private vs. commercial

[cpw]

hey guys.. well, I figured I'd start the every popular private practice OD vs. Commercial practice OD debate.

There are pros and cons to both. The pros to private practice being:

Freedom to choose employees
Freedom to decide pricing and rates
Self ordering of frame stock and contact lens supplies
Set your OWN hours
Generally better respect from your patients

Pros to commercial practice (wal-mart, sears, Pearle, Lenscrafters, etc)

Set salary
benefits (usually)
work is done when you leave (no taking work home with you)
not having to deal with employee issues
not having to deal with ordering of frames/contacts

Well, those are just some good points... I just wanted to get everyone started. the rest is up to you.
I personally, am leaning toward private practice, but you never know how things are going to end up.

Let the conversation flow!!

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[Popoy]

Where would consider health management organizations?

 

[Popoy]

Sorry, I don't think I was clear enough....

Where do HMO's fall under, private or commercial?

 

[cpw]

They're more toward the commercial side. You dont pick your staff, you're paid a salary, you usually get benefits..

They usually are listed seperately, but they run almost exactly the same as commercial practices.

The OD I talked to at Kaiser when I did interviews with OD's in different styles of practice hated it. Although, he said a lot of his co-workers liked it because they were paid well, didn't have to bring work home, got benefits, but got KILLED in the number of patients they have to see a day. (he averaged between 25-30 exams) not to mention rx checks, contact checks, pink eyes etc.

To put it in perspective.. the OD I worked for in private practice refused to see more than 16 exams a day.. plus rx checks, cl checks, etc. And he was always running from room to room even at that pace. I can't fathom doing 30!!!

But, you're there to make money for the HMO, not yourself.

 

[Popoy]

Doesn't the added headache of being in a private practice outweights being in an HMO?

I mean, in private practice you have to be your own business man, right?

 

[abs1]

It does, Popoy.

Personally, the private practice approach doesnt appeal to me all that much (I know thats riduclously hard to believe!). Who knows, though, how Ill feel once school tries to indoctrinate me with private being the way to go????

All those points you made about the +'s of commercial, cpw, in your first post on this topic are major +'s for me about commercial/corporate. I have shadowed many a doc in corporate opt and they do do ALOT of exams a day. But they dont have to do some of the procedures, there are techs there for pre-exam. And most of them are happy, especially when they head home with no business worries at night.

I just dont really think that corporate/commercial opt is as bad as many think it is. Some just have the private practice bug and others dont, I guess. I love everybody, ya see

 

[Popoy]

For your experiences, did you folks see any difference with the personality types of those in private vs. commercial?

 

[cpw]

I guess the people in private practice are just into running their own show. They want to be their own boss. There's no real personality time.. I sometimes wonder if I'm going to be good enough or have the time to devote to running a practice of my own.

Most OD's i've talked to have said that women usually the flexible hours of HMO/commercial.. but then again I"ve heard of some commerical places firing women for taking too much time off after having a baby. (how dare they stop making money!!)

So, it's mostly a matter of personal preference. I think Id rather be my own boss.. but then again it is a lot of extra work. I'm going to have to do a whole lot of soul searching.

 

[Popoy]

too much time off for a baby!!! How dare they!!!

I'm sure the point that we are all going through professional schools is for us to find ourselves through the process.... Finding our own niche and seeing if it fits us.... possibly pursuing that route.

How about your experience abs1?

 

[Popoy]

oppss let me clarify that....

"How dare they fire women because of that reason!!!!"

 

[abs1]

I agree wholeheartedly with cpw. Its just personal preference. I, personally, couldnt really imagine running my own business at this pt. And, cpw sounds like she doesnt want someone else setting her hours for her, which I can totally understand if youve got a child!

So, no the personality types arent really diff in the two settings, just the atmospheres.

I would consider getting involved with pre/post-lasik care, but I dont really know much about that route at this point. I guess thats what school's for!

 

[cpw]

well, with pre/post lasik care you usually also take care of the OMD's post cataract and post glaucome surgery patients as well. It might be something I"d consider part-time to make some extra money.. but not something I think I would enjoy full-time for a long time.

This is fun.. it's like the three of us are having a real conversation.. just.. more drawn out!

 

[abs1]

Im enjoying myself!

At this rate, we'll be at 200 in no time!!

 

[Popoy]

Me too!!!

I do have a question about lasiks.... or other alterntative treatment of nearsightedness....

Which would you recommend.... Contact lenses (Hard or soft), lasiks or other similar methods (if there's anything else out there), or just plain old glasses? I know both of you aren't full pledge professionals yet but what are why would you choose one over the other.... I ask because I tried the contact (hard) lenses and it irritate my eyes so much.... After that, I kind of stayed away from other things besides glasses.... Maybe I can find some reason again to go back to contacts or lasiks or something... any thoughts?

I'll like to hear some of your opinions....

 

[mpp]

Don't forget that there are many different types of private practices. I shadowed an O.D. in a big private practice (5 O.D.'s, 4 M.D.'s, and numerous techs and opticians). One O.D. acted as the "manager" taking care of employee concerns (i.e., scheduling, accounting, etc.) while all the partners made the bigger business decisions. Profits were shared according to actual billing by each doc so that those who wished to see more patients (and hence bill more) would see a larger share of profts while those that wanted to spend more time with patients would still be accomodated but earn less. Most seemed happy but there was the typical bickering when toes were stepped on or heads butted.

I also shadowed a tiny little practice -- one O.D. whose wife took care of all administrative duties. He had no dispensary (he referred them to an optical shop in the same building), did only straight forward refractions, and referred medical cases to the aforementioned eye clinic. He wasn't the wealthiest man in town but seemed to thoroughly enjoy running his own business at his own pace with no one else to worry about.

 

[abs1]

Popoy,
Not yet being a opt, its hard to really say for sure? (call me in 4 yrs )

But, never one to back down from a question, I would say that its largely a matter of personal preference first. Judging from the fact that you have been scripted for hard contacts, you prob arent a candidate for soft ones. If the hard lenses irritate you, as they clearly do, then you might just not be the type of person that likes contacts. Some people cant stand them.

Eyeglasses are, of course, a great alternative. With all the fashionable frames and light-weight lenses we have these days, its a good way to go if you dont like contacts, but thats obvious. You can never go wrong with specs.

As for lasik, you have to ask yourself whether or not you like the idea of a laser slicing through your cornea? Some people think it's too risky, some think its the greatest thing ever created. Is it safe? Absolutely. Does it work? You bet. Are there complications? Theres always potential for them with any surgery. You just have to decide if you hate glasses and contacts so much that you are willing to try it? And if its worth the $ knowing that you're just going to need glasses when you turn 40 anyways? It absolutely works (usually) though.

I am blessed to not need vision correction, but I can tell you that all 3 are great ways to help nearsightedness. As I said, it's mainly a matter a personal preference. My fiancee wears only contacts, my brother wears only glasses, and my uncle has had Lasik. All three wouldnt do it any other way.

 

[abs1]

mpp,
That is very true, there are several types of private practice. While I have no great desire to have my own practice at this point(this, of course, could change any day
), I have to tell you that a group practice does appeal to me. Its a great way to go these days from everything I hear.

Being new here I have not met everyone. Mpp, are you in opt school or going to start soon?

 

[Popoy]

WoW!!! I appreciate that abs1.... That's true, when it all comes down to it... it's pretty much personal preference.

I heard some side effects on lasik is blurred vision during night time? How often does that happen.... Oh no... I think I'm off topic now... sorry....

Hey we have a new visitor..."mpp".... mpp welcome to "our" optometry forum!!!

 

[abs1]

Popoy,

Im happy to help. I can tell you all I know, but remember that I am not an OD or an OMD....yet.

From my understanding, blurred vision at night does indeed tend to occur as a side effect from Lasik....but rarely. At times it will go away and other times one needs a follow-up procedure. How often does this side effect appear? Not very often, but it does occur. Its merely a risk to weigh, but certainly not a norm.

Some decide to only have one eye done at a time. Thats a good option for those that are a little weary of the whole process. This was pretty usual in the beginning days of Lasik, but most patients do both eyes the same day now.

Keep in mind that many are not even a candidate for Lasik. If you have thin corneas, etc its not even an option, so that could make the decision very easy for you

.

Again, in 4 years, ill be more than happy to help you further!

 

[abs1]

We definitely need our moderator cpw to reroute this to a new thread! HA

 

[Popoy]

LOL!!! Where R U cpw?!!!

 

[mpp]

abs1,

I was planning on going to optometry school begining this fall. But now I've decided against it. Instead I am applying to medical school. Here is something from an old post of mine about why I've decided to pursue medical school:

I had my eyes set on optometry at one point. I applied (and was accepted) to SUNY and Pacific University. Although I never worked with optometrists I spent many many hours with different doctors of optometry in several types of practices. In my opinion, here are the advantages of optometry as compared with medicine:
-- you often have more time for patient interaction as an O.D., none of this 5-minute in and out business.

-- it's a very cut and dried profession. Most of the time you go to work at 8 a.m. and leave at 5 p.m.

-- it's pretty clean. Some people want to be in the health field but just don't like the "icky stuff". Not much of that in optometry.

-- Rarely must you be the bearer of bad news (beyond the fact that you need a stronger prescription). Sure there are glaucoma cases and occassionaly O.D.'s will discover the presence of some neural disorder, but most of the time patients leave pretty happy.

-- It is possible to make a fair sum of money depending on the location and scope of practice. It is not unheard of to have O.D.'s making $150,000+ per year although $75,000 is more realistic.

-- The education of an O.D. is quite rigorous (four years beyonds a bacherlor's) and once your are finished with your four years (and pass the national boards) you can practice. There are residencies available if your want to specialize but it is not required. So the advantage over an M.D. degree here is a shorter (yet still thorough) education.

-- The field is changing and expanding. Beyond the standard "Is it better like this or is it better like this" O.D.'s now do lots of pre- and post-operative care for LASIK and PRK patients. In some states trained O.D.'s can perform some minor corrective "surgeries". O.D.'s treat medical eye disorders. However, there are some that say all this corrective surgery is cutting into O.D.'s income as sales of glasses and contact lenses go down but I have yet to see valid statistics showing this is the case.

But after all these good things (and I'm sure there are many more that I just can't remember at the moment) I decided not to pursue optometry but instead go into medicine. My reasons for doing this include:

-- the limited scope of practice. Although I find the eyes and vision quite fascinating, it's a narrow field. I think I want to do more and I may find other things out there that are even more interesting.

-- some O.D.'s express concern that they are not treated with the same respect as M.D.'s treat each other. Also, often the public misnderstands the roles of optometrists, opticians, and ophthalmologists in health care. I think this is similar to the concern some osteopathic physicians have about their field. This is more an education issue (I mean education of the public, not the doctor) and it's a shame that such a wonderful field as optometry has such a bad rap. Some blame it on the fact that optometrists are now found everywhere...Walmart, Target, and Sears. To me however, this shouldn't cheapen the profession but rather the profession should be praised for trying to broaden their practice to the everyday population. I know of many people that get uncomfortable immediately after they enter a clinic or medical building, but you can't say the same thing about walking into a Walmart (some people probably disagree with me about this, so I'd love to hear your opinions on the matter).

-- the job can be tedious if you are not into the clinical aspect of the profession. I spoke with some optometrists that only give glasses/contacts presecriptions. If they find any medical condition at all, they refer them. I wouldn't like to soley do vision checks all day but for others it's heaven.

-- the cost of the education is about the same as in medicine and I feel my "return on investment" would be worse going into optometry. This not because there is anything wrong with being an optometrist but after four years of medical school I'll still have some choice about what I want to do. After four years of optometry school, I'm stuck being an O.D.

-- the re-training aspect is worse for O.D.'s. I know of M.D.'s that were specialists in one area and after a few years they found they didn't like it, so they went back into a residency in a different field and changed specialties. Certainly this isn't common but it is possible. O.D.'s don't have that luxury. They're stuck treating vision problems.

If you can't tell, I've though a lot about this. I think I'm making the right decision, but I'm me and I'm sure others will (and do) find optometry to be a wonderfully fulfilling career that is an integral part of total health care.

I hope this helps you out, but don't let me make up your mind. Go talk with optometrists and physicians and see what fits with your lifestyle. By the way, I think you'll find optometrists much more open than M.D.'s into allowing you to watch them work...I think the deal is there are fewer privacy issues when dealing with vision problems then with typical medical problems...if an O.D. asks his/her patient to undress it is probably time to revoke a license or something more drastic. Cheers.

 

[abs1]

mpp,
Yea, i read that once before as a matter of fact. You make some really good points and it sounds like you are headed in the right direction for yourself! Congrats!

Its strange, but some of your neg aspects of opt are actually some of my positives. Weird, huh? It takes all kinds in this world, I guess.

 

[Popoy]

cpw.... sorry I missed you at the chatroom.... When you came back, I had to leave.... Maybe next time....

Here's a pretty ignorant question on my part.... What does OD stand for exactly?

I'm assuming it's Optometry Doctor.... Is it?

 

[Popoy]

I just looked it up...

OD = Doctor of Optometry

Funny how it's more like DO but it's not because DO = Doctor of Osteopathic Medicine. I wonder if that's the reason to distinguish between the two.... huh?!

 

[abs1]

you got it!

 

[cpw]

Hey guys.. sorry.. some of us have to work!

Our topic has diverted.. but I cannot as of yet redirect topics. I'm not officially a moderator. Kimberli did write to LB about it though on my behalf.

I was wondering.. If DO's had actually switched to DOM.. would OD's have switched to the more logical DO?? Hmmmmm....

And as for your contacts/glasses/lasik questions.. I totally agree with abs1.. it's personal prefernce. Chances are, if your OD put you in RGP's (hard lenses) there's a specific reason for it.. maybe you weren't a candidite for softs. But, it also depends on how long ago it was.. before 1988 or so there weren't really soft toric lenses (for people with astigmastism) So, if that's what your OD was correcting then there's lots more options for you with softs now a days.

As for lasik.. that's your own judgement call. My boyfriend did it and worships it! Watching him put contacts in was like watching him torture himself (he's VERY eye phobic) So Lasik was ten minutes of pure hell for him.. but he loves it now ! (although, he did say he'd never do it again if he needed a touch up) He knows he's going to have to wear reading glasses when he ages and he's fine with that.

Well, i need to get back in the lab. I was SHOCKED when i saw there were 25 replies!! You guys rock!

 

[Jubileee]

Okies...I am getting in on this mid-stream..but I do have 7 years running optical experience working with a chain.

One...Popoy...

How long have you been wearing RGP's? In the past, those with strong astitgmatism corrections, or with special base curve needs were put into Gas Perms in order to custom make them to fit the eye. Where as the soft lenses are made in a set variety of curves and rxs with little increments..so often times you don't get an exact fit which might be needed in some cases.

Most agree soft lenses are more comfortable, but optic wise they aren't always the best.

Now some docs use RGP's for patients cause they are rigid enough to shape the cornea. This is the theory behind Ortho-K. The theory is that if you use specialty contact lenses at night, that the shape of the eye will gradually change, reducing you need for glasses during the day.. and eventually for all times.. New advances are being made in this area and it is being talked about as a major surgery alternative.

Glasses offer not only the ability to correct your vision in the best possible manner, but it can offer additional coatings that can enhance it as well..such as anti-reflective coating..tint..uv protection and the like.

If you don't like the feel of RGP's...(and I don't know many who do ) then feel free to talk to your OD or OMD and ask if you might benefit from a soft lense...

You should always have a pair of glasses with your current rx. There are times in which you might not be able to wear your contacts (one rears, eye infection, injury..) and when you can't see is not the time to try and find something that not only helps you see, but also enhances your appearance..

Cassandra

 

[Jubileee]

Now as far as that whole private vs commercial...

Feel free to see my postings on the FutureOptometrists forum. I think I am probably the most active poster..thanks in part to TomOD and this subject.

Most of it is personal taste. I currently work as an optician in a commercial practice. I have done everything from making your glasses in just about an hour, to selling, to dispensing, to working the doctor's office and doing pretest and contact lens disp and care...

Most ODs who work for the chains are independents. Their space is leased to them in the major chain's store. The fee schedule, number of exams, what insurance plans to accept, staffing...all of that is still their responsibility. The majority will take in the exam fees and contact lenses, while the store gets the glasses sale. A few locations, such as one that I worked in WA, actually will give you staffing, if you give up contacts...

You get increased traffic thanks to the chains advertising and reputation..They benefit by having a doctor on hand to lend credibility and exams when needed for glasses purchase. Often they will help finance you equip and the like...cause, If you look good..they look good.

I do believe they are eligible to get into group plans with the benefits portion. So while they pay full cost of the benefits, they get them at a reduced rate..

Now for HMO's or Clinics...might be a different story all together.

I am in 100% support of the docs in the commercial setting. As been said by others, they have had the same training as the privates. It is a matter of preference as to which style fits them best. To hell with reputation and how being easily accesible makes being an OD worth less somehow..

I personally though want to go private practice. I do want to run my own business the way I want to with my own lab, dispensary, the whole nine yards. Then again, I also have the experience of doing this and love it. I love to troubleshoot and do what it takes to make people happy. I want to train my own staff, order the products I want to use..etc and not have someone tell me what I can or can not order for a patient..

But that is just me
Call me a control freak if you like

Cassandra

 

[abs1]

Hi Cassandra! Ive read many of your posts over at FutureOD. Very informative, thanks!

Let me ask you and cpw (and anyone else)..what do you guys think about the "saturation of ODs" debate? Meaning, are the schools of opt pumping out too many grads???? Will there be enough jobs?

Just curious what you guys think.

 

[cpw]

I think some schools are pumping out too many OD graduates.. I can think of one (ICO ) that graduates almost 200 OD's a year. But, you also have to look at the fact that there are only sixteen schools in the greater US.. so they have to cover for the states that don't have schools.

But, I think I'll start a thread on this...

 

[Jubileee]

I think there are plenty of opportunities available..it is a matter of if they are where you want them to be

It is funny cause everyone is complaining that there is an OD on every corner. yet the government is still willing to pay for schooling if people go to underserved areas like near reservations, working in the VA hospitals, and in certain rural areas...

Then there is also the possibility of specializing in an area..be it vision therapy, sports vision, surgery co-management, specialy contact lens, occupational..pediatrics...basically creating a niche and a market for yourself...

Casssandra

 

[eyeguy]

Popoy,
In my honest opinion, having been a lasik sx tech and an ophthalmic tech for 4 years, I would probably not do the lasik thing. You really ought to try soft ctl's. They tend to be more comfortable on the eyes and eaiser to adjust too initially. Lasik has its side effects..possible coneal damage etc. There is also a belief that it causes nerve fiber layer damage in the retina. Do not get me wrong, it certainly is a life-changing procedure and can give great results but if you can be well corrected without permanently altering the physical structure of the eye you are better off.eyeguy
p.s. You rx will also mostly likely chnage during school because you will be reading so much...this also speaks against lasik.

 

[drbizzaro]

this is a great thread to bring back, so people can read it again