my rant on the current state of optometry...

[prettygreeneyes]

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.

PBEA,

Could you share with us what state you are practicing in? Likewise, did you have any difficulty getting on those medical plans?

Thanks!

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[PBEA]

PBEA,

Could you share with us what state you are practicing in? Likewise, did you have any difficulty getting on those medical plans?

Thanks!

NY

Initially it was a very time consuming process (as well as eye-opening ). But, eventually I joined every major medical plan in the area. The few issues I ran into were: some plans have adequate # providers, so may not be looking to add more. And some just flat out do not accept OD's for medical care (GHI/HMO). I give their reps a VERY hard time, but to no avail. I've heard of far more onerous problems getting on plans, so I credit my EXTREMELY aggressive approach (I treat reps like the barking dogs that they are, WOOF, WOOF) with my success here. The way I see it, while I largely agree with KHE's mantra, I do not think its possible to really know all the regional insurance nuances that exist. So stop trying. Instead, pick an area to live based on x # variables, and then try and learn of the local plans, etc. If you cant get on plans then join your state, local assoc and kick up a fuss. Anything else, grasshopper

 

[posner]

Once you pick the area you think you want to live/practice in, take a look at what major forces drive the local/statewide economy. This will have a large impact on what the future will hold for you in the way of medical and vision insurances. You can then use this info the see how you can get into the game in your area and to see how you will be able to compete. Obviously, the best case scenario would be to see cash paying patients(and lots of them)all the time who will pay your fees, but the reality is that this is not a likely scenario.

It has been my experience that it takes a few years(unless you walk into a medical optometric practice) to evolve into a well oiled machine.

Posner

 

[prettygreeneyes]

Anything else, grasshopper

*grasshopper backs away quietly, bowing as she goes*

Nope... I'm good. Thanks!

 

[H20Man]

For whatever it is worth, here's an additional voice to add to this discussion:

I graduated from optometry school in the late 1980's. After finishing my residency, I had by most outside measures a successful career. However, throughout my entire career as a full-time faculty member at two optometry schools as well as a practitioner in both optometry and medical school teaching clinics and hospitals and at VA hospitals, I had from the beginning a restless need to change the profession. I was sure that my medical-based residency and my first job in a very successful ophthalmology referral center had enlightened my ability to see what was both good about optometry's traditional approach to caring for people as well as what needed to be adopted from medicine in order to flourish in the future. I dedicated most of my career teaching both students and practicing optometrists the cognitive skills that physicians used to manage the problems that optometrists traditionally felt were either too risky or too complex. In addition, over 12 years ago, I and my business partner started a venture that had the expressed purpose of teaching practicing optometrists how to practically implement the steps necessary to incorporate medical insurance and medical care into their practices.

The truth is, and for many reasons, the vast majority of optometrists simply were unable or uninterested - and likely still are - in making wholesale changes in how they practice. And why should they? Most make a comfortable living emphasizing or even limiting their practices to refractive care, utilizing a model that they were well trained in and feel uncomfrotable in abandoning. The discussion that is occurring here is not new material: the issues are the same ones we talked about 20 years ago will likely be discussed by optometrists 20 years from now.

Optometry is what it is. Most people choose to go into it because they are the type of people who are attracted to what makes it different from medicine: independence, predictable hours and the lack of life-and-death responsibility. These desires are not without virtue, however, they don't create a collective character that seeks, let alone demands, frequent change and more responsibility, no matter the desire of a few frustrated and charged-up activists.

My advice to those who are thinking about going into optometry: optometry school is not the place to discover yourself. Take lots of really good courses in literature, history and classics in college for that. Know yourself - and what optometry really is - very, very well. The truth is both demographics (combined with the refusal of optometry colleges to drastically cut their class sizes) and capitalism have led to a trend where increasingly more and more opportunities will be in big box corporate environments where you will almost entirely prescribe contacts and glasses. While that makes many of us old-timers cringe, it does mean that there is significant opportunities for those who enjoy and see rewards in that. I'm not trying to dash any dreams or any ambitions - simply make those ambitions based on facts, not fantasies.

I no longer practice optometry. I am not bitter - I made many friends, took care of many people, and I think made a difference over the course of my career. However, I made the determination that I wasn't made for the profession - no anger, no complaints.

Good luck to all of you. Be happy.

 

[gtnpaid]

I totally agree with Posner. I've been out of school for 8 years and have managed to see the light at the end of the tunnel year by year with respect to success in Optometry. I started corporate, which is a great fellowship experience but one can easily get too comfortable with that mode of practice if you don't strive for autonomy in your professional life.

I do not agree with KHE. It's not all about medical. I do implement the medical model in my practice but, I started with just medicare, which represented 10% of my medical visits. I have all the latest diagnostic equipment to approriately care for all pathologies similar to Posner. I will not tell you how much I make but it is just over three times what I was making as a first year doctor in 1999 - this is with 10% medical...I am now working on becoming a provider on several other medical plans...but I don't have to, I just want to.

I am from the South and compete with 9 other OD's and 3 OMD's within a 1.5 mile distance on the same street. Is that enough competition for you?

 

[posner]

I totally agree with Posner. I've been out of school for 8 years and have managed to see the light at the end of the tunnel year by year with respect to success in Optometry. I started corporate, which is a great fellowship experience but one can easily get too comfortable with that mode of practice if you don't strive for autonomy in your professional life.

I do not agree with KHE. It's not all about medical. I do implement the medical model in my practice but, I started with just medicare, which represented 10% of my medical visits. I have all the latest diagnostic equipment to approriately care for all pathologies similar to Posner. I will not tell you how much I make but it is just over three times what I was making as a first year doctor in 1999 - this is with 10% medical...I am now working on becoming a provider on several other medical plans...but I don't have to, I just want to.

I am from the South and compete with 9 other OD's and 3 OMD's within a 1.5 mile distance on the same street. Is that enough competition for you?

I am delighted by this post. I hope the rest of the folks that peruse this board see that it can be done and there are many of your peers that are making a good go of it in spite of all the doom and gloom on this board. I wish you continued success.

Posner

 

[KHE]

I totally agree with Posner. I've been out of school for 8 years and have managed to see the light at the end of the tunnel year by year with respect to success in Optometry. I started corporate, which is a great fellowship experience but one can easily get too comfortable with that mode of practice if you don't strive for autonomy in your professional life.

I do not agree with KHE. It's not all about medical. I do implement the medical model in my practice but, I started with just medicare, which represented 10% of my medical visits. I have all the latest diagnostic equipment to approriately care for all pathologies similar to Posner. I will not tell you how much I make but it is just over three times what I was making as a first year doctor in 1999 - this is with 10% medical...I am now working on becoming a provider on several other medical plans...but I don't have to, I just want to.

I am from the South and compete with 9 other OD's and 3 OMD's within a 1.5 mile distance on the same street. Is that enough competition for you?

I understand where you are coming from, but the fact that you are doing only 10% medical means that you are doing 90% optical. (please correct me if I'm wrong)

WHile you can certainly make money doing this (and for the 100th time, I never said you couldnt make good money in optometry) it is this type of scenario that only reinforces the publics image of optometrists as eyeglasses merchants first and foremost and "doctors" a distant second. As long as this trend continues to occur, it is going to put optometry at the mercy of large corporations because the fact remains that large commercial opticals can provide high quality optical services to 95% of their customers faster, cheaper, and more efficiently than 95% of private practice ODs out there.

ODs are the only health care delivery professional that makes the majority of its income from material sales. As long as ODs continue to make the bulk of their revenue from material sales, I predict a fate for optometry just like pharmacy. ODs will always make very good money, and always above the national average. But they will end up working retail hours in retail locations, just like pharmacy. I see no trend on the horizon that is going to reverse this course soon enough.

If you are doing 10% medical and 90% optical, you are essentially running an eyeglass store. There is absolutely nothing wrong with that. But you don't need 8-9 years of very expensive post secondary education to run an eyeglass store. You might as well just go to community college right out of high school, get your opticians certification and open your eyeglass store.

 

[gtnpaid]

I understand where you are coming from, but the fact that you are doing only 10% medical means that you are doing 90% optical. (please correct me if I'm wrong)

WHile you can certainly make money doing this (and for the 100th time, I never said you couldnt make good money in optometry) it is this type of scenario that only reinforces the publics image of optometrists as eyeglasses merchants first and foremost and "doctors" a distant second. As long as this trend continues to occur, it is going to put optometry at the mercy of large corporations because the fact remains that large commercial opticals can provide high quality optical services to 95% of their customers faster, cheaper, and more efficiently than 95% of private practice ODs out there.

ODs are the only health care delivery professional that makes the majority of its income from material sales. As long as ODs continue to make the bulk of their revenue from material sales, I predict a fate for optometry just like pharmacy. ODs will always make very good money, and always above the national average. But they will end up working retail hours in retail locations, just like pharmacy. I see no trend on the horizon that is going to reverse this course soon enough.

If you are doing 10% medical and 90% optical, you are essentially running an eyeglass store. There is absolutely nothing wrong with that. But you don't need 8-9 years of very expensive post secondary education to run an eyeglass store. You might as well just go to community college right out of high school, get your opticians certification and open your eyeglass store.

I don't see where you are getting your facts from but they are totally presumptuous.

I do 10% medical billing therefore, I do approximately 40% vision plan eye exams and my optical accounts for another 50%.

So, your argument is relative to your misinterpretation of Optometry and the optical industry. In other word, your argument serves you and your experience with Optometry. You do have some good points but they are self justifiable with your belief system and have nothing to do with my post. You have tangentially argued medical billing with optical income - stay on one subject at a time.

You seem to have a limited business experience relative to private practice optometry. Working in the business is not necessarily the same as running the business. Private practice is dynamic and personal to the owner - success depends on the personality, experience and, knowledge of the owner/owners. This can be said for any business.

 

[KHE]

I don't see where you are getting your facts from but they are totally presumptuous.

I do 10% medical billing therefore, I do approximately 40% vision plan eye exams and my optical accounts for another 50%.

So, your argument is relative to your misinterpretation of Optometry and the optical industry. In other word, your argument serves you and your experience with Optometry. You do have some good points but they are self justifiable with your belief system and have nothing to do with my post. You have tangentially argued medical billing with optical income - stay on one subject at a time.

You seem to have a limited business experience relative to private practice optometry. Working in the business is not necessarily the same as running the business. Private practice is dynamic and personal to the owner - success depends on the personality, experience and, knowledge of the owner/owners. This can be said for any business.

I don't really understand your posting.

Of course my arguments are based on my experience, research and observations. What else would I base them on?

You seem to be equating "success" with the amount of money someone earns. That's certainly an important measurement and given the choice, I think we would all like to make as much money as we could.

The point I'm making is that while yes, you can make good money making the majority of your income from your optical and doing routine "vision plan exams", doing so puts the profession on very shaky footing and leaves it open to commercial exploitation.

Wouldn't it be much more desireable and much more secure for the future of the profession if more of our incomes came from the "exam" part of the whole process instead of the "glasses" part?

If the patient/customer gets a small bill for the exam and a HUGE bill for their glasses, it only reinforces the sterotype of optometrists as spectacle merchants first and foremost and doctors second.

 

[POJO]

I don't see where you are getting your facts from but they are totally presumptuous.

I do 10% medical billing therefore, I do approximately 40% vision plan eye exams and my optical accounts for another 50%

Dear gtnpaid,

Is it fair to say that the vision plan exams are being driven by a need for glasses?

Is it also fair to say that most of the medical eye exam are opportunistic rather than planned.,e.g. I have pain, and I want to see my optometrist.

 

[gtnpaid]

Dear gtnpaid,

Is it fair to say that the vision plan exams are being driven by a need for glasses?

Is it also fair to say that most of the medical eye exam are opportunistic rather than planned.,e.g. I have pain, and I want to see my optometrist.

Answer #1

Yes, Obviously

Answer #2

No, not at my practice

 

[POJO]

Answer #1

Yes, Obviously

Answer #2

No, not at my practice

In the second question, then your patients will automatically go to you for their medical eye problems? Do you see them if they went to the ER?

 

[hye345]

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