my rant on the current state of optometry...

[posner]

After attending a meeting/dinner last evening honoring the many achievements of our school nurses and their efforts to help elementary school children in our county I quite accidentally stumbled upon this forum. After reading several threads and posting a few responses I thought long and hard about many of my colleagues from last evenings dinner and the state of the profession. I must say I was quite disappointed with the profession I have chosen.

Let me start by saying, I have been in practice for a little more than six years since finishing my residency. I worked as an associate in a very successful multi-doctor/multi office practice for 2 years and then bought out the senior partner 3.5 years ago. I have a partner and we have two full time Ods wokring for us and ophthalmology that leases space in one of our offices 1.5 days a week. Optometry has been very good to me.

I could have sold out to corporate optometry to spin dials, have no control over my career, and also leave myself little upward mobility. However, I knew I wanted to call my own shots, I believed there were great opportunities, and I refused to settle for less. I worked my ass off my first year out of school, learned how to run a business from a wise man, and was able to make about $87,000 that year. I knew I had to work much smarter if I ever really wanted to make any money. I wrote a major grant proposal to our county to secure funding for preschool children. It wasnt much(about $80,000 over three years) but it was a great opportunity to do a good service, network, and get a little income while I was out of the office building my practice. I joined the serive clubs, volunteered for everything and met every MD, DC, DDS, etc. It wasnt long before I had a significant volume of patients to really start building a practice. I waited for a few years for the new cars and big house and I sought ownership in our office buildings. I marketed heavily from within, and heavily embraced the medical model. I always made sure(and still do) patients know what I can do, I am on call on the weekends for emergencies, and have developed a wonderful relationship with several local opthamologists. I would mark out an occasional morning to go see patients with a local retina guy, glaucoma specialist, or corneal specialist. I proved to them I was competent and made it very clear that I expected each of my patients back after their surgeries, etc.

I have always made sure I looked professional(not dockers with a wrinkled collared shirt) even when I couldnt afford nice clothes. I always iron my shirts, comb my hair, try to look successful, and I am sure to hire good staff. Patients notice and appreciate this. They do not want to see a doctor that looks like he/she pushes a shopping cart around town after hours. I have embraced technology; we bought an OCT, 8 Mega pixel digital cameras for our offices, fancy phoropters, etc and I am sure to take every opportunity to explain as much as I can to each patient. And you know what? Patients come back again and again and they send everyone they know to me!

The point to all of this is not to pat myself on the back, but to try and let everyone out there know that it is possible to be successful in optometry. Listen to patients, and refuse to be average. Stop whining there is no money in optometry.. I believe there is plenty of money but very few MONEY MAKERS in optometry. Never feel inferior to OMDs...there are as many if not more bad surgeons out there. You are capable of treating 95% of every eye patient that exists.

I say all these things as I prepare to catch a flight tomorrow to Las Vegas. I will see many colleagues who will blame everyone but themselves for thier failure to earn a good living in optometry. Thankfully, I will also see a few colleagues that believe as I do- that there is a good career to be had in optometry.

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[alferec]

Hi posner - just curious, but where are you practicing?

Also, for some reason I'm not exactly seeing the "rant." What exactly is your disappointment with the field? Is it the negativity that you see in these forums?

 

[DrSpontaneouz83]

Posner,
Congratulations on your efforts to succeed, it looks like you've managed. It's nice to see a post like that, this place can really make you start doubting yourself and your career choice. I am applying/have applied to Optometry schools this month and hope after all is said and done that I'll have the same outcome. I completely agree about sitting your ass off in an office limiting yourself to mundane tasks, I want to practice, research, and possibly even become a professor at an optometry school. I am an ophthalmic assistant and our practice just hired a fresh-out-of school optometrist and she seems so uninterested and bored in what she does, it upsets me because I often wonder if that will be my fate. I will definitely try to become an entrepreneur and branch out to keep my career interesting and hopefully financially satisfying. But at any rate, thanks for restoring some hope in us OD hopefuls who actually have a passion for the field.

 

[KHE]

After attending a meeting/dinner last evening honoring the many achievements of our school nurses and their efforts to help elementary school children in our county I quite accidentally stumbled upon this forum. After reading several threads and posting a few responses I thought long and hard about many of my colleagues from last evenings dinner and the state of the profession. I must say I was quite disappointed with the profession I have chosen.

Let me start by saying, I have been in practice for a little more than six years since finishing my residency. I worked as an associate in a very successful multi-doctor/multi office practice for 2 years and then bought out the senior partner 3.5 years ago. I have a partner and we have two full time Ods wokring for us and ophthalmology that leases space in one of our offices 1.5 days a week. Optometry has been very good to me.

I have embraced technology; we bought an OCT, 8 Mega pixel digital cameras for our offices, fancy phoropters, etc and I am sure to take every opportunity to explain as much as I can to each patient. And you know what? Patients come back again and again and they send everyone they know to me!

The point to all of this is not to pat myself on the back, but to try and let everyone out there know that it is possible to be successful in optometry. Listen to patients, and refuse to be average. Stop whining there is no money in optometry.. I believe there is plenty of money but very few MONEY MAKERS in optometry. Never feel inferior to OMDs...there are as many if not more bad surgeons out there. You are capable of treating 95% of every eye patient that exists.

I say all these things as I prepare to catch a flight tomorrow to Las Vegas. I will see many colleagues who will blame everyone but themselves for thier failure to earn a good living in optometry. Thankfully, I will also see a few colleagues that believe as I do- that there is a good career to be had in optometry.

Let me point out a few things in response to this post.

There is no doubt that I have been one of the more negative posters on these forums. However, I want to remind everyone that I have never EVER said that success in optometry is not possible or that there is no money in it. In fact, I have empasized on more than one occasion that you CAN in fact make a good living in optometry.

The above poster describes what they have attained and I'm sure that many of the current or prospective students are reading that and thinking to themselves "Oh yeah! I would like to be like THAT one day."

You very likely CAN.

However, this posting underscores the main theme that I have harped on to you guys, and what is that?? ALL TOGETHER NOW BOYS AND GIRLS!

YOU MUST PRACTICE IN AN AREA OF THE COUNTRY WHERE YOU CAN BE ADMITTED ONTO MEDICAL INSURANCE PLANS!!

The OP has described some of the fancy technologies that they have in their office. For those of you not familiar with OCT, it is an advanced diagnostic instrument that is very expensive.

However I am willing to bet $100 that the poster and his practice are able to accept and bill the majority of MEDICAL insurance plans in his or her area. That's what I'm trying to tell you guys.

Not being able to take insurance plans = patients not coming through your door regardless of how nice you dress or how nice your staff is. No one is going to pay an OD $600 out of pocket for a glaucoma evaluation when they can have it done be a fellowship trained glaucoma specialist accross town for a $10 copayment.

So kudos to the OP for his or her successes. But read between the lines. YOU NEED TO ACCEPT MEDICAL INSURANCE PLANS.

I too will be in Las Vegas tomorrow for the conference. I hope that those who go have good luck and remember to always lay full odds on the DONT PASS line.

 

[cpw]

Have a blast in Vegas guys !! I have two classmates who will be there together. I wish I could be there. Maybe next year. This year, I'm stuck covering for someone else so they could go Oh well.

 

[posner]

KHE you are absolutely right about being able to bill insurance plans..it is essential to our success in my offices. WE do have a relatively large cash paying patient base in one of our offices(about 56%). In our other office it is just shy of 40%.

I practice in california, which is where I was born and have lived for almost all of my life. The purpose of this post was to hopefully let others know that in spite of all the negativity and lack of success that seem to be shared bymany ODs, optometry can still be a very rewarding profession. I am just sick and tired of seeing ODs tht refuse to exude success and then complain about not making a good living. Look at any OD that you know that is successful, pay attention to how he or she runs their business. I was trying my very best not to come across as an arrogant jerk when I first posted, so I turned what I felt was going to be a rant into more of an attempt to encourage those that have not lived up to what they thought was possible and to encourage those who may be considering optometry as a career.

I will be in LaS Vegas this evening by about 8:00. I take 4 or 5 of the girls in the offices each year and try to show them a good time. I will be at the Venetian, usually in the lounge for an hour or so after classes end. If any of you are planning to attend, PM me and I will be happy to buy you a drink and shoot the breeze.

 

[drmhyde]

I love optometry...it's a great field and it means different things for different people. If you don't like it..do something else. It's that simple. If you think you are going to "get rich" in optometry, you are fooling yourself. You'll make a good living..your probably going to do better than most. My best friend is an Orthopedic surgeon...geez..he's not even rich. The days of docs being stinking rich is WAY over. I say diversify. We invest in real estate and me and a couple of buddies are planning other side businesses. I do optometry because I'm good at it , I like it and whne I stop feeling that way..I will exit and do oher things that I like (and are way more profitable). Maybe I'll be a rock star...get your lighters ready!!!!!!!!!!!!

 

[posner]

The only real friends I have that are "rich" (earning in excess of $1 million per year) are relatively uneducated and in no way involved in health care. Funny isnt it? I agree with Hyde, use optometry as a avenue to get into other business opportunities. That is why we have invested in alot of real estate and socked away alot of money for other opportunities should they arise. Optometry has given me the chance to participate in some great investments that would not have been possible if I was working as a prison guard for $60K a year.

 

[Ben Chudner]

I will be in LaS Vegas this evening by about 8:00. I take 4 or 5 of the girls in the offices each year and try to show them a good time. I will be at the Venetian, usually in the lounge for an hour or so after classes end. If any of you are planning to attend, PM me and I will be happy to buy you a drink and shoot the breeze.

Since you are buying, I'll be there. Without trying to sound like I am pushing my status as a "guru" , if anyone happens to show up to my lecture on Thursday, make sure to introduce yourself. It's always nice to put a face with the screen names.

 

[posner]

I did not register for your class on thursday, but nonetheless, I will still be found in the venetian lounge most evenings and the offer still stands to buy you a drink. I will be easily spotted...there will be about 7 of us at a table and I will likely be wearing some variation of camo shorts and a button down shirt. See you there.

 

[Ryan_eyeball]

I did not register for your class on thursday, but nonetheless, I will still be found in the venetian lounge most evenings and the offer still stands to buy you a drink. I will be easily spotted...there will be about 7 of us at a table and I will likely be wearing some variation of camo shorts and a button down shirt. See you there.

Posner,

Thanks for creating this thread, but I had a question for you. I believe you said you were practicing in Cali? Maybe I'm understanding this wrong but I didn't think OD's in Cali could be on medical panels? Or are you only able to take medicare but shut out of the others like BC/BS, United health care, Cigna? I think KHE has makes a great point every time about really making the income go up by living in an area that allows you to get on medical panels.

Do you all have a retinal camera, and if so do you recommended one particular brand. I remember practicing over the summer with an OMD that had a nice retinal camera (digital) that displayed the images right onto a computer screen, and then we just saved them.

Have fun in sin city.

 

[jlc111]

1

 

[prettygreeneyes]

Dear Posner,

Do you think that you are doing any favor to prospective optometry students by telling your successful story? All of us know that it is possible to be very successful and make tons of money in optometry. However, on the average, the chance for achieving it is small when compared to other health professions. I’m quite that that there are many millionaires in Bangladesh, but the chance of becoming one is greater in a more affluent country.
Every prospective optometry students should be aware of this so that they go into optometry because they understand and like the profession, and that optometry does not attract (as you said) ‘so many underachievers’ who come to optometry thinking that they can make a lot of money without hard work.

We must paint a realistic picture of the state of optometry.

So... no one should share their success story because it might makes us dumb students think we could be...successful???

Maybe the school I attend is different, but I don't think anyone stood up at orientation and proudly proclaimed that they chose optometry because it was so easy to make money.

Give us a little credit. Everyone who regularly posts on these forums realizes that this will be a lot of hard work, and that we have to have very specific plans before we even start school. And, we realize that making tons of money is unrealistic.

 

[WoodyJI]

...it is possible to be very successful and make tons of money in optometry. However, on the average, the chance for achieving it is small when compared to other health professions. I’m quite that that there are many millionaires in Bangladesh, but the chance of becoming one is greater in a more affluent country.

This seems like a typical "grass is always greener" attitude...can you support your implication that Optometry is a much less "affluent" profession compared to other health professions with anything other than just your opinion? The average chance of being one of the "successful people" in whatever field you choose is always small, right? There's no single profession where everybody goes in and, just through the "affluence" of the job, is handed everything on a silver platter. I know you don't mean to imply that success should just be given to Optometrists, but how do you differentiate between normal difficulties achieving success anywhere and relative "affluence" of various professions? I'm not going to sit here and go, "Damn, those Radiologists just get out in the job market and are instantly in demand and successful..." when they had to land a highly competitive 5 year residency slot after going through 4 years of med school just to start working. So whatever comparisons you make need to be fair too...if you want to try and say Dentists, Pharmacists, Podiatrists, Nurses, PA's, etc. go ahead and try to explain it to me, but I really don't know what other "more affluent" health professions you're referring to here, unless you mean Plastic Surgeons...they make a lot of money pretty easily, right?

 

[jlc111]

1

 

[yanky5]

I agree with "the grass is greener on the other side" saying. Most doctors don't make 500k a year. The average salery of a primary care doctor (Internist, peds, Family medicine) is 100-130k/yr nation wide out of school. So if you could make 90k a year in optometry, it is a decent salery given the short amount of training you are given. Us medical school guys have 4 yrs of Medical School plus 3+ yrs of residency. You guys are just too greedy. I like primary care and will probably be a general internist so 110k is fine. No need to be so greedy, do what you like peeps.

 

[jlc111]

I agree with "the grass is greener on the other side" saying. Most doctors don't make 500k a year. The average salery of a primary care doctor (Internist, peds, Family medicine) is 100-130k/yr nation wide out of school. So if you could make 90k a year in optometry, it is a decent salery given the short amount of training you are given. Us medical school guys have 4 yrs of Medical School plus 3+ yrs of residency. You guys are just too greedy. I like primary care and will probably be a general internist so 110k is fine. No need to be so greedy, do what you like peeps.

The gross is $500,000, and since he's most likely netting about 30%-40%, his income is $150,000 -$200,000 which is very reasonable for a busy dentist...

 

[WoodyJI]

I think both of you have brought up really good points here. Wouldn't the fact that dentistry closed 5-6 dental schools and reduced the class sizes by 20% about 20 years ago mean that right now it's harder to get into dentistry school than optometry school? If so, perhaps they "deserve" that extra income on a whole for managing their profession better...I don't know. What does organized dentistry have that organized optometry doesn't? How were they able to make those changes, and why hasn't the collective field of optometry hasn't learned from dentistry and taken enough action?

Another question: can anybody tell me what the secret is to getting onto vision plans, just for future reference? Why is this such a hard thing for optometrists to do? It seems like if there's one thing organized optometry is doing, it's constantly fighting for legislation producing an increase in scope of practice. At least, that's what a lot of the talk seems to be about. I also hear plenty of stories about how far the profession has come in just a generation or so. What causes this difficulty with insurance companies, and how are some optometrists able to do it and others are not? I don't want to seem greedy, but I would like to be able to have a private practice and keep it afloat. Sure I don't need $500k at the end of the day, but it would be nice if that were an option, right? In the end, most people will practice their chosen profession regardless of the compensation (take musicians for example) but it doesn't seem right for optometry to slide into not being worth the money/effort of 4 years just to work in a vision mill. What do pharmacy students think of working for corporate? Perhaps we can learn from the collective path they've taken since their training is similar to ours as well.

 

[Hines302]

Another question: can anybody tell me what the secret is to getting onto vision plans, just for future reference? Why is this such a hard thing for optometrists to do?

I am going to assume you met to type MEDICAL plans as opposed to vision plans.

It does seem odd and almost counterintuitive that OD's have trouble being admitted onto medical plans in the sense that OD's can provide some of the same medical services more conveniently, and sometimes less costly than compared to an OMD. So why would insurance companies not want OD's on their panels if it would make eye care more convent for patients and less costly???

The only reason I can think of is that there must be very influential MD's who sit on the executive boards of most of these companies.... (or have very close ties to them) ... and they want to protect market share.

I'm not sure... ?? but this is my best guess.

 

[posner]

In california, we are able to participate on most plans...BC/BS/United/cigna, etc etc. I never realized how lucky we are. I have always thought of CA as being behind the times.

I would also like to take the time to respond to the grass is greener crowd. There are many MDs that do not make a ton of money. Most or many of my friends around here are Mds, dentists, or other OD's. Of these guys, I find the dentists tend to do pretty well across the board. With the rest of them, they vary widely. One of my really close friends is an MD and does quite well in family practice(a discipline that many think is tough to really do well in). The cardiologist I know well has been in practice about 7 years and makes about $200K(quite a bit less than myself and my friend in family practice). SO the point is, the grass is not always greener!

As an OD you should never feel as though there is a ceiling to your earning potential, no matter what the major publications say is the average income. I apologize if sharing my success with the group makes it seems like I am boasting or being unrealistic. The point was, I started out 6 years ago just like every one of you. I didnt have a practice to walk into out of residency, and nobody was bank rolling me. I did better than many my first year out, but was by no means a high income earner. The past 3-4 years have been great. I bought our senior partner out and we have continued to grow by 10-12% per year(much of this has been due to increasing the medical aspect of our practice). Those of you that sell your souls to doc-in-the-boxes have only yourselves to blame in many cases. Not only do you shoot the future of optometry in the leg, you doom yourself to the golden handcuff phenomenon(when you cant afford to leave the dial spinning to get into private practice).

For those of you that want to sit on your asses and talk about there being no money in optometry, that's fine. But, it is your own fault and not the fault of the profession. I was so glad to talk with some other OD's this weekend who were doing well. There are many of them out there, in spite of what many of the whiners on this board may think and it was refreshing to hear their stories. Every patient you see is an opportunity to provide a good service and to generate a good income. I would be more than happy to share some of our practice's procedures and strategies with those that may be interested.

By the way Ben, you didnt take me up on the drink this weekend in Vegas. I was at the same bar in the Venetian thursday and friday evening. Maybe next time?

 

[posner]

jlc111- I meant to more directly address your post earlier. No I dont think I am doing a disservice to prospective students or new graduates. I do however feel that you are the one doing the disservice. Just because you cannot or have not managed to either earn a good income or to associate with other OD who have, doesnt mean you should paint a picture of dispair for others. I do feel like I have alot to share with others on this board. Not because I am any better, but because I have learned from my experiences and would like others to do well also. I like the profession of optometry. I would like to see the whiners go away an make room for others that want to take the ball and run with it.

And for the other poster who was referring to ODs being greedy. I would also like to disagree. Just because you are ready to settle for $110K as an MD doesnt mean the rest of us(who didnt do a 3 year residency) should automatically make less money.I sure am glad that noone ever showed me the profession based income ceiling.

 

[Ben Chudner]

By the way Ben, you didnt take me up on the drink this weekend in Vegas. I was at the same bar in the Venetian thursday and friday evening. Maybe next time?

Next time for sure. I was stuck in meetings most of the weekend that ran into the evenings and included dinners.

 

[Ben Chudner]

It does seem odd and almost counterintuitive that OD's have trouble being admitted onto medical plans in the sense that OD's can provide some of the same medical services more conveniently, and sometimes less costly than compared to an OMD. So why would insurance companies not want OD's on their panels if it would make eye care more convent for patients and less costly???

The insurance company is willing to pay a certain amount for every procedure which is based on the RBRVU year they choose and their conversion factor. There is no difference in the amount they are willing to pay based on provider type. The only way it will be less expensive for the insurance company to use OD's would be if the OD's fees were too low, therefore requiring them to pay less than what they are willing to pay. Now the reality is that many OD's fees are too low, but the insurance companies cannot count on that because if the OD's did raise their fees, they would be forced to pay them the same as the MD's. When you then take into account that OD's must refer out a lot of patients for treatment in some states (such as California where not all OD's have obtained their glaucoma certification) the expense can actually be higher for the insurance companies. This is because not only will they have to pay for the exam done by the OD, but then they would have to pay for another exam (a consultation which pays even more) by the specialist. I haven't done the research, but I suspect that the states in which it is more difficult to get onto medical plans (and California is one) are those where the law is either behind the rest of the country or only recently expanded. I would assume that the ability to successfully lobby for expanded scope is related to the ability to lobby for an "any willing provider" law.

 

[Hines302]

The insurance company is willing to pay a certain amount for every procedure which is based on the RBRVU year they choose and their conversion factor. There is no difference in the amount they are willing to pay based on provider type. The only way it will be less expensive for the insurance company to use OD's would be if the OD's fees were too low, therefore requiring them to pay less than what they are willing to pay. Now the reality is that many OD's fees are too low, but the insurance companies cannot count on that because if the OD's did raise their fees, they would be forced to pay them the same as the MD's. When you then take into account that OD's must refer out a lot of patients for treatment in some states (such as California where not all OD's have obtained their glaucoma certification) the expense can actually be higher for the insurance companies. This is because not only will they have to pay for the exam done by the OD, but then they would have to pay for another exam (a consultation which pays even more) by the specialist. I haven't done the research, but I suspect that the states in which it is more difficult to get onto medical plans (and California is one) are those where the law is either behind the rest of the country or only recently expanded. I would assume that the ability to successfully lobby for expanded scope is related to the ability to lobby for an "any willing provider" law.

makes sense. thanks for explaining that Ben

 

[Elfego Baca]

Did Posner say what part of California he practices in? It's a big state. My bet is that he's in some place like Weed, Needles, or Barstow -- not in Laguna Beach, Palos Verdes, or San Francisco.

 

[posner]

You are incorrect Elf. I am on the central coast here in CA.

 

[KHE]

I have been practicing optometry for 15 years, and I feel that I am very lucky. I took a chance and opened cold very soon after graduation when getting onto vision plans was not difficult, and I am doing O.K. financially (I make well over $100,000). However, I do see a lot of my colleagues, especially recent graduates, struggling. It seems like they don’t see any alternative to working in a vision mill even though they hate it. In my area, I saw 3 failed optometry practices within past 2 years. The primary reason for the failure was that they were not able to get onto vision plans. KHE has mentioned many times that YOU MUST PRACTICE IN AN AREA OF THE COUNTRY WHERE YOU CAN BE ADMITTED ONTO MEDICAL INSURANCE PLANS” to have a chance to have a successful practice. The reality is that in most metropolitan areas you will not only have a very difficult, if not impossible, time getting onto medical plans, you will also have very difficult time getting onto vision plans that pays $30 for a routine eye exam. As KHE likes to say “not being able to take insurance plans = patients not coming through your door regardless of how nice you dress or how nice your staff is. No one is going to pay an OD $600 out of pocket for a glaucoma evaluation when they can have it done be a fellowship trained glaucoma specialist across town for a $10 co-payment” or pay $80 for an eye exam and $200 for a pair of eyeglasses when they can go to an O.D. who takes their vision plan and pay only $20 co-payment.

So this is the reality of the two professions that have the similar training in terms of length and rigor, but have a huge difference in income and ability to own a private practice.

As I said, I hope that students will go into optometry because they truly understand and love the profession while fully knowing the current state of the profession. And, those students, who are only thinking about optometry because they think that it is a good path to make a comfortable living, they should know that there are many careers in and out of health-care field that offer easier and shorter training and better prospect than optometry.

I just returned from Vision Expo in Las Vegas. WHile there, I attended two practice management courses, one of which was titled "How to be a million dollar practice" or something like that and the other one I forget but had the same basic theme: Growing your practice to be large a successful.

The theme of both courses was identical. Do heavy medical billing. The instructors lamented that most ODs refer out too much and don't do enough advanced testing and treatment.

That may be true, but once again, if you can't get on insurance plans good luck doing heavy medical billing. Some people in the audience pointed this out and the person conducting the course basically shrugged and said they were aware that this situation exists in large parts of the country. For those people unable to obtain access to medical plans, the suggestion was to prescribe lots of Crizal Alize (a high end AR coating.)

So there it is again students.....PRACTICE WHERE YOU CAN GET ON MEDICAL PLANS!

I know that there was a poster on here one time who claimed that he or she wanted to open and own a high end fashion optical. That's fine and dandy. Nothing wrong with that except for the fact that you don't need 8-9 years of post secondary education to open a high end optical. Go to community college, get your opticians certificate and do that if its what you want.

For the rest of you who have any notion of doing anything even remotely resembling medical management of any of your patients, you better get your butts on some medical insurance plans or you will doom yourself to a career of providing routine care and competing with lenscrafters and walmart and you will pay well over 100k for the honor of doing so.

 

[Ben Chudner]

The theme of both courses was identical. Do heavy medical billing. The instructors lamented that most ODs refer out too much and don't do enough advanced testing and treatment.

Something that is also lost on most of the guys making a living giving lectures on how to make a living is that for the majority of optometric practices in this country, there just isn't enough disease to sustain a practice. Yes, there are those practices that see a ton of medical, but the average practice out there is mostly routine, and not necessarily by choice.

 

[posner]

I would argue your point Ben. If there is one thing I learned when I used to spend time in the offices of my Ophthalmology friends, it is that they see very many of the same patients we see. They bring thier dry eye patients back and treat them aggresively, they use punctal plugs, dilate and irrigate puncta, follow and perform tests on the glaucoma and glaucoma suspects, put their ARMD patients on AREDS vits and bring them back periodically, etc, etc. They photograph a nevus and monitor it, the same for lattice. THey bring those patients back for additional testing including scleral depression. THey treat iritis patients, and bring them back to follow up, etc etc. Follow your diabetics, bring them back for extended ophthalmoscopy when indicated. I could go on and on. YOu are right there are not a ton a patients with exotic retinal parasites or syndromes, but there is a ton of disease if you change your definition of disease. Treat your allergy sufferers, and bring them back to follow them(like your own doctor may do with you).

Today is a great example. I was in the office with our ophthalmologist. He saw 32 patients and I saw 25. Of his patients, 7 were primary care exams, 6 were post ops of one type or another, a few FREE lasik consults(referred by me of course) a few glaucoma visits, a red eye or two, and a couple diabetic checks. Not exactly a day in the OR. My patients were 11 primary care exams(2 of which are coming back in 2 weeks for additional testing), 4 glaucoma checks including OCT,30-2 fields,and gonio, a few dry eye patients, 4 complete contact lens evluations, some dilated retinal exams/diabetic checks, a couple red eye patients, and a post lasik. Gross receipts for the day including optical were $4960. That was just me and only in one of our offices. One of the doctors that works for me was in the other office seeing patients and my partner and our other associate are on vacation. YOu can see what can hapen when there is more than one doctor in the office and multiple locations.

My point is these patients are already soming to see you, but you dont recognize or listen to their problems because you want to put glasses on their face. Treat these people and they will send their friends and family who will also see you and purchase your goods and services. It is not that hard. Start by trying to develop 2 medical patients per day. Once you get the hang of it, 2 becomes 4 becomes 6, etc. I know what KHE is going to say about medical plans...he is right if you cant bill insurances you are going to have some trouble. If you want to ignore 60-70% of your schooling and only prescribe glasses and contacts so be it.

 

[Ben Chudner]

I would argue your point Ben. If there is one thing I learned when I used to spend time in the offices of my Ophthalmology friends, it is that they see very many of the same patients we see. They bring thier dry eye patients back and treat them aggresively, they use punctal plugs, dilate and irrigate puncta, follow and perform tests on the glaucoma and glaucoma suspects, put their ARMD patients on AREDS vits and bring them back periodically, etc, etc. They photograph a nevus and monitor it, the same for lattice. THey bring those patients back for additional testing including scleral depression. THey treat iritis patients, and bring them back to follow up, etc etc. Follow your diabetics, bring them back for extended ophthalmoscopy when indicated. I could go on and on. YOu are right there are not a ton a patients with exotic retinal parasites or syndromes, but there is a ton of disease if you change your definition of disease. Treat your allergy sufferers, and bring them back to follow them(like your own doctor may do with you).

Today is a great example. I was in the office with our ophthalmologist. He saw 32 patients and I saw 25. Of his patients, 7 were primary care exams, 6 were post ops of one type or another, a few FREE lasik consults(referred by me of course) a few glaucoma visits, a red eye or two, and a couple diabetic checks. Not exactly a day in the OR. My patients were 11 primary care exams(2 of which are coming back in 2 weeks for additional testing), 4 glaucoma checks including OCT,30-2 fields,and gonio, a few dry eye patients, 4 complete contact lens evluations, some dilated retinal exams/diabetic checks, a couple red eye patients, and a post lasik. Gross receipts for the day including optical were $4960. That was just me and only in one of our offices. One of the doctors that works for me was in the other office seeing patients and my partner and our other associate are on vacation. YOu can see what can hapen when there is more than one doctor in the office and multiple locations.

My point is these patients are already soming to see you, but you dont recognize or listen to their problems because you want to put glasses on their face. Treat these people and they will send their friends and family who will also see you and purchase your goods and services. It is not that hard. Start by trying to develop 2 medical patients per day. Once you get the hang of it, 2 becomes 4 becomes 6, etc. I know what KHE is going to say about medical plans...he is right if you cant bill insurances you are going to have some trouble. If you want to ignore 60-70% of your schooling and only prescribe glasses and contacts so be it.

You aren't seriuosly lecturing me on how to build a medical practice are you?

 

[posner]

No Ben, I was not speaking only to you I was doing my best to point out to others the importance of embracing the medical model. My take home message was that OMDs, unless in a referral center type setting, 75-80% of the time are seeing the same patients that you and I are seeing.

I would like to see more ODs get paid well for their services. It brings me down to hear of others that struggle in optometry. Especially since I feel that many times those that struggle create thier own prison.

 

[KHE]

My point is these patients are already soming to see you, but you dont recognize or listen to their problems because you want to put glasses on their face. Treat these people and they will send their friends and family who will also see you and purchase your goods and services. It is not that hard. Start by trying to develop 2 medical patients per day. Once you get the hang of it, 2 becomes 4 becomes 6, etc. I know what KHE is going to say about medical plans...he is right if you cant bill insurances you are going to have some trouble. If you want to ignore 60-70% of your schooling and only prescribe glasses and contacts so be it.

There really isn't much point in me carrying on about this issue on this thread because its been pretty much exhausted but I will do it ONE MORE TIME.

TO ALL THE STUDENTS OUT THERE READING THIS THREAD:

You have seen these two doctors (Chudner and posner) describe their practices and I would bet $100 that you are all sitting there thinking that you would like to have offices like theirs one day because 1) It sounds sexy 2) It sounds fun 3) It sounds lucrative

All 3 are generally true. But they are able take medical insurances in their area. If they could not, I would almost guarantee you that their practices would not be as lucrative or as fun and I'm sure that they would admit the exact same thing.

SO PRACTICE IN AREAS WHERE YOU CAN GET ON MEDICAL PLANS, NOT IN AREAS THAT HAVE WIDE SCOPE OF PRACTICE LAWS OR YOU WILL BASICALLY END UP PROVIDING ROUTINE EYECARE AND RETAILING EYEWEAR. YOU DON'T NEED 8-9 YEARS OF POST SECONDARY SCHOOLING AND HUNDREDS OF THOUSANDS OF DOLLARS IN DEBT TO DO THAT.

 

[posner]

There really isn't much point in me carrying on about this issue on this thread because its been pretty much exhausted but I will do it ONE MORE TIME.

TO ALL THE STUDENTS OUT THERE READING THIS THREAD:

You have seen these two doctors (Chudner and posner) describe their practices and I would bet $100 that you are all sitting there thinking that you would like to have offices like theirs one day because 1) It sounds sexy 2) It sounds fun 3) It sounds lucrative

All 3 are generally true. But they are able take medical insurances in their area. If they could not, I would almost guarantee you that their practices would not be as lucrative or as fun and I'm sure that they would admit the exact same thing.

SO PRACTICE IN AREAS WHERE YOU CAN GET ON MEDICAL PLANS, NOT IN AREAS THAT HAVE WIDE SCOPE OF PRACTICE LAWS OR YOU WILL BASICALLY END UP PROVIDING ROUTINE EYECARE AND RETAILING EYEWEAR. YOU DON'T NEED 8-9 YEARS OF POST SECONDARY SCHOOLING AND HUNDREDS OF THOUSANDS OF DOLLARS IN DEBT TO DO THAT.

Your point is well made KHE...again. Medical plans are essential to a successful practice in my opinion. SO the message is to practice in an area that offers BOTH access to medical plans and a broad scope of practice. THer are many locations that fit this description so good luck.

 

[Ben Chudner]

There really isn't much point in me carrying on about this issue on this thread because its been pretty much exhausted but I will do it ONE MORE TIME.

TO ALL THE STUDENTS OUT THERE READING THIS THREAD:

You have seen these two doctors (Chudner and posner) describe their practices and I would bet $100 that you are all sitting there thinking that you would like to have offices like theirs one day because 1) It sounds sexy 2) It sounds fun 3) It sounds lucrative

All 3 are generally true. But they are able take medical insurances in their area. If they could not, I would almost guarantee you that their practices would not be as lucrative or as fun and I'm sure that they would admit the exact same thing.

SO PRACTICE IN AREAS WHERE YOU CAN GET ON MEDICAL PLANS, NOT IN AREAS THAT HAVE WIDE SCOPE OF PRACTICE LAWS OR YOU WILL BASICALLY END UP PROVIDING ROUTINE EYECARE AND RETAILING EYEWEAR. YOU DON'T NEED 8-9 YEARS OF POST SECONDARY SCHOOLING AND HUNDREDS OF THOUSANDS OF DOLLARS IN DEBT TO DO THAT.

Ken, you are absolutely correct. I am the first to admit that my type of practice is not the norm, even in states with a wide scope of practice and the ability to get on medical plans. I know of practices in California that are more lucrative than mine (over $2MM), but the majority of their patients are routine. This is because of the difficulty getting onto medical plans. I am not sure how posner was able to easily get on to medical plans, as I have met a ton of OD's in Cali that say it's just not that easy. Maybe it's because he has ophthalmology in his practice. No matter what the reason, the only way to be as successful as him is to get on those plans. I would advise all students to strive to have the type of practice that posner has because it is a much more fun way to practice.

And for the record, it is not the type of practice that is sexy, it's the doctor.

 

[posner]

We have had set backs with some of our medical plans. FOr a while we were not allowed to prescribe Restasis for Blue Cross only. Thankfully, after a successful COA lobby it was overturned and all is well again. I am not on every medical plan. In fact, in some cases I cannot provide for some of the EPO or HMO plans. In other cases, my patients ask for a referral to me from their PCP and he or she will authorize it. It just depends. It is not all rosey and perfect however. My staff does field calls from angry patients wondering why thier insurance didnt pay more, etc. But, again, I have a great staff. Our ophthalmolgy group leases space from us, but they maintain a separate practice. Good luck

 

[WoodyJI]

SO PRACTICE IN AREAS WHERE YOU CAN GET ON MEDICAL PLANS, NOT IN AREAS THAT HAVE WIDE SCOPE OF PRACTICE LAWS OR YOU WILL BASICALLY END UP PROVIDING ROUTINE EYECARE AND RETAILING EYEWEAR. YOU DON'T NEED 8-9 YEARS OF POST SECONDARY SCHOOLING AND HUNDREDS OF THOUSANDS OF DOLLARS IN DEBT TO DO THAT.

So could we work together to list which states suck for optometry and which ones are good? I would think that it'd help people across the board. Students in the affected areas would have awareness to get more involved in lobbying etc. I mean, if the state I want to practice in is bad for optometry and I don't know it yet, I'd rather know now--sooner rather than later...

 

[WoodyJI]

I don't know how to delete double posts. Like this post right here...I'd delete it if I could...

 

[KHE]

So could we work together to list which states suck for optometry and which ones are good? I would think that it'd help people across the board. Students in the affected areas would have awareness to get more involved in lobbying etc. I mean, if the state I want to practice in is bad for optometry and I don't know it yet, I'd rather know now--sooner rather than later...

You're doing the right thing by trying to find out sooner rather than later.

But it's hard to do this because the problem is vary regional and can vary even within a state. For example, northern Florida may not be a problem while southern Florida is. Or you may have an area where you can get on every plan you want except one but if that one plan is the dominant plan in the area, you are going to have trouble. For example, if Microsoft employees have Aetna insurance and you can get on every plan except Aetna, opening an office in Redmond, WA may not be the best idea.

The best advice I can give you is find a town within a 30 mile radius of where you want to practice. Then find out what the top 5 medical plans in the area are. Then phone those plans up and ask if they are credentialling new ODs to see patients on their MEDICAL plan. If more than one of them isn't, pick a new place to practice unless you don't mind being an eyeglass salesman for the bulk of your career.

Mistakes that I made:

1) Assuming that if a state has a broad scope of practice, that optometrists are welcomed onto insurance plans.

2) Assuming that if there are already ODs on a plan in a particular area that I would be allowed to join too.

Don't make those mistakes.

 

[docvisionX]

Posner and Ben:

Thanks for all the valuable information. Keep it coming!

 

[docwatson]

I just returned from Vision Expo in Las Vegas. WHile there, I attended two practice management courses, one of which was titled "How to be a million dollar practice" or something like that and the other one I forget but had the same basic theme: Growing your practice to be large a successful.

The theme of both courses was identical. Do heavy medical billing. The instructors lamented that most ODs refer out too much and don't do enough advanced testing and treatment.

....

So there it is again students.....PRACTICE WHERE YOU CAN GET ON MEDICAL PLANS!

I think you're speaking to the wrong people. Young doctors in training or new grads already know about the medical side. We spend so much time in optometry school nowadays being trained to be OMDs so they have already gotten the message. What's happening now is that these docs are slowly forgetting their roots: THE OPTICAL.

I'm not sure what lectures you attended, but the one I attended addressed this very subject. At least 1/3 of your income should come from your optical. Don't forget about this part of your practice! You can make money on this end without hardly lifting a finger since you have people working for you...

As one or more of you have said... There are docs out there with million dollar plus practices built on vision plans and dispensing...

Not that I don't think the medical stuff is good. My practice was built on this. I doubled our revenue in two years based on medical optometry...

The other thing I want to address is the two headed monster that optometry is today. KHE (I hope he actually has a name... ), says that we all need to be on medical plans. I don't think commercial ODs even give that a thought since they are more worried about those walkins they can zip out the door. They aren't doing any medical stuff so why worry about it? Why not get the cash? Commercial optometry is the fastest growing segment of our profession and private optometry is dying.

Sure, get on the medical plans, but it may not do us any good if we are all working for Wal-Mart some day...

I don't have anything against commercial optometrists per say, but I do have something against too many ODs and too many commercial interests dominating our profession... [ I'm going to post another thread on this ]

P.S. So you know where I'm coming from: I have a million dollar practice.

 

[posner]

I would disagree with your post Keith. Many new grads are not getting the picture about proper medical billing. I get calls or emails from classmate on a weekly basis asking how I would code a particular visit, how much to charge, should I bring the patient back, etc. I do think headway is being made, but there is a long way to go.

Most OD's think they are less qualified than OMDs to treat and manage many eye conditions. Therefore they charge less, and in many cases feel guilty for charging at all(afterall, they say to themselves, "it was just a mild abrasion and all I did was give the patient some artificial tears."). I am reminded of a joke/story someone told me about a lady that called a computer guy over to her house to fix her computer. He pounded on the side of the tower and it turned on. He then presented her with a bill for $100. SHe exclaimed, "this is ridiculous! $100 dollars to pound on my computer tower?" He replied, " you're right. He grabbed the bill and changed it to read pounding the computer $1. Knowing where to pound it $99.

I agree that optical is important. My corporation grosses nearly a million dollars annually on optical alone. It is a part of the business that allows me to make money while I vacation or ride dirt bikes with my wife and son. However, it is not the part of the business that gives me the greatest personal satisfaction. I enjoy patients that present with challenging problems and trying to solve them. WHile I would be a fool to ignore the optical part of our business, I would have quit optometry long ago if that was all that there was. My goal is always to see to it that our services comprise 60% or better of our revenue. I can see 3-4 glaucoma patients in an hour(some of whom also get glasses) in addition to regularly scheduled exams. I can NET an average of 250-300 per patient. It takes 5-10 minutes of my time(if ancillary personnel are used correctly) and there is very little overhead.

Posner

 

[docwatson]

I would disagree with your post Keith. Many new grads are not getting the picture about proper medical billing. I get calls or emails from classmate on a weekly basis asking how I would code a particular visit, how much to charge, should I bring the patient back, etc. I do think headway is being made, but there is a long way to go.

...

Posner

I think that's where we differ. I think there is a lot of headway being made. You may be getting quite a few calls but hey, even seasoned veterans have questions. We all do.

Not all OMDs are that great either. You know there's a lot of OMDs out there who are pretty sloppy...

I've probably been practicing for fewer years than you have so I know how new grads are thinking. Sure there's not enough billing and coding experience in the schools but it's not like that stuff can't be learned fairly quickly. Take a few classes, ask other doctors on this and other forums, ask reps, start buying instruments, etc. That's what I did. Anyway... At least young docs have the medical model mindset. They all say that they are going to bill medical when they get their opportunity to open a private practice or buy someone out. Do you think ANYONE nowadays says they are going to do optical only??? Hardly...

The real problem is that there aren't very many young private practice doctors. When I go to meetings sponsored by buying groups, I am one of the youngest in attendance and I'm 40! (I had a previous career as an engineer so that's why I've only been practicing for 7 years). So this topic can easily get warped into how hard it is to open a private office because of high student debt, etc., but I won't get into it...

 

[WoodyJI]

I want to thank you guys for weighing in on these forums for us students. I think already, just a few weeks into my first year of optometry school, that we definitely are going to be more medically-minded as a graduating class. However, I can see the point that our bread and butter is going to be optical, and I'm excited to do both so long as I can have a challenging and fulfilling career...

 

[posner]

I think that's where we differ. I think there is a lot of headway being made. You may be getting quite a few calls but hey, even seasoned veterans have questions. We all do.

Not all OMDs are that great either. You know there's a lot of OMDs out there who are pretty sloppy...

I've probably been practicing for fewer years than you have so I know how new grads are thinking. Sure there's not enough billing and coding experience in the schools but it's not like that stuff can't be learned fairly quickly. Take a few classes, ask other doctors on this and other forums, ask reps, start buying instruments, etc. That's what I did. Anyway... At least young docs have the medical model mindset. They all say that they are going to bill medical when they get their opportunity to open a private practice or buy someone out. Do you think ANYONE nowadays says they are going to do optical only??? Hardly...

The real problem is that there aren't very many young private practice doctors. When I go to meetings sponsored by buying groups, I am one of the youngest in attendance and I'm 40! (I had a previous career as an engineer so that's why I've only been practicing for 7 years). So this topic can easily get warped into how hard it is to open a private office because of high student debt, etc., but I won't get into it...

You are correct about there not being many young private practice ODs. I am 33 and have been practicing for 6 years now. I bought out our senior partner 3.5 years ago. I am without a doubt one of the youngest if not the youngest private OD in and around my area. YOu also make a good point; billing and coding can be learned fairly quickly. The new grads certainly have the know how to embrace this.

Posner

 

[bournehall]

Am I reading this right? You are making quite a bit more than 200K a year? If so, you are in the top .000000000000001% of optometrists.

The cardiologist I know well has been in practice about 7 years and makes about $200K(quite a bit less than myself and my friend in family practice).

 

[Ben Chudner]

Am I reading this right? You are making quite a bit more than 200K a year? If so, you are in the top .000000000000001% of optometrists.

If the average OD nets 30% of the practice gross then any practice that nets over $600K would result in a salary of close to $200k. Even if you took that number and reduced it to 20% then any practice that grosses over a million would yield a $200K salary. He said that he grosses nearly a million dollars in the optical alone and his target is for medical to represent 60% of his total revenue. If my math is correct that means that his total gross is somewhere between 2.25 mil and 2.5 mil. It's not unrealistic to think that an owner of a 2 million dollar practice would take home over $200K. Trust me, $200K may not be the norm, but it is more common than you think.

 

[posner]

Your numbers are right Ben. We should do about $2.1 mil this year between our offices(this is revenue not charges). I have one partner and myself and we are 50/50. Last year we netted almost 31%, and we are hoping to do better this year, but the bigger you get the harder it is to run efficiently. Nevertheless, I also agree with Ben. Most ODs I know and associate with earn between $125K and $200K. While I would agree it may not be the norm, it is possible and not uncommon. Good luck.

Posner

 

[PBEA]

Your numbers are right Ben. We should do about $2.1 mil this year between our offices(this is revenue not charges). I have one partner and myself and we are 50/50. Last year we netted almost 31%, and we are hoping to do better this year, but the bigger you get the harder it is to run efficiently. Nevertheless, I also agree with Ben. Most ODs I know and associate with earn between $125K and $200K. While I would agree it may not be the norm, it is possible and not uncommon. Good luck.

Posner

I"ll echo your comments. I'm at 500k (small town), and I net 40% +/-5% depending on the year. This is an above average net but we are lean and mean, so I basically end up in the same neighboorhood as the above. The previous OD (who I bought out) was vision plan and optical only and netted somewhere around 25%. I brought in every major medical plan in the area, and I treat right up to the limit of my scope. I would say this is integral to practicing as the modern day OD should/can.

 

[Ben Chudner]

I"ll echo your comments. I'm at 500k (small town), and I net 40% +/-5% depending on the year. This is an above average net but we are lean and mean, so I basically end up in the same neighboorhood as the above. The previous OD (who I bought out) was vision plan and optical only and netted somewhere around 25%. I brought in every major medical plan in the area, and I treat right up to the limit of my scope. I would say this is integral to practicing as the modern day OD should/can.

I think it does bring up a point about net vs. size of practice. I think posner was dead on when he stated that it's harder for a large practice to be as efficient as a smaller one. I guess the end result works out the same whether you gross $500K and net 40% or you gross $1MM and net 20%.

 

[PBEA]

I think it does bring up a point about net vs. size of practice. I think posner was dead on when he stated that it's harder for a large practice to be as efficient as a smaller one. I guess the end result works out the same whether you gross $500K and net 40% or you gross $1MM and net 20%.

Exactly, while I havent been financially involved in a large partnership, and cant comment on their relative inefficiencies, I do think that we operate very efficiently as a smaller practice. Especially when I compare national averages.