Friends at Wal-Mart

[swiftiii]

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Thought some people might get a kick out of this article.

http://www.nytimes.com/2006/05/14/b...48356800&en=e8ec63084109d111&ei=5070&emc=eta1

Looks like we shall soon have some "friends" at Wal-Mart....

 

[aarlan]

I don't believe a MEDICAL profession belongs in a mass merchant. IT CHEAPENS THE WHOLE PROFESSION...PERIOD. Let them sell tires, and diapers, and toys, and dunkin donuts...but doctors belong in an appropriate setting. What's next? A menu w/ surgical procedures ( Lasik, Heart Bypass, Apendectomy, etc) a la carte?

They need to knock this stuff off.

Incidentally, you don't see any surgeons/doctors in walmarts, or podiatrists, or dentists,or chiropracters, or any other 'Health Professional'...This is one of the problems with Optometry...How we appear to the General Public. The general public equates us w/ those we surround ourselves w/ (example in WalMart there are Photo studios, Coffee shops, Hair Dressers and EYE DOCTORS?!?!?!).

AA

 

[nova2010]

I work in an optometry office and we are insulted that a doctor of optometry would even darken their doors. Wake up and be proud of who you are and where you offer your services. Doctors of Optometry, don't sell your profession to some cheap thrift store.

I don't believe a MEDICAL profession belongs in a mass merchant. IT CHEAPENS THE WHOLE PROFESSION...PERIOD. Let them sell tires, and diapers, and toys, and dunkin donuts...but doctors belong in an appropriate setting. What's next? A menu w/ surgical procedures ( Lasik, Heart Bypass, Apendectomy, etc) a la carte?

They need to knock this stuff off.

Incidentally, you don't see any surgeons/doctors in walmarts, or podiatrists, or dentists,or chiropracters, or any other 'Health Professional'...This is one of the problems with Optometry...How we appear to the General Public. The general public equates us w/ those we surround ourselves w/ (example in WalMart there are Photo studios, Coffee shops, Hair Dressers and EYE DOCTORS?!?!?!).

AA

 

[Ryan_eyeball]

I work in an optometry office and we are insulted that a doctor of optometry would even darken their doors. Wake up and be proud of who you are and where you offer your services. Doctors of Optometry, don't sell your profession to some cheap thrift store.

You're insulted?? The last time I checked we all received education and training at an OD school. Who cares what type of setting you work in, as long as you can provide the best care for a patient. I've been through all sorts of modes of practice of optometry (private, corporate, Veteran's hospital, Low vision clinics, OMD-OD practices) during working through school and externships. One private practice I externed through that "SPECIALIZED" in contact lenses would a lot of times fit -1.50 cylinders patients in sphericals. Some corporate doctors I've seen have limited the number of CL checks they have back because it eats up exam book time, since they work as independent contractors.

I'm accepting a private practice position to work at, but I don't look down on others. Maybe its the best fit for themselves. Again, doing whats best for patients, and accepting a position that best fits your individual needs should be what's most important, even if this "darkens optometry." If you concerned what Ophthalmologists think of us, go to back to med school, and join them as one.

 

[swiftiii]

You're insulted?? The last time I checked we all received education and training at an OD school. Who cares what type of setting you work in, as long as you can provide the best care for a patient. I've been through all sorts of modes of practice of optometry (private, corporate, Veteran's hospital, Low vision clinics, OMD-OD practices) during working through school and externships. One private practice I externed through that "SPECIALIZED" in contact lenses would a lot of times fit -1.50 cylinders patients in sphericals. Some corporate doctors I've seen have limited the number of CL checks they have back because it eats up exam book time, since they work as independent contractors.

I'm accepting a private practice position to work at, but I don't look down on others. Maybe its the best fit for themselves. Again, doing whats best for patients, and accepting a position that best fits your individual needs should be what's most important, even if this "darkens optometry." If you concerned what Ophthalmologists think of us, go to back to med school, and join them as one.

I was rather appalled as well. I certainly wouldn't like to work for Wal-mart, but I am also not going to say it's never going to happen. Like it or not, Wal-Mart DOES provided a necessary service for some people and there must be ODs willing to be providers. So, at the very least, blame the government, blame the state of healthcare, but don't blame the optometrist that works there.

BTW I would also take issue with is someone who worked at Wal-mart, whose level of care was substandard because of the fact. It's no excuse, but the more we poh-poh the people that work there, the worse the standard of care is going to get.

 

[iiiimonica]

good post swiftii!


i have read from many posters how they look down on the od's who go corporate but really what can you excpect them to do? especially if they cannot find a good gig with a private practice. i have seen od's habitially promise associateships (is that a word?) to new graduates only to change thier minds down the road. how many new graduates can really excpect/afford a job in private practice? i am willing to work part time for a few years to wait for that golden opprutinty, but i have a husband who is willing to foot most of our bills until this happens. i know not many people have this security - why look down on those who are only trying to pay their student loans/rent/bills?

we should only look down on od's who give substandared care and they do not have to work in Wally world to be bad od's - sad but true. your practice mode is NOT what makes you a good od, what makes you a good od is giving excellent care to your patients whether thay pay 85 or 35 dollars for their exam.

 

[aarlan]

I disagree. In the short term, a walmart or other big box setting fulfills our need. BUt big boxes are notorious for being more interested in bottom line than quality. Do you honestly believe that after the corporates succeed in watering down our profession that they won't replace all the $100K ODs w/ $85K...and then $65K and so on (while the bean counters and executives will walk home w/ huge paychecks and bonuses) as soon as they can? Yes taking a position working in a Big box pays well now, but the overall impact on Optometry is very negative (in my opinion), both in the public perception and and from a mid to long term financial standpoint.


AA

 

[swiftiii]

I disagree. In the short term, a walmart or other big box setting fulfills our need. BUt big boxes are notorious for being more interested in bottom line than quality. Do you honestly believe that after the corporates succeed in watering down our profession that they won't replace all the $100K ODs w/ $85K...and then $65K and so on (while the bean counters and executives will walk home w/ huge paychecks and bonuses) as soon as they can? Yes taking a position working in a Big box pays well now, but the overall impact on Optometry is very negative (in my opinion), both in the public perception and and from a mid to long term financial standpoint.


AA

No offense, but your logic seems flawed to me. First, a doctor who works for a "Wal-Mart" doesn't have to provide poor service. The company may only care about the bottom line, but they need the doctor to provide services, and he or she has an impact on the level of service given.

Second, salaries will never go "that low." Certainly, us money grubbers 🙄 may never see the $100K we were "promised" when we decided we wanted to be ODs, but I guarantee that should salaries continue to decline, less people will be interested in taking on the debt burden necessary once they understand the returns (money-wise) aren't that great, supply of ODs will go down, allowing individuals to be more selective, and "big boxes" will be forced to pay respectable salaries for their employees.

Finally, the public's perception/respect of ODs is only going to decrease so far as in those who work for "big boxes" not mention the big boxes themselves. If this becomes the case, people will stop going to Wal-Marts and return to more "respectable providers"...once again forcing corporations to increase the level of care being provided to customers as well as the salaries being offered to ODs (to ensure they, the company, remain competitive).

And could some people explain to me why working for a corporation is bad again? In a non-defensive, respectable way (as opposed to senseless bashing as we seem wont to do...). We seem to spend all this time hating "big boxes" that I have forgotten why we started in the first place.

 

[orangezero]

"""""And could some people explain to me why working for a corporation is bad again? In a non-defensive, respectable way (as opposed to senseless bashing as we seem wont to do...). We seem to spend all this time hating "big boxes" that I have forgotten why we started in the first place."""

I can certainly see both sides of this. I've worked for a walmart and other commercial offices. I'll try to explain in a respectable way.

#1 pt walks in with a red eye, wants to get glasses, has a history of diabetes, doesn't want to get dilated, and expects all of this for $40. This is a fact. no way to explain to them that medicare (a DISCOUNT program, by the way) allows about $135 for these services normally. At many, many commericals its one size fits all exams and the OD looses money on patient after patient. Remember, they only want you there to sell glasses. So if you are treating glaucoma and other things, do you think your commercial handlers really like that?? another example was a paracentral corneal ulcer I saw in the office a few weeks ago. The patient returned the next day (a lot don't) and at the end my office worker was shocked I would charge him for the followup visit... and I was very close to sending him off to a corneal specialist

#2 standard of care?? There are people in walmarts treating glaucoma with a perimeter machine and goldmann IOP. What about pachymetry readings, what about HRT, OCT, etc? These are rapidly becoming standard of care, and are reimbursable, but thats a tricky thing to do at a commercial office.

#3 the place i'm at sees contact fitting exams as a waste of time and are actively working on a way to discourage it (no money in contacts, and people are less likely to buy glasses)

#4 back to fees. you know some consider it insurance fraud to be charging the same fee to each patient that comes in...

#5 how are insurance reimbursment fees determined?? the insurance companies look around and see the private doc charging $110 for an exam and all the retail opticals charging $40 or $50. Then they say the usual and customary is somewhere around $60 and reimburse $45 to the doc. They are different exams, but not to vision insurance. I think this is the reason for horrible reimbursement rates and if you notice a lot of successful private ODs, they don't take a lot of vision insurance plans (reimbursement rates are making them loose money seeing these patients). Vision insurance plans love commercial because we are stuck giving away our services... who benefits??

#6 I was at a walmart in a rural setting and saw a patient that had been there for years and years. in 1997 the patient was charged $40 for an exam. You know how much I had to charge him in 2004? you guessed it $40. So explain to me how that is a good thing? The only way to keep up with inflation is to actually be able to raise prices, at least every once in a while. with this model of practice, i have to see more patients every year just to get a raise.

#7 when you hear me say all this I bet to some it sounds "greedy" but try and keep in mind how much money the commercial optical is making because they have you right next to them. Sure they could replace you, but someone with an OD license has to be there.

#8 some walmarts have been known to strong arm Docs into actually lowering their prices to below other walmarts in the area with the promise of more patient flow. Then they turn around and tell the current doc at the higher priced practice, "look, they lowered their prices, you probably should too to stay competitive"

#9 remember at a walmart, or any commercial place really, you can be replaced almost at any time. 30day or 60day doesn't mean a whole lot if you've put 10yrs into a place. What type of practice are you building there? I see a lot of patients at my current place, but most would drive across town if the exam was $1 cheaper. Don't get it in your head they are coming there for you, no matter how great of a doc you are.

#10 I think all of this above eventually wears away at the good ODs, and makes the poor ODs dislike their job even more. Patient care suffers along with the OD.

#11 I saw a lady with suspected MS and optic neuritis with best corrected VA of about 20/60 or so, its been a while. After I spent 5-10min just discussing this condition and its causes, and the outlook, treatment, etc. she asked me, so why can't you just give me new contacts to make me see 20/20?? Another bottom line, you are an eye doctor, but you are an eye doctor next to a nail salon (that charges almost as much as your exam to do nails!!!). No amount of patient education or selfdelusion will make people see otherwise.

Now, I don't think commercial establishments are the devil. I just think in the long run, and short run, they are bad things to get into with the way the vast majority of commercial ODs set up their contracts.

Hope that gives you some idea of the downsides. I'm sure there will be people replying and telling me how they have a different experience at walmart and they do practice up to the standard of care, and they do have patients that return to them, etc. etc. and that they are satisfied with their current situation.

I also see a lot of ODs that get out of 8+years of schooling, eating ramen noodles. They get a commercial job, start making good money, get married, get a new car, new house, get some kids, then BOOOM> they can't afford to try to open that private practice they've always dreamed of. They can't even afford to work for less at a private practice to eventually buy in. They are stuck in the commercial setting. I've seen this happen to a lot of people in my area and my friends in other states as well. I think this might be the worst part about it, the lure of a high paying salary....

ask yourself this, would you still want to be an optometrist and go through all that schooling and incur all that debt to make $50,000-70,000 in a private practice??

 

[eyestrain]

I also see a lot of ODs that get out of 8+years of schooling, eating ramen noodles. They get a commercial job, start making good money, get married, get a new car, new house, get some kids, then BOOOM> they can't afford to try to open that private practice they've always dreamed of. They can't even afford to work for less at a private practice to eventually buy in. They are stuck in the commercial setting. I've seen this happen to a lot of people in my area and my friends in other states as well. I think this might be the worst part about it, the lure of a high paying salary....

I get the feeling I'm going to be seeing this scenario play out with many of my friends too. Many of them seem to think they'll work corporate for a few years, live like a poor student during that time and then join or start a private practice. I don't think it will happen, for the reasons you stated. If they can manage to live like a poor student for those years, then yeah, they might be able to pull it off. But it's really easy to say you'll live that way when you are a student and don't have any money. It's going to be hard to keep it up once those checks start coming in. And then when a few years are up and it's time to get into private practice like they had planned, they're stuck in corporate. It seems smarter to me to get into private practice right away if that's what you want to ultimately do. Of course, that's easier said than done...

 

[KHE]

I've worked in a number of both commercial and private practices, though I have never worked at Walmart outside of the extremely rare fill in day covering for a doctor who was on maternity leave. Most of my experiences in commercial practice have been with Lenscrafters.

I am not a fan of commercial practice, but commercial practice fills a need. We have millions of people uninsured and the fact that there is a low cost option for eyecare is NOT a bad thing. In medicine, there are low cost clinics and there are Park Avenue/Beverly Hills clinics that cost a hell of a lot more.

Every practicing doctor can tell you all kinds of stories about patients who presented to them in private practice and remarked how "this is the BEST eye exam I've ever had!" I've had that happen to me. I've also had it happen JUST AS MUCH in commercial practices. I've had hundreds of patients over the years come see me in a commercial venue and remark how their last doctor tried to force them into an expensive pair of glasses, or wouldn't give them their CL Rx.

In my opinion, the reason that private practices complain about Walmart "degrading" the profession or cause the public to expect Walmart prices in private practices is because in reality, private practices aren't that much different than other commercial prcatices. Walk into 9 out of 10 "private practices" and what will you see? You will see a facility where 90% of the floor space is dedicated to the retailing of optical goods with the examination room in the back.

What does a patient/customer think when they walk into one of these private practices? Do they think that this is a place where healing arts are practices, or is this a "store?" I would bet $100 that 90% of them think "store."

So why is it that private optometric practices are so threatened by "low cost" eye care? I doubt the physicians practicing on Park Avenue care about the low cost clinic in the Bronx. Again, I contend that this is because most private practices are only margianlly different than commercial ones.

I also think that the degree of "control" in a private practice is also mostly fantasy. You might have control over what color to paint the office, or what "girl" to hire, but 90% of private practices (optometry AND medical) are so wedded to managed care (VSP being the big one) that they DON'T have control over the MOST IMPORTANT PART OF THEIR PRACTICE! That being the control of the MONEY.

If Walmart forces you to lower fees, you can claim that you don't have control over your fee structure, and you would be right. However, in a private practice, you can charge $500 for an eye exam or you can charge $100 and the patients insurance is still going to pay you $72.43.

In my experience, the "control" in a private practice is mostly an illusion.

"""""

I can certainly see both sides of this. I've worked for a walmart and other commercial offices. I'll try to explain in a respectable way.

 

[orangezero]

KHE,

I understand your point of view. There are private ODs opening up stores that look a lot like optical shops in supermarkets. I've noticed a lot of private offices look dated and unappealing.

I do think/believe you do have a lot more control in private practice. You can set you office hours. You can decide when you want to go on vacation... sure you don't make the money when you aren't there, but the world is not all about money.

Try telling your walmart manager you want to leave to see your kid play baseball on a thursday at 5pm... In fact, try convincing them at all that you dont' want to be there for even 1hr out of the day, anytime...

Private practice is what you make of it, sure you can try to compete with commercial, but I doubt you have the big pockets for that... You have to convince people that there is value in coming to your practice, that there is a difference. I think there is an uphill battle there, somewhat. But i know it can be done. Not everyone wants to shop at walmart, either, remember that.

I see a lot at my commercial practice that are generally unhappy with the service they receive at a lot of the other commercial places in town, for whatever reason. I don't have the heart to tell them you get what you pay for, especially if i told you how little I get to charge for an eye exam (YEs, i said that right, I'm "Independent" but i don't get to set my fees, thats not right)

 

[orangezero]

two other points,

lenscrafters: doctors own the lease and can generally set their fees what they want (and in my opinion closer to what is acceptable, although still low). in most cities in my area, they are usually $10 to $40 higher on their fees than walmart and still are booked full. why is that? perceived quality perhaps, or the hour eyeglasses thing?

try working in sams club where you get $37 an exam...

the guys i work with wanted to pay me the same for a routine exam as a contact fitting exam, to take away the incentive to upcharge my exams. IE. they don't make money when i fit contacts, but i get a slighly higher exam fee.



VSP: i know lots of private docs hate them, but they do bring in patients. They do like their hands in everything though. There are a lot of issues in there.

 

[KHE]

When I held a commercial lease, I went on vacation whenever I wanted to. I had to find a doc to replace me for those days but there was never any shortage of young hungry ODs falling all over themselves to fill in.

VSP DOES bring patients into a private practice, but again, the issue of control is mostly an illusion because VSP controls 90% of the practices that take them. Don't believe me? Then why, with all the negativity does any doctor continue to take them? Because most probably couldn't get patients in the door without them.

I would bet $100 that if commercial practices were allowed to take VSP tomorrow, at least 25% of the private practices in the USA would be decimated. If VSP decided to slash reimbusement accross the board by 50%, over half of the private practices would be ruined.

In commercial practice, the "corporation" you are beholden to is the commercial location.

In private practice, the "corporations" that control you are Blue Cross and VSP.

Is there really that much difference?

two other points,

lenscrafters: doctors own the lease and can generally set their fees what they want (and in my opinion closer to what is acceptable, although still low). in most cities in my area, they are usually $10 to $40 higher on their fees than walmart and still are booked full. why is that? perceived quality perhaps, or the hour eyeglasses thing?

try working in sams club where you get $37 an exam...

the guys i work with wanted to pay me the same for a routine exam as a contact fitting exam, to take away the incentive to upcharge my exams. IE. they don't make money when i fit contacts, but i get a slighly higher exam fee.



VSP: i know lots of private docs hate them, but they do bring in patients. They do like their hands in everything though. There are a lot of issues in there.

 

[VA Hopeful Dr]

I've worked in a number of both commercial and private practices, though I have never worked at Walmart outside of the extremely rare fill in day covering for a doctor who was on maternity leave. Most of my experiences in commercial practice have been with Lenscrafters.

I am not a fan of commercial practice, but commercial practice fills a need. We have millions of people uninsured and the fact that there is a low cost option for eyecare is NOT a bad thing. In medicine, there are low cost clinics and there are Park Avenue/Beverly Hills clinics that cost a hell of a lot more.

Every practicing doctor can tell you all kinds of stories about patients who presented to them in private practice and remarked how "this is the BEST eye exam I've ever had!" I've had that happen to me. I've also had it happen JUST AS MUCH in commercial practices. I've had hundreds of patients over the years come see me in a commercial venue and remark how their last doctor tried to force them into an expensive pair of glasses, or wouldn't give them their CL Rx.

In my opinion, the reason that private practices complain about Walmart "degrading" the profession or cause the public to expect Walmart prices in private practices is because in reality, private practices aren't that much different than other commercial prcatices. Walk into 9 out of 10 "private practices" and what will you see? You will see a facility where 90% of the floor space is dedicated to the retailing of optical goods with the examination room in the back.

What does a patient/customer think when they walk into one of these private practices? Do they think that this is a place where healing arts are practices, or is this a "store?" I would bet $100 that 90% of them think "store."

So why is it that private optometric practices are so threatened by "low cost" eye care? I doubt the physicians practicing on Park Avenue care about the low cost clinic in the Bronx. Again, I contend that this is because most private practices are only margianlly different than commercial ones.

I also think that the degree of "control" in a private practice is also mostly fantasy. You might have control over what color to paint the office, or what "girl" to hire, but 90% of private practices (optometry AND medical) are so wedded to managed care (VSP being the big one) that they DON'T have control over the MOST IMPORTANT PART OF THEIR PRACTICE! That being the control of the MONEY.

If Walmart forces you to lower fees, you can claim that you don't have control over your fee structure, and you would be right. However, in a private practice, you can charge $500 for an eye exam or you can charge $100 and the patients insurance is still going to pay you $72.43.

In my experience, the "control" in a private practice is mostly an illusion.

I would suggest that all aspects of healthcare are becoming more commercialized as the general public begins to see them as such.

 

[Idok]

man, long posts but good info...........

To the Docs (orangezero and KHE) you guys are SO on the ball....there may be other docs floating around this thread too, but no offense...i just particularly like what these 2 had to say....

I have held the lease within Pearle Vision now for the past 3 years in Jax FL. I work for an INDEPENDENT company that staffs every PV from jax to gainseville to Daytona......


ahhhhh, the old corporate vs. private debate...


to you students, y'all have alot to learn...but it wont be so bad......


here are somethings you want to consider when trying to decide what type of modality is right for you:

hours-do you have a life? or do you want/like to work 5-6 sometimes 7 days a week--corporate might warrant this, but so migh

pay-yeah, we all want to get rich, but remember...in optometry the more you WORK, the more you make....that rings true for both private/commercial

how much time do you actually want to spend at your office NOT seeing patients (ie not generateing revenue)..when I leave at the end of the day I forget that Im an optometrist until I arrive again the next morning..i LIKE that

no matter where you go and what you do youre going to get the "not a real doctor" speech........and if anyone ever says it to you in office, dont waste your time.......dont bother to waste your breath and educate them...just smile and move on, as they probably dont geive a **** anyway....


i could go on, but my fingers are getting tired.........



but just remmeber, sometimes people are going to get mad....and there isnt a damn thing you can do about it...just keep your head and move on

 

[orangezero]

Idok,

Good to point out some positives. I do like to be able to go home and not have to think about work. However, I think optometry is a profession where you should always be thinking about it. I work in corporate, but constantly worry if the people they pay minimum wage are really doing what is right, or what is the quickest. An example of this is them wanting to change the Rx I've written because the patient is having problems seeing. If i didn't yell at them early on about it, they'd do it all the time and I could potentially miss a medical problem, Diabetes, AION, etc.

Since this is a student site, I think it should be worth mentioning that to be a successful OD, you should really want to do these things. The private ODs I've seen that arent' very successful don't like to do things (or aren't very good at it) like staffing, marketing, office management, etc. Sure you can get by doing corporate, but at some point in your career I think it will be necessary.

In a lot of states, you need to have a separate phone line, separate employees, etc. than the lab. Not all states are like that.

Also, you could work in a partnership, where one OD does a lot more of the office manager stuff and another does more of something else. You could also hire an office manager if you dont' like to do those things. Generally, it seems that most ODs are inventive and really curious to see how things work.

I've done commercial for 3+ years and its getting old. I dont' see a future in it. I'll make as much this year as I will in 10years probably. At first a -2.00 myope that wanted contacts was interesting to me, but not anymore. Now I'm wondering how medicare works, what frames people like, how to run an office, what EMR software to use, etc. I don't think I'd like optometry at all in 5 years if i was still doing exams on myopes all day long without any other intellectual stimulation. Just me. Perhaps some would be fine doing 15-20 routine exams all day every day for 30 years.. Does anyone think they will be able to stay in a commercial place for that long?

I know one guy that works in a pearl in the mall, is employeed and has been there for probably 10 or 12 years. He probably gets 4weeks vacation every year, plus a 2-5% raise every year, and a decent number of benefits. I'm guessing they could bring in a new OD and give him less benefits, 2weeks vacation, and a starting salary of $10-30K less per year. When you have a profitable office, who cares, but I'm guessing the people crunching the numbers would notice that pretty quickly if the office wasn't doing as well do to a downturn in the economy, competition, etc. Sure, some will say that he's established and people like him. The truth is, though, is that people come to these places for convenience and/or price. Generally as long as the doctor is alive and not threatening, people in a commercial setting will go there. Not a good feeling to have.

In this scenario above, what happens when the patients come back for an exam the next year or two? I bet they may find out that there is a new doctor only after making the appointment. And I bet they will "try the new one out" to see if he/she is good. I highly doubt they will ask where the old OD went and ask for his number. Do you think the optical place would willingly give it out anyway?

 

[ProZackMI]

Some of the issues referenced about private practice are not unique to optometry. Unless you're rich (or, more usually, unless Mommy & Daddy are rich), entering private practice after school (or school and residency) is difficult for many practitioners. Think about the immense cost:

1) rental space/good location
2) equipment
3) health insurance
4) building/equipment insurance
5) malpractice insurance
6) staff/personnel + benefits
7) computers
8) supplies
9) inventory, stock, medications
10) utilities (e.g., heat, a/c, electricity, gas, water)
11) taxes
12) professional licensing fees
13) lab services (if MD/DO/DPM/DDS)
14) optical grinding services (or optical labs)

Those are just the things that come to mind...many more exist. For a new doc, optometrist, vet, psychologist, podiatrist, chiro, whatever, to start off in private practice is terribly expensive and really difficult. I can see why many ODs would gravitate toward the corporate sector; it's a steady job with a good income and doesn't impose a huge financial burden coupled with the huge responsiblity that comes with private practice. Not to mention the hassle of hiring staff to deal with that horrid insurance stuff! I'm sure Wal-mart and K-Mart ODs have a ton less stress than private practice ODs.

Plus, keep in mind, even after all of the expenses listed above, there is no guarantee you'll make big bucks. In some ways, this dilemma is similar to what lawyers and doctors experience in government and military work: good hours and benefits/less stress and responsibility coupled with less pay. It's a quid pro quo type of situation.