Optometrists are overtrained???

[alferec]

In this post, drgregory mentioned that optometrists are "overtrained." I've heard some responses, but I want to make this a separate discussion. Do any of you agree? I'm starting to believe it myself because of a lot of this information that I'm learning so far as a first year doesn't seem so relevant...at least, as a practicing optometrist.

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[EyeBaller]

Well.. I think it comes down to a couple of things. A lot of the stuff you learn in 1st year does come back to haunt you in 2nd or 3rd year, especially when you learn about ocular diseases and treatments, it's all based on the physiology of the body. Not to mention the systemic conditions. Heck, we got shown histology slides of the cornea just last week talking about degenerations and dystrophies!!

The other main factor in my opinion, is that if we want to be out there fighting to get orals and minor "surgical" procedures etc, we have to demonstrate as a profession we are equipped to do it. We want to Rx orals, MDs Rx orals, they take a course in Histology, well then, we have to take it. Yes, some of it may be redundant but if we want to push forward we have to show that we are learning what we need to, and more (that's a slightly extreme example, but you get the idea?).

So hang in there, learn all those stupid facts for the boards that you probably won't use.. but more than you think does actually come back at you at some point... you'll see! 😉

 

[posner]

I think the point being made, if I may infer, is related to the limited scope of practice in may areas. I do not think we are overtrained however. I use alot of my clinical medicine stuff each day ordering tests, etc. I also use my pharm knowledge on a daily basis which also forces me to consider anatomy and physiology and structure/function. YOu will tie it all together in the end and see its relevance. Unless, of course, you go to work in a doc-in-the-box location, in which case you could get by being a refracting optician in many cases.

Posner

 

[Ryan_eyeball]

I think the point being made, if I may infer, is related to the limited scope of practice in may areas. I do not think we are overtrained however. I use alot of my clinical medicine stuff each day ordering tests, etc. I also use my pharm knowledge on a daily basis which also forces me to consider anatomy and physiology and structure/function. YOu will tie it all together in the end and see its relevance. Unless, of course, you go to work in a doc-in-the-box location, in which case you could get by being a refracting optician in many cases.

Posner

"Unless, of course, you go to work in a doc-in-the-box location, in which case you could get by being a refracting optician in many cases."

With all respect, I think this is kinda a slander against certain doctors. I don't believe it matters where you practice, but how comfortable you are in your skills and decision making. There are just docs that want to refract, but this happens at BOTH private and commercial establishments. You can run full scope in a commercial if you have the necessary equipment to treat say glaucoma, remove FB's, follow diabetics.

Just because a doctor owns his own dispensary doesn't make him a medically oriented optometrist.

Just my 2 cents.
And you have good posts posner for people to learn from about private practice

 

[cpw]

With all respect, I think this is kinda a slander against certain doctors. I don't believe it matters where you practice, but how comfortable you are in your skills and decision making. There are just docs that want to refract, but this happens at BOTH private and commercial establishments. You can run full scope in a commercial if you have the necessary equipment to treat say glaucoma, remove FB's, follow diabetics.

Just because a doctor owns his own dispensary doesn't make him a medically oriented optometrist.

True ! It's all about motivation... you can be a full medical practice inside a commerical setting.. or you could be nothing more than a refractionist inside a private optical office. It goes both ways.

 

[drgregory]

True ! It's all about motivation... you can be a full medical practice inside a commerical setting.. or you could be nothing more than a refractionist inside a private optical office. It goes both ways.

but more one way than the other. see how long you can hold a lease at wally world if you put your procedure fees at an appropriate level and start doing office visits yielding no spec Rxs. when you have done this, come back and post for everyone to see how you enjoyed your 6 week lease that was terminated at wally world.

 

[posner]

but more one way than the other. see how long you can hold a lease at wally world if you put your procedure fees at an appropriate level and start doing office visits yielding no spec Rxs. when you have done this, come back and post for everyone to see how you enjoyed your 6 week lease that was terminated at wally world.

Great post! YOu could not be more correct. I admit I was coming across quite belittling towards doc in the boxes, but I just cant help it. It does nothing to push the profession forward; I would argue it does quite the opposite but that is a different discussion. The bottom line is that MOST people dont think of a Walmart type setting if thier primary objective is to receive quality health care. They go to Walmart because they are cheap bastards that want to save a buck so why not go to the local Walmart where some joker is pumping out $39 exams? Because the doc in the box has devalued their services, there is no perceived value attached to them. And by the way, Walmart doesnt care of the perceived value of your services or patient care for that matter so long as patients stop by the dispensary and drop some loot on a new pair of specs. Sad but true.

Our local Walmart's vision center has had some problems in the past few months, and I have been seeing several patients that would otherwise go to Walmart. In almost every case, they leave the office with a whole new appreciation for thier eyes and what we do. Furthermore, they dont hesitate to stop by the dispensary and purchase quality eyewear. Again, my staff is trained to ensure patients understand the percevied value of the goods and services we provide.

Posner

 

[Ryan_eyeball]

but more one way than the other. see how long you can hold a lease at wally world if you put your procedure fees at an appropriate level and start doing office visits yielding no spec Rxs. when you have done this, come back and post for everyone to see how you enjoyed your 6 week lease that was terminated at wally world.

Good post. I was going to include this in my orignial one. That is one restraint you have in working commercial. They want you generating spec exams more than medical visits. I think there can be an integration of the two into your practice. Procedure fees for exams will be lower (mine's 70) but that doesn't mean that a threshold VF, pachymetry, gonio, retinal photo, FB removal have to be set lower if you're going to bill to an insurance company.

You have to compromise if you're going to work in corporate for sure. I do believe that private practice does do more for the profession, but its a convenient option for me now for another two years til I open. =)

Cheers

 

[posner]

Ryan- I wish you well if you do in fact open your own office in the future. I hope you are salting away your pennies for a rainy day. The problem that most doc in the boxes come to realize is that they cant afford not to make what they have grown accustomed to at Wally world. When you open your own office, not only do you now have a considerable overhead and start up costs, you dont necessarily have a steady stream of patients coming in the door. Furthermore, you most certainly will not charge $39 for an exam(if you want to stay in practice for long) because when it is all said and done you will be lucky to take $15-$20 home with you at days end; If you only see 10-15 patients a day to start, you might as well have been a substitute teacher. Generally speaking, you will likley earn less in your first 1-3 or 4 years in private practice. You will leap frog the 90-100K you might have made at the doc in box in a relatively short time, but can you afford a pay cut for the next few years while you build your empire? THis is why I think the best time to get into a private practice setting(if that is the end goal) is from the outset. I hate to say it, I dont think I could ever seriously entertain a doc in the box convert as an associate in the future of our practice.

Posner

 

[prettygreeneyes]

but more one way than the other. see how long you can hold a lease at wally world if you put your procedure fees at an appropriate level and start doing office visits yielding no spec Rxs. when you have done this, come back and post for everyone to see how you enjoyed your 6 week lease that was terminated at wally world.

I'm curious to know if you differentiate between "wally world" and other commercial optometry places like Sears, Binyons, Lenscrafters, Pearle, Eyemasters? You seem to direct most of your hatred towards "wally world", but I don't hear other companies mentioned as much.

I guess another way to say it would be... "Are there 'classes' in commercial optometry?

 

[Ryan_eyeball]

I'm curious to know if you differentiate between "wally world" and other commercial optometry places like Sears, Binyons, Lenscrafters, Pearle, Eyemasters? You seem to direct most of your hatred towards "wally world", but I don't hear other companies mentioned as much.

I guess another way to say it would be... "Are there 'classes' in commercial optometry?

I think most consider them all the same. Some of the Lenscrafters you can sell your own contact lenses.

I think Lenscrafters is the best looking, and has the advantage of having a lab to do one hour jobs.

 

[Ryan_eyeball]

Ryan- I wish you well if you do in fact open your own office in the future. I hope you are salting away your pennies for a rainy day. The problem that most doc in the boxes come to realize is that they cant afford not to make what they have grown accustomed to at Wally world. When you open your own office, not only do you now have a considerable overhead and start up costs, you dont necessarily have a steady stream of patients coming in the door. Furthermore, you most certainly will not charge $39 for an exam(if you want to stay in practice for long) because when it is all said and done you will be lucky to take $15-$20 home with you at days end; If you only see 10-15 patients a day to start, you might as well have been a substitute teacher. Generally speaking, you will likley earn less in your first 1-3 or 4 years in private practice. You will leap frog the 90-100K you might have made at the doc in box in a relatively short time, but can you afford a pay cut for the next few years while you build your empire? THis is why I think the best time to get into a private practice setting(if that is the end goal) is from the outset. I hate to say it, I dont think I could ever seriously entertain a doc in the box convert as an associate in the future of our practice.

Posner

I believe a lot of the "doc in a boxs" fall into a trap of living at a lifestyle of want instead of need. They want all the materialistic goods right off the bat (consumer vs school debt trade = TRAP). I don't want to be in consumer debt, and I think after 2.5 months of practicing so far I've bought a PSP and $70 bucks worth of clothes for myself. I'll probably still continue to work corporate to supplement income when the private practice is just starting up.

My reasons to open private are because I don't want to work for anyone else for the rest of my life. Plus I wanted more experience refracting, b/c any remakes are on the corporate entity right now instead of your own lab bill. I've had two remakes so far, and its a learning experience.

You wouldn't hire someone b/c they worked corporate at one time in their lives? Shouldn't finding the right personalty, drive, and people skills be the main attributes of hiring a good associate?

 

[drgregory]

I'm curious to know if you differentiate between "wally world" and other commercial optometry places like Sears, Binyons, Lenscrafters, Pearle, Eyemasters? You seem to direct most of your hatred towards "wally world", but I don't hear other companies mentioned as much.

I guess another way to say it would be... "Are there 'classes' in commercial optometry?

One way to answer would be an analogy of fast food:

vision world, walmart, and sams club = white castle
sears, jcpenny, eyemasters, macy's, et al = burger king or mcdonalds
pearle or lenscrafters = arbys
of course you have some private offices that are pretty much like no-namer fast food drive ins

best i could do at such a late hour.

 

[posner]

I believe a lot of the "doc in a boxs" fall into a trap of living at a lifestyle of want instead of need. They want all the materialistic goods right off the bat (consumer vs school debt trade = TRAP). I don't want to be in consumer debt, and I think after 2.5 months of practicing so far I've bought a PSP and $70 bucks worth of clothes for myself. I'll probably still continue to work corporate to supplement income when the private practice is just starting up.

My reasons to open private are because I don't want to work for anyone else for the rest of my life. Plus I wanted more experience refracting, b/c any remakes are on the corporate entity right now instead of your own lab bill. I've had two remakes so far, and its a learning experience.

You wouldn't hire someone b/c they worked corporate at one time in their lives? Shouldn't finding the right personalty, drive, and people skills be the main attributes of hiring a good associate?

Yes, the main attributes you described are most important. However, I could not imagine seriously considering an individual as an associate who right out of school kicked the profession of optometry in the scrotum by running over to a doc in the box. It is just my personal opinion, and I am sure it is not shared by all practicing OD's. YOu sound like a decent dude and I wish you well, it is just a hang up of mine.

As for your reference to perfecting the refraction, I am concerned. There are techs that work for our ophthalmologist that do all his refractions. They are $12 per hour employees with nowhere near the level of training you have. Furthermore, if you work with a quality lab, you can usually negotiate at least one free redo and usually more depending on your volume. By the way, just so you know a pair cr39 single vision lenses will set you back about $12-13. Even if you wreck a set of hi index drill mounted progressive transitions with MARC it wont set you back more than $200 in most cases. SO you have managed to save yourself a whopping $400 assuming your redos were the best of the best. Is that really worth not going into private practice? I think you are missing the point. Redos will happen no matter how good YOU are. Whatever floats your boat.

Posner

 

[prettygreeneyes]

I hate to say it, I dont think I could ever seriously entertain a doc in the box convert as an associate in the future of our practice.

Posner

With all due respect... you would specifically not hire someone because they had worked in commercial optometry? I don't have the statistics, but don't a lot of optometrists who open cold have to supplement their income with outside jobs... like... Walmart? Do you also opt not to sit next to them at CE meetings because their former transgressions against the profession might somehow make you unclean too?

Let me add that I'm not wearing an "I love Walmart" T-shirt or anything, nor do I have an undying affection for commercial optometry. In my naive, first year mind, I still view those optometrists as my colleagues. Maybe I'm overly-sensitive, but I find that to be a somewhat arrogant statement. Am I completely off base here?

 

[Ryan_eyeball]

"However, I could not imagine seriously considering an individual as an associate who right out of school kicked the profession of optometry in the scrotum by running over to a doc in the box."

I'm not sure how to respond. We obviously differ on opinions, and as a business owner you are entitled to your opinion on who you decide to hire. Kicking the profession, we could just go to an argument of private practice docs low-balling new graduates. To me this didn't affect my situation at all, because I had no desire to work in a private practice under another doctor. Would I have done more for the profession if I took an associateship with a private practice for two years? Corporate lets me work 7 days a week, and build patient relations (which maybe 30% follow me to a private practice).

Most of the reason I chose my path was to make and save money so I didnt have to starve or worry about not paying myself for six months in private practice. Also while in school we see a patient, we write an Rx and never see the patient again. If they came back for an Rx check it was to a different student or tech in a big ophthalmology practice. Yeah I wondered if i was going to have a lot remakes on Rx's when I got out.


Sounds like we both like our current situations, and I wish the best for you =)

 

[posner]

With all due respect... you would specifically not hire someone because they had worked in commercial optometry? I don't have the statistics, but don't a lot of optometrists who open cold have to supplement their income with outside jobs... like... Walmart? Do you also opt not to sit next to them at CE meetings because their former transgressions against the profession might somehow make you unclean too?

Let me add that I'm not wearing an "I love Walmart" T-shirt or anything, nor do I have an undying affection for commercial optometry. In my naive, first year mind, I still view those optometrists as my colleagues. Maybe I'm overly-sensitive, but I find that to be a somewhat arrogant statement. Am I completely off base here?

I mentioned in an earlier post, that I believe starting cold to be a very difficult endeavor in todays marketplace. It can be done, and I have a great deal of respect for those that can or have done it. I would agree with your assessment of yourself being naive green. You will understand more when you are out in the real world. When I was a first year I thought we were all together. I quickly learned that is not the case. Many ODs are self serving till the bitter end, and they offer nothing to help move the profession of optometry forward. This angers me. I dont feel "unclean" around corporate ODs...I dont understand their choices in many cases. THey love to complain about their situation and many of these folks that I know feel like the profession has let them down; obviously, I feel THEY have let the profession down.

I admit that my initial post sounded arrogant. This is a contentious issue for me and I apologize for offending those of you that have chosen corporate optometry. You are correct there are those that have used corporate optometry to pay the bills while they grown a practice. I also acknowledge that this is often necessary for many beginning thier careers. I still dont like the idea, and it will never sit well with me. I love this profession and when I feel that others are bringing it down, I take it personally. Maybe I am the one that is overly-sensitive?

Posner

 

[posner]

"However, I could not imagine seriously considering an individual as an associate who right out of school kicked the profession of optometry in the scrotum by running over to a doc in the box."

I'm not sure how to respond. We obviously differ on opinions, and as a business owner you are entitled to your opinion on who you decide to hire. Kicking the profession, we could just go to an argument of private practice docs low-balling new graduates. To me this didn't affect my situation at all, because I had no desire to work in a private practice under another doctor. Would I have done more for the profession if I took an associateship with a private practice for two years? Corporate lets me work 7 days a week, and build patient relations (which maybe 30% follow me to a private practice).

Most of the reason I chose my path was to make and save money so I didnt have to starve or worry about not paying myself for six months in private practice. Also while in school we see a patient, we write an Rx and never see the patient again. If they came back for an Rx check it was to a different student or tech in a big ophthalmology practice. Yeah I wondered if i was going to have a lot remakes on Rx's when I got out.


Sounds like we both like our current situations, and I wish the best for you =)

Again I concur with your statement regarding private practice docs low balling new grads. It is disgusting and sadly, it is all too common. However, if you look at it from their perspective, they are taking a pretty big chance and making a significant energy investment bringing an untested associate into the practice. It is a leap of faith on both ends, and many times it doesnt work out.

I would like to remind you of your patient base in the corporate world. These people come to you because they think you are the best deal in town, not because they value your service; if anything you have reenforced to them that your services are not that valuable(that is why you are so much cheaper than most other offices in town because corporate hopes you can run more folks through the dispensary by enticing them with cheap fees). I am not saying that your patients dont like you or wont follow you, but if you dont create a perceived value for your services, there is nothing to say these folks wont frequent the sucker that takes your place.

It is also my opinion that a group practice is not only more profitable most of the time, but allows for more freedom and fewer work hours. It is definitely not for everyone. I will leave the discussion about the pitfalls of a partnership for another time, because there are many(it is not unlike a marriage). I enjoy having the office productive when I am on the beach in Fiji or otherwise vacationing. I also enjoy splittting the managerial duties(if you have not learned yet, you will find that this will be your single largest headache period; seeing patients is the easy part!) and sharing weekend call with my partner and associates. There are many different opinions on this so I will quit. Again, I do apologize for being so abrasive towards corporate optometry, I will attempt to return to more productive discussions.

Posner

 

[drgregory]

i'll again add that while in corporate offices YOU SET YOUR OWN FEES, not the "manager". why would one ever agree to offer their services for such a low rate? if your fees were appropriate, you COULD DEVELOP patient relationships and at the same time make a decent living. why is this concept so difficult?

 

[posner]

i'll again add that while in corporate offices YOU SET YOUR OWN FEES, not the "manager". why would one ever agree to offer their services for such a low rate? if your fees were appropriate, you COULD DEVELOP patient relationships and at the same time make a decent living. why is this concept so difficult?

Good question. It is the same question I ask myself when I see Costco offering $99 exam and glasses and Walmart offerring a $49 exam. If you set your fees appropriately, then what would keep the typical bargain hunter patient(which I maintain is the typical doc in the box patient) from going elsewhere? If this happened enough, and the optical volume dropped off, be ready to look for another job. You will never convince me that most patients seek out quality health care at a doc in the box...it simply isnt true. What they do seek, however, are the least expensive new glasses they can find(which after the bait and switch, turns out to usually be more expensive than they thought; the corporate uses you to devalue your services so that patients come in, and THEY reap the profits while you peddle your $49 exam).

I cannot understand why we cant call a spade a spade. The doc in the boxes understand how the game is played, and they understand their clients/demographics. They are not trying to attract quality minded individuals, but rather high volume, repeat bargain hunting customers. They dont change their philospohy in the dispensary, in spite of how much autonomy you feel you may have. You dance to thier tune plain and simple. If you dont think so, try running it your way for a while and be sure to let us know how it goes for you.

POsner

 

[drmhyde]

but more one way than the other. see how long you can hold a lease at wally world if you put your procedure fees at an appropriate level and start doing office visits yielding no spec Rxs. when you have done this, come back and post for everyone to see how you enjoyed your 6 week lease that was terminated at wally world.

I've been doing it for 2 years at walmart. you are wrong (and a bit arrogant.)
LETS BOX!!!!!!!!!!!!!!!!!!!!!!!!!!😡

 

[drmhyde]

I saw a red eye patient that happened to be a postier uveitis and a secondary fb removal unrelated to the uveitis .

Her bill was $325 and she paid it...so now WTF was your point again???

 

[posner]

I saw a red eye patient that happened to be a postier uveitis and a secondary fb removal unrelated to the uveitis .

Her bill was $325 and she paid it...so now WTF was your point again???

That is how it should be. Sadly, your example is rarely the norm for the doc in the box setting. I am glad to hear you didnt wrap of your services in the $50 eye exam fee.

Posner

 

[PBEA]

I saw a red eye patient that happened to be a postier uveitis and a secondary fb removal unrelated to the uveitis .

Her bill was $325 and she paid it...so now WTF was your point again???

You are the exception, get it, thats the point. You work in Texas ( I think), right? Are you in an underserved (or undesirable) rural area? Maybe that is why your corporate overlord does not mind so much. In my somewhat dense suburban area there isnt' a wallfart in the book that would bill anything above "routine" refractive exam (~$49), even if they did remove the FB. This type of billing is frowned upon by the corporate boss, as it does not generate spectacle sales for the money-maker dispensary.

 

[drmhyde]

They can't stop you from billing that. Sure I do spec rx's all day long. But now that word is out...people come in for med exams too. My real difference is I am on all the medical panels and I set my usual and customary fees accordingly. Is there medical panel restriction in other states (your state)?

 

[cpw]

I saw a red eye patient that happened to be a postier uveitis and a secondary fb removal unrelated to the uveitis .

there's something you don't see every day .... has she been tested systemically ?

Unfortunately, in Florida, I'd have to refer this one out... I can't write for oral steriods 😡

 

[drmhyde]

there's something you don't see every day .... has she been tested systemically ?

Unfortunately, in Florida, I'd have to refer this one out... I can't write for oral steriods 😡

They media cleared today and I could see the retina much better. She had a large pearly white neoplasm (raised and vascularized). Shes in deep doo doo. I sent her to the ER (she had no insurance...only place to go)

 

[cpw]

They media cleared today and I could see the retina much better. She had a large pearly white neoplasm (raised and vascularized). Shes in deep doo doo. I sent her to the ER (she had no insurance...only place to go)

wow... that's really not good. 🙁 Poor thing. I hope things turn out okay for her.

 

[drgregory]

I've been doing it for 2 years at walmart. you are wrong (and a bit arrogant.)
LETS BOX!!!!!!!!!!!!!!!!!!!!!!!!!!😡

so post your fee schedule. and if you truly are charging appropriately i submit and say "good job to you". but if you are giving any "cash payers discount" or any other garbage you are no better than your boss (the 19 year old district manager). so, what is your fee for a new patient comprehensive exam + refraction? its one thing to list your fee. but to actually charge it without exceptions is another.

 

[drgregory]

The doc in the boxes understand how the game is played, and they understand their clients/demographics.
POsner

which is why it is so frusterating. to continually agree to degrade your profession, even when you have the power to set your own fees and let your services be what they are worth. sitting back and letting the corporate boss dictate your fees is disturbing.

 

[bournehall]

Come on guys. I know it is degrading to say you are a doctor and spent 8 years in school to work next to the pots and pans at Sears or Walmart. BUT, if you charge 70 for a routine exam and do 14 a day thats 980 per day less 196 for rent/help and you take home 794 dollars. Working 5 days a week for 50 weeks a year that turns out to be 198,500. And this does not even count your contact fees. Look, no matter what you do it becomes routine after awhile. How many fb/rust rings can you remove, how long can you baby sit drops for glaucoma, and on and on and on. After awhile reimbursement begins to move up the food chain. So after 23 years I have become a tad more tolerant of these corporate "prostitutes". My concern and question is how the heck do you get to be part of this fraternity? Maybe I am not as sexy or good looking as Dr. Hyde but I do clean up OK. Do any of the Walmarts have 2 lanes and do they prohibit your hiring a tech to refract?

I've been doing it for 2 years at walmart. you are wrong (and a bit arrogant.)
LETS BOX!!!!!!!!!!!!!!!!!!!!!!!!!!😡

 

[prettygreeneyes]

so post your fee schedule. and if you truly are charging appropriately i submit and say "good job to you". but if you are giving any "cash payers discount" or any other garbage you are no better than your boss (the 19 year old district manager). so, what is your fee for a new patient comprehensive exam + refraction? its one thing to list your fee. but to actually charge it without exceptions is another.

drgregory,

Call me crazy, but it appears that "hatred of corporate optometry" undertones are present in all of your posts. (They're subtle... you gotta look for 'em.😉 ) From what I gather, one of the bigger reasons you hate them is that professional fees in these locations are not set appropriately (correct me if I'm wrong). You specifically mention that "its one thing to list your fee but to actually charge it without exceptions is another." So, you feel that these doctors are devaluing (sp?) our profession. How does this hatred of accepting less than one's worth relate to low ball vision plans? It doesn't matter how high you set your fees, if Vision-Plans-R-Us only pays X dollars (and that's less than your set fee) aren't you doing the same thing? The difference being... the corporate optometrist is upfront about it?

Call me "naive" or "green"... but it seems like unless an optometrist has a strictly cash-paying patient base, or exclusively accepts medical insurances that pay well, he/she would ALWAYS be accepting less than their set fees, meaning the only difference between a private practice doctor (who accepts all the low ball vision plans) and a corporate doctor is... location? (Patients per day and owning your dispensary not withstanding)

 

[posner]

drgregory,

Call me crazy, but it appears that "hatred of corporate optometry" undertones are present in all of your posts. (They're subtle... you gotta look for 'em.😉 ) From what I gather, one of the bigger reasons you hate them is that professional fees in these locations are not set appropriately (correct me if I'm wrong). You specifically mention that "its one thing to list your fee but to actually charge it without exceptions is another." So, you feel that these doctors are devaluing (sp?) our profession. How does this hatred of accepting less than one's worth relate to low ball vision plans? It doesn't matter how high you set your fees, if Vision-Plans-R-Us only pays X dollars (and that's less than your set fee) aren't you doing the same thing? The difference being... the corporate optometrist is upfront about it?

Call me "naive" or "green"... but it seems like unless an optometrist has a strictly cash-paying patient base, or exclusively accepts medical insurances that pay well, he/she would ALWAYS be accepting less than their set fees, meaning the only difference between a private practice doctor (who accepts all the low ball vision plans) and a corporate doctor is... location? (Patients per day and owning your dispensary not withstanding)

The difference, is that in private practice YOU can choose to either accept or not accept a vision plan. There are plenty of plans that I feel are insulting and I refuse to participate. I let others(like yourself perhaps) degrade themselves and accept pennies on the dollar for their services. Sadly, we(as well as most other health care professions) are pushed around by third party payers. This is not a new problem, and will likely always be a problem. As long as there are providers willing to accept low ball fees these plans will stay around.

posner

 

[drmhyde]

drgregory,

Call me crazy, but it appears that "hatred of corporate optometry" undertones are present in all of your posts. (They're subtle... you gotta look for 'em.😉 ) From what I gather, one of the bigger reasons you hate them is that professional fees in these locations are not set appropriately (correct me if I'm wrong). You specifically mention that "its one thing to list your fee but to actually charge it without exceptions is another." So, you feel that these doctors are devaluing (sp?) our profession. How does this hatred of accepting less than one's worth relate to low ball vision plans? It doesn't matter how high you set your fees, if Vision-Plans-R-Us only pays X dollars (and that's less than your set fee) aren't you doing the same thing? The difference being... the corporate optometrist is upfront about it?

Call me "naive" or "green"... but it seems like unless an optometrist has a strictly cash-paying patient base, or exclusively accepts medical insurances that pay well, he/she would ALWAYS be accepting less than their set fees, meaning the only difference between a private practice doctor (who accepts all the low ball vision plans) and a corporate doctor is... location? (Patients per day and owning your dispensary not withstanding)

OHHH...SNAP!! Can I get a HELL YEAH! So cancel eyemed and spectera NOW!!! Before they ruin your good name!

 

[orangezero]

Stupid question perhaps, but why do plans like spectera feel justified in offering lowball figures to doctors for their exam?

Is it because they truely feel private ODs are "overpriced?"

Or, do they do surveys in the area and come up with a reasonable number?

I'm certianly not trying to take anything away from spectera or justify what they do. But if we didn't have commercial opticals charging 10 to 25% of what a private OD charged, do you really think spectera could come into a private office with a straight face and ask a doc to accept a reimbursement fee of 20% the usual and customary for private ODs in the area?

There are just too many factors in all of this to just blame one thing. But, those $30 eye exams are hurting every other doctor in the area and across the nation when it comes time to set reimbursement.

Another thing to think about. When I worked commercial we had the exact same fees for a regular exam in 1996 that we had in 2004. Tell me what part of health care, or any customer service area really, that has stayed flat as far as fees for services. I know of other areas where its actually gone down. Heck my local barber doubled his haircutting prices in that time. The nail salon next door was almost charging as much as I did for an eye examination, and people woudl not have a problem coming in there every few weeks to have that done.

I think thats another thing to think about. Do you want to be in a work environment in which the only way you can make more money is to squeeze in more patients? Who does that work out good for??

Damn right some people may be upset over this. It spills over into private no matter how hard we try to separate the two.

 

[orangezero]

Also, does anyone here that works commercial do/did these things?

1) recheck outside Rxs for the optical at no charge?
2) see other ODs Rx rechecks at no charge?
3) see other ODs Cl followups at no charge?
4) get asked to do $100 global lasik prescreening and followup for a year?
5) been asked to come in at 9pm on a saturday night and not even get paid for it because the register wasn't open then?
6) do four exams an hour with no pretest help plus squeeze in walkins?
7) dilate patients before refraction because it speeds up the exam time?
8)

I've been asked to do all these things. One OD does it and then magically it becomes standard and the walmanagers expect it of all of us. One guy was whipping out 30-40 "exams" in a day with no help, because he didn't even talk to the patient and only overrefracted the autorefractor. Not even a 90D or BIO in his "office" I'm certainly not saying this because I think thats how all commercial ODs act, but that kind of stuff has a ripple effect all ODs have to deal with. all of those patients view every optometrist as poor and the staff real from this and view it as normal. Its not the "good" doc in commercial that does spend 45 minutes thats necessarily the problem (i have other posts for that guy or girl) but its the commercial environment that sets the stage for these types of things to happen, and the resulting affects on vision plans, the publics perception of optometry, optometry's professionalism, etc. etc... not that it couldn't happen in a private office, but it if does, only the optometrist is to blame there. then I can just be upset with them, instead of the "system"

 

[KHE]

Also, does anyone here that works commercial do/did these things?

1) recheck outside Rxs for the optical at no charge?
2) see other ODs Rx rechecks at no charge?
3) see other ODs Cl followups at no charge?
4) get asked to do $100 global lasik prescreening and followup for a year?
5) been asked to come in at 9pm on a saturday night and not even get paid for it because the register wasn't open then?
6) do four exams an hour with no pretest help plus squeeze in walkins?
7) dilate patients before refraction because it speeds up the exam time?
8)

I can honestly say that during my tenure in commercial practice, which was mercifully short, I was not asked to do any of those things. In fact, I know of no collegue that has been asked to do any of those things with the exception of rechecking an occasional Rx. The only other OD I would do free rechecks was the other OD at the commercial practice, and I know that he did a bunch of mine, so no problem there.

 

[PBEA]

In this post, drgregory mentioned that optometrists are "overtrained." I've heard some responses, but I want to make this a separate discussion. Do any of you agree? I'm starting to believe it myself because of a lot of this information that I'm learning so far as a first year doesn't seem so relevant...at least, as a practicing optometrist.

I'll try and put this thread back on topic.

No, we are not overtrained. The things you learn in first and second year will be smattered with seemingly unrelated/unimportant material. You will connect the dots later in your training. Eventually you may decide to devote a huge chunk of your time to learn something that somebody else will not. This is called specialization, get used to it.

 

[prettygreeneyes]

I let others(like yourself perhaps) degrade themselves and accept pennies on the dollar for their services.

😕 😕 😡

Because anyone who calls out your (or drgregory's) blatant hatred and disrespect towards those in corporate optometry must by default be one of "them"? I'm nothing more than a lowly first year who should be studying for her biochem exam Thursday, instead of arguing with you.

As I've said before, I'm not a "wally world" lover, by any means. I am, however, saddened and discouraged by the way which some optometrists (yourself and drgregory included) speak about your colleagues. These people were your classmates and lab partners and somehow, you believe you have become worth more than they are because your address doesn't include "care of Wal-Mart, Sears, EyeMasters, etc." and their address does?

My last post was a serious one. I know of some private practice doctors who take every vision plan under the sun. EyeMed, Spectera, etc. They seem to pay lower amounts than any of the commercial joints charge for eye exams. I'll even throw VSP into this discussion, which seems to be one of the "classier" vision plans, for a lack of a better word. From my understanding (and I'm sure you'll correct me if I'm wrong) VSP pays based on a regional average usual and customary fee. So, even if I decide to charge $500 for my eye exam, if everyone else in town charges only $100... I'm not going to see anything remotely close to my full exam price as reimbursement. Therefore, if I accept VSP (which I'm fairly sure that drgregory has mentioned that he does... posner I'm not sure if you do) I will be accepting less than my "worth" for the sake of getting those patients in my door. In that respect, how would I be different than a corporate optometrist?

The difference, is that in private practice YOU can choose to either accept or not accept a vision plan. There are plenty of plans that I feel are insulting and I refuse to participate. Sadly, we(as well as most other health care professions) are pushed around by third party payers. This is not a new problem, and will likely always be a problem. As long as there are providers willing to accept low ball fees these plans will stay around.

posner

OP... sorry for the hijacking of your thread...

 

[orangezero]

I don't think its a one to one connection between a vision insurance plan and setting low fees at a commercial location. One is at least superficially behind the scenes, while the other is plastered on signs and banners when you walk in the door. Big difference, in my opinion.

I bet if you asked most people about their vision plan, the patient would probably say it reimburses their optometrist 80 to 90% of the normal charge. Not the 30 to 60% that is a more realistic number (at least off the top of my head). So, in some ways, vision plans still respect the "value" of an exam.

Most of my friends dont' believe me when I tell them how low some plans are for reimbursement.

 

[posner]

😕 😕 😡

Because anyone who calls out your (or drgregory's) blatant hatred and disrespect towards those in corporate optometry must by default be one of "them"? I'm nothing more than a lowly first year who should be studying for her biochem exam Thursday, instead of arguing with you.

As I've said before, I'm not a "wally world" lover, by any means. I am, however, saddened and discouraged by the way which some optometrists (yourself and drgregory included) speak about your colleagues. These people were your classmates and lab partners and somehow, you believe you have become worth more than they are because your address doesn't include "care of Wal-Mart, Sears, EyeMasters, etc." and their address does?

My last post was a serious one. I know of some private practice doctors who take every vision plan under the sun. EyeMed, Spectera, etc. They seem to pay lower amounts than any of the commercial joints charge for eye exams. I'll even throw VSP into this discussion, which seems to be one of the "classier" vision plans, for a lack of a better word. From my understanding (and I'm sure you'll correct me if I'm wrong) VSP pays based on a regional average usual and customary fee. So, even if I decide to charge $500 for my eye exam, if everyone else in town charges only $100... I'm not going to see anything remotely close to my full exam price as reimbursement. Therefore, if I accept VSP (which I'm fairly sure that drgregory has mentioned that he does... posner I'm not sure if you do) I will be accepting less than my "worth" for the sake of getting those patients in my door. In that respect, how would I be different than a corporate optometrist?





OP... sorry for the hijacking of your thread...

Interacting with you is like talking to Charlie Brown's parents....wah wah wah. I am saddened and discouraged by those that drag the profession of optometry down each day as they pass the shopping carts, closeout household items, and bargain electronics bins as they walk through the front door of thier office. You can be as righteous as you want, but like it or not, corporate optometry mentality affects all of us.

I dont think I am any better than any other OD who may choose to practice at Walmart. I do however, disagree with their mode of practice and feel very strongly that it drags the profession down. Enough said. There is no reason to continue to debate this. You still think you can save the world one pair of glasses at a time. More power to you.

You manage to make a cogent point in regards to VSP. I do accept VSP. Depending on the plan, I am usually reimbursed about $89 for an exam(including copay). ALthough I am not thrilled with this(our fee for a routine exam is $120 now and will go up to $135 in december) I do feel that they make an attempt to support private practice(although not at the expense of thier bottom line). The message here, is that if you have a large VSP volume, you better figure out additional revenue streams if you want to put food on the table.

Posner

 

[Ben Chudner]

Stupid question perhaps, but why do plans like spectera feel justified in offering lowball figures to doctors for their exam?

Is it because they truely feel private ODs are "overpriced?"

Or, do they do surveys in the area and come up with a reasonable number?

Not that this has anything to do with this thread, but the reason plans offer these lowball reimbursements to doctors is because they know someone will take it. Unfortunately, there is a large percentage of OD's that just do not understand the economics of these plans. To them, these lowball plans bring patients in the door. The problem is that these patients take up the space of better paying insurance patients. They do not realize that they are better off seeing just one cash paying patient an hour than seeing 6 Spectera patients an hour. They will say that they are willing to accept the pitiful reimbursement in optical because they can sell second pairs. They do not realize that on average these patients only want what their insurance will cover. What's worse is that when the patient gets the covered glasses, the practice actually loses money because of all the staff time involved.

 

[xmattODx]

Interacting with you is like talking to Charlie Brown's parents....wah wah wah. I am saddened and discouraged by those that drag the profession of optometry down each day as they pass the shopping carts, closeout household items, and bargain electronics bins as they walk through the front door of thier office. You can be as righteous as you want, but like it or not, corporate optometry mentality affects all of us.

You wanna tone it down a little bit?

PGE asks great questions. You could have the courtesy to treat her with some respect. I'm sure you've convinced her that private practice is the only way to go because she'll have the opportunity to associate herself with the most arrogant, condescending optometrists around.

 

[drgregory]

As I've said before, I'm not a "wally world" lover, by any means. I am, however, saddened and discouraged by the way which some optometrists (yourself and drgregory included) speak about your colleagues. These people were your classmates and lab partners and somehow, you believe you have become worth more than they are because your address doesn't include "care of Wal-Mart, Sears, EyeMasters, etc." and their address does?

my reason for displaying my disgust is not to say that these ODs at the mall are not as competent. if you read ANY of my posts you'd understand that. i mean, you should have all of the time in the world to search and read my posts as an optometry student. anyways, my hatred springs from THE FACT THAT THESE ODS IN THE MALL ARE KNOWINGLY DEGRADING OUR PROFESSION. in fact, many of them are excellent ODs. that is the problem - YOU SHOULD NOT BE ABLE TO RECEIVE ANY SORT OF EVALUATION or CONSULTATION with any eye care professional for $29. and the more we feed this problem, the more the public will assume that is what our services are worth. AND YOU GUYS WONDER WHY SOME OMDS FROWN ON US.

 

[rpie]

my reason for displaying my disgust is not to say that these ODs at the mall are not as competent. if you read ANY of my posts you'd understand that. i mean, you should have all of the time in the world to search and read my posts as an optometry student. anyways, my hatred springs from THE FACT THAT THESE ODS IN THE MALL ARE KNOWINGLY DEGRADING OUR PROFESSION. in fact, many of them are excellent ODs. that is the problem - YOU SHOULD NOT BE ABLE TO RECEIVE ANY SORT OF EVALUATION or CONSULTATION with any eye care professional for $29. and the more we feed this problem, the more the public will assume that is what our services are worth. AND YOU GUYS WONDER WHY SOME OMDS FROWN ON US.

Just wanted to add an interesting bit from LUX dated 6/20/2006

RE: Luxottica sublease agreement. Article 7 G. Hansra O.D. director of eye care LUX

7) BOOKS AND RECORDS: All doctor are required to report monthly sales. We have enclosed a sample reporting form for you reference. Doctors should submit such electronic statements via e-mail to drbilling @ lux (not the full email address)


I find this fascinating that corp. is requiring the subleasing OD to show them what their income is.
😱

 

[bournehall]

I agree in part with what you are saying but I am not sure I agree with the assumption that patients from lowball plans take up space from regular higher paying patients. The facts of life are that the vast majority of optometrists can not fill their schedules with regular paying patients. So, I would rather have VSP patients than larger holes in the daily schedule.

Not that this has anything to do with this thread, but the reason plans offer these lowball reimbursements to doctors is because they know someone will take it. Unfortunately, there is a large percentage of OD's that just do not understand the economics of these plans. To them, these lowball plans bring patients in the door. The problem is that these patients take up the space of better paying insurance patients. They do not realize that they are better off seeing just one cash paying patient an hour than seeing 6 Spectera patients an hour. They will say that they are willing to accept the pitiful reimbursement in optical because they can sell second pairs. They do not realize that on average these patients only want what their insurance will cover. What's worse is that when the patient gets the covered glasses, the practice actually loses money because of all the staff time involved.

 

[Ben Chudner]

I agree in part with what you are saying but I am not sure I agree with the assumption that patients from lowball plans take up space from regular higher paying patients. The facts of life are that the vast majority of optometrists can not fill their schedules with regular paying patients. So, I would rather have VSP patients than larger holes in the daily schedule.

I can understand your skepticism, as I was the same way until I saw for myself the truth. And to be clear, I am not saying that if you see 15 Spectera patients a day and you dump the plan that you will be able to fill those spots with 15 cash paying patients. My point is that you only have to fill those 15 spots with 5 cash paying patients, or 3 medical patients which is actually a lot easier to do. On top of that, you will be working less and making just as much or maybe more. Why would you want to work harder to make the same or less?

I have several friends that dumped VSP. In the first year after they did it they saw less patients and their gross production went down on average 20%, however their gross collection only went down on average 9% . What's more important is that their net (actual money they took home) went up on average 5%. What this tells me is that they were able to replace those VSP patients with more profitable patients, or to put it another way, those VSP patients took up spots for better paying patients. Furthermore, they worked less to make more money. Now to be honest, I still take VSP but it is my benchmark. I won't take any plan that pays less than VSP, and while the data is there to suggest I might make more money if I did dump it, I have a couple of reasons why I keep it for now. I assure you that will change.

 

[posner]

You wanna tone it down a little bit?

PGE asks great questions. You could have the courtesy to treat her with some respect. I'm sure you've convinced her that private practice is the only way to go because she'll have the opportunity to associate herself with the most arrogant, condescending optometrists around.

No I wont "tone it down a little bit". I will continue to freely speak my mind as I see fit. I have also said I dont see myself as any better than corporate ODs. My point was that these wally ODs are not good for the future of our profession. Period. While PGE may ask what you feel to be great questions, she is up for a real awakening from her crayon world of paper clouds. As a first year student, you would think that PGE would be more interested in learning from others that have been doing it for a while rather than speaking as though she has some kind of clue.

Nevertheless, my intentions have always been to try and help other ODs be as successful as possible(not just monetarily). If you look back on my original post(my rant on the current state...)you will see this. I understand that not everyone desires to be in private practice and that is fine. But, don't piss on my leg and tell me it is raining either. I will never believe $49 eye exams are good for our profession.

On a side note, I dont feel that the way we do it in our practice is the only way. I always learn from colleagues and attempt to apply the successes of others to my own practice. It can always be done better and more efficiently than the way it is being done.

Posner

 

[xmattODx]

I will never believe $49 eye exams are good for our profession.

I'd respond to your post by saying that you really shouldn't take message boards so seriously, and that there are far kinder ways of getting your, probably valid, point across but I can't.

I have a $39 exam waiting, and then I have to see my DFE who also paid $39 for her eye exam. Hurts doesn't it?

 

[drgregory]

\
I have a $39 exam waiting, and then I have to see my DFE who also paid $39 for her eye exam. Hurts doesn't it?

nothing illustrates my points better than this.