If you make a claim on this forum, substantiate it!

[Princeod2583]

It gets pretty tiring coming to this forum and seeing all this negativity. Negativity breeds more negativity. Its like a virus. With that being said, all these people/docs/students who come to this forum making claims should back it up with evidence. Give us some numbers or some substantiated claims that optometry is dying. Just because you are doctor who wants to start his or her own practice and is SCARED doesn't mean you should come on this forum and SCARE everyone else. The entrepreneurial spirit has and always will involve some calculated risk. Why do banks still lend to optometrists if the profession is supposedly DEAD. If there is a doctor in private practice, who posts to this forum, he or she should give us numbers backing up his or her claims. I.e I pay this much in rent, this is my optical sales, my specialty sales, my total costs for the year and how much I made after total costs. I understand some docs might be frustrated because their profits are dwindling, but if you are still able to survive and run a business then you are just going through rough times. That doesn't signal the end of a profession, only a bump in the road.

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[Visionary]

Please understand that there is an inherent sampling bias on these forums. Unfortunately, many posters on all sorts of forums tend to be negative (go look at any sports site, even CNN or ESPN article commentary). Those who are unhappy tend to complain and complain loudly to anyone who will listen. Those who are content tend to simply go about their business. There are real issues to be considered by those entering our respective fields, no doubt. The extent of the doom and gloom displayed on these forums, however, is not a true reflection of the real world. I'm not suggesting you ignore it, just take it with a grain of salt.

 

[thecgrblue]

There is no points in facts in threads such as that one. Whomever is stuck in their ways will never respond to facts, ESPECIALLY on an online forum. Get someone with enough keyboard-courage and it's all downhill from there.

 

[thecgrblue]

Just think about it...when you go to a restaurant and the food is AMAZING how often do you get on urbanspoon or open-table to rave about it. Now, when food sucks for how often do you want to tell EVERYONE that will listen how bad it was?

 

[KHE]

It gets pretty tiring coming to this forum and seeing all this negativity. Negativity breeds more negativity. Its like a virus. With that being said, all these people/docs/students who come to this forum making claims should back it up with evidence. Give us some numbers or some substantiated claims that optometry is dying. Just because you are doctor who wants to start his or her own practice and is SCARED doesn't mean you should come on this forum and SCARE everyone else. The entrepreneurial spirit has and always will involve some calculated risk. Why do banks still lend to optometrists if the profession is supposedly DEAD. If there is a doctor in private practice, who posts to this forum, he or she should give us numbers backing up his or her claims. I.e I pay this much in rent, this is my optical sales, my specialty sales, my total costs for the year and how much I made after total costs. I understand some docs might be frustrated because their profits are dwindling, but if you are still able to survive and run a business then you are just going through rough times. That doesn't signal the end of a profession, only a bump in the road.

The problem is that there isn't any empirical data or really any reliable data. It's just the experience of doctors on there.

I would encourage people to not become engrossed in the negativity on here but to not dismiss it simply because it's something you don't feel like you want to hear. There's a lot of negatives in this profession, as there is in any profession of course but I think the problem we have in optometry is that most of the negatives are things that people don't see coming.

 

[Tippytoe]

Statistics? Numbers? Facts? Hmmmm.........here's some numbers to think about:

1. Pick an OD number out of your local phone book and call to schedule an appointment. Ask for the quickest routine exam you can get. My guess is THAT number will be "how soon can you come in?"

Now do that same thing with an OMD, a dentist and a dermatologist. Report back (and I realize others have suggested this experiment in the past).

2. Another number: $28,000/month to run a small 4 employee OD office. That's before you make a penny.

3. Homework with numbers: Calculate how many $60 VSP exams you will have to do to break even.

4. Numbers: $20/hr to get reasonable employees (hourly pay plus taxes/benefits).

5. Numbers: 10-20 years of paying $2,500/month school loans.

6. Numbers: $5,000 - $50,000 to purchase mandatory Electronic Medical Records software. $2,000+ yearly mandatory renewal fee.

7. Fun number: $60,000 ++ in yearly taxes.

8. Numbers: Look up the population where you want to live and look up how many OD AND OMDs are there. Divide and see how little patient population you will have to work from. Unless you will be in the remote outback, you might be surprised.

My last number: It's 10:00. I'm going to bed.

It's not about complaining. It's about people giving you info we never got. Optometry is okay in 2011. But it won't be forever. Times are a changing. Think typewriter manufactuers. Think horse buggy makers. Think encyclopia salesmen.

 

[Eyes Only]

The problem is that there isn't any empirical data or really any reliable data. It's just the experience of doctors on there.

I would encourage people to not become engrossed in the negativity on here but to not dismiss it simply because it's something you don't feel like you want to hear. There's a lot of negatives in this profession, as there is in any profession of course but I think the problem we have in optometry is that most of the negatives are things that people don't see coming.

I agree. You won't find a lot of "facts" or "evidence" because no one has it.

If all you want is sunshine read the AOA's website, but you really should know both sides of the story. Ignoring the profession's negatives won't get you anywhere. Maybe if you know the "dark side" it will help you avoid these things in the future.

Some ODs are happy, some aren't.

Decisions you make right now will help determine which kind of OD you will be. For example, do you borrow the maximum students loans will allow each year? If you do, do you know how much your loan payments will be? Too many young ODs are unhappy because they have so much debt and the monthly payments are much higher than they originally thought they'd be.

Find out why these ODs are unhappy and maybe you can avoid the same mistakes.

 

[DILLIGAF]

I will try to do the same as the last poster did....here goes.

1. If you call my office we will be ABLE to see you immediately, but you will be screened to see if your condition requires it. I.E. My glasses aren't working anymore vs my eye is beet red and filled with pus. If you are the first, you will be asked to hopefully come in within the next week. If the latter, I will do everything in my power to accommodate. A local dentist or dermatologist will do the same thing. Call and ask for an appt today w a complaint of toothache , 1 week please. Call with extreme pain and inability to eat plus lesions on half your face, see you in 2 hours. Also, my exams take anywhere from 20 min to an hour, depending on complexity. A dental exam takes much longer, an hour at very least. A better comparison would be to call your average DO family doc, and do the same experiment. They have similar flexibility in exam times.

2. My current building is paid off. Overhead is about 4k a month, before labor. The newer practice (in a much better, higher land value location) = 11k a month. I am assuming the above poster is in a very affluent community. I can rent a warehouse the size of an airplane hangar here for 28k, in NH.

3. Average pt's per day, per doctor = 21.2....this is between 6 docs, 2 of which graduated in 2008, in 2 locations. The 3rd location I am only partial owner and don't keep much track of the P&L, in all honesty.

4. My office managers (2) = $22 an hour
Technicians (10) = $9 - $17 an hour, varying with skill
Receptionists (5) = $13 - $20 an hour; the high one does a lot of advertising for us
Lens techs (4) = Free to $12 an hour; a pre-op that does it as a reference

5. 8 years of paying off loans in the area of about 100k. I lived in a 1-bedroom and sold my soul to CostCo for a few years. It was much more awful that anyone tells you it is. Those are long-gone now. Anyone that is paying their loans back at age 45 (20 years past school) could REALLY use some Dave Ramsey books!

6.WHOA on the EMR there! What does it do, see pt's for you too? I have actually heard of higher than that....yes, EMR software stinks, no way around it. Mine was a bargain at 12 grand, but no renewal unless new templates are wanted. (Would be nice. We operate every practice now on 3 templates, one of which is for when you called the pt. Not good)

7. I wish mine were 60k in total taxes....more like 104k last year. NH has awful business tax rates, especially if you plan on hiring more than 5 people. (Seriously, that is the limit)

8. Mine comes out to about 1 OD or OMD per 9000, at least according to the labor dept. Not great, and getting worse...however, I know of literally 4 practices in the next town over (a larger one, about 50k population) where not a single doc is younger than 55. The number of docs up here that graduated in the early 70's is astounding.

Now....some numbers not mentioned.

9. A solid 150k to start a practice, perhaps less if you know what you are doing and can compensate early on. This is bare bones. I know a guy that opened a new practice outside of Boston, spent 550k on it...don't ask me how, other than pretty much the best equip money can buy + an optical Paris Hilton would be proud to step into....was closed 2 years later.

10. No $60 VSP exams for me....they are banned here. VSP is like the mafia. You can get it, but you can't get out.

11. Biggest one here....110k. That is the amount it will take to pull a great doc into your place, at least one with experience.

12. But my biggest number of all:

$120. The cost of my cheapest comp eye exam. Now take 21 pt's a day x 4 docs at the least working any given day at both places. Add in an OCT (that has awful fees to operate, mind you), a VF machine, a retinal camera (don't get me started. If I re-incarnate, I am making ret cams. HUGE FEES on those, but worth it), and a VT room that never gets used.'

Do that math I guess....can't speak for anyone else, nor do I pretend that my situation says something grandesque, good or bad, about the profession. For a 40 year old doc in NH though, those are the numbers. Hope they help.

 

[imemily]

I keep on hearing mixed stories re: price of exams.


If you charge $120 for an eye exam do you get the full amount? I've heard stories that you would get half or even $40 since insurance doesn't pay that well.

 

[Princeod2583]

Please understand that there is an inherent sampling bias on these forums. Unfortunately, many posters on all sorts of forums tend to be negative (go look at any sports site, even CNN or ESPN article commentary). Those who are unhappy tend to complain and complain loudly to anyone who will listen. Those who are content tend to simply go about their business. There are real issues to be considered by those entering our respective fields, no doubt. The extent of the doom and gloom displayed on these forums, however, is not a true reflection of the real world. I'm not suggesting you ignore it, just take it with a grain of salt.

Very true. But with the above posts, especially Dilligaf, We are seeing some truth rather than irrational arguments. Evidence always puts things in perspective.
New grads now face more loans, and if you look at the above claim of paying 2500k/month over 10 years on loans I d say you are an idiot for doing so. KHE has mentioned (with good reason) to stretch your loan payments for 30 years and keep steady cash flow so you can invest in potential assets (i.e opening your own practice, buying real estate,etc.) Furthermore, new grads now have the option of IBR (income based repayment) that would definitely be feasible when starting out as a new grad. If it is as hard as the above poster says to make ends meet opening a practice, a new grad would easily qualify for IBR. This would cut loan costs to approx $750 a month (25 years on a 250,000 loan) and the remainder of the balance is forgiven after 25 years. I ve also heard from consultants such as Dr. Gailmard that opening cold is possible with as little as $75k as long as you are able to support the practice in its infancy (open the office part time and work outside the practice to support its growth).

 

[optsuker]

I'm the greatest optometrist in the world!

Just call my mom & she'll substatiate it.

 

[Tippytoe]

[/QUOTE]

I will try to do the same as the last poster did....here goes.

2. My current building is paid off. Overhead is about 4k a month, before labor. The newer practice (in a much better, higher land value location) = 11k a month. I am assuming the above poster is in a very affluent community. I can rent a warehouse the size of an airplane hangar here for 28k, in NH.

Your practice overhead is $4,000? That seems impossible. Do you not have these bills:

Advertising Yellow Page- $1,200/month (dropped years ago because every OD felt they had to go bigger than the next).​

Advertising Other- 230​

Depreciation​

Dues Association Office- 135​

Dues AOA- 125​

Dues Employees-0​

Insurance Basic Office - 135​

Insurance Disability- 46.60​

Insurance Major Medical- 950.00​

Insurance Property/Liability- 131​

Insurance Malpractice- 80.00​

Insurance Life- 39.75​

Insurance Workers Comp​

Lease Professional Equip​

Lease Office Equipment- 945.00
Equipment
Rent- 3,000​

Salary Dr​

Salary Staff # 1 - 1,035​

Salary Staff #2 - 945.65​

Salary Staff # 3 - 906.98​

Salary Staff # 4 - 845.00​

Taxes Property - ​

Taxes - 4912​

Telephone Basic Service - 216.73​

Telephone Cellular - 168​

Telephone Long Dist. - 50.95​

Internet Service - 89.95​

Telephone Maintenance​

Variable Expenses:​

Accounting- 216​

Advertising General 259​

Attorney/Legal ​

Automotive​

Bank Card Discount 156​

Bank Charges 53​

Cont. Education OD​

Cont. Education Staff​

Entertainment 96.45​

Equipment Purchase Disp.​

Equipment Purchase Front Office​

Equipment Purchase Professional​

Equipment Purchase Lab​

Equipment Repairs​

Furnishings​

Miscellaneous - 145​

Office Supplies - 20.15​

Optometric Supplies - 69​

Postage - 67.05​

Printing​

Publication​

Refunds - 264​

Subscriptions 53​

Temp. Services​

Tenant Improvements​

Tuition​

Utilities 283.73​

So that's about $18,000 for an average month. Actually a good month. There were no necessary repairs and I didn't have a bunch of people buy glasses and then want to return them because they saw a Lenscrafters 50% sale. THEN add in whatever loan payment (I have paid my ed loans off and your crazy if you stretch them out for 100 years).

So that's $18,000 + $2,000/month school loan + $3,000/month start up loan payment and you have to come up with $23,000 per month BEFORE YOU MAKE A PENNY.​

 

[Eyes Only]

Your practice overhead is $4,000? That seems impossible.


Got to agree with this. Maybe you don't understand the term "overhead". Where I practice most people pay this much or more for rent alone.

 

[Princeod2583]

So that's $18,000 + $2,000/month school loan + $3,000/month start up loan payment and you have to come up with $23,000 per month BEFORE YOU MAKE A PENNY.[/QUOTE]

Now we're cookin! thanks for the numbers. would you be willing to tell us how much you gross and how much your take home is on an annual basis. Also what state do you practice in and how large is your practice; are you surviving? Again, thanks for the figures.

 

[Shnurek]

I didn't know people still advertise on the yellow pages lol.

BTW, automotive is for the gas / car maintenance deductions for your car being used to drive to/from the practice?

Just get a PO Box in like Trinidad and pay barely any taxes like GE does. http://www.nytimes.com/2011/03/25/business/economy/25tax.html?_r=1

Heh, might be kind of hard to do in optometry, but just a thought.

 

[Tippytoe]

So that's $18,000 + $2,000/month school loan + $3,000/month start up loan payment and you have to come up with $23,000 per month BEFORE YOU MAKE A PENNY.

Now we're cookin! thanks for the numbers. would you be willing to tell us how much you gross and how much your take home is on an annual basis. Also what state do you practice in and how large is your practice; are you surviving? Again, thanks for the figures.[/QUOTE]


- $420,000 gross last year.
- On paper, I netted $140,000. In reality, about $80,000. (S-corp accounting wonders).
- Southeast NC
- All the fancy equipment- OCT, VF, ant and post seg cameras, EMR fully integreted, corneal topo, b-scan, etc.....
- No growth since 2004. 6 ODs added to the local economy since then with no population growth. 46 ODs and 10 OMDs. 1 eyecare provider (OD/OMD) per 4,200 population. Fought to stop a local college from starting an OD school to serve our "underserved area". Hell the freaking state paid back part of my school loan because I am working in an 'underserved area". What a joke! But I laughed all the way to the bank saving myself $30,000.

- I'm doing okay because I planned well. Work outside jobs to pay off my student loans as fast as I could and most of my practice loans. Invested heavily outside of optometry because I have seen the writing on the wall after about year 2. Had the foresight to buy my office building (overpaid but better than rent). So it will be paid off in 4 more years. So as income decreases, hopefully so will my expenses.

One thing is for sure. On-line optical WILL increase, Expenses will INCREASE. And insurance payments will DECREASE. Private pay patients are almost non-existent unless you are in a special area. So we live and die by insurance.............and they live in the wild-wild west. NO RULES AT ALL FOR INSURANCE COMPANIES. You bill $130 and they pay $85 or $16.49 or nothing at all. AND THERE IS NOT A DAMN THING YOU CAN DO ABOUT IT. That's health care in 2011. Certain to get worse.

 

[Tippytoe]

I didn't know people still advertise on the yellow pages lol.

BTW, automotive is for the gas / car maintenance deductions for your car being used to drive to/from the practice?

Just get a PO Box in like Trinidad and pay barely any taxes like GE does. http://www.nytimes.com/2011/03/25/business/economy/25tax.html?_r=1

Heh, might be kind of hard to do in optometry, but just a thought.

Automotive is a quasi-deduction. Can't use it for expenses for driving to and from work. It's only supposed to be used for expenses incured during work, such as delivering glasses or something. But it all depends on how aggressive you and your accounting is. I used it briefly when working between two or more offices.

 

[JeffChou]

So that's about $18,000 for an average month. Actually a good month. There were no necessary repairs and I didn't have a bunch of people buy glasses and then want to return them because they saw a Lenscrafters 50% sale. THEN add in whatever loan payment (I have paid my ed loans off and your crazy if you stretch them out for 100 years).

So that's $18,000 + $2,000/month school loan + $3,000/month start up loan payment and you have to come up with $23,000 per month BEFORE YOU MAKE A PENNY.​

Tippytoe,
Thank you for sharing your experiences and providing some examples to think about. Same applies to all the other doctors.
I had a couple questions I was hoping you could clarify as well. I'm assuming that you own this practice. Are you currently the only working doctor there, if so, approx how many hours are you working per week. Also, in your 18k of business overhead expenses, are you drawing a salary for your own Dr. hours?

Could you also share a little more regarding the fee schedule for comprehensives, CL evals, and give us an idea of your pt payer breakdown(insurance, cash, etc).

One more thing, I was wondering how you net 140 on paper but take home 80. From what I understand, net income is the businesses bottom line after all expenses and taxes. What am I missing here?

Thank you,
Jeffrey Chou

 

[Tippytoe]

Answers in red below:

Tippytoe,
Thank you for sharing your experiences and providing some examples to think about. Same applies to all the other doctors.
I had a couple questions I was hoping you could clarify as well. I'm assuming that you own this practice. Are you currently the only working doctor there, if so, approx how many hours are you working per week. Also, in your 18k of business overhead expenses, are you drawing a salary for your own Dr. hours? Yes, I an the only doc. Work about 30 hrs per week (office is open M-F 8:30-5 pm). Would gladly work more patient hours but the patients just aren't there. I could stretch them out with 30-45 minute time slots like many ODs do to make themselves feel busy but there is no reason with good tech support. You make the same $$ seeing 12 patients over 4 hours or over 9 hours...makes no difference. I could work late evenings and weekends but I have kids and would like to see them grow up. If I wanted to work till 8 pm, I'd have sold cars or something.

Could you also share a little more regarding the fee schedule for comprehensives, CL evals, and give us an idea of your pt payer breakdown(insurance, cash, etc). My private pay comprehensive exam fee is $130. New CL fit is $75. Insertion/removal training is $25. Medical visits vary. One insurance pays that full amount (Tricare). Medicare pays about $118 (for now) after fighting their secondary insurance for the 20%. Most old timers feel they should never pay anything just because they have lived 65 years on this earth. The rest of insurances pay less right down to United Health Care which pays me $35 for a comprehensive exam. Everything is filed electronically and insurance pay anywhere from 2 1/2 weeks to 6 months. Some never pay and patients will NEVER pay their balance. We spend $350 to file a small claims court case (for what, a $200 balance), then file with a collection agency. In 12 years, we've collected on one claim (out of maybe 50 we bothered to file). It's location depending but people in NC are free to write as many bad checks as they like. There is no penalty to them, thus many places have stopped taking personal checks. And when the gov't doesn't pay..........who do you complain to???

My office is about 25% Medicare, 20% Medicaid, 15% Tricare, 15% VSP, 5% cash and the rest various medical insurance such as United Health Care, BCBS, etc.....

I have 5 super Wal-marts, a Lenscrafters, Vision Works, Pearle Vision, JC Pennys, Sears (can't remember the rest) and 40+ ODs (most charging less) within 10 miles of my office offering MUCH lower exams prices.

One more thing, I was wondering how you net 140 on paper but take home 80. From what I understand, net income is the businesses bottom line after all expenses and taxes. What am I missing here?

It's complicated. Alot of real and imaginary benefits are implied in an S-corp. Like I say it's complicated and that's why you will pay an accountant MANY THOUSANDS of dollars a year. He won't know the rules for sure and neither will the IRS. So it's a game.

Thank you,
Jeffrey Chou

 

[Princeod2583]

- On paper, I netted $140,000. In reality, about $80,000. (S-corp accounting wonders).

So is that with all of your student loan/startup loans included?

 

[thiaeyemd]

not sure if this is helpful...but I know starting salaries for a pediatric ophthalmologist in washington D.C to be between 60 and 70K.

 

[Jason K]

Statistics? Numbers? Facts? Hmmmm.........here's some numbers to think about:

.....

It's not about complaining. It's about people giving you info we never got. Optometry is okay in 2011. But it won't be forever. Times are a changing. Think typewriter manufactuers. Think horse buggy makers. Think encyclopia salesmen.

For those of you who keep requesting hard data and numbers to back all the negative claims - there they are, right in front of you. Don't think you're smarter than basic math - the money has to come from somewhere.