New grad with 2 offers

[Princeod2583]

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Would you work at lenscrafters or America's Best

Private practice docs- do you have a bias if a graduate works at one vs the other.
Everyone answering- assume being a refraction machine makes no difference to me- which do you choose

High volume (America's Best) v mid volume (lenscrafters)

Looking to start my own practice within 1-2 years. What would you do?

 

[eyestrain]

Would you work at lenscrafters or America's Best

Private practice docs- do you have a bias if a graduate works at one vs the other.
Everyone answering- assume being a refraction machine makes no difference to me- which do you choose

High volume (America's Best) v mid volume (lenscrafters)

Looking to start my own practice within 1-2 years. What would you do?

Start a practice now.

 

[Eyes Only]

Start a practice now.

Couldn't agree more.

 

[Princeod2583]

Couldn't agree more.

I wish. How the heck would I bill/code/run a staff without any experience. How do you pick a place to open? How do you prevent an existing doctor from ripping you off? I want to open straight out of school, don't know how.

 

[imemily]

Was there ever a time period where there were NO optometry corporate entities?

 

[KHE]

I wish. How the heck would I bill/code/run a staff without any experience. How do you pick a place to open? How do you prevent an existing doctor from ripping you off? I want to open straight out of school, don't know how.

Do you think working at Americas best will give you those skills you think you lack?

You say you want to open straight out if school but you dont know how. What have you done to educate yourself or prepare yourself for that? Who have you talked to? What books have you read? What research have you done?

 

[4Eyes]

Working a corporate gig won't really give you any experience in terms of billing/coding unless you really get proactive in learning it. It won't just happen. So I agree that you might do better just learning it now. You might learn to work with office staff, but if you're an independent contractor, they may still work for the company...meaning they don't really work for you.

Working a corporate gig could give you the experience to make you a better doc...OR, depending on your situation and how you handle it, you could pick up some bad habits.

If you're interested in an answer to your original question, I'd pick LC over America's any day. High volume in that context isn't really a positive, in my opinion. And LC seems to do a better job of having techs on the doctor side and opticians on the optical side. At America's, everyone is there to sell glasses, but they might know how to run the autorefractor or NCT. These are just my impressions. I wouldn't go so far as to say that an OD that works at America's isn't going to be a good doctor. But your situation may make it more difficult for you to be one.

 

[Princeod2583]

Do you think working at Americas best will give you those skills you think you lack?

You say you want to open straight out if school but you dont know how. What have you done to educate yourself or prepare yourself for that? Who have you talked to? What books have you read? What research have you done?

I understand you become a refraction wh*re at A.B. but, capital is sorely needed. I need medical insurance and potentially surgery for conditions I have putting off for over 8 years now because I have been in school. What books can you suggest reading and what is the best way to learn how to run a business KHE? I don't plan on doing this long term (i mean that sincerely) but the govt still needs to collect on its loans and at this point, with my health going down the tubes, I have to take an offer that brings in money and benefits right away. I can't afford to put off a surgery that I have needed for 8 years and running any longer.
I dont think working any corporate model will help me learn any business skills, but the one thing it can do is give me capital to start my own business. The learning portion, well now, that is up to me and it will be done; especially after I end up seeing 50 pts on a sat.

 

[KHE]

I understand you become a refraction wh*re at A.B. but, capital is sorely needed. I need medical insurance and potentially surgery for conditions I have putting off for over 8 years now because I have been in school. What books can you suggest reading and what is the best way to learn how to run a business KHE? I don't plan on doing this long term (i mean that sincerely) but the govt still needs to collect on its loans and at this point, with my health going down the tubes, I have to take an offer that brings in money and benefits right away. I can't afford to put off a surgery that I have needed for 8 years and running any longer.
I dont think working any corporate model will help me learn any business skills, but the one thing it can do is give me capital to start my own business. The learning portion, well now, that is up to me and it will be done; especially after I end up seeing 50 pts on a sat.

So the answer then is that you have done nothing to prepare yourself?

 

[Eyes Only]

So the answer then is that you have done nothing to prepare yourself?

And I get a load of attitude from optometry students when I put a post on this forum about them not taking their practice management classes seriously.

 

[DrSpontaneouz83]

And I get a load of attitude from optometry students when I put a post on this forum about them not taking their practice management classes seriously.

Glad to be reading these posts now, as I will definitely be paying keen attention in my practice management class next semester and educate myself outside. I see many ODs, including many friends that recently graduated, that have no clue where to start with opening a private practice. The last advice I was given by a doc from a state school was "DO NOT open a private practice cold turkey." She went bankrupt and had no choice but to work commercial to pay off her non-existant practice. Mind you, this happened to her 10-12 years ago when optometry did not have as much competition with other corporate companies.

Realistically, is it really that bad to work as a lease holder at, say, a Lenscrafters?

 

[Princeod2583]

KHE- I recently contacted a private practice doctor who wants to meet next week and talk. He says he owes it to the profession to do so. In the mean time, I am looking for guidance from anyone I cann. I have only read books by Robert Kiyosaki about successful business practices in general. I respect your opinion so I won't snap back at you, but I really have no idea where to start. I have a practice management book given to me by school, that about sums it up. Do you recommend any reading material in specific? 😕

 

[KHE]

I understand

Have you already graduated?

 

[DILLIGAF]

For books, my personal favorite is Irving Bennett's "Optometric Practice Managment". It is a little old, a 2002 book, but it at least has some innovative thinking in there. I DO NOT recommend the newer 2009 AMPE book in optometry, as they are in my opinion a little bit of a shill for VSP and dismiss medical reimbursement as a viable cash flow model. (All of my experience says otherwise)

That will get you started at least....I also recently read Entrepreneur Press's new 2010 book, "Start Your Own Business" 5th Edition. For me, a lot of people will use and understand basic optometric practice. By that, I mean how to increase efficiencies, suppliers, how and who to hire, etc. What will separate you out, even to someone who is hiring you as a part of their private practice, is innovative thinking.

Case in point: I was new doc searching about 18 months ago, and had 30 or more interviews or meets with potential doctors. One of them happened to be a new grad, had been out for 8 months, and was as confident a guy as you could ever meet. I was very impressed by his clinical experience (had spent time at Walter Reed seeing 40 pt's a day in rotation time), and he just had "it". Anyway, I gave him a 2 week trial in the practice, see how he works with the pt's and staff, etc. After week one, he comes into my office with a plan.

He says, "I was going through the computer and made a list of the zip codes of all of our patients. I made a print out for you." He then proceeds to hand me a color coded county map of where most of our patients are coming from. No idea how much time that must've taken. "I think that we should pull some money away from advertising over here, and put it instead further north. Also, I did an analysis on our recall, and I think the mailings are a waste of money. We can spend half that amount in labor making personal phone calls, and drop the referrals that are not returning patients."

This is the kind of thing they definitely DO NOT teach in op school. Now he runs almost all day to day operations of the new location (1 of 3), and does the accounting work himself, much more cheaply and effectively than a hired gun....and this from a guy that is 29. He will likely be the major holder of that place within a few years.

So, my point is that it is what you read about, the ideas you bring, that will impress a new boss. I can get a doctor any time. Educate yourself into being an innovator, that person that sees the stuff your boss doesn't, and you become unexpendable, and wealthy!

My advice is to read up, take the private job if you can, and blow them away.

 

[thecgrblue]

Optometric Management gives some pretty brief tips and seems to have been doing it for quite some time.

http://www.optometric.com/om_mtotw.aspx

I've read quite a few of them trying to keep in mind what I'd like to eventually try out and do.

Docs, thanks for the other leads.

 

[Princeod2583]

My advice is to read up, take the private job if you can, and blow them away

Thanks Dilligaf that helps alot. Too bad I wasn't able to work about 3 months ago. I helped the doctor at my last externship with a couple of areas he was struggling with. He was using the IZON lenses aberrometer machine in his practice and I suggested he only print out the reading when the aberrations came out reading red (hence he'd save on paper and ink costs from excessive printing and actually make a print out for patients who'd benefit from izon lenses). He also is involved in neurooptometric rehab and wanted to be an externship host site for that as well, but his wife didn't want to have to pay the resident from their office income. I suggested he use one of his offices where he already provides housing as leverage to attract students to his office (and therefore reduce his costs by paying the grad less- win win for both). I am good at offering suggestions, but I still have a lot to learn. I just want to get my foot in the door, but I am unsure where to start. I am hoping my upcoming conversation with that private practice doc is productive

KHE- yes i just graduated.

 

[KHE]

My advice is to read up, take the private job if you can, and blow them away

Thanks Dilligaf that helps alot. Too bad I wasn't able to work about 3 months ago. I helped the doctor at my last externship with a couple of areas he was struggling with. He was using the IZON lenses aberrometer machine in his practice and I suggested he only print out the reading when the aberrations came out reading red (hence he'd save on paper and ink costs from excessive printing and actually make a print out for patients who'd benefit from izon lenses). He also is involved in neurooptometric rehab and wanted to be an externship host site for that as well, but his wife didn't want to have to pay the resident from their office income. I suggested he use one of his offices where he already provides housing as leverage to attract students to his office (and therefore reduce his costs by paying the grad less- win win for both). I am good at offering suggestions, but I still have a lot to learn. I just want to get my foot in the door, but I am unsure where to start. I am hoping my upcoming conversation with that private practice doc is productive

KHE- yes i just graduated.

Ok Prince....look....I'm really not trying to pick on you here so please don't take it this way but I'm going to use you as an example of what NOT to do for a few minutes here...

You say you want to own a private practice and here it is, you've graduated and the only thing you've managed to do to prepare yourself for that is to read a Robert Kiyosaki book.

When you read that, does it not sound just a little bit absurd to you?

You needed to be asking these questions like TWO YEARS AGO, MAN!

It's too LATE!!

Now you're saying you have no idea where to start, are considering working in a horrible commercial environment that you yourself says won't teach you any business skills.

Are you kidding me? How is that going to get you where you want to go?

If you're SERIOUS about owning a practice, you CAN get financing. Even 100% financing. Matsco/Wells Fargo practice finance? Vision One Credit Union? VSP has practice financing available.

Are you familiar with any of those? If not, why not?

If I were you I would bag the whole Americas Best/Lenscrafters thing. I don't know what state you are in but in most states ODs can't be employed to corporations so they aren't going to give you benefits anyways. From a future goals perspective American's Best is NOT going to give you the business skills or the patient management skills to be a successful private practice owner. Lenscrafters MIGHT in a few rare situations but most of them, not them either.

Your best bet is probably to get on board at some ophthalmology practice, bust your butt seeing a bunch of patients and learn whatever you can about billing and coding for a year. During that year, read as much as you possibly can about practice management. Join forums like odwire. Consider a consulting group. Read optometric management. Irv Bennet's textbook is pretty good. It will at least give you lots of things to think about.

Contact your state association in whatever state you're in and ask them if they have a mentorship program or perhaps they could hook you up with a private practice doc who will take you under their wing a little bit.

Your biggest problem though, and this is the part that I want everyone reading this to understand is that YOU'VE STARTED THINKING ABOUT THIS STUFF MUCH TOO LATE!

 

[Oogilily]

And I get a load of attitude from optometry students when I put a post on this forum about them not taking their practice management classes seriously.

Our practice management class is crap, a little hard to take it seriously.

 

[Eyes Only]

Our practice management class is crap, a little hard to take it seriously.

How about you PrinceOD2583, was your class also "crap".

If this is the case, let that be a lesson to everyone who hasn't graduated, you have to take some responsibility for this yourself.

 

[ILOD]

I would look at joining a private practice with a option to become a partner or buy out a retiring doc. Work on your day off at a corporate place for extra money to pay down your student loans or save.

This is what I did. Starting a practice without an existing patient base has a high chance for failure.

My first practice I joined did not work out due to lack of patients. The existing doc wanted a partner I guess for security. We underestimated the growth of the practice, I left after three years. The next practice the doc was older, but still not enough patient to keep two docs busy. After three years he finally sold me the practice after I threatened to leave. The doc financed the whole deal, and I had it paid off after six years. I learned what to do and what not to do over the six years I was an associate.

For twelve years I made a lot less than what I could working corporate full time. But after I paid off the practice I started making much more. I believe that it was well worth it.

A lot of sacrifices, no vacations for eight years, only one new car that was low end. We lived like students saving about 40% of my take home pay from the private practice and part time corporate job. I worked six days a week for six years.

The main concern when looking at a practice is will the revenue provide enough cash flow to pay off the doc and still let you live. You need to be able to pay all your committed expenses with 50% of your take home pay after taxes. This allows you to save for retirement, pay extra on your student loans, save a little for a downpayment on a house. After signing the contract to purchase the practice, I had enough saved up to put 20% down on a new house and fill it with furniture and quit my part time job.

My house is just average, not anything fancy. Most of my neighbors have similar homes but have household incomes that are half of mine.

Running a successful practice is not difficult if you have enough patient flow and you watch your expenses. Keep an emergency fund for your practice and your household. I started out with three months for each and have built it up to 12 months. I only pay cash for any new equipment I buy. After I paid off the old doc I did remodel the office and increased the building loan but it still was within the benchmark that are standard. The old doc did not finance the building. We worked out a price for the building separate since I wanted to stay there.

So I wouldn't open up cold. Just join another practice as an associate and learn and watch and after a few years consider buying an existing practice if the one you initially join does not work out.

Sorry for the long post. But the general idea is that you are going to have to sacrifice if your dream is to be a partner in or own a private practice.

 

[Princeod2583]

Eyes only- yes, our practice management class sucked; we had 3 weeks of management classes that were not very informative.

KHE- Point taken. I don't make excuses but I do have a different situation than most. I put myself through opto school, with a terribly messed up home situation. For that I am proud. But it also made me worry a lot. Which meant I spent ALL of my time worrying about passing classes and actually getting through school. I almost failed out first year. Then I learned how to study the right way, and I brought my grades up alot. But I always felt uptight and worried about making it through all the way. Which is why i never networked, and never studied the business side as much as I could have. I was more concerned with just getting through school.

 

[thecgrblue]

Our practice management class is crap, a little hard to take it seriously.

Aren't you at Pacific? Guess I should start reading other books now.

 

[optsuker]

I wish. How the heck would I bill/code/run a staff without any experience. How do you pick a place to open? How do you prevent an existing doctor from ripping you off? I want to open straight out of school, don't know how.

For coding, there are multiple ways to educate yourself:

• Cross-Country Uninversity: travels the country offering 1-2 day seminars on Optometry-specific coding. Very comprehensive and since there'll be 25 other coders from your area attending, you hear all the area specifics (billing Medicare in Oregon is different than billing Medicare in Florida). Be sure any course you take is Optometry specific or you'll be learning about hospitals & wheelchairs
• Find a busy OD practice and spend a day or 2 with the insurance clerk (make your own cheet sheet based on how they do it)
• Companies like Back in Black can do your billing for you
• Tom Miller, a practicing OD, has a great (& cheap) billing guide that is more user friendly than any thing you'll find anywhere.
• Attend/read anything by the coding gurus (Brownlow, McGreal, etc)
• If you open cold, you'll have tons of downtime to educate yourself by trial and error: claim gets denied>try something else or call the carrier.

Agree with others that in-school PM isn't great, but remember they're limited to doing broad ideas since so much is area-specific(east vs west, urban vs rural) so glean what you can.

My #1 advice for success is to buy an existing practice (for a fair price) & only consider cold-start if one can't be found.

In most cases, you'll need a mentor or paid consultant initially.

 

[KHE]

Eyes only- yes, our practice management class sucked; we had 3 weeks of management classes that were not very informative.

KHE- Point taken. I don't make excuses but I do have a different situation than most. I put myself through opto school, with a terribly messed up home situation. For that I am proud. But it also made me worry a lot. Which meant I spent ALL of my time worrying about passing classes and actually getting through school. I almost failed out first year. Then I learned how to study the right way, and I brought my grades up alot. But I always felt uptight and worried about making it through all the way. Which is why i never networked, and never studied the business side as much as I could have. I was more concerned with just getting through school.

Ok...I get that but on some level it's actually MORE of a problem because here you are now, you've struggled and fought like a dog and busted your ass and for what? A job at America's Best?

That ain't what you want to be doing, man!

Understand this....there's only so much you can learn about practice management from books or journals or conferences or whatever. It's one of those things where most of what you "learn" you learn by just doing it.

So trust me on this.....take the job with the private practice even if it means less "capital" a year from now because two things will happen:

1) You'll be less burnt out
2) The education you receive in practice management (sometimes it's also an education in how NOT to manage a practice) will far exceed the difference in salary.

 

[JeffChou]

There are also plenty of resources online regarding optometric practice management.
I have found helpful benchmarks and forms here:
http://www.mba-ce.com/
AOA website doctor section has some sample practice start-up tables (just takes a little more digging around. hopefully your free student membership still works).
Practice Management Magazine has a "New OD" section with information geared for, well, new ODs. (http://www.optometric.com/newod.aspx)

There are numerous resources out there but make sure to consider each source with a analytical mind. Think about whether or not those principles will work for you. There are many ways to do private practice, but the beauty of it is that you get to do it your way!

I think the best way to get started is to just go ahead and write a business plan. If you don't know how to write a business plan, I'm sure you can figure it out between the books in the library and the myriad resources the internet has to offer. Consider looking for a used copy of the bennet book. If you can learn how to treat eye disease, you can independently learn how to write a business plan. I wrote wrote one for a scholarship competition that I ultimately didn't win, but the exercise alone made a worthwhile impact in my understanding of business and practice management. It has helped me build up a framework of how I would like to structure my practice and given me deeper perspective when visiting other private practices of all types.

To reiterate: Start writing a business plan for a private practice! Just make up a practice if you don't have a location. The point is to go through the motions of starting, calculate actual startup costs, and learn the components of a profit and loss statement. You must first learn the lexicon of terms and concepts at play behind the scenes in an office. You can always adapt the plan to an actual practice later on, but you will understand other businesses (perhaps your employer's) much better with this experience.