sometimes luxury items are purchased in poorer areas if they are a status symbol (ie fancy cars, sneakers) so maybe people would buy expensive glasses in a poor area. Not sure. . Just my two cents.

 

[Optometry Master]

So are you saying your job as an OD is to constantly try to get as many patients as possible to buy as expensive a pair of glasses as you can talk them in to? Is that really how you want to be viewed by your patients and the community? Do you REALLY think a $400 pair of single vision -2.00 sph glasses are any better than a $29 pair? Just because you can sucker a patient into buying them doesn't make it right. That said, a sucker is born every minute so some fools will pay $200 for a t-shirt with a made-up designer name on it. I view my job as being an ally for my patients and telling them the truth be it over-priced glasses or an unnecessary multifocal IOL implants (got a local yahoo OMD trying to sucker every 90 year old macular degeneration patients to dip into their life savings for $4,000 out-of-pocket Restor IOls). If they WANT expensive, more power to them. But I'm willing to be you don't give people an honest option. Not necessarily knocking you for selling over-priced glasses. If you have the suckers willing to pay and you can sleep at night, I guess no harm-no foul. Enjoy it while you can though. It won't last much longer.

 

[KHE]

So are you saying your job as an OD is to constantly try to get as many patients as possible to buy as expensive a pair of glasses as you can talk them in to? Is that really how you want to be viewed by your patients and the community?

When did I ever say that? My job is to educate people on what options are available to them. Judging from my schedule, I'd say the patients in my community are quite content with the job I'm doing. I'm happy that my patients view me as the place to get quality, fashionable eyewear with a generous return policy and warranty instead of the discount warehouse. If they want that, they can go literally right next door to Walmart which is about 150 feet south of my office.

Do you REALLY think a $400 pair of single vision -2.00 sph glasses are any better than a $29 pair? Just because you can sucker a patient into buying them doesn't make it right.

Do you feel that the $20 disposable camera you can buy at the pharmacy is as good as the $3000 Nikon you get a professional camera store? I guess anyone who spends more than $20 on a camera is getting suckered. And it seems that your patients don't deserve the benefit of transitions, or an anti-reflective coating that doesn't pit or craze after 2 weeks of use nor do they don't deserve the benefit of a frame that doesn't come out of adjustment every 90 minutes. I'm glad you're such an "ally" for your patients. 🙄

That said, a sucker is born every minute so some fools will pay $200 for a t-shirt with a made-up designer name on it. I view my job as being an ally for my patients and telling them the truth be it over-priced glasses or an unnecessary multifocal IOL implants (got a local yahoo OMD trying to sucker every 90 year old macular degeneration patients to dip into their life savings for $4,000 out-of-pocket Restor IOls). If they WANT expensive, more power to them. But I'm willing to be you don't give people an honest option. Not necessarily knocking you for selling over-priced glasses. If you have the suckers willing to pay and you can sleep at night, I guess no harm-no foul. Enjoy it while you can though. It won't last much longer.

What possible long term benefit is it to me to be dishonest about anything? There is none. I tell people all the time with low prescriptions that they don't need to do the "super-thin" lenses. I wonder of Lenscrafters does that or does everyone "need featherweights?"

 

[KHE]

Interesting points here. I would say one thing that may play a role with the glasses and its prices. I do know from the ophthalmology point of view things like Botox, Lasik and refractive lenses are only purchased by individuals at a certain income level. For example, Allergan has researched it and found that if you practice in an area where the mean income is less than 70K, it will be very difficult if not impossible to develop a botox practice. People just can't afford it no matter how good it is. The same is true for refractive lenses which is more analagous to glasses in that there are several options and patients are getting the cataract surgery anyway like they are getting the glasses. I would guess the mean glasses price really depends on the income level of the area where one practices. That being said, sometimes luxury items are purchased in poorer areas if they are a status symbol (ie fancy cars, sneakers) so maybe people would buy expensive glasses in a poor area. Not sure. . Just my two cents.

I'm not sure what a "Botox" practice is but even in lower income areas, there are certainly people who want Botox or premium refractive lenses. Again, in that arena, you're competing with other vendors for someone's disposable income. Even if someone is of limited means, and they only have a few hundred or thousand dollars of disposable income to spend in a year, which are they going to choose?

Botox from you, or the Coach bag this year?
The premium IOL, or the trip to Disneyworld this year?
Botox from you, or the iPhone upgrade?
The premium IOL, or the new flat screen?

Don't make the decision for people.

 

[20DOC20]

QUOTE: "
Something is really not right here.

$350 for an eyeglass ticket is painfully low. Either you or your optician is not doing your jobs correctly. "most" of your VSP pateints are walking out the door? That right there sets of huge alarm bells.

Are you the only doctor in this practice or is the owner present there as well? If so, it makes no sense that a two doctor practice would have only one optician, one tech and one receptionist. That's a sign of a practice that really only needs one doctor.

Regarding glaucoma suspects, the incidence of glaucoma in the general population is approximately 6%. It would seem to reason then that pateints classifeid as glaucoma suspect would be higher than that. What percentage of your pateints do you think are glaucoma suspects?"


It's true. There isn't something right with the management of the practice.

Upon closer examination, have discovered the new manager is not using a wholly-owned VSP lab, and is not using VSP products. So that's money sucked right out of the reimbursement checks. Have tried talking new owner into going with good VSP lab and at very least VSP AR coat and they won't do it.

The owner is retired and gone. Just one OD here.

Glaucoma suspects? Around 6% - 10% under my care. The other OD was closer to 20% on his glaucoma suspects, which is too high.

Too bad the new owner won't listen to me.

 

[KHE]

I just wanted to post something here to give people a glimmer of hope amidst all the doom and gloom.

My practice is up 19% over the same period last year and our average eyeglass sale and contact lens sales are up more than that.

I'm telling you all.....if you as a doctor are committed to providing a top notch environment and experience for your patients and you have a well trained, passionate staff who is committed to educating patients on the difference between your products and Walmart, Zenni, Warby Parker etc. etc. there are plenty of patients out there willing to pay top dollar for those better products.

It is no different than why people spend thousands of dollars on TVs when they can get cheap ones at Costco.
It is no different than why people spend hundreds of dollars on shoes when they could go to payless or Walmart and get shoes for $25.
It is no different than why people spend hundreds of dollars to upgrade to the new iPhone when the iPhone they have works just fine and the new one doesn't really do anything different.

Again.....you need to stop viewing Walmart and Costco and Zenni as your competition. Those people aren't who you're competing with. You're competing with the jewelry store, the travel agent, the purse store, the shoe store for the person's disposable income. So you have to take the time, show them, explain to them the differences in the products, how those differences benefit the patient and why your practice is the value added proposition.

Does it work every time? Of course not. Some people simply don't care. Some people are loyal to Walmart or whatever they perceive to be the "lowest price." But many people are more than willing to spend disposable income on a quality pair of eye wear if you educate them on the difference.