Another Plea

[KHE]

---

Members do not see this ad.

Even though it has been many months since I posted my story on here, I’m still getting a fair amount of email about it. Some of it is supportive, and I continue to get the occasional story of another OD who also left the profession. Unfortunately, a number of them are also quite hostile, and usually degenerate into name calling. I can’t quite figure out why this is. I’ve been called all kinds of things including but not limited to: “Lazy” “dingus” “Fvcking dingus” “Jerk” “Fvcking jerk” and “Commercial apologist” (?!?!?) That last one really stung. Lol.

Let me try (once again) to reiterate a few things for people out there. Once again, this is only my opinion, based on my experience. You can take it for what it’s worth.

1) I left for a wide range of reasons. The MAIN reason was my inability to be admitted onto insurance panels. I know there are areas of the country where this is not a problem, and some of those doctors post here. That’s great. Students should consider practicing in those areas of the country unless they want to spin dials all day and pray to God that every patient wants to buy transitions and Acuvues from them.

2) I made decent money. As an OD, you will never starve. You will not default on your student loans. I make less money now (though not much less) in my new career than I did in my old.

3) Contrary to what the trade publications will tell you, there is not a huge unmet demand for Low Vision, or RGP bitoric bifocal lenses that you can charge hundreds of dollars for, or vision therapy. I worked at a practice that was owned by a diplomate of the AOA contact lens section, and this guy had years of experience with “tough” cases and was well known in the community. We saw one of these patients MAYBE every three months.


4) The vast majority of old doctors out there will screw you. Do not even bother trying to find a practice to buy from an old guy. In theory, this is the way to go, because it would be nice to hit the ground running, but my experience was that most old guys simply want to sell you their tired old offices for much more than it’s actually worth. I would recommend that people who want to go into private practice to open cold. While initially that may be tougher, in the long run you can set up the office the way you want, with the furnishing and equipment that you want, with the staff that you want, and practice the way that you want. I’m sure that Drs Langford and Chudner, who post on here frequently would disagree because I understand that they are doing quite well for themselves after having purchased another ODs office. That’s fantastic. Unfortunately, it was not my experience nor was it the experience of the vast majority of my colleagues.

5) Ultimately, I feel that the independent solo OD is doomed. Fact is that most revenue in most private offices come from retailing optical product, and the fact is that large chain retailers can do it better, faster, and cheaper than the private OD. That’s why you don’t see independent pharmacies, hardware stores, or funeral homes very much any more. Regrettably, I feel that the future of optometry is much like pharmacy. Working retail hours in retail locations.

6) Another reason why I feel that the independent solo practitioner is doomed is because of insurance. This may seem contradictory in light of the fact that I left because I couldn’t get onto insurance panels, but in actuality, that inability turned out to be a blessing in disguise. And this is why I feel that way. Unfortunately, as an OD (and this applies to the vast majority of the medical field) you really have very limited control over your income. You will take what the insurance company deems to give you and you will like it. And if VSP decided tomorrow that they are cutting reimbursement by 30%, well, that’s just tough titties for you isn’t it? If medicare decides to bundle all those tests into one global fee for “glaucoma evaluation” and slash the reimbursement by 70%, well that’s just tough titties for you isn’t it? And even though optometry has expanded its scope of practice substantially, it is still a fact that number of billable procedures that we can perform is very very low. We have the array of glaucoma tests, foreign body removals, punctal plugs, and office visits. That’s about it. So (excluding optical) the only practical way to increase revenue is to just see more patients. And from a purely business perspective that doesn’t seem to me like a good situation. Is there any other small business out there where anyone other than the business owner sets the fees? I can’t think of any other than the health care field.

And yes, I did do a lot of research before I entered the field. I decided that this is what I wanted to do when I was 14 years old, and I worked for numerous ODs throughout high school, and college. I think two big things happened from the time I entered school to the time I graduated and both of my former OD employers agree with this:

1) The huge explosion in disposable contact lenses which made contact lenses so much safer, easier to fit, drove down already pathetically low fitting fees, and also made them attractive to bulk retailers.
2) The huge expansion of internet commerce also drove down reimbursement for materials and was also attractive to bulk retailers.

These two things essentially decimated contact lenses and contact lens related revenue for the majority of practices out there. The days of the $400 yearly contact lens that the patients loses once or twice a year and has to replace through your office are OVER.

Because of the limitation in procedures, even when I was able to work in practices that were on plans, I ultimately came to find optometry very boring. The vast majority of private practice is increasing minus on teenagers, and increasing adds on presbyopes. Treating pink eyes, and removing foreign bodies also gets very dull over time. The vast majority of cases in optometric practices are just not that challenging. How much skill does it take to put a 2.00 diopter acuvue on a 2.00 diopter myope, or to prescribe FML for a keratitis? (Please spare me all the details of the brain tumor and RD patients you have out there. That’s why I said the vast majority.)

And this is why I never understood why there is so much denigration directed at commercial docs from private ones. In commercial practice as in private, you mostly increase minus on teenagers, and increase adds on presbyopes. In fact, because I sometimes worked weekends in commercial practice, I got to see MORE interesting cases there because I got all the weekend “emergencies” and got all the sick patients who had no insurance.

I also don’t get the denigration because so many private offices are strip mall optical locations with an exam lane in the back. I will agree that commercial practice doesn’t usually provide the best “image.” But right before I left, I had an offer to buy an office that was in a strip mall next to a nail salon on one side, and a pizzeria on the other. When I talked to the doc on the phone, he chastised me because I was working part time commercial at the time and lamented the “image” I was portraying. Yet, here was his office….an optical store with an exam lane in the back stocked with equipment from the Eisenhower era. Is he projecting a “positive image?” A colleague of mine practices in an urban area and he just visited an office to interview for an associate position where the space next to the ODs office was occupied by a store that sells lingerie and sex toys on one side and a dollar mart on the other.

Can anyone honestly say that a Lenscrafters in an upscale mall is less of a positive image than the ODs office next to the porn shop? Cmon.

So please, who ever is sending me the hate mail, please stop it.

Sorry for the slightly rambling message. But ultimately, I just got too frustrated, and too bored. That doesn’t mean it can’t be rewarding for you. I have colleagues out there that regret going into optometry and wish every day that they could get out but they feel trapped. I know others who are so thrilled with the practice of optometry that to them, it’s almost like a drug. Hopefully, you will all fall into the latter category.

 

[aphistis]

Have you reported any of the people who harassed you?

 

[Hines302]

KHE,

I value your opinions, and you make a very good case about why you left the profession and I am glad it worked out for you. However I would just like to throw in my two cents about why I think Optometry is a growing and promising profession.

As we all know the population of the U.S is quickly aging, the age group of people between the ages of 55-75 is suppose to increase 60% over the next 20 years. Also we all know vision as well as vision related problems and Dx's increase dramatically with age (AMD for example). Thus the need for vision care is on the rise. While I do believe Optometrist will always provide primary eye care, I do believe that the scope of primary eye care will expand simply because there will just not enough ophthalmologists to meet the demand. The increases in Dx's coupled with the increase in laser surgery proceedures means that O.D.'s will be responsible for treating (and co-managing) more and more Dx's and vision problems once reserved for an M.D.

We have already started to see it, there are more and more O.D.'s working with M.D's and even OD's working in settings that are strictly for medical cases... 15 years ago, this was not the case. The scope of primary eye care and what is considered to be primary eye care will expand. Thus optometry has the ability to become more of a procedural profession than it once was. In the future Optometrist might handle all vision problems that does no involve surgery. Leave the surgery for the more highly trained Ophthalmologist.

With this I think we will also see an increase in specialization. Optometry's specialty areas such as Ocular Disease, Low Vision, and Pediatrics will become more defined than what they are now. Much like the subspecialty’s of dentistry. With these newly added responsibilities of optometrist, the lengths and scopes of residencies will also have to increase. (MCO has just added courses on managing Laser and Refractive Surgery and Injectable Pharmaceuticals. Keep in mind that schools were teaching pharmacology courses and teaching how to treat glaucoma well before they were allowed to in practice)

While its true that Optometry has many many hurdles to overcome, I feel that all in all it is a promising profession. It will take the next generation of O.D.’s to lead and shape the field into what it has the potential to become.

 

[Opii]

Unfortunately, a number of them are also quite hostile, and usually degenerate into name calling. I can’t quite figure out why this is. I’ve been called all kinds of things including but not limited to: “Lazy” “dingus” “Fvcking dingus” “Jerk” “Fvcking jerk” and “Commercial apologist” (?!?!?) That last one really stung. Lol.

I have also experienced a few of these OD's in meetings. I couldn't believe how discouraging they can be. I used to take it very personal, now I think it is just a manipulation tactic to knock off the competition. Like politicians do to each other. You can't let it get to you, but it is difficult because we all sort of depend on each other too. Is there a way you can distance yourself from people like that? Maybe relocate? Start fresh somewhere else?
Well, what do I know, I'm not in the Biz yet.
Unfortunatly I'm too in debt to backout.
Good Luck.

 

[rpie]

Ken,

I think many private practicing OD’s feel it paramount to have as much visibility and foot traffic as possible. Locating their offices in strip and enclosed malls helps them achieve this goal. However, by doing this they go after the retail market, and in most case compete against the corporate originations. I agree with you that trying to compete against the corporate organizations is very difficult if not almost impossible. This is why like Ben; we chose not to compete against corporate.

About 7 years back our practice felt the need for more exposure etc., so we opened a second office in a strip mall between a Chinese restaurant, and a Dollar general store. Our optical dispensary was in the front with exam lanes in the back. In this setting, about 55-60% of the income was derived for the sales of glasses and contacts. The exposure increased our patient volume and gross income. However, our overhead increased, and there were occasions where material sales were lost because we could not match the corporate offers. The bottom line profit was less than our main office, which is located on the 5th floor of an office building. Our main office optical is not in the front and accounts for about 30-35% of our revenue. The rest is from professional services since we see a lot of medical eye cases. After finishing the 4-year lease we considered selling the strip mall office but closed it down and enlarge our main office. The reason we did not sell the practice is because the landlord insisted on increasing the rent which would have made it difficult to make a decent profit and allow the buyer a chance at having a successful practice. (Not all OD’s try to screw younger OD’s)

I can understand why you left Optometry but also would like to point out that all professions have people that leave for various reasons. My youngest brother left medicine to become and OD after practicing Family medicine for 4 years. He got fed up with the disrespect form patient, the games he had to play to get some insurances to pay him, and the politics of who can participate on which insurance panels. Since his desire was to be a primary care provider, he chose OD school instead of trying to match for Ophthalmology since invasive Surgery did not interest him. Today after practicing Optometry for the past 8 years he is very happy being an OD and does not miss his family practice days.

 

[Kristene9]

Even though it has been many months since I posted my story on here, I’m still getting a fair amount of email about it. Some of it is supportive, and I continue to get the occasional story of another OD who also left the profession. Unfortunately, a number of them are also quite hostile, and usually degenerate into name calling. I can’t quite figure out why this is. I’ve been called all kinds of things including but not limited to: “Lazy” “dingus” “Fvcking dingus” “Jerk” “Fvcking jerk” and “Commercial apologist” (?!?!?) That last one really stung. Lol.
.......Sorry for the slightly rambling message. But ultimately, I just got too frustrated, and too bored. That doesn’t mean it can’t be rewarding for you. I have colleagues out there that regret going into optometry and wish every day that they could get out but they feel trapped. I know others who are so thrilled with the practice of optometry that to them, it’s almost like a drug. Hopefully, you will all fall into the latter category.

This exact same letter was sent out to the optometry sucks yahoo group. (I shorted it for convenience 🙂... I find this very suspicious

 

[Opii]

This exact same letter was sent out to the optometry sucks yahoo group. (I shorted it for convenience 🙂... I find this very suspicious

Ken isn't hiding his identity. So he surfs a couple of sites big deal.
Maybe he just needs a little time to reevaluate his direction in life. Doesn't mean he's gone for good. His licence is still active. Maybe he just needs a little change of pace. He'll be back. Can't imagine working with 16-17 year olds for too long.

 

[VA Hopeful Dr]

Regarding the "old ODs trying to screw over new ODs when it comes to selling their practices" part of KHE's post. I fail to see how this is possible. I recently sold a practice to a grad fresh out of New England, and I couldn't have screwed the guy over even if I'd wanted to. Here's how this works. You get an appraisal on the property/building. Usually the person looking at buying the practice will as well. Any difference in the values is hammered out between the appraisers. Second, you get someone to appraise the value of the practice. The AOA has a list of reputable ODs who will do this. They come and tell you how much the practice is worth. You add the 2 numbers together and that's what you sell for. There is an additional little bit of "goodwill", but that maxes out at a good bit less than 100K.
While I don't doubt that some older ODs would love to get as much money as possible out of new grads, but there's a limit to how much they can screw you.

 

[Opii]

Regarding the "old ODs trying to screw over new ODs when it comes to selling their practices" part of KHE's post. I fail to see how this is possible. I recently sold a practice to a grad fresh out of New England, and I couldn't have screwed the guy over even if I'd wanted to. Here's how this works. You get an appraisal on the property/building. Usually the person looking at buying the practice will as well. Any difference in the values is hammered out between the appraisers. Second, you get someone to appraise the value of the practice. The AOA has a list of reputable ODs who will do this. They come and tell you how much the practice is worth. You add the 2 numbers together and that's what you sell for. There is an additional little bit of "goodwill", but that maxes out at a good bit less than 100K.
While I don't doubt that some older ODs would love to get as much money as possible out of new grads, but there's a limit to how much they can screw you.

Phew. Good to hear that.

 

[sco1styear]

Ken isn't hiding his identity. So he surfs a couple of sites big deal.
Maybe he just needs a little time to reevaluate his direction in life. Doesn't mean he's gone for good. His licence is still active. Maybe he just needs a little change of pace. He'll be back. Can't imagine working with 16-17 year olds for too long.

I think kristen was just pointing out that this letter was used for an argument on another site and that the name calling may not have been from members of this forum.

 

[KHE]

This exact same letter was sent out to the optometry sucks yahoo group. (I shorted it for convenience 🙂... I find this very suspicious

I did post the identical message on optometrysucks because the two places where I posted that story where there and on here. I do not know where some of these idiot emails are coming from. It could be from either group. But really, it doesnt matter.

I've tried once again to reiterate my position. Contrary to what one person accused me of, I am NOT the moderator of optomerysucks.

Good luck to you all as you pursue your careers.

 

[KHE]

Regarding the "old ODs trying to screw over new ODs when it comes to selling their practices" part of KHE's post. I fail to see how this is possible. I recently sold a practice to a grad fresh out of New England, and I couldn't have screwed the guy over even if I'd wanted to. Here's how this works. You get an appraisal on the property/building. Usually the person looking at buying the practice will as well. Any difference in the values is hammered out between the appraisers. Second, you get someone to appraise the value of the practice. The AOA has a list of reputable ODs who will do this. They come and tell you how much the practice is worth. You add the 2 numbers together and that's what you sell for. There is an additional little bit of "goodwill", but that maxes out at a good bit less than 100K.
While I don't doubt that some older ODs would love to get as much money as possible out of new grads, but there's a limit to how much they can screw you.

In some ways, I agree with you. Fact is, I never even got close to having a practice appraised. Too many people were so ridiculous in their asking price, that I never bothered because once the appraisal comes back as $200000 less than what they asked for, you are so far apart that a sale is impossible. So there's not much point in wasting the money on an appraisal.

I've had more than one appraiser tell me not to bother having different practices appraised because the net was so far out of line with the asking price that it wasn't worth even bothering.

 

[KHE]

Ken,

I can understand why you left Optometry but also would like to point out that all professions have people that leave for various reasons. My youngest brother left medicine to become and OD after practicing Family medicine for 4 years. He got fed up with the disrespect form patient, the games he had to play to get some insurances to pay him, and the politics of who can participate on which insurance panels. Since his desire was to be a primary care provider, he chose OD school instead of trying to match for Ophthalmology since invasive Surgery did not interest him. Today after practicing Optometry for the past 8 years he is very happy being an OD and does not miss his family practice days.

Thats AMAZING that your brother left primary care medicine to pursue optometry when he was concerned about "disrespect from patients, the games he had to play to get some insurances to pay him, and the politics of who can be on those plans."

That pretty much sums up why I LEFT.

Wow. lol

 

[KHE]

KHE,

I value your opinions, and you make a very good case about why you left the profession and I am glad it worked out for you. However I would just like to throw in my two cents about why I think Optometry is a growing and promising profession.

As we all know the population of the U.S is quickly aging, the age group of people between the ages of 55-75 is suppose to increase 60% over the next 20 years. Also we all know vision as well as vision related problems and Dx's increase dramatically with age (AMD for example). Thus the need for vision care is on the rise. While I do believe Optometrist will always provide primary eye care, I do believe that the scope of primary eye care will expand simply because there will just not enough ophthalmologists to meet the demand. The increases in Dx's coupled with the increase in laser surgery proceedures means that O.D.'s will be responsible for treating (and co-managing) more and more Dx's and vision problems once reserved for an M.D.

We have already started to see it, there are more and more O.D.'s working with M.D's and even OD's working in settings that are strictly for medical cases... 15 years ago, this was not the case. The scope of primary eye care and what is considered to be primary eye care will expand. Thus optometry has the ability to become more of a procedural profession than it once was. In the future Optometrist might handle all vision problems that does no involve surgery. Leave the surgery for the more highly trained Ophthalmologist.

With this I think we will also see an increase in specialization. Optometry's specialty areas such as Ocular Disease, Low Vision, and Pediatrics will become more defined than what they are now. Much like the subspecialty’s of dentistry. With these newly added responsibilities of optometrist, the lengths and scopes of residencies will also have to increase. (MCO has just added courses on managing Laser and Refractive Surgery and Injectable Pharmaceuticals. Keep in mind that schools were teaching pharmacology courses and teaching how to treat glaucoma well before they were allowed to in practice)

While its true that Optometry has many many hurdles to overcome, I feel that all in all it is a promising profession. It will take the next generation of O.D.’s to lead and shape the field into what it has the potential to become.

Those are all very tender notions but I respectfully disagree.

Optometry can not specialize in ocular disease because we can't TREAT anything other than glaucoma or pink eye. Sure, we can diagnose all we want, but then out the patient goes. What good is that?

Low Vision is impossible to make money at. Most docs that I know who do this essentially do it as charity because these folks are usually on medicaid and can not afford even the most basic low vision rehab. ONce in a blue moon, you might find someone who springs for a CCTV but those are exceedingly rare.

I also don't agree with the notion that because baby boomers age, that that will increase a demand for optometric services. It may be true in theory, but who is going to be providing these services? Walmart? Costco? Lenscrafters? I doubt it.

Respectfully, your post is essentially a commercial from the AOA. I think you're just regurgitating the line that you've been fed by the schools and the AOA.

But in any event, I did not come on here to argue. Let me point out again that I have many friends who love optometry. I hope that you all find the rewards that I never really did.

 

[Kristene9]

I realize that all professions have good points and bad points, but do other professions fight like optometry does? I'll totally admit I've see, heard, and cared more about optometry then MD, PA, DMD, and what have you, but I never heard of them arguing like we do. Or like optometrist argue with ophthalmologist, but maybe I’m just uninformed. If you know of any arguments or hurdles of other professions could you post them? I just want to see what other professions are fighting about.

 

[Hines302]

I also don't agree with the notion that because baby boomers age, that that will increase a demand for optometric services. It may be true in theory, but who is going to be providing these services? Walmart? Costco? Lenscrafters? I doubt it.

I think your missing my point. Walmart, and Costco wont be the ones providing these services. Private pactices will... who will specialize in optometric subareas. Private Practices are no where near dead like you imply. There is a place for private practices and well as commercial. Yes there is an influx of commercial practices, but eventually these will level out and there will be a nich for both private and commercial practices. The reason is simple... I know tons of people who are fine going to Walmart for an eye exam, and I know tons of people who wouldn't step foot in Walmart if thier life depended on it.

And right now I realize optometrist cant TREAT many diseases.. but they can treat a lot more than they could 20 years ago. And there are currently O.D.'s out there that handle a lot of Dx's and those who work with OMD to see lots of Dx's. Thus there is growth and an expanding scope of the profession, and it will continue to expand because of the aging population. I dont understand how you can make the argument that the population isnt aging.... that is a fact. It is also a fact vision problems increase with age.

I am not saying that OD's will exclusivly be responsible for treating Dx's with out the aid of OMD's... however I am saying that the scope of thier practice will increase for the reasons stated above. It already has... the the trend is in motion... I have sited many examples in this post and in my previous one. However with all do respect... the profession will never expand will attitudes like your own.

I dont mean to argue... but I do feel the need to defend my choosen profession. I dont like to see or hear people bashing it. If its not for you... thats fine... I respect that. But why post points about the negatives of the profession if your already out of it... why do you care?!

 

[Hines302]

I realize that all professions have good points and bad points, but do other professions fight like optometry does? I'll totally admit I've see, heard, and cared more about optometry then MD, PA, DMD, and what have you, but I never heard of them arguing like we do. Or like optometrist argue with ophthalmologist, but maybe I’m just uninformed. If you know of any arguments or hurdles of other professions could you post them? I just want to see what other professions are fighting about.

I agree with you... I hate the constant fighting.. I wish that could be overcome.... but at the same time I do feel the need to defend the profession.

 

[Ben Chudner]

I also don't agree with the notion that because baby boomers age, that that will increase a demand for optometric services. It may be true in theory, but who is going to be providing these services? Walmart? Costco? Lenscrafters? I doubt it.

Ken, you know my experience was much different than yours, but I know there are plenty of other OD's that have run into the same issues as you. To answer the above statement, yes Wal-Mart will provide those services. I hate to be the bearer of bad news (since I really enjoy optometry, and my posts should prove that) but it has come to my attention through a very reliable source that Wal-Mart is trying to figure out how to move into med/surg care. They have hired a consultant to help move their doctors into that direction. Wal-Mart's goal is to hire 1200 OD's per year. Considering we graduate about 1130 per year that means they anticipate not only capturing all the new grads, but also taking some OD's from private practice. I believe they are planning to (or have already) purchase insurance plans so that patients are forced to go to their docs for eye exams. In one state, they are experimenting with having a PA in the store. This is a serious problem for private practice OD's and potentially other professions. What I forsee is that private practices will merge to form larger practices so that they can increase their buying power, and those practices that stay small will be picked off one by one.

I still believe optometry is a great profession. My advice to students and new grads is to look to larger practices and try to differentiate yourselves from the corporate locations now. The offices that continue to try and compete with the corporate locations will lose in the long run because a small private practice cannot run on the same margins that a large corporate location can.

 

[sco1styear]

Ken, you know my experience was much different than yours, but I know there are plenty of other OD's that have run into the same issues as you. To answer the above statement, yes Wal-Mart will provide those services. I hate to be the bearer of bad news (since I really enjoy optometry, and my posts should prove that) but it has come to my attention through a very reliable source that Wal-Mart is trying to figure out how to move into med/surg care. They have hired a consultant to help move their doctors into that direction. Wal-Mart's goal is to hire 1200 OD's per year. Considering we graduate about 1130 per year that means they anticipate not only capturing all the new grads, but also taking some OD's from private practice. I believe they are planning to (or have already) purchase insurance plans so that patients are forced to go to their docs for eye exams. In one state, they are experimenting with having a PA in the store. This is a serious problem for private practice OD's and potentially other professions. What I forsee is that private practices will merge to form larger practices so that they can increase their buying power, and those practices that stay small will be picked off one by one.

I still believe optometry is a great profession. My advice to students and new grads is to look to larger practices and try to differentiate yourselves from the corporate locations now. The offices that continue to try and compete with the corporate locations will lose in the long run because a small private practice cannot run on the same margins that a large corporate location can.

http://www.post-gazette.com/pg/05278/583075.stm

And without revealing your source...what makes them reliable?
I'm not saying I disagree...just courious. I have several close friends that work at wal-mart headquarters and I'm going to see if I can gather any more info. Even if it's just office gossip, haha.

 

[KHE]

I think your missing my point. Walmart, and Costco wont be the ones providing these services. Private pactices will... who will specialize in optometric subareas. Private Practices are no where near dead like you imply. There is a place for private practices and well as commercial. Yes there is an influx of commercial practices, but eventually these will level out and there will be a nich for both private and commercial practices. The reason is simple... I know tons of people who are fine going to Walmart for an eye exam, and I know tons of people who wouldn't step foot in Walmart if thier life depended on it.

And right now I realize optometrist cant TREAT many diseases.. but they can treat a lot more than they could 20 years ago. And there are currently O.D.'s out there that handle a lot of Dx's and those who work with OMD to see lots of Dx's. Thus there is growth and an expanding scope of the profession, and it will continue to expand because of the aging population. I dont understand how you can make the argument that the population isnt aging.... that is a fact. It is also a fact vision problems increase with age.

I am not saying that OD's will exclusivly be responsible for treating Dx's with out the aid of OMD's... however I am saying that the scope of thier practice will increase for the reasons stated above. It already has... the the trend is in motion... I have sited many examples in this post and in my previous one. However with all do respect... the profession will never expand will attitudes like your own.

I dont mean to argue... but I do feel the need to defend my choosen profession. I dont like to see or hear people bashing it. If its not for you... thats fine... I respect that. But why post points about the negatives of the profession if your already out of it... why do you care?!

Dear Friend,

Defending your "chosen profession" is certainly a good thing, but looking at your profile it states that you are applying for ADMISSION in the fall of 06. I would submit that that means that you don't have an adequate perspective on some of these issues.

Unfortunately, your post only serves to back that assertion up. It's the same talking points that you get from the AOA and the schools on why optometry is such a wonderful profession. And it's all true in THEORY. But reality is something much different. You know tons of people who would never "set foot" in a Walmart but once Walmart gets involved in managed care and the patients new vision or medical plan forces them to go to Walmart, well guess where they're going to go? That's right, Walmart.

And please don't dry to kid yourself into thinking that since you're going to be such a wonderful doctor, patients will flock to your office and pay you out of pocket to avoid going to Walmart. In all the time I practiced, I can count on one hand the number of patients who paid me out of pocket for services that they could have covered elsewhere. And it only makes sense. Health care is DAMN expensive. I only go to doctors who are on my plan, why would I expect my patients to be any different? Why would I pay for insurance, and then see a non network provider?

 

[KHE]

Ken, you know my experience was much different than yours, but I know there are plenty of other OD's that have run into the same issues as you. To answer the above statement, yes Wal-Mart will provide those services. I hate to be the bearer of bad news (since I really enjoy optometry, and my posts should prove that) but it has come to my attention through a very reliable source that Wal-Mart is trying to figure out how to move into med/surg care. They have hired a consultant to help move their doctors into that direction. Wal-Mart's goal is to hire 1200 OD's per year. Considering we graduate about 1130 per year that means they anticipate not only capturing all the new grads, but also taking some OD's from private practice. I believe they are planning to (or have already) purchase insurance plans so that patients are forced to go to their docs for eye exams. In one state, they are experimenting with having a PA in the store. This is a serious problem for private practice OD's and potentially other professions. What I forsee is that private practices will merge to form larger practices so that they can increase their buying power, and those practices that stay small will be picked off one by one.

I still believe optometry is a great profession. My advice to students and new grads is to look to larger practices and try to differentiate yourselves from the corporate locations now. The offices that continue to try and compete with the corporate locations will lose in the long run because a small private practice cannot run on the same margins that a large corporate location can.

Thank you for your comments, Ben.

Your right. It is a very serious issue. But is likely where we will ultimately head. And as you said, it doesn't just apply to optometry but to many areas of health care.

However, I don't think that simply merging practices is not going to be an adequate solution. That may work well in the very near short term, but even a practice with 4 or 5 docs still has no where near the buying power of a large corporation. But buying power isn't the real issue. The real issue is going to be "Walmart Blue Cross" Will ODs be able to get on that plan? More importantly, will the reimbursement be adequate to support a private practice or will we be back to the land of the $45 exams?

I also don't think that asking students to seek out these groups is going to work. I think that's what the vast majority of students are already doing when they graduate. I submit that there isn't nearly enough of these large practices to support the high number of new grads being turned out. This leaves them working in commercial.

 

[Hines302]

KHE

Are you implying the "Death" of the private practice??

Please dont write off my opinions becuase I am just a student. Although it is true that I do not have as much experience as you... it does not mean that I am not educated about what I am speaking about. I have done a lot of research and have spoken with many O.D.'s who share share my views... and have worked along side many more. I have worked in a private practice who are part of vision source. www.visionsource.com. This arrangement provides a way for private practices to compete with retail chains by giving them greater buying power. What do you guys think about arrangments such as Vision Source??

 

[sco1styear]

Dear Friend,

Defending your "chosen profession" is certainly a good thing, but looking at your profile it states that you are applying for ADMISSION in the fall of 06. I would submit that that means that you don't have an adequate perspective on some of these issues.

Unfortunately, your post only serves to back that assertion up. It's the same talking points that you get from the AOA and the schools on why optometry is such a wonderful profession. And it's all true in THEORY. But reality is something much different. You know tons of people who would never "set foot" in a Walmart but once Walmart gets involved in managed care and the patients new vision or medical plan forces them to go to Walmart, well guess where they're going to go? That's right, Walmart.

And please don't dry to kid yourself into thinking that since you're going to be such a wonderful doctor, patients will flock to your office and pay you out of pocket to avoid going to Walmart. In all the time I practiced, I can count on one hand the number of patients who paid me out of pocket for services that they could have covered elsewhere. And it only makes sense. Health care is DAMN expensive. I only go to doctors who are on my plan, why would I expect my patients to be any different? Why would I pay for insurance, and then see a non network provider?

I know that it doesn't work for everyone, but I know of several doctors that do not accept any insurance and have very very successful practices. Of course it depends on your patient demographics whether or not they would even be able to afford to pay out of pocket, but don't write the idea off completely. It has been done. But like I said, I know it doesn't work for everyone and isn't something that optometrists should expect to be able to do.

 

[KHE]

KHE

Are you implying the "Death" of the private practice??

Please dont write off my opinions becuase I am just a student. Although it is true that I do not have as much experience as you... it does not mean that I am not educated about what I am speaking about. I have done a lot of research and have spoken with many O.D.'s who share share my views... and have worked along side many more. I have worked in a private practice who are part of vision source. www.visionsource.com. This arrangement provides a way for private practices to compete with retail chains by giving them greater buying power. What do you guys think about arrangments such as Vision Source??

I'm not dismissing your opinion. I merely stating the fact that as a student (a college student no less, not even an optometry student) you don't have an adequate frame of reference to understand these issues with any real depth. Your parroting if optometry school brochures and AOA recruitment material sort of confirms that. Having "spoken with many ODs who share your views" and "working along side many more" does not prepare you for the realities of day to day practice nor provide you with an understanding of some of these issues any more than watching court TV, working as a secretary in a lawyers office and discussing the OJ simpson trial with your brother-in-law lawyer makes you qualified to form a cogent opinion on issues facing the legal profession. That's not a knock against you because we've all been there. It's just fact.

Vision source is not the answer. Buying power isn't really the issue because the problem isn't the fact that private ODs have to buy their lenses at $5 each while Walmart buys them at $0.25 each.

So yes. I AM predicting the death of private practice. Not of optometry. But of private practice optometry. In my opinion, optometry will end up like pharmacy. WHile there might be a few hospital based docs, and a scant few independants around, the overwhelming majority of practicing optometrists will be working in retail settings working retail hours seeing essentially routine patients. You will likely make decent money doing this. So I would NOT worry about money. But I do believe that that is the future of this profession for the overwhelming majority of docs.

 

[KHE]

I know that it doesn't work for everyone, but I know of several doctors that do not accept any insurance and have very very successful practices. Of course it depends on your patient demographics whether or not they would even be able to afford to pay out of pocket, but don't write the idea off completely. It has been done. But like I said, I know it doesn't work for everyone and isn't something that optometrists should expect to be able to do.

The only docs that I know who do this are NOT seeing high income patients. They are seeking lower class patients who work many part time jobs, or a full time job that does not provide health insurance benefits.

I have had the opportunity to work in some very upscale areas. WIthout fail, those patients were the WORST to deal with because they would pinch a penny until Lincoln screamed for mercy. And because most of them had "good jobs" with "good benefits" they usually only wanted "what their insurance covers" and would usually flip out over a $10 copayment.

If you want to have a practice that does not take insurance, you will be much better off setting yourself up in a LOWER socioeconomic area than a high one.

And you are right, the vast majority of ODs should not expect to be able to do this. Lots of press coverage goes towards the 40 million people in the USA who don't have health insurance. That makes for a good story, but it also drives home the reality that 260 million Americans DO have health insurance coverage and you can rest assured that 99.99% of those people are seeing doctors who are on their plans.

 

[Ben Chudner]

http://www.post-gazette.com/pg/05278/583075.stm

And without revealing your source...what makes them reliable?
I'm not saying I disagree...just courious. I have several close friends that work at wal-mart headquarters and I'm going to see if I can gather any more info. Even if it's just office gossip, haha.

He is very active in the AOA and has met with Wal-Mart execs. Part of their plan is to get all the Wal-Mart docs to join the AOA which will form a voting block.

 

[Ben Chudner]

What do you guys think about arrangments such as Vision Source??

Vision Source is in the business to make money for Vision Source. The current fee to be a member is in the neighborhood of 2.4% of your annual gross. For larger practices, you can't save that much per year through their discounts.

 

[Ben Chudner]

However, I don't think that simply merging practices is not going to be an adequate solution. That may work well in the very near short term, but even a practice with 4 or 5 docs still has no where near the buying power of a large corporation. But buying power isn't the real issue. The real issue is going to be "Walmart Blue Cross" Will ODs be able to get on that plan? More importantly, will the reimbursement be adequate to support a private practice or will we be back to the land of the $45 exams?

I also don't think that asking students to seek out these groups is going to work. I think that's what the vast majority of students are already doing when they graduate. I submit that there isn't nearly enough of these large practices to support the high number of new grads being turned out. This leaves them working in commercial.

Ken...always good to have this discussion with you.

Buying power is not the only benefit of a large practice, as I agree you cannot compete with the big boxes. Having a large practice, and if possible an OD/MD practice, allows you to offer services that may not be available from the big box. It also creates the appearance of a professional setting which is appealing to some patients. This will not prevent the big boxes from getting bigger, but it will protect a segment of private practice, hopefully. There will always be patients that will not want to have their exams done next to the tire section of a Wal-Mart. There will also always be other insurance providers besides Wal-Mart, so there will be a patient base.

As for having enough large practices to support all the grads, you are right. There will never be enough of them, but I disagree that most grads are looking for them right out of graduation. I believe a lot of grads look at their student debt and feel that corporate offers them the best opportunity to pay back their loans with the least risk. To be honest, they are right. OD's are notoriously cheap when it comes to paying associates. If I had the choice of working for an OD at $60-$70K vs working at Wal-Mart for $100K with $150K in debt, it would be hard to support private practice. This is a problem that will not go away no matter how much some people attack OD's that go into corporate settings.

 

[rpie]

Thats AMAZING that your brother left primary care medicine to pursue optometry when he was concerned about "disrespect from patients, the games he had to play to get some insurances to pay him, and the politics of who can be on those plans."

That pretty much sums up why I LEFT.

Wow. lol

Ken, I am fortunate to come a family with members and close relatives who are MD’s OD’s DDS’s and RPh’s. All of my family members have expressed the experience and problems that got you to leave Optometry. Two members of my family have switched professions, so what you did is not unusual and in some ways becoming more common. However, you must admit that Education has its own problems. (My undergraduate major was Secondary education, Chemistry/Biology) The point I wanted to let all students know is that the problems that OD’s have are similar to all professions. Being in a group practice does have many advantages and I think is the best way for young OD’s to start. Will private practices die? Maybe/maybe not. I think that there will always be equilibrium where one will not kill off the other.

 

[KHE]

Ken...always good to have this discussion with you.

Buying power is not the only benefit of a large practice, as I agree you cannot compete with the big boxes. Having a large practice, and if possible an OD/MD practice, allows you to offer services that may not be available from the big box. It also creates the appearance of a professional setting which is appealing to some patients. This will not prevent the big boxes from getting bigger, but it will protect a segment of private practice, hopefully. There will always be patients that will not want to have their exams done next to the tire section of a Wal-Mart. There will also always be other insurance providers besides Wal-Mart, so there will be a patient base.

As for having enough large practices to support all the grads, you are right. There will never be enough of them, but I disagree that most grads are looking for them right out of graduation. I believe a lot of grads look at their student debt and feel that corporate offers them the best opportunity to pay back their loans with the least risk. To be honest, they are right. OD's are notoriously cheap when it comes to paying associates. If I had the choice of working for an OD at $60-$70K vs working at Wal-Mart for $100K with $150K in debt, it would be hard to support private practice. This is a problem that will not go away no matter how much some people attack OD's that go into corporate settings.

Ben,

Always glad to have a civilized discussion about these issues because I know it's something that the vast majority of us are pationate about.

WHile the ideal situation may be an OD/OMD practice, I think that this is tough to set up. I tried it once, and it died a horrible death. Most optometrists are notoriously independant and don't normally work and play well with others. MDs tend to work better in "group practices" but it would take a real shift in attitudes for OD/OMD relationships to work in this setting. ESPECIALLY if there is ownership issues involved. OD/OMD relationships are usually ok if the OD is employed. But once you become true partners, I think that confounds things a lot. It's almost like suddenly asking cats and dogs to play nice together.

I agree with your 2nd point. However, I think that most students initially seek out a solo or group private practice because no one sits there in their 4th year and dreams of hitting that Lenscrafters or that Walmart. As you correctly point out, once they see the difference in pay and the difficulty in finding a quality position, it becomes much harder even if you can find those quality group practice opportunities which are exceedingly rare. Most private ODs are still independant solo operations.

 

[Ben Chudner]

Ken, maybe you and I should create the McDonalds of private practices. We could francise out private practices while we own the buildings. If we had enough offices, then we could recreate the buying power of the big boxes while still hanging on to the idea that private practice is more professional.

 

[KHE]

Ken, I am fortunate to come a family with members and close relatives who are MD’s OD’s DDS’s and RPh’s. All of my family members have expressed the experience and problems that got you to leave Optometry. Two members of my family have switched professions, so what you did is not unusual and in some ways becoming more common. However, you must admit that Education has its own problems. (My undergraduate major was Secondary education, Chemistry/Biology) The point I wanted to let all students know is that the problems that OD’s have are similar to all professions. Being in a group practice does have many advantages and I think is the best way for young OD’s to start. Will private practices die? Maybe/maybe not. I think that there will always be equilibrium where one will not kill off the other.

There is absolutely NO DOUBT that education has it's problems. Oooooo BOY does it have problems. I could go on for hours already and I've only been at it for a relatively short amount of time.

You may be correct in that the problems that face ODs are similar accross all health professions. HOwever, I don't think that the AOA or the schools are doing a good job of preparing people for this eventuality.

Most entering students and even senior optometry students are filled with the idea of "getting paid a lot of money to help people see better while sitting in their Guggenheim like offices with a waiting room stuffed full of cool and exciting ocular pathology and stamping out eye disease accross the world"

And who can blame them? That is what the AOA and schools put out isn't it?

Students should have a much clearer vision of what is ahead of them. I don't think that many of them do and I put the blame for that on the colleges and the AOA.

 

[KHE]

Ken, maybe you and I should create the McDonalds of private practices. We could francise out private practices while we own the buildings. If we had enough offices, then we could recreate the buying power of the big boxes while still hanging on to the idea that private practice is more professional.

Good idea, Ben. But I think they already have that. It's called Pearle Vision.

😉

 

[Ben Chudner]

Good idea, Ben. But I think they already have that. It's called Pearle Vision.

😉

Oh well, there went our millions.

 

[NEATOMD]

Just my thoughts, but I really find it a paradox that so many OD threads on this forum are regarding problems with OD's not being seen as legit doctors, yet so many also insist on standing up for places like Walmart vision center's. Whether it's right or not, as long as you continue to have Optometry clinics sitting right next to Malibu Nails, discount liquor, and cheap guitars, you are never going to get the respect from the medical community that you deserve. If I could offer one piece of advice to the OD world it would be this: Stop selling out to Walmart and the like (at least until you see a Walmart with a ICU and E.R. attached to it.) By the way, I have to agree that OD is not a dying profession, its just beginning to spread its wings... Best of luck in the future.

 

[ProZackMI]

Ken,

I think many private practicing OD’s feel it paramount to have as much visibility and foot traffic as possible. Locating their offices in strip and enclosed malls helps them achieve this goal. However, by doing this they go after the retail market, and in most case compete against the corporate originations. I agree with you that trying to compete against the corporate organizations is very difficult if not almost impossible. This is why like Ben; we chose not to compete against corporate.

About 7 years back our practice felt the need for more exposure etc., so we opened a second office in a strip mall between a Chinese restaurant, and a Dollar general store. Our optical dispensary was in the front with exam lanes in the back. In this setting, about 55-60% of the income was derived for the sales of glasses and contacts. The exposure increased our patient volume and gross income. However, our overhead increased, and there were occasions where material sales were lost because we could not match the corporate offers. The bottom line profit was less than our main office, which is located on the 5th floor of an office building. Our main office optical is not in the front and accounts for about 30-35% of our revenue. The rest is from professional services since we see a lot of medical eye cases. After finishing the 4-year lease we considered selling the strip mall office but closed it down and enlarge our main office. The reason we did not sell the practice is because the landlord insisted on increasing the rent which would have made it difficult to make a decent profit and allow the buyer a chance at having a successful practice. (Not all OD’s try to screw younger OD’s)

I can understand why you left Optometry but also would like to point out that all professions have people that leave for various reasons. My youngest brother left medicine to become and OD after practicing Family medicine for 4 years. He got fed up with the disrespect form patient, the games he had to play to get some insurances to pay him, and the politics of who can participate on which insurance panels. Since his desire was to be a primary care provider, he chose OD school instead of trying to match for Ophthalmology since invasive Surgery did not interest him. Today after practicing Optometry for the past 8 years he is very happy being an OD and does not miss his family practice days.

Your brother is an MD who left medicine to become an optometrist? Wow...that's just...amazing.

 

[rpie]

There is absolutely NO DOUBT that education has it's problems. Oooooo BOY does it have problems. I could go on for hours already and I've only been at it for a relatively short amount of time.

You may be correct in that the problems that face ODs are similar accross all health professions. HOwever, I don't think that the AOA or the schools are doing a good job of preparing people for this eventuality.

Most entering students and even senior optometry students are filled with the idea of "getting paid a lot of money to help people see better while sitting in their Guggenheim like offices with a waiting room stuffed full of cool and exciting ocular pathology and stamping out eye disease accross the world"

And who can blame them? That is what the AOA and schools put out isn't it?

Students should have a much clearer vision of what is ahead of them. I don't think that many of them do and I put the blame for that on the colleges and the AOA.

Yes, I can agree that the AOA does “sugar coat” the realities of Optometry but that is what most professional organizations do. I have read news letters from the American family practice board saying that there will be a shortage of FP’s due to the ageing baby boomers, and how the NP’s and PA’s has little effect the PCP’s, AAO ‘s news saying how Ophthalmology will take back the primary care market and the blinding of America since OD’s want to do invasive retinal /cataract surgery with scalpels..… I think you get the picture. My solution is that everyone should be active in the association so there will be a more diverse and true stating of the status of the profession. I think the last stats shoed that only about 45-50% of the practicing OD’s were AOA/state assoc. With this amount of participation the active members can and will represent Optometry in any light they wish.

Neato, if it was my choice I would have every OD in his or her own practice, but have come to the realization that corporate will always be around.

 

[jefguth]

Just my thoughts, but I really find it a paradox that so many OD threads on this forum are regarding problems with OD's not being seen as legit doctors, yet so many also insist on standing up for places like Walmart vision center's. Whether it's right or not, as long as you continue to have Optometry clinics sitting right next to Malibu Nails, discount liquor, and cheap guitars, you are never going to get the respect from the medical community that you deserve. If I could offer one piece of advice to the OD world it would be this: Stop selling out to Walmart and the like (at least until you see a Walmart with a ICU and E.R. attached to it.) By the way, I have to agree that OD is not a dying profession, its just beginning to spread its wings... Best of luck in the future.

Its not only optometry that is going to have this problem with comercial modes of practice. Coming soon to your local giant supermarket... you guessed it, your friendly family physician.

http://www.canhealth.com/News064.html

 

[Opii]

Its not only optometry that is going to have this problem with comercial modes of practice. Coming soon to your local giant supermarket... you guessed it, your friendly family physician.

http://www.canhealth.com/News064.html

Yes, Dentists are also thinking about opening up in malls too right?

 

[Kristene9]

Yes, Dentists are also thinking about opening up in malls too right?

Really??? I don’t want to get a filling in the supermarket 🙁... sorry for some reason that’s scary. A routine cleaning wouldn't be bad 🙂 or an orthodontist, then you can drop your kids off and shop with out them 😀

 

[Opii]

A routine cleaning wouldn't be bad 🙂 or an orthodontist, then you can drop your kids off and shop with out them 😀

 

[aphistis]

Yes, Dentists are also thinking about opening up in malls too right?

There are some corporate dental chains out there, and some private practices like to open up in strip malls & the like, for the same reasons an opto would. It works for some, it doesn't for others. It's worrisome to see the corporate retail guys looking at med & dental with hungry eyes, but I suspect medicine & dentistry will be more resistant as professions to being taken over that way.

Pharmacy & optometry generate a big portion of their revenue from salable merchandise walking out the door, which means you can buy cheap in bulk. When I charge someone $100 for a filling, the vast majority of that fee is for the knowledge & procedural skill it takes to place the restoration effectively, not for the half gram of composite resin I'm squishing into the cavity preparation. Likewise a child visiting the pediatrician for a checkup; the doc is charging primarily for his/her knowledge, not for the couple tongue blades s/he uses checking the kid's tonsils.

As long as medicine & dentistry remain driven chiefly by service fees for individual, customized services, rather than by profit margin on product sales, there won't be a lot of financial incentive for McWal-MartBucks to branch into them

 

[rpie]

Your brother is an MD who left medicine to become an optometrist? Wow...that's just...amazing.

One of my cousins sold her dental practice after 12 years and became a CPA… I guess crunching numbers was what she always wanted to do… Some how I think being a CPA is a butt sweating tedious job… 😱

 

[ProZackMI]

One of my cousins sold her dental practice after 12 years and became a CPA… I guess crunching numbers was what she always wanted to do… Some how I think being a CPA is a butt sweating tedious job… 😱

Usually, those who leave medicine and dentistry and other professions like that do so for personal reasons, usually burn out with health care in general, and end up moving on into different professions. Often it's medicine to law, or medicine into business. I've even heard of medicine to acting! However, medicine to optometry? That's a new one.

I remember reading about a professor at Michigan State University who started off as a BSN-level nurse, then went on for her MD. She practiced for many years a pediatrician, but for whatever reason, decided to become a veterinarian, so she went back and got her DVM, and now is a veterinary professor at MSU CVM. She's doing what she loves to do, but she's a rare creature out there: physician to other health care professional. http://cvm.msu.edu/lcs/Faculty/Kaiser.htm

I know I'm not well liked on these opto threads, but I will say I am quite surprised any MD would want to become an OD. Usually, it's the OD who "upgrades" to an MD. As long as your brother is happy, who cares, right? It's not up to me or anyone else to judge him. I just can't imagine being that unhappy with family practice. He could have done a residency in psych, peds, path, derm, etc., and found another speciality more rewarding.

 

[Ben Chudner]

As long as medicine & dentistry remain driven chiefly by service fees for individual, customized services, rather than by profit margin on product sales, there won't be a lot of financial incentive for McWal-MartBucks to branch into them

The real concern is when Wal-Mart owns the insurance company, which is a long-term goal for them. If they feel they can collect higher premiums by including dental as a benefit, it won't matter that dentistry is not a retail profession. I am not saying this will happen, but I am sure 20 years ago, no one expected optometry to head down this road.

 

[Opii]

.... She's doing what she loves to do, but she's a rare creature out there: physician to other health care professional....

Not that rare, Oklahoma's Optometry school has a clinician who was a D.O. first and an O.D. second. Can't remember his name (hispanic last name). Oklahoma student will have to help me with this one.

 

[sco1styear]

At SCO one of our professors has BS, MS, PhD in ophthalmology from Oxford, England. MD from Glasgow and fellowship in orthopaedic surgery from Wake Forest. He then went to optometry school at sco and teaches there with his wife (he graduated number 1 and she graduated number 2 in their sco class).
It happens....

 

[jefguth]

...and a third year at ICO with an MD from Tulane and a few years of practicing medicing beneath his belt. Much more common than I ever would have imagined!

 

[Caffeinated]

Mall-based practice is expanding to new frontiers. Our local mall has an after-hours pediatrics urgent care center called "Pediatrics @ Nite."

 

[alferec]

Not that rare, Oklahoma's Optometry school has a clinician who was a D.O. first and an O.D. second. Can't remember his name (hispanic last name). Oklahoma student will have to help me with this one.

That clinician is a DOOD!