more future speculating about optometry

[blobs]

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What exactly is the concern right now among the private practice docs about the future of private practice? I gather three main things.. corporate competition, medical insurance hating on you, and oversupply of OD.

It seems that all the people who would be getting their eyes checked at walmart already do, and the people who go to private practices will probably not switch to walmart unless their vision plan disappeared, since the copay (10-20 dollars?) is less than the 39 or 49 they charge at the cheapo commerical sites. Most "employed" people at middle class jobs have vision plans. In other words it seems the market has reached equilibrium in terms of the negative market influence of corporate places so this isn't really going to get any "worse".

The medical insurance thing, is that something which is "bad and getting worse", "bad but stable", or "bad now but improving slowly"? From the OD newsletters i got from the optometrist's office it seems its bad-but-improving but from what people on here say, especially Ken, its getting worse. Is the trick here simply to make phone calls to all your future locations and ask if you can get on the panel there?

Last is the oversupply thing.. anyone have a website containing cities and states with breakdowns of (OD * available hours * capita^-1)? I havent found one yet. The other thing is that tons of the new ODs are asian females (some of my friends) and they fully intend to work 20ish hours/wk max for most of their careers, and also have parents paying for their tuitions. Therefore although the number of ODs is large, the number of OD-labor hours is probably not increasing at such an enormous rate.

My own optometrist runs a very successful group practice containing 2-3 docs including himself at any given time and that's probably the situation I would want to be in eventually. How do you suggest I get into this position? His patient files are approximately 60% ortho-K, 40% regular contacts/glasses, personally sees about 8-10 patients a day and is booked full about 3 weeks forward. This is in the CA bay area suburbs with four other optometry places on the same block and ~20 others in a 3 block radius... and UC berkeley optometry school is 1 hour away. His money is almost exclusively from vision plans, medical plans, and Ortho-K sales. Nobody has paid upfront in several months, according to the front desk lady.

 

[Dr Gump]

What exactly is the concern right now among the private practice docs about the future of private practice? I gather three main things.. corporate competition, medical insurance hating on you, and oversupply of OD.

It seems that all the people who would be getting their eyes checked at walmart already do, and the people who go to private practices will probably not switch to walmart unless their vision plan disappeared, since the copay (10-20 dollars?) is less than the 39 or 49 they charge at the cheapo commerical sites. Most "employed" people at middle class jobs have vision plans. In other words it seems the market has reached equilibrium in terms of the negative market influence of corporate places so this isn't really going to get any "worse".

The medical insurance thing, is that something which is "bad and getting worse", "bad but stable", or "bad now but improving slowly"? From the OD newsletters i got from the optometrist's office it seems its bad-but-improving but from what people on here say, especially Ken, its getting worse. Is the trick here simply to make phone calls to all your future locations and ask if you can get on the panel there?

Last is the oversupply thing.. anyone have a website containing cities and states with breakdowns of (OD * available hours * capita^-1)? I havent found one yet. The other thing is that tons of the new ODs are asian females (some of my friends) and they fully intend to work 20ish hours/wk max for most of their careers, and also have parents paying for their tuitions. Therefore although the number of ODs is large, the number of OD-labor hours is probably not increasing at such an enormous rate.

My own optometrist runs a very successful group practice containing 2-3 docs including himself at any given time and that's probably the situation I would want to be in eventually. How do you suggest I get into this position? His patient files are approximately 60% ortho-K, 40% regular contacts/glasses, personally sees about 8-10 patients a day and is booked full about 3 weeks forward. This is in the CA bay area suburbs with four other optometry places on the same block and ~20 others in a 3 block radius... and UC berkeley optometry school is 1 hour away. His money is almost exclusively from vision plans, medical plans, and Ortho-K sales. Nobody has paid upfront in several months, according to the front desk lady.

My simple advice to you is get out of California and move to an area of need.

If you need a big city, you will have to deal with oversupply. If you can live within 2 to 3 hours of a city, find a niche and enjoy life. There will be no barriers to medical panels, only barriers to massive amounts of people.

 

[IndianaOD]

Sorry to say it for the millionth time, but its the image that corporate ODs give us that is the problem, not the competition.

 

[broadway]

I would say vision plans are more of a problem than medical plans. People not getting there eyes checked is another big problem.You wouldn't believe the number of people out there that have never had an eye exam. If everyone got an exam every year optometry's problems would be solved.

 

[KHE]

What exactly is the concern right now among the private practice docs about the future of private practice? I gather three main things.. corporate competition, medical insurance hating on you, and oversupply of OD.

The medical insurance thing, is that something which is "bad and getting worse", "bad but stable", or "bad now but improving slowly"? From the OD newsletters i got from the optometrist's office it seems its bad-but-improving but from what people on here say, especially Ken, its getting worse. Is the trick here simply to make phone calls to all your future locations and ask if you can get on the panel there?

Last is the oversupply thing.. anyone have a website containing cities and states with breakdowns of (OD * available hours * capita^-1)? I havent found one yet. The other thing is that tons of the new ODs are asian females (some of my friends) and they fully intend to work 20ish hours/wk max for most of their careers, and also have parents paying for their tuitions. Therefore although the number of ODs is large, the number of OD-labor hours is probably not increasing at such an enormous rate.

My own optometrist runs a very successful group practice containing 2-3 docs including himself at any given time and that's probably the situation I would want to be in eventually. How do you suggest I get into this position? His patient files are approximately 60% ortho-K, 40% regular contacts/glasses, personally sees about 8-10 patients a day and is booked full about 3 weeks forward. This is in the CA bay area suburbs with four other optometry places on the same block and ~20 others in a 3 block radius... and UC berkeley optometry school is 1 hour away. His money is almost exclusively from vision plans, medical plans, and Ortho-K sales. Nobody has paid upfront in several months, according to the front desk lady.

In my opinion, commercial practice is not a threat to private practice, and is little more than an annoyance.

It is also my opinion that medical insurance accessibility is by far and away the biggest issue facing the profession of optometry. It's difficult to say if it's "bad" or not because if you are in area where you can gain access, then you are golden. If you are not, you are screwed. On the whole, there are far too many areas where ODs still can not gain access, and it is not a good omen.

Oversupply and a future increase in oversupply is the second biggest issue. To me, this issue is further compounded by our professional organizations who won't even acknowledge the problem out of a completely irrational fear of anti-trust litigation and by a select group of people who stunningly feel that we actually have an UNDERsupply.

As far as how to get involved in a large group practice, I can't offer any advice except to say be willing to relocate, and when you find an office you are interested in joining, get everything in writing.

 

[KHE]

I would say vision plans are more of a problem than medical plans. People not getting there eyes checked is another big problem.You wouldn't believe the number of people out there that have never had an eye exam. If everyone got an exam every year optometry's problems would be solved.

This is basically true, but the fact is it's never going to happen. And this is where the biggest disconnect between practicing ODs out in the trenches actually trying to keep a clinic running and the AOA comes from.

According to the AOA, every soul needs a comprehensive eye exam each and every year from an OD. That is their definition of "need."

However, the fact is that a tremendous number of people DON'T GET THEM. Even people with vision problems will put off examinations for months, or even years at a time. People without vision problems will go years without an exam. Many people get their "eye exams" from sources other than ODs....the school nurse....the pediatrician.....ophthalmologists....the nurse at their company etc. etc. So the DEMAND is much less than the AOAs theoretical concept of "need" This is the biggest source of disconnect.

 

[blobs]

In my opinion, commercial practice is not a threat to private practice, and is little more than an annoyance.

It is also my opinion that medical insurance accessibility is by far and away the biggest issue facing the profession of optometry. It's difficult to say if it's "bad" or not because if you are in area where you can gain access, then you are golden. If you are not, you are screwed. On the whole, there are far too many areas where ODs still can not gain access, and it is not a good omen.

Oversupply and a future increase in oversupply is the second biggest issue. To me, this issue is further compounded by our professional organizations who won't even acknowledge the problem out of a completely irrational fear of anti-trust litigation and by a select group of people who stunningly feel that we actually have an UNDERsupply.

As far as how to get involved in a large group practice, I can't offer any advice except to say be willing to relocate, and when you find an office you are interested in joining, get everything in writing.

about the medical insurance thing: does it fluctuate in a given area? I'm more interested in the national trend for medical insurance acceptance of OD, so that if I start a practice that is somewhat kept alive by medical reimbursements, the insurance doesnt someday randomly pull the plug and drop all ODs i the area.

if the trend is for increasing acceptance of ODs on these panels then its not so bad since you can just pick an area where its good, like KHE says, but if ODs everywhere are slowly getting cut and there's a downward trend, then thats no good since even if you get a good area you stand a chance of getting screwed at an arbitrary time in the future.

about joining private practice:

so there two ways to join one of these things right, as a partner where you own an equity share, and as an associate, which is an employee. an associate seems basically like a less hours, less paid, more enjoyable version of commercial optometry, but is a step that is a good to build experience and hopefully get a buy-in later (if everything is in writing). is this impression correct?

to become a partner, you basically have to "buy in" to a share of all the equipment and rent and management duties and whatnot, and after that you're an owner and make whatever the practice makes minus expenses, correct? I went on the palcement websites for the schools and saw that lots of the private practice opportunities have a vague "possible buy-in at a future time" comment like a dangling carrot. KHE tells us that these are bad unless you get a written contract on hiring that says someethig like "Mr. Jones will sell 45% of his practice to me by June 18th, 2010 or he pays me 500k in penalty".

 

[Ben Chudner]

if the trend is for increasing acceptance of ODs on these panels then its not so bad since you can just pick an area where its good, like KHE says, but if ODs everywhere are slowly getting cut and there's a downward trend, then thats no good since even if you get a good area you stand a chance of getting screwed at an arbitrary time in the future.

If the ERISA legislation ever passes, then OD's could be in trouble. Otherwise, the trend seems to be for states to push for "any willing provider" laws. If they are succesful then OD's will benefit.

 

[Ben Chudner]

Sorry to say it for the millionth time, but its the image that corporate ODs give us that is the problem, not the competition.

Saying it for the millionth time does not make it true. In my opinion, it's the competition not this paranoid belief that corporate OD's affect our image.

 

[KHE]

about the medical insurance thing: does it fluctuate in a given area? I'm more interested in the national trend for medical insurance acceptance of OD, so that if I start a practice that is somewhat kept alive by medical reimbursements, the insurance doesnt someday randomly pull the plug and drop all ODs i the area.

if the trend is for increasing acceptance of ODs on these panels then its not so bad since you can just pick an area where its good, like KHE says, but if ODs everywhere are slowly getting cut and there's a downward trend, then thats no good since even if you get a good area you stand a chance of getting screwed at an arbitrary time in the future.

I don't know if there is a national "trend" or not. If anything, it is probably slightly in the direction of MORE ODs being allowed access but a dangerous trend we are starting to see is that you can only gain admission onto medical plans by also signing on board for some horrible vision plan like Spectera or Davis. Not a good situation at all.....The issue of possibly being dropped in the future is always there, but I think a bigger concern would be that insurance companies will continue to try to drive down reimbursements, not that they will comletely pull the rug out from under you but that's always possible.

about joining private practice:

so there two ways to join one of these things right, as a partner where you own an equity share, and as an associate, which is an employee. an associate seems basically like a less hours, less paid, more enjoyable version of commercial optometry, but is a step that is a good to build experience and hopefully get a buy-in later (if everything is in writing). is this impression correct?

to become a partner, you basically have to "buy in" to a share of all the equipment and rent and management duties and whatnot, and after that you're an owner and make whatever the practice makes minus expenses, correct? I went on the palcement websites for the schools and saw that lots of the private practice opportunities have a vague "possible buy-in at a future time" comment like a dangling carrot. KHE tells us that these are bad unless you get a written contract on hiring that says someethig like "Mr. Jones will sell 45% of his practice to me by June 18th, 2010 or he pays me 500k in penalty".

You're basically correct about all this....

The idea of the possible buy in are not "bad" per se, if you go into them the right way. What are you looking for? What is the owner doctor looking for?

If the owner doctor is looking for a partner, and they are SERIOUS about wanting a partner, then they should be willing to specify the terms and conditions under which they will allow an associate to buy in. They can be whatever you want....certain revenue targets met, certain number of new patients in the office etc. etc. Whatever works....but I would proceed with caution because my experience has been that most of these people aren't really looking for some to buy in, they are looking for an associate doctor. When going into the negotiations, YOU as the junior doctor need to bring something to the table...you want to buy in but what are YOU going to bring to the table other than a warm body and a license to practice?

 

[JAZZEYE]

If the ERISA legislation ever passes, then OD's could be in trouble. Otherwise, the trend seems to be for states to push for "any willing provider" laws. If they are succesful then OD's will benefit.

Dr. Chudner.....please elaborate on how ERISA works and how would that have a negative impact on OD's ?

 

[Ben Chudner]

Dr. Chudner.....please elaborate on how ERISA works and how would that have a negative impact on OD's ?

ERISA stands for Employee Retirement Income Security Act. ERISA preempts all state laws that relate to any employee benefit plan. If the previously proposed legislation ever goes through all health care plans would fall under ERISA thereby eliminating the "Any Willing Provider" laws that some states have. If that happens, providers can be denied access onto medical panels based on their specialty. Considering that OD's are not allowed on medical plans in several states currently, I imagine that the same thing would happen in the AWP states.

 

[student2008]

ERISA stands for Employee Retirement Income Security Act. ERISA preempts all state laws that relate to any employee benefit plan. If the previously proposed legislation ever goes through all health care plans would fall under ERISA thereby eliminating the "Any Willing Provider" laws that some states have. If that happens, providers can be denied access onto medical panels based on their specialty. Considering that OD's are not allowed on medical plans in several states currently, I imagine that the same thing would happen in the AWP states.

Can someone please explain the "any willing provider" law in more detail? I gather this means any health care provider can get onto medical insurance panels by law, is this correct? if so, what does ERISA have to do with this law? I don't see the connection. Sorry I'm kinda slow.

 

[362.04]

Dr. Chudner.....please elaborate on how ERISA works and how would that have a negative impact on OD's ?

ERISA's history (source: http://www.dol.gov/ebsa/aboutebsa/history.html) was originally about pension plans and was expanded beyond that to employee benefits. In a nutshell state or local legislation, statute or regulation cannot supersede ERISA's employer-run heath plans. The administrators of the health plan are just that, they do not set the benefit level or the type of provider who can provide that benefit to its employee.

Thus "any willing provider" law was originally a concept to confront another issue of medical physicians and surgeons who were shut out of medical panels and plans and was only recently expanded to include non-physicians and surgeons (or tried to). In my opinion, the any willing provider law is ineffective or even irrelevant to ERISA plans

 

[Ben Chudner]

In my opinion, the any willing provider law is ineffective or even irrelevant to ERISA plans

I agree. ERISA plans are not subject to AWP legislation. In the states that have this legislation (I practice in one), AWP has been very effective in making sure OD's can get on any open panel (non-ERISA plns). We have had several instances where an insurance panel claimed to be closed only to find out it was closed to OD's only. Our state association has been very successful in fighting to make sure those plan reopen to OD's.