Something Corporate

[eggman20]

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I would like to hear some opinions/stories on corporate practice....good, bad, whatever you have to say. In what ways is it changing the profession? How much impact does it have on private practice?

 

[prettygreeneyes]

Where's Dr. Gregory when you need him? 😱

 

[blazenmadison]

I would like to hear some opinions/stories on corporate practice....good, bad, whatever you have to say. In what ways is it changing the profession? How much impact does it have on private practice?

Having worked at a corporate office as a tech for 3 years...
I believe
PROS:
Easy 100k
Some companies pay for your staff
No optical store headaches
No pressure to give everyone a Rx so you can sell more frames/lens.
You're more concerned about the patient's eye health than pushing sales of eyeglasses (You're an 'independent' doctor of optometry)
The patient files are yours and not Corporate's.

CONS:
At least 5-6 days/week. Long hours.
No paid vacation/medical benefits
Corporate owns your office, but you lease it from them.
Bad rep from private office docs who thinks you're a sellout.
Salary is stagnant
You have to take certain insurance plans [Eyemed ]
Most if not all your appts are refractions. (no pathology)
Corporate's control is growing. (ie. Lenscrafters and Luxottica wants to sell contacts lens now, which used to be the doc's responsibility) Soon optometrists might be salaried?

 

[prettygreeneyes]

Having worked at a corporate office as a tech for 3 years...
I believe
PROS:
Easy 100k
Some companies pay for your staff
No optical store headaches
No pressure to give everyone a Rx so you can sell more frames/lens.
You're more concerned about the patient's eye health than pushing sales of eyeglasses (You're an 'independent' doctor of optometry)
The patient files are yours and not Corporate's.

CONS:
At least 5-6 days/week. Long hours.
No paid vacation/medical benefits
Corporate owns your office, but you lease it from them.
Bad rep from private office docs who thinks you're a sellout.
Salary is stagnant
You have to take certain insurance plans [Eyemed ]
Most if not all your appts are refractions. (no pathology)
Corporate's control is growing. (ie. Lenscrafters and Luxottica wants to sell contacts lens now, which used to be the doc's responsibility) Soon optometrists might be salaried?

My knowledge of corporate optometry is somewhat limited... but if the corporation is paying for your staff, how would you be considered independent? It is my understanding that paying your own staff is one of the "tests" for independent contractor. Also, I have a sneaking suspicion that corporate would be none to happy if you didn't "push" a certain number of glasses. While they can't outright force you out, they can choose to not renew your lease or raise the payments on you if your exam prices are too high, your hours aren't desirable, you don't bring over enough glasses sales, etc. Can optometrists be "salaried" by corporations? I know that in some, perhaps most, states, it is illegal for an optometrist to be employed by a corporation.

 

[blazenmadison]

My knowledge of corporate optometry is somewhat limited... but if the corporation is paying for your staff, how would you be considered independent? It is my understanding that paying your own staff is one of the "tests" for independent contractor. Also, I have a sneaking suspicion that corporate would be none to happy if you didn't "push" a certain number of glasses. While they can't outright force you out, they can choose to not renew your lease or raise the payments on you if your exam prices are too high, your hours aren't desirable, you don't bring over enough glasses sales, etc. Can optometrists be "salaried" by corporations? I know that in some, perhaps most, states, it is illegal for an optometrist to be employed by a corporation.

The docs told me the # of glasses sold in the optical store is none of our concern, unless they're about to go out of business. Usually people take it over next door for the 1 hour convenience or they like the brand names. The docs have even recommended taking the Rx over to Costco/Wal-mart for their prices to some patients. And my experience is just limited to the lenscrafters docs i work with- not wal-mart or america's best...

 

[iiiimonica]

corporate

pro's:
they hire new grads
no out of pocket costs
staff in place

cons:
at the mercy of corporate mangers (bottom line main focus)
"independent" contractor (no benefits)
staff in place (sometimes this hurts more, especially when hourly wage is set but corporate and they pay less than 10 bucks, i mean how great can staff be at such low wages? eventually a great employee is going to leave for greener pastures)

lenscrafters/eye exam:
worked here of and on for a few years, as an optician its a great place to work BUT from my own experience, they treated their od's very shabbily. at our store meetings (the idea that eyeexam and lenscrafters is seprate is a joke) the docs would get blamed for not selling enough retinal photos, or low dilation sales, also docs would be criticized for not writing a script out if the patient had very little rx change, corporate also required our store docs to walk thier patients over to lenscrafters (a long walk for them because our eye exam is seperated by the lab) i worked with some AWESOME docs,who really took me under their wing when i decided to do optometry, it would really piss me off to see how shabbily these great docs were treated, over 1/2 quit.


walmart:
okay here is the trading lightly part: uhhh, i worked there for 3 months. walmart excpected (fall 98) the doc to be very proactive in marketing and more hands on business wise, which is fine for some, but for others not so good. the doc we worked with was ...let''s just say staff wondered out loud how he managed to pass his clinical boards. BUT he never complained about how walmart treated him, even when they increaed his lease by 20%

 

[KHE]

I had the opportunity to work a number of different corporate and private practices. My experiences were as follows:

In corporate practice, it is uncommon for you to be paid as an employee directly by the corporation. In fact, in many states this is illegal unless the "corporation" is an HMO like Kaiser. I did work for a short time at a Lenscrafters in White Plains, NY where I was paid directly by LC as an employee. I only worked there one day a week, so I did not receive any benefit package, but if I worked 30 hours, I would have been entitled to their benefit package which was fairly decent.

Most "corporate" positions fall under two catagories:

1) You are the "leaseholding" doctor in which case you lease space from the corporation and run your little space like a little office. Many of the points of the lease are negotiable in most cases. In some cases, you hire and manage your own staff, in other cases the corporation does it. In some cases, you may sell the contact lenses, in other cases the corporation does it. The hours you are to provide coverage are specified in the contract and are usually extensive. (which if you think about it, it doesn't cost them anything to have you there 7 days a week) Some of these points are very negotiable, some of them are "take it or leave it" type of arrangements. The few leases that I held were generally negotiable on most things.

2) You can be an emploee of a lease holding doctor. Obviously, if someone holds a lease that specifies that there must be a doctor in the office 7 days a week, they aren't going to work 7 days a week. So they may hire another doctor to cover a little or a lot of that time. Since you are a technically an employee of the lease holding doctor and not the corporation you may be paid as an employee of the lease holding doctor, or as an independent contractor. Most of the time if you are paid as an independent contractor in this situation, it is illegal. However, its such a common practice in this industry no one really complains.

In some cases, you may find a corporate location or an independent optical shop that is not busy and therefore doesn't want to have a lease. They may simply invite you to come into the office a couple of days a week and see a few patients. Often times they will have a lane of equipment there and you can bring in whatever other equipment you need to use. So you can tell them "next week, I will come in on Wednesday afternoon and Saturday morning." And they will schedule you some patients. Usually, there is no insurance involved in these situations. Strictly cash and carry with the doctor keeping the professional fees and the optical dealing with everything else. This is as close to a true "independent contractor" situation that you will find. Some days, you can see one patient and make $75 in a morning if there is only one patient. I have had this happen. On other days, you can make over $1000 in a morning if they have a number of patients scheduled. I have had this happen as well. Usually in these cases, I averaged 3-4 patients in a morning and made a few hundred bucks.

Corporate practice (and by coporate I assume we all mean working in Lenscrafters, Walmart, JCPenney etc. etc) is generally bad for the profession in that it projects a retail image. However it does fulfil a need for the public. Low cost eye care is important for people because just like we all can't afford a Mercedes, we all can't afford to spend thousands of dollars a year on eyecare and eyewear for our families.

It would be ideal that ODs only practice in "private practices" though I have always found that to be a bit of a misnomer because most of the private practices that I have worked in were way more commercial than the commercial places.

So the problem isn't corporate vs private. It's really optometry as a whole.

 

[drgregory]

Where's Dr. Gregory when you need him? 😱

i dont even know where to start. im going to ditto everything KHE said, but, naturally add a little as to why my hatred towards corporate is so deep. the problem lies in the very low fees charged in most corporate locations, which basically belittle our already belittled profession. IF INDEPENDENT CONTRACTORS AT CORPORATE LOCATIONS (and some private locations) WERE TRULY INDEPENDENT, THEY COULD AND MOST IMPORTANTLY SHOULD HAVE THE DESIRE TO RAISE THEIR FEES TO A LEVEL APPROPRIATE WITH THE SERVICE THEY ARE PROVIDING. however, a large proportion of the corporate ODs i have observed are basically doing a autorefractor refinement and glancing at the retina. i applaud them for only giving a service worth the tiny exam fee charged, however i shun them for doing something we could teach an optician to do. and then there are those who do an excellent job in corporate locations, all for less than what it costs for a haircut in the salon next to them in the mall. this is where i get my coined term "selling out" - as these ODs are basically doing just that by lowering the value of theirs, ours, and OMDs-who-do-refractive-care services. they need to look at what they should be charging per level of education/time in training/debt in training. they would then see that 20 minutes face time with your accountant, lawyer, dentist etc would result in fees incurred that would very much surpass those charged by ODs in corporate and some private ODs offices.
i could live with the fact that an OD practices next door in a mall to glasses and contacts salespeople if that said OD was truly "independent".

i'll stop here, and wait for my throat to be ripped out via replies.

 

[eggman20]

I will be starting school this fall at ICO, but I figure it never hurts to gain knowledge early. Thanks for your replies.

 

[xmattODx]

the problem lies in the very low fees charged in most corporate locations, which basically belittle our already belittled profession.

Can you speak to the idea that many of those who frequent some of the more commercial of commercial practices (i.e. free exam with glasses, $29 exam, etc.) would not be able to afford any other type of exam? I'm not supporting commercial optometry or belittling it. I honestly am just curious as to your take on the "market" for commercial optometry.

 

[Ben Chudner]

the docs would get blamed for not selling enough retinal photos, or low dilation sales

Getting blamed for low dilation sales?!?!? I would like to believe this is because the corporation realizes the benefits of a dilated exam, but I am not that naive. I am very concerned that docs (corporate and private) are not performing routine dilated exams, and that some docs charge an extra fee for it.

 

[drgregory]

Can you speak to the idea that many of those who frequent some of the more commercial of commercial practices (i.e. free exam with glasses, $29 exam, etc.) would not be able to afford any other type of exam? I'm not supporting commercial optometry or belittling it. I honestly am just curious as to your take on the "market" for commercial optometry.

really, the market, and its prices, should be set on demand and LEVEL OF SERVICE. are our services really less than that of dentists? if so, then you have your answer as to why commercial gives it away. if our level of service is on par with dental, then why shouldnt compensation for such services be the same? it should not "fill a need" for those who want something cheap - if you cant afford something, you should then find a way to or go without, and certainly not expect the provider of that service to lower their costs. or, the consumer could exert some effort and locate an insurance plan that includes vision, and if that plan is too expensive, and you truly are in hardship (and not spending your extra cash on cell phones, cigarettes, and liquer), then one should attempt to obtain federal or state funded healthcare, which includes eyecare. this sounds cold and extremely pompous, but last i checked, my degree wasnt handed to me, and im still, and will be, paying for my student loans for another 20 years - i dont expect anyone to pay for my health, dental, and vision services, and certainly dont expect them to be offered at a reduced rate just because i think they are "too expensive".

 

[xmattODx]

i dont expect anyone to pay for my health, dental, and vision services, and certainly dont expect them to be offered at a reduced rate just because i think they are "too expensive".

But the market is there and optometrists are making money offering low price services. I think we can agree that the services offered at these places are typically of very low quality but the demand is there and where there is a demand there will be a supply.

What do you suggest we do to rid the world of the demand for cheap eye care? I would argue that even if we cut enrollment and forced every OD over 70 to retire some would still offer their services for $19 as doing so gives you access to a rather large market and from that relatively good income. What do we do with private practitioners who accept insurance plans that pay $19 for the exam? Is encouraging the poor (define that any way you want) onto low paying insurance plans helping optometry more than having commerical practices? Again just curious as to your thoughts.

 

[drgregory]

I would argue that even if we cut enrollment and forced every OD over 70 to retire some would still offer their services for $19 as doing so gives you access to a rather large market and from that relatively good income. What do we do with private practitioners who accept insurance plans that pay $19 for the exam? Is encouraging the poor (define that any way you want) onto low paying insurance plans helping optometry more than having commerical practices? Again just curious as to your thoughts.

as much as it pains me to agree with you, you make excellent points. there always will be some who give away their services - you are definately correct there. and yes, most "poor" would end up on state insurance plans that really dont pay well. i guess my hopes would be that the state funded plans would be "selective" in weeding out and dismissing those who themselves think they are "poor" and giving access to those who are truly in need, thereby reducing the amount of people on state funded plans. as we can already see, most states (if not all) have already failed here. i guess some of our problems dont have readily availible answers, but most can agree that lowball insurers and lowball providers dont help. i hate agreeing with you xmattODx - something feels sacrilegious about it 😉 .

 

[VA Hopeful Dr]

Getting blamed for low dilation sales?!?!? I would like to believe this is because the corporation realizes the benefits of a dilated exam, but I am not that naive. I am very concerned that docs (corporate and private) are not performing routine dilated exams, and that some docs charge an extra fee for it.

The problem I have seen concerning dilated exams is this: what is the standard of care?

My OD, who passed away about a year ago, dilated EVERYONE at each yearly exam, and often at check ups depending on what problem they had. When he died and other ODs were coming in until the practice was sold, some of them only dilated every other year. My girlfriend has gone 4 years of exams without dilation (she refuses, though the MD never explains why dilation is important.... BIG liability if she turns up with some pathology). My point is, how often should one do a DFE on a regular patient who comes in once a year?
As for charging an extra fee for dilation, well I'd hate to be a doc that does that facing an insurance audit.

 

[KHE]

The problem I have seen concerning dilated exams is this: what is the standard of care?

My OD, who passed away about a year ago, dilated EVERYONE at each yearly exam, and often at check ups depending on what problem they had. When he died and other ODs were coming in until the practice was sold, some of them only dilated every other year. My girlfriend has gone 4 years of exams without dilation (she refuses, though the MD never explains why dilation is important.... BIG liability if she turns up with some pathology). My point is, how often should one do a DFE on a regular patient who comes in once a year?
As for charging an extra fee for dilation, well I'd hate to be a doc that does that facing an insurance audit.

As far as you're concerned, the standard of care is whatever the plaintiff's expert witness says it is.

I never charged extra for DFE. However, when patients refused I rarely argued with them. Actually, I did when I was first done school because like all young doctors I had visions of saving the world and finding all that dangerous retinal pathology. Very few patients who refused dilation would allow me to do it and the ones that "rescheduled" to come in for the DFE had a show rate of less than 5%.

If a patient refused DFE, I simply noted "stressed importance DFE and risk of VA (down arrow) s DFE" and said "I'll see you in a year."

Fact is, I found very little in patients with no risk factors for retinal disease. As such, for patients without risk factors, I dilated every 3 years.

Why is your girlfriend seeing an MD? lol.

 

[iiiimonica]

Getting blamed for low dilation sales?!?!? I would like to believe this is because the corporation realizes the benefits of a dilated exam, but I am not that naive. I am very concerned that docs (corporate and private) are not performing routine dilated exams, and that some docs charge an extra fee for it.

what happens is this, your future patient calls and staff quotes them the basic exam (29-39) patient shows up and of course the good docs would try to explain the benifits of dilation, but a lot of patients get upset, they think it is the bait and switch. so here is the doc trying to get his patients dilated (adding an extra 20-30 dollars to the exam price) and those retinal photos which add another 10-15, so the 39 exam is now over 70 dollars

one doctor i worked with tried to get around all this by having staff quote the comprehensive price of $~79, sure enough exam sales slipped corporate got wind and he was publicly scolded. he later went to hmo optometry, were they hardly ever dilate

my first optician job was with an AMAZING private practice optometrist she dilated every patient every year,no exceptions. her patients appreciated the throughness of her exam and the new ones would comment how they never had such a great exam. this is the kind of optometrist i want to be, she is smart, really good at what she does and the patients are willing to pay the price. i am sad to report that not all private practice docs had this quality, yet the price on exams only differed slightly.

 

[xmattODx]

as much as it pains me to agree with you, you make excellent points..

I always make excellent points!

i hate agreeing with you xmattODx - something feels sacrilegious about it 😉 .

Funny! I think we agree on more than I let on. Its the interweb and I enjoy playing "devil's advocate".

I'll be truthful now. I do work in commercial optometry. I do $39 dollar eye exams and the advertisements for the optical side are "2 pairs of glasses for $99".

I hate my job.

I hate my job because in order to do $39 eye exams and in order to get the patient flow for the optical to make money using the infamous not-quite-bait-and-switch-but-darn-close I need to see patients every 15 minutes. On the not so busy days its not a big deal because I can stretch that out. On the busy days when you have 5 charts up and you know you should dilate this patient but its going to put you very, very far behind the temptation to go to the dark side and put it off is huge.

I am not considered a doctor. I don't care about the doctor part but when you give a treatment plan and the patient completely ignores it you have to question would it be ignored in a different setting?

What I find funny, however, is that on many, many occassions I'll finish a half-assed exam and the patient will say that is the most thorough exam I've ever had. The only reason it was thorough is because I do near testing on every patient and I don't trust the auto-refractor. A lot of these patients have been to private practices but my exam is more thorough?

I love my job.

I love my job because I've been able to work part-time and earn way too much money for what I do while going to school. I love my job because I'll be taking a week off to go to Florida in two weeks and then three weeks off to go to Romania at the end of August. I couldn't do that working for a private practice. I like that probably a quarter of my patients are truly poor. They couldn't afford any other type of eye health care and they are appreciative and listen to me. I like that I've been able to move across the country to pursue other interests without being tied to my own private practice.

That said, I want out, my wife (an OD) wants out. We're commercial practice burnouts. At the end of the day you have to ask yourself is the lack of respect from patients, optical staff, other ODs (justified or not), and yourself worth it. I say no. I say no because I'm not able to offer comprehensive care for my patients. I can't even treat a corneal ulcer because there is no guarantee that I'll be at the practice when they come for follow-ups and I'll be damned if I trust anyone else that works for the practice. In the end my referral to an OMD costs the patient more than they would have paid had I been able to treat them myself at a private practice (and worked out a sliding scale payment if they are truly needy.) I can't offer low vision services because the optical makes no money from that. I can't offer VT because the optical makes no money from that.

I'm the last person who needs a certain income to be happy so we're getting out. We're willing to risk bankruptcy for personal fulfillment. I graduate with my MPH on May 15. On May 16 we're starting to look for a practice back on the west coast. If we don't find a decent practice to buy in a year we'll open cold. If we fail, we fail but we won't be working for the man anymore!

Boy that was long... back to writing my paper "Do user fees impact the accessibility of health care services for the poor in developing countries?"

 

[drgregory]

If we don't find a decent practice to buy in a year we'll open cold. If we fail, we fail but we won't be working for the man anymore!

youll make it in private practice. just set your fees appropriately, which equals about 5 times what they are at now. you wont have to see 6 patients per hour to make it, and your patients WILL NOT BE SHOCKED AT YOUR FEES, especially when you spend quality time explaining the results. theyll actually heed what you tell them as well.