Support + opinions to back up the OD profession

[a1bui]

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I guess this thread is more for reassurance purposes, but I'm also interested.

LOTS of people (including ODs) have told me that optometry is a dying profession, but I don't feel it's that way. From what I've experienced, and researched, I love the profession. I would like to think of myself as a risk taker, and "the cup is half full" type of person, but in order to do so, I have just a few questions...to help me back up the profession.

Yes I know jobs are pretty much slim in big city states, like CA, but don't speciality practices help with that? I mean, with the abundance of primary care offices out there, would a specialty in anything, like lets say, contact lens (ortho k?), vision therapy, or even low vision (not sure if this is one), help a practice stand out? Do specialists make any more then primary care ODs.?

Also, whats so bad about commercial practices? I know it's looked down upon, but some people just need some money to get their foot into the door. How much do those commercial OD's make anyway, because, with the loans I have for undergrad, and loans for grad...there's no way I can start cold turkey, off the bat. I wouldn't want to stay in one permanently, but just for starters.

Haha, sorry if it's hard to find my questions...they're embedded in there somewhere.

I'm a 3rd year in undergrad, but I'd like to plan ahead...for interview ?'s...and to get my parents + "the glass is half empty" optometrists off my back.

 

[Ben Chudner]

LOTS of people (including ODs) have told me that optometry is a dying profession, but I don't feel it's that way. From what I've experienced, and researched, I love the profession. I would like to think of myself as a risk taker, and "the cup is half full" type of person, but in order to do so, I have just a few questions...to help me back up the profession.

Optometry is not a dying profession, but it is changing and there are a lot of private practice doctors, particularly older docs, that will not or cannot change with the times. In my opinion, these practices will either die off with their owners, or be bought out by bigger practices.

Yes I know jobs are pretty much slim in big city states, like CA, but don't speciality practices help with that? I mean, with the abundance of primary care offices out there, would a specialty in anything, like lets say, contact lens (ortho k?), vision therapy, or even low vision (not sure if this is one), help a practice stand out? Do specialists make any more then primary care ODs.?

There are lots of practices that "specialize" in those areas and I am sure they can be very successful. Adding a specialty to a practice can be more profitable, but I don't think this adds a lot of jobs to the marketplace.

Also, whats so bad about commercial practices? I know it's looked down upon, but some people just need some money to get their foot into the door. How much do those commercial OD's make anyway, because, with the loans I have for undergrad, and loans for grad...there's no way I can start cold turkey, off the bat. I wouldn't want to stay in one permanently, but just for starters.

Commercial practices have turn eyecare into a commodity where the consumers (patients) look for the best deals. They have destroyed the margins in contact lenses, and are eroding the profits in the optical side of private practices. You will hear some private OD's talk about patient care, but the truth is that there are plenty of private OD's that provide a lower level of care than corporate OD's. The real issue is money. These places are threatening the existence of private practices and that is why people say this is a dying profession. I have a different take on it, in that I think it will kill off the smaller practices and allow the bigger practices to get bigger. My vision of the future of this profession is no solo practices. Only larger group practices that offer a wider range of services than can be offered in the corporate setting, and the rest will be corporate practices where all of the coupon patients will get their exams.

 

[KHE]

Its probably fair to say that I'm one of the "glass is half empty" people.

I agree with what Dr. Chudner has said. IMHO, optometry will not die. But I believe that it will end up like pharmacy. That is to say, you will see the vast majority of ODs working retail hours in retail environments. While there may be a few ODs who work in hospitals, or academia, or clinics, most will end up in retail establishments and the independant solo OD will be non existant. Unfortunately, the schools are producing far too many graduates for the current demand.

Specialty practice is nice to do, but contrary to what the AOA, and your instructors in school will tell you, there is not a multitude of patients out there falling all over themselves to pay you hundreds of dollars and to be fit with bitoric RGP bifocals, or wanting ortho-K.

When I practiced, I viewed myself as a part of the healthcare team who could counsel patients on preventative eye and general health practices. My patients (both in commercial and private offices) viewed me as an obstacle to refilling their prescription for acuvues. If a recommendation was made, 99% of the time the first thing out of patients mouths was "does my insurance cover it?" If the answer was "NO" then I would say more than 95% of patients declined the recommendation. That gets frustrating after a while.

Many students make the mistake of thinking "that won't happen to me. I plan to "work hard" and impress my patients by doing lots of extra tests and having a high end practice filled with designer merchandise and a waiting room stuffed with cool ocular pathology which I will fix, and my patients will love me for it."

However, the vast majority of patients don't WANT a whole lot of "extra tests." They want what their insurance covers, and nothing else, and they want to get out of there as fast as possible.

Oddly enough, I found this attitude far more prevalent in upscale areas than in the neighborhoods of the "working poor."

But don't let my negativity dissuade you. I have many collegues who hate optometry and regret every day that they entered this field. I also have collegues who love optometry so much that to them, its like a drug.

I guess this thread is more for reassurance purposes, but I'm also interested.

LOTS of people (including ODs) have told me that optometry is a dying profession, but I don't feel it's that way. From what I've experienced, and researched, I love the profession. I would like to think of myself as a risk taker, and "the cup is half full" type of person, but in order to do so, I have just a few questions...to help me back up the profession.

Yes I know jobs are pretty much slim in big city states, like CA, but don't speciality practices help with that? I mean, with the abundance of primary care offices out there, would a specialty in anything, like lets say, contact lens (ortho k?), vision therapy, or even low vision (not sure if this is one), help a practice stand out? Do specialists make any more then primary care ODs.?

Also, whats so bad about commercial practices? I know it's looked down upon, but some people just need some money to get their foot into the door. How much do those commercial OD's make anyway, because, with the loans I have for undergrad, and loans for grad...there's no way I can start cold turkey, off the bat. I wouldn't want to stay in one permanently, but just for starters.

Haha, sorry if it's hard to find my questions...they're embedded in there somewhere.

I'm a 3rd year in undergrad, but I'd like to plan ahead...for interview ?'s...and to get my parents + "the glass is half empty" optometrists off my back.

 

[Ben Chudner]

Its probably fair to say that I'm one of the "glass is half empty" people.

Specialty practice is nice to do, but contrary to what the AOA, and your instructors in school will tell you, there is not a multitude of patients out there falling all over themselves to pay you hundreds of dollars and to be fit with bitoric RGP bifocals, or wanting ortho-K.

This is true of pathology as well. I do believe that in order to survive, OD's need to adopt a medical model for their practices, but for the majority of private practices, there just isn't that much disease to treat.

When I practiced, I viewed myself as a part of the healthcare team who could counsel patients on preventative eye and general health practices. My patients (both in commercial and private offices) viewed me as an obstacle to refilling their prescription for acuvues. If a recommendation was made, 99% of the time the first thing out of patients mouths was "does my insurance cover it?" If the answer was "NO" then I would say more than 95% of patients declined the recommendation. That gets frustrating after a while.

I believe the blame here lies with the insurance companies that promise their subscribers complete eyecare but pay their participating doctors very little for those covered services, and the corporate locations that offer a free eye exam with spectacle purchase. Or better yet, sell those Acuvues for 50 cents more than I pay for them from my distributor.

Many students make the mistake of thinking "that won't happen to me. I plan to "work hard" and impress my patients by doing lots of extra tests and having a high end practice filled with designer merchandise and a waiting room stuffed with cool ocular pathology which I will fix, and my patients will love me for it."

The sad fact is that this will happen to the majority of students graduating. Wal-Mart expects to hire more OD's per year than we graduate over the next couple of years. They plan on taking the majority of new grads, plus some older docs that are getting out of private practice before they retire.

 

[Hines302]

It is great to see different view points on these boards, thats what makes them so informative. But something you have to realize is that every profession has its problems, not just optometry. In general there are two types of people who post on this board... students looking for answers... and current OD grads, who are still looking for answers. These people are the ones that usually talk negative about the profession. It is much easier for them to say that "the profession failed them".. rather than "they failed at the profession" There are tons of successful OD's out there.. who's practices are thriving.

Every so often you do find very successful OD's who come in and offer contructive advice and opionions (Ben being one of these).

The thing is so many times people talk about how they hate optometry and how they should have gone to Med School. I admit when I first started to read post like these I freaked out and registered for the MCAT. But then I started looking into things furthur... and browsing other forums on this website.. and what I found is that there are people in every profession that hate thier jobs and wish they would have done something else (with the exception of Dentist... because as we all know, they have it made it the shade).

http://forums.studentdoctor.net/showthread.php?t=195799

This thread is a topic asking current MD (and DO's) residents and doctors... "if they had a chance to do it again.. would they?" About 75% of the people responding said NO. They would not go to med school if they had to do it again.

 

[Hines302]

The "Glass if Half Full" Answers to typical concerns about optometry (just my take... and i am kinda bias):

To Many Optometrist??
My dad is a pharmacist. When he went to pharmacy shcool they actually predicted that there would be to many pharmacist!!! Funding and seats were cut at most schools.. and he almost didnt get in because of this. Well we all know they cant pump out pharamacist fast enough to keep up with demand. One of the factors that led to this wrong prediction is that they didnt take into account that starting about 15-20 years ago... the majority of pharamcy students were female!! Who are more apt to work part time.. retire early.. or take long periods of time off. I dont have the figures infront of me... but I am pretty sure that the majority of OD students are female now.

I don't think that there will ever be a huge shortage of OD's... but things may not be as bad as people make it out to be.

Refracting Opticians
I point you to pharmacy once again. Is there really a need for a pharmacist. A pharmacy tech can do mostly everything that a pharmacist has to do. The pharamcist is basically just there to sign off and check what the pharmacy tech did. but they still keep pharmacist around... and pharmacy techs are not replacing them...

Aging Population Does not Equal More Work of OD's
This is right... and aging population does not equal more work for OD's. Simply because most of these people are already recieving eye care for refractive errors, However I do believe it will pave the way for a more medicaly geared OD. Consider this....

As baby boomers age they will require more surgical procedures... which menas OMD's will be responsible for providing this. These OMD's will spend much less time doing anything that is non-surgical in nature. This responsibility will be shifted to OD's who are capable of taking on these type of patients. This coupled with the fact that the saleries for general OMD's are dropping will intice many OMD's to complete surgical fellowships. Thus in the furture I see some OD's practicing like non-surgical OMD's are today. I don't see a future for the general 'non-surgical' OMD

Like someone once said on this board... those OD's who are capable of handeling medical eye conditions... will be busy in the future.

Retail
While its true this is a problem... I don't see the death of private practice anytime soon. There are tons of very successful private practices already... and some that continue to open and thrive. Why do some thrive and why do some die?? I have no idea... but the fact of the matter is there are tons of OD's out there who have found a way to thrive and be successful.

I agree with Ben.. the future of private practices in Optometry are group practices... that can offer more total eye care... than these retail settings will ever offer.

 

[ariel winter]

i can completely relate to this and agree with this stance, Hines. my father is a pharmacist as well and he tells me exactly the same thing. group practice is definitely the future of optometry, and that is the direction i hope to be headed in a few years time. good insight. 👍

The "Glass if Half Full" Answers to typical concerns about optometry (just my take... and i am kinda bias):

To Many Optometrist??
My dad is a pharmacist. When he went to pharmacy shcool they actually predicted that there would be to many pharmacist!!! Funding and seats were cut at most schools.. and he almost didnt get in because of this. Well we all know they cant pump out pharamacist fast enough to keep up with demand. One of the factors that led to this wrong prediction is that they didnt take into account that starting about 15-20 years ago... the majority of pharamcy students were female!! Who are more apt to work part time.. retire early.. or take long periods of time off. I dont have the figures infront of me... but I am pretty sure that the majority of OD students are female now.

I don't think that there will ever be a huge shortage of OD's... but things may not be as bad as people make it out to be.

Refracting Opticians
I point you to pharmacy once again. Is there really a need for a pharmacist. A pharmacy tech can do mostly everything that a pharmacist has to do. The pharamcist is basically just there to sign off and check what the pharmacy tech did. but they still keep pharmacist around... and pharmacy techs are not replacing them...

Aging Population Does not Equal More Work of OD's
This is right... and aging population does not equal more work for OD's. Simply because most of these people are already recieving eye care for refractive errors, However I do believe it will pave the way for a more medicaly geared OD. Consider this....

As baby boomers age they will require more surgical procedures... which menas OMD's will be responsible for providing this. These OMD's will spend much less time doing anything that is non-surgical in nature. This responsibility will be shifted to OD's who are capable of taking on these type of patients. This coupled with the fact that the saleries for general OMD's are dropping will intice many OMD's to complete surgical fellowships. Thus in the furture I see some OD's practicing like non-surgical OMD's are today. I don't see a future for the general 'non-surgical' OMD

Like someone once said on this board... those OD's who are capable of handeling medical eye conditions... will be busy in the future.

Retail
While its true this is a problem... I don't see the death of private practice anytime soon. There are tons of very successful private practices already... and some that continue to open and thrive. Why do some thrive and why do some die?? I have no idea... but the fact of the matter is there are tons of OD's out there who have found a way to thrive and be successful.

I agree with Ben.. the future of private practices in Optometry are group practices... that can offer more total eye care... than these retail settings will ever offer.

 

[Ben Chudner]

I dont have the figures infront of me... but I am pretty sure that the majority of OD students are female now.

I don't think that there will ever be a huge shortage of OD's... but things may not be as bad as people make it out to be.

I have the stats. The majority of students in optometry school are female. The class of 2007 is 60% female. Furthermore, even though the females will eventually make up about 59% of the practicing OD's by 2020, they are only projected to handle about 44% of the patient encounters. This is due to many females choosing to work part-time (or at least expected to).

 

[cpw]

my class at UHCO was 67% female... and many of my fellow classmates are not working full-time. (partly due to job shortage in Dallas and Houston.... and partly due to desire to work less and raise families)

 

[still_confused]

so who wants to be in my group???

haha jk

 

[KHE]

In general there are two types of people who post on this board... students looking for answers... and current OD grads, who are still looking for answers. These people are the ones that usually talk negative about the profession. It is much easier for them to say that "the profession failed them".. rather than "they failed at the profession" There are tons of successful OD's out there.. who's practices are thriving.

Every so often you do find very successful OD's who come in and offer contructive advice and opionions (Ben being one of these).

.

For the record, I do not feel that optometry "failed me" or that I "failed it" I make the good salary now in my new career in large part because of my optometry degree.

I also do agree that group practice is the way to go. However, there are not nearly enough group practices out there to even come close to absorbing the number of graduates being produced. Unfortunately, I don't see anything in any of the current trends that will change that. Most new OD offices that are opened up are opened up by a solo OD.

Optometrists in general, have a "lone wolf" mentality. MDs are much more used to working in groups whereas ODs are not. For whatever reason, many ODs are simply reluctant to give up any notion of "control" of "their practice" in order to form a group, in spite of the fact that it might me much more economically viable for them and the profession in the long term.

Unfortunately, most solo ODs (and therefore by default, most ODs) are "small time" thinkers. They are content to make their 100k working in their little office and seeing their patients. The desire to grow or expand is often times just not there.

Commercial locations on the other hand, want to continue to expand. As such, they will continue to do so, and it is my opinion that the vast majority of graduates will end up in commercial locations in a relatively short amount of time.

This isn't necessarily a bad thing. You can make good money working there, and most of the cases are not difficult. It's not what I wanted to do for 35 years, but there are a lot worse jobs out there.

 

[cpw]

Optometrists in general, have a "lone wolf" mentality. MDs are much more used to working in groups whereas ODs are not. For whatever reason, many ODs are simply reluctant to give up any notion of "control" of "their practice" in order to form a group, in spite of the fact that it might me much more economically viable for them and the profession in the long term.

Unfortunately, most solo ODs (and therefore by default, most ODs) are "small time" thinkers. They are content to make their 100k working in their little office and seeing their patients. The desire to grow or expand is often times just not there.

part of that is the desire to stay family-oriented. I'd much rather go to someone who's smaller and spends more than 10 minutes with me.. rather than some large office with 10 docs who crank through patients like a factory. So yes, I might make less practicing that way, but patients like that I take the time to talk to them and I can devote all of my time to my one office. (and spend time with my family out side of work)

100k a year is nothing to sneeze at.

But, I am in a group.. there are three of us even though only two of us really work the office. the third has another office and fills in when one of us is on vacation.

 

[xmattODx]

part of that is the desire to stay family-oriented. I'd much rather go to someone who's smaller and spends more than 10 minutes with me.. rather than some large office with 10 docs who crank through patients like a factory. So yes, I might make less practicing that way, but patients like that I take the time to talk to them and I can devote all of my time to my one office. (and spend time with my family out side of work)

100k a year is nothing to sneeze at.

But, I am in a group.. there are three of us even though only two of us really work the office. the third has another office and fills in when one of us is on vacation.

Group practice, eh? It is in a commercial setting, no?

 

[KHE]

part of that is the desire to stay family-oriented. I'd much rather go to someone who's smaller and spends more than 10 minutes with me.. rather than some large office with 10 docs who crank through patients like a factory. So yes, I might make less practicing that way, but patients like that I take the time to talk to them and I can devote all of my time to my one office. (and spend time with my family out side of work)

100k a year is nothing to sneeze at.

But, I am in a group.. there are three of us even though only two of us really work the office. the third has another office and fills in when one of us is on vacation.

A quaint and noble thought.

You're right. 100k is NOT anything to sneeze at.

However, optometry is going to run the risk of suffering the same fate as the mom and pop hardware store, and pharmacy.

As other entities grow larger and larger, their economic power is going to become greater and greater.

In your "group" of 3 doctors, you say that only two of you work at the office. Are you both "full time?"

 

[3eb4me]

However, optometry is going to run the risk of suffering the same fate as the mom and pop hardware store, and pharmacy.

Add medicine to the list. You can get an exam by a PA or NP in Target, CVS, and Wal-mart. Walgreens is also planning on adding express clinics. Get a physical while you wait for your pictures to be developed.
http://www.sun-sentinel.com/busines...,0,1164587.story?coll=sfla-business-headlines

http://www.bizjournals.com/sanantonio/stories/2006/01/16/story2.html?from_rss=1

Dentists can breathe for now, but I'm sure Wal-Mart is drawing up plans to put dental clinics in their stores. Why not get a tooth filling while you get your tires changed.
As long as consumer/patients demand for faster and more convenient services, we will see more and more retail/commericalized healthcare settings.

 

[Hines302]

Group practice, eh? It is in a commercial setting, no?

No.. the group practice we are referring to is a private practice. Usually a group of 2-4 docs in a large office (and maybe operating a satellite office).

 

[Hines302]

Optometrists in general, have a "lone wolf" mentality. MDs are much more used to working in groups whereas ODs are not. For whatever reason, many ODs are simply reluctant to give up any notion of "control" of "their practice" in order to form a group, in spite of the fact that it might me much more economically viable for them and the profession in the long term.

Unfortunately, most solo ODs (and therefore by default, most ODs) are "small time" thinkers.

KHE,

If I may ask.. how are you using your OD degree in your career now? I am just curious as to what other non traditional applications the degree can have.

I value your opinions and your experience in the profession.. I am just a student and really do not have any facts or experiences to back my opinions... they are simply my opinions.

However, these above statments are generalizations... and you really need to give more credit to recent OD grads and future OD's. I think young OD's are more willing to open group practices, more willing to incorporate technology into their practice, and more willing to handel medical conditions and act as true primary care providers. (Granted it will not be easy)

Your generalization might be correct for older OD's ... but I just don't think that is the case for new OD's. Simply put, the majority of people in this board are young OD's or young students. We are recognizing these problems, discussing them, and firguring out ways we can adapt our pratice and our profession. We are not the "small time thinkers" that you make us out to be. Hopefully schools will begin to address these issues in the near future.

Do you think that as a profession we do not have the ability or the desire to adapt? I think we do have that ability. The one's that are able to adapt will thrive and be succesfull. (and there are lots that already are)

 

[xmattODx]

No.. the group practice we are referring to is a private practice. Usually a group of 2-4 docs in a large office (and maybe operating a satellite office).

Sorry I'll be more explicit. It was a specific question to CPW. I believe that the group practice CPW is speaking about is a commercial practice. More fuel to the fire that most opportunities are in the commercial market.

 

[gsinccom]

I agree that OD schools need to do a better job of telling prospective students the realities facing the profession.

I also think that many current and future OD students think they'll be the one that won't need to work corporate; that is what I think and I do know that I may very well be wrong when all is said and done.

Yes there are pros/cons to any career but one of the things that lies ahead of you with optometry is uncertainty. At least with pharmacy you know going into it that 90% of your class will work corporate. I wonder if there is anyway that ODs can unite and come up with a common direction for the profession or if there will always be such a divide (for example) as we know it now... half will work corporate and half will work group practice with a select few that will do something else such as personal private practice, military, public health, vision therapy, research, consulting, teaching, etc.

hmm?

 

[Ben Chudner]

However, these above statments are generalizations... and you really need to give more credit to recent OD grads and future OD's. I think young OD's are more willing to open group practices, more willing to incorporate technology into their practice, and more willing to handel medical conditions and act as true primary care providers. (Granted it will not be easy)

Your generalization might be correct for older OD's ... but I just don't think that is the case for new OD's. Simply put, the majority of people in this board are young OD's or young students. We are recognizing these problems, discussing them, and firguring out ways we can adapt our pratice and our profession. We are not the "small time thinkers" that you make us out to be. Hopefully schools will begin to address these issues in the near future.

Do you think that as a profession we do not have the ability or the desire to adapt? I think we do have that ability. The one's that are able to adapt will thrive and be succesfull. (and there are lots that already are)

I don't think the profession has the ability to adapt. The desire, maybe, but not the ability. This is a issue of economics. The students on this forum will graduate with more debt than those of us in practice would ever had thought possible. There are fewer and fewer jobs in private practice available because there are so many OD's graduating every year. This allows us to pay less because the supply blows away the demand (plus we are cheap). So now you come out of school and to get that perfect private practice job you have to be willing to take a lower salary and now you have difficulty meeting your financial obligations. Here comes Cole Vision saying come work "with" us and you can make $100K to start. Well that sounds great, so you figure you will only work at Sears for a couple of years until you pay down your loans. Those years pass, and you've spent the last few years acquiring more debt (new car, house, etc) while managing to pay down your loans. You decide now is the time to get out of corporate and go into private practice. The problem is the only jobs available are those same low paying ones you looked at when you graduated. How can you make you new car payment, mortgage, and loan payment making only $75K a year?

New grads may not be "small-time thinkers", but many are short-sighted and naive. The basic fact is that many of your classmates will end up in Sears, JC Penny's, LensCrafters, Wal-Mart, Target, Sam's Club, Pearle Vision, etc and they will have a very difficult time leaving.

 

[KHE]

Because I have a doctorate level education, I started at the second highest payscale in my new job.

I was not referring to young ODs as small time thinkers. I was referring to old ODs. The vast majority of them are not interested in growing or expanding their business. They are "happy" doing what they are doing. That is, running their little office and seeing their patients.

I don't think young ODs are more willing to open group practices. They might be more open to the idea of group practice, but a group practice is not something that you open. It's something that you create over time by growing an existing solo office, or merging a few of them. Unfortunately, what happens all too often is that even as a new graduate, if you are fortunate enough to find a older doctor who wants to take you on as an associate and not just sell you their tired old office, you end up slowly taking over an office while the old guy slowly retires. In theory that's not bad, but you still end up a solo OD.

I pulled out my phone book. There is a listing for about 40 ODs in the area covered by my yelling pages, which is an area of about 225-250000 people. There are only two offices that are not run by solo ODs, and one of them is a husband and wife team.

I do not forsee the profession adapting nearly soon enough to stave off the commercial onslaught. The continued rise of managed vision care plans, and the continued reduction of reimbursement for materials along with discriminatory practices of managed medical plans will continue to erode the solo ODs income. If you feel that you can survive, and be content in a commercial retail environment (and lets be really honest here, that's basically what you'll be in even if you are in a "private" practice) then optometry will be rewarding for you.

KHE,

If I may ask.. how are you using your OD degree in your career now? I am just curious as to what other non traditional applications the degree can have.

I value your opinions and your experience in the profession.. I am just a student and really do not have any facts or experiences to back my opinions... they are simply my opinions.

However, these above statments are generalizations... and you really need to give more credit to recent OD grads and future OD's. I think young OD's are more willing to open group practices, more willing to incorporate technology into their practice, and more willing to handel medical conditions and act as true primary care providers. (Granted it will not be easy)

Your generalization might be correct for older OD's ... but I just don't think that is the case for new OD's. Simply put, the majority of people in this board are young OD's or young students. We are recognizing these problems, discussing them, and firguring out ways we can adapt our pratice and our profession. We are not the "small time thinkers" that you make us out to be. Hopefully schools will begin to address these issues in the near future.

Do you think that as a profession we do not have the ability or the desire to adapt? I think we do have that ability. The one's that are able to adapt will thrive and be succesfull. (and there are lots that already are)

 

[KHE]

If I could have found a private practice position that would have paid me anywhere close to 75k, I would have been all over it like white on rice.

When I finished my residency, the best offer out of 3 in private practice that I got was $32 per hour working a 9-6 two days a week as an independant contractor, no benefits, no paid vacation, no CE, no malpractice, and some amorphous offer to maybe "buy in" after "a few years." Even stringing a few of these types of positions together, it wasn't even going to come close to meeting my expenses.

The commercial offers ranged from 88k to just over 100k, paid as an employee with health benefits but no paid vacation, and no CE or malpractice.

I took a position as clinic director for a large refractive surgery center in which I was paid 78k with full benefits.

I don't think the profession has the ability to adapt. The desire, maybe, but not the ability. This is a issue of economics. The students on this forum will graduate with more debt than those of us in practice would ever had thought possible. There are fewer and fewer jobs in private practice available because there are so many OD's graduating every year. This allows us to pay less because the supply blows away the demand (plus we are cheap). So now you come out of school and to get that perfect private practice job you have to be willing to take a lower salary and now you have difficulty meeting your financial obligations. Here comes Cole Vision saying come work "with" us and you can make $100K to start. Well that sounds great, so you figure you will only work at Sears for a couple of years until you pay down your loans. Those years pass, and you've spent the last few years acquiring more debt (new car, house, etc) while managing to pay down your loans. You decide now is the time to get out of corporate and go into private practice. The problem is the only jobs available are those same low paying ones you looked at when you graduated. How can you make you new car payment, mortgage, and loan payment making only $75K a year?

New grads may not be "small-time thinkers", but many are short-sighted and naive. The basic fact is that many of your classmates will end up in Sears, JC Penny's, LensCrafters, Wal-Mart, Target, Sam's Club, Pearle Vision, etc and they will have a very difficult time leaving.

 

[Hines302]

New grads may not be "small-time thinkers", but many are short-sighted and naive. The basic fact is that many of your classmates will end up in Sears, JC Penny's, LensCrafters, Wal-Mart, Target, Sam's Club, Pearle Vision, etc and they will have a very difficult time leaving.

Well thats a bummer 🙁 Thats just depressing to think about

Any advice Ben on how to avoid this fate?

 

[ariel winter]

at the risk of sounding naive, what is so bad about commercial practice? the pay seems quite reasonable ($80,000 to $100,000 per year) without the hassle of managing your own business. i understand that the hours are rarely flexible and often long, but other than that, what are other commercial practice downsides?

thanks 🙂

 

[Ben Chudner]

Well thats a bummer 🙁 Thats just depressing to think about

Any advice Ben on how to avoid this fate?

That's the million dollar question. I only wish I knew the answer.

 

[xmattODx]

at the risk of sounding naive, what is so bad about commercial practice? the pay seems quite reasonable ($80,000 to $100,000 per year) without the hassle of managing your own business. i understand that the hours are rarely flexible and often long, but other than that, what are other commercial practice downsides?

thanks 🙂

four patients an hour
little to no respect from patients, optical staff, and area managers
little to no independence

 

[meb302]

Well thats a bummer 🙁 Thats just depressing to think about

Any advice Ben on how to avoid this fate?

This may seem like an obvious answer, but if you want to open a private practice in the future (as do I), simply write your goals down and work towards them! Try to save up some money, invest in certain areas, and most importantly, review your goals every once and a while! Without a goal, there would be nothing in life to achieve. If you don't want to work in a commercial setting, you don't have to. Hines302, you'll learn a lot about this info and your options first quarter at OSU! You should be excited!

 

[meb302]

at the risk of sounding naive, what is so bad about commercial practice? the pay seems quite reasonable ($80,000 to $100,000 per year) without the hassle of managing your own business. i understand that the hours are rarely flexible and often long, but other than that, what are other commercial practice downsides?

thanks 🙂

It may not be that bad of an aspect, but working commercially under a salary has different tax situations than owning a private practice. The portion of your salary will be immediantly removed after taxes, while being an owner of a business (the practice), you can spend and invest in the practice. Taxes are only taken out after this point. So, when you look at it, you have a little more control of your earnings in a private practice. Hopefully, I've stated this correctly and clearly.

 

[KHE]

at the risk of sounding naive, what is so bad about commercial practice? the pay seems quite reasonable ($80,000 to $100,000 per year) without the hassle of managing your own business. i understand that the hours are rarely flexible and often long, but other than that, what are other commercial practice downsides?

thanks 🙂

If you elect to go commercial, try to stick with Lenscrafters, Pearl Vision or places like that.

Try to avoid Walmart, Target, Sears, Costco etc. etc.

At least with Lenscrafters and Pearle, you're working in a place that just deals with "eye stuff."

Its hard to feel very doctorly when you're working next to big bags of ice melt or huge tubs of Tide detergent.

I always found that patients in commercial offices tend to be a bit more demanding and argumentative. Rest assured, you get a LOT of that in private offices too, it just seems to be a bit more prevalent in commercial practices. Hard to really explain why.

 

[cpw]

A quaint and noble thought.

You're right. 100k is NOT anything to sneeze at.

However, optometry is going to run the risk of suffering the same fate as the mom and pop hardware store, and pharmacy.

As other entities grow larger and larger, their economic power is going to become greater and greater.

In your "group" of 3 doctors, you say that only two of you work at the office. Are you both "full time?"

I'm the only full time doc.. the other doc works between this office and another farther away which is his main one. The third doctor owns her own office north of us and fills in when one of us needs days off.

I'd also appreciate you not talking down to me. I enjoy my job, love the people I work with and yes, we're a group who works together. We're not a "group" nor am I quaint. But no, we're not a group of docs who all share one office space at the same time.


I wouldn't mind being noble though 😉

 

[KHE]

I'm the only full time doc.. the other doc works between this office and another farther away which is his main one. The third doctor owns her own office north of us and fills in when one of us needs days off.

I'd also appreciate you not talking down to me. I enjoy my job, love the people I work with and yes, we're a group who works together. We're not a "group" nor am I quaint. But no, we're not a group of docs who all share one office space at the same time.


I wouldn't mind being noble though 😉

Are these all private practices? Do you have an ownership interest in any of this?

I can't figure out what you're referring to. In your original post you said you are in a group. But in this post you are saying you are a "group" that works together but then you say you are NOT a "group."

Pardon my confussion.

 

[cpw]

It may not be that bad of an aspect, but working commercially under a salary has different tax situations than owning a private practice. The portion of your salary will be immediantly removed after taxes, while being an owner of a business (the practice), you can spend and invest in the practice. Taxes are only taken out after this point. So, when you look at it, you have a little more control of your earnings in a private practice. Hopefully, I've stated this correctly and clearly.

Depends on where you work. Most states have laws that prevent corporations from hiring your directly as employees, you have to still be hired and paid by other doctors.

so, even though you work corporate you're still an "independant contractor". No benefits, no paid time off, no CE, no malpractice.

If you set yourself up from the start with a good CPA he/she can fix ya up as your own PA (professional association) to avoid the self employment tax.

I never though when I got out of school I'd be on a first name basis witih my CPA.

And YES.. I work corporate. I'm at a Lenscrafers. And yes, i work full-time and make more than 100k a year. (right out of school for those of you playing along at home).

When I first graduated I worked in three different offices, commuting all over town to make full-time hours (2 commercial offices and one private). I could have worked seven days a week if I wanted to the demand was so high in this area. i met some docs at a B&L dinner, they offered me a full-time job at Lenscrafters and I took it. I work less than 8 minutes from home... I hire my own staff... and set my own patient schedules.

For the record: I made the least working one day a week in private practice and had no guarantee I'd ever get to "buy in".

And yes.. I owe 90k in student loans.

 

[KHE]

For the benefit of the students, when you say the demand was so high, you could work seven days a week, how much of this demand was in commercial offices vs private offices?

I'm sure most of the students would prefer to work in a private office.

Depends on where you work. Most states have laws that prevent corporations from hiring your directly as employees, you have to still be hired and paid by other doctors.

so, even though you work corporate you're still an "independant contractor". No benefits, no paid time off, no CE, no malpractice.

If you set yourself up from the start with a good CPA he/she can fix ya up as your own PA (professional association) to avoid the self employment tax.

I never though when I got out of school I'd be on a first name basis witih my CPA.

And YES.. I work corporate. I'm at a Lenscrafers. And yes, i work full-time and make more than 100k a year. (right out of school for those of you playing along at home).

When I first graduated I worked in three different offices, commuting all over town to make full-time hours (2 commercial offices and one private). I could have worked seven days a week if I wanted to the demand was so high in this area. i met some docs at a B&L dinner, they offered me a full-time job at Lenscrafters and I took it. I work less than 8 minutes from home... I hire my own staff... and set my own patient schedules.

For the record: I made the least working one day a week in private practice and had no guarantee I'd ever get to "buy in".

And yes.. I owe 90k in student loans.

 

[Ben Chudner]

It may not be that bad of an aspect, but working commercially under a salary has different tax situations than owning a private practice. The portion of your salary will be immediantly removed after taxes, while being an owner of a business (the practice), you can spend and invest in the practice. Taxes are only taken out after this point. So, when you look at it, you have a little more control of your earnings in a private practice. Hopefully, I've stated this correctly and clearly.

You cannot deduct everything spent on the business from your salary. There are also differences between "S" corps, "C" corps, independent contractors, LLC's, LLP's, partnerships, etc. For example, my "S" corp pays my business note. Unfortunately, only the interest on the note is tax deductable. So, even though I don't see any of the money that goes to pay back my business loan, I get to pay personal taxes on a good portion of it. My advice is to discuss all options with you accountant.

 

[cpw]

For the benefit of the students, when you say the demand was so high, you could work seven days a week, how much of this demand was in commercial offices vs private offices?

I'm sure most of the students would prefer to work in a private office.

Most of the demand in this area for relief work or part-time work is in commercial settings. (they also pay better for the most part)

I worked in three places a few months ago and was getting calls from all over town from docs looking to pick up other days on days off. I do get letters from private offices in town looking for docs for a few days a week, but no one is usually hiring a full-time associate.

I actually took a small pay cut to come to the Lenscrafters full time based on what i was working doing part time in mutilple places. But, I'm happier working somewhere everyday with the same people establishing my own patient base.

It also makes my patients happier to be able to have me here more than one day a week (unlike when I was working in three places... it was brutal trying to get patients back to see me for follow ups)

The advantage to the Florida boards being so nasty brutal is if you get out of the Miami/ Ft. Lauderdale area there are jobs. Jobs that pay very well compared to what I would be getting had I stayed in Texas. (in a major city)

 

[Ben Chudner]

And YES.. I work corporate. I'm at a Lenscrafers. And yes, i work full-time and make more than 100k a year. (right out of school for those of you playing along at home).

CPW, I mean no disrespect to you or any other doctor working at LensCrafters, however, this highlights a serious problem with our profession. I realize you had difficulty finding full-time work and there was no guarantee of a buy-in. I can understand the appeal of making over $100k right out of school. I can't blame you for doing what you feel is necessary to provide for you and your family. Now it is time for the corporate doctors to realize something. The problem is not about patient care. As Ken has said many times (and I completely agree with him), there are many private practice OD's that practice at a lower standard of care than most corporate docs. This is an issue of money and influence. I have already posted about the money issue. Smaller practices cannot survive in a competition against the boxes. That's why they hate corporate optometry. There is another issue which, in my opinion, is much scarier. Traditionally, corporate docs are not as involved in the state associations, nor are they active in the AOA. There are exceptions, but the majority of membership in the AOA is made up of docs not in corporate locations. As more docs are forced into these settings, we lose people who are committed to the advancement of our profession. We lose lobbying power. We risk losing ground in our scope of practice efforts.

The easy answer is to say that corporate docs should get more involved. The problem is that they don't. Wal-Mart is trying get all of their members to join the AOA. Sounds like a great plan, and it could certainly eliminate this problem. Or would it? Being a skeptic, I tried to think about what would be so bad about all of the Wal-Mart docs becomming AOA members. Then I realized that would give them a significant voting block, and now the interests of the private practice doc may not be the priority of our AOA. As we try to fight being excluded from medical panels, maybe the Wal-Mart docs aren't as concerned about that because they have their own eye insurance that only Wal-Mart takes. If you think that's paranoid, just look at Cole Vision. I am sure there are a hundred other things that could happen that would benefit corporate optometry in this scenario that I can't predict. Before you know it, private practice as we know it could cease to exist.

I know it's very paranoid, and the truth is my practice doesn't compete with the boxes. I have patients that get their glasses outside my office, but those patients are looking for the lowest price, and I cannot offer them that. They still come to see me for exams, and in a lot of instances for medical problems. My practice is big enough that I believe I will be one of the OD's still standing at the end of the battle. My whole point, however, is that all of the students on this forum and most of the corporate docs don't understand the inherent problem with allowing corporate optometry to continue to grow. These corporations do not have the patient's best interest in mind. They don't even have their doctor's best interest in mind.

 

[HOLLYWOOD]

I'll tell you why optometry stinks .
1.vision plans
2.medical plans
Now for those of you who say dump the vision plans, not that easy to do ,depends on your practice demographics.
For those of you who say follow a medical model, that depends where you are practicing. ie my friends in FL can not be on medical plans. I was just kicked off cigna in manhattan. In my new jersey practice it took me two years to get on health net.

Young Doctors have to understand that insurance companies make all the decisions. It is a bad situation for all health professions. 3 OF MY pts. quit medicine, 1 of my friends quit medicine, my wifes ob just quit delivering babies. She said malpractice was to high and payment was to low. She had'
nt gotten a pay increase in 14 years( for C-section). I would not go into optometry ,dentistry, or medicine. Just go out there and speak to your doctors if you don't believe me. For the record I told my brother not to go into optometry.

 

[KHE]

CPW, I mean no disrespect to you or any other doctor working at LensCrafters, however, this highlights a serious problem with our profession. I realize you had difficulty finding full-time work and there was no guarantee of a buy-in. I can understand the appeal of making over $100k right out of school. I can't blame you for doing what you feel is necessary to provide for you and your family. Now it is time for the corporate doctors to realize something. The problem is not about patient care. As Ken has said many times (and I completely agree with him), there are many private practice OD's that practice at a lower standard of care than most corporate docs. This is an issue of money and influence. I have already posted about the money issue. Smaller practices cannot survive in a competition against the boxes. That's why they hate corporate optometry. There is another issue which, in my opinion, is much scarier. Traditionally, corporate docs are not as involved in the state associations, nor are they active in the AOA. There are exceptions, but the majority of membership in the AOA is made up of docs not in corporate locations. As more docs are forced into these settings, we lose people who are committed to the advancement of our profession. We lose lobbying power. We risk losing ground in our scope of practice efforts.

[\QUOTE]

But again Ben, the whole situation that she described was similar to my experience. I too, had all kinds of offers for part time and relief work in corporate settings, and a few days here and there in private offices and made decent money doing that.

But her story, and mine, and so many others just highlights the fact that schools are churning out far too many graduates and those graduates have too high a debt load. There are simply not even close to enough private practice positions available to accommodate the number of students graduating.

So what is she or anyone else supposed to do? Starve? Stand on principle and work only two days a week at the private office for next to nothing?

She is happy now. She likes the people she works with, and is taking home good money. But I would be willing to bet $500 that if we talk to her, or any other new graduate working commercial 5 years from now they will not be happy campers.

Is that what students are hoping will happen to them when they graduate? Piecing together a work week doing fill in days at commercial locations? Or even working full time at a commercial office? I highly doubt it.

Again, I stand by my position that in a relatively short amount of time, optometry will become like pharmacy. The vast majority of optometrists will be working retail hours in retail locations. Will they make good money? Probably. Is it what most people in optometry school viewed as the future for themselves when they sat in their 3rd and 4th year classes and clinics? Probably not.

 

[Ben Chudner]

duplicate post

 

[Ben Chudner]

But again Ben, the whole situation that she described was similar to my experience. I too, had all kinds of offers for part time and relief work in corporate settings, and a few days here and there in private offices and made decent money doing that.

But her story, and mine, and so many others just highlights the fact that schools are churning out far too many graduates and those graduates have too high a debt load. There are simply not even close to enough private practice positions available to accommodate the number of students graduating.

So what is she or anyone else supposed to do? Starve? Stand on principle and work only two days a week at the private office for next to nothing?

She is happy now. She likes the people she works with, and is taking home good money. But I would be willing to bet $500 that if we talk to her, or any other new graduate working commercial 5 years from now they will not be happy campers.

Is that what students are hoping will happen to them when they graduate? Piecing together a work week doing fill in days at commercial locations? Or even working full time at a commercial office? I highly doubt it.

Again, I stand by my position that in a relatively short amount of time, optometry will become like pharmacy. The vast majority of optometrists will be working retail hours in retail locations. Will they make good money? Probably. Is it what most people in optometry school viewed as the future for themselves when they sat in their 3rd and 4th year classes and clinics? Probably not.

Ken I fear you are right my friend. I believe there will be commercial locations everywhere with a couple of large OD clinics to handle the stuff the corporate locations either don't want to or are to busy to.

 

[gsinccom]

is there any way we can band together with the OMDs to stop this. If we are going to be true primary care providers for the eye and they are going to be mainly surgeons can't we work together on this issue?

 

[Ben Chudner]

is there any way we can band together with the OMDs to stop this. If we are going to be true primary care providers for the eye and they are going to be mainly surgeons can't we work together on this issue?

They don't need us. As long as patients see an OD to get a referral for surgery they don't care that it came from a corporte location.

 

[gsinccom]

isn't all the reduction in reimbursemnt fees killing the OMDs too? Is this why OMD practices are trending to surgery only?

 

[cpw]

So what is she or anyone else supposed to do? Starve? Stand on principle and work only two days a week at the private office for next to nothing?

It KILLED me to have to leave my private practice friends. It was the two doctors I externed with. An ideal setting in a great town, a husband and wife team, huge office, nice patients, fabulous staff... but I was only there one day a week. It was also a 47 mile drive EACH WAY from my house.

I lost sleep for a week making the decision to leave to work full time in a commercial setting. I was a stress case !! (ask my fiance he'll verify that I was fairly schizo for two solid weeks) I cried when I had to tell them goodbye... lost sleep... and lost weight. This doctor was my mentor and one of my best friends in Florida .. and for what it's worth he still is... he's going to be at my wedding in Oahu. (with an invite list of less than 20 people) He's family.

But, I didn't want to be a martyr, default on my loans, and go into even MORE debt just because I'm not a huge fan of corporate practice.

I don't think it's fair that I'm being judged for decisions I made by people who don't know me or my circumstances.

Feel free to call me in five years....

 

[gsinccom]

is reimbursement for services just going to keep getting less and less and so this will push OMDs to surgery only and then will push all ODs to corporate?

 

[Ben Chudner]

I don't think it's fair that I'm being judged for decisions I made by people who don't know me or my circumstances.

Feel free to call me in five years....

To be clear, I am not judging you. In fact in my post I state that I understand exactly why you would choose to go into corporate optometry. I just would like all of the corporate OD's to understand that there is a lot at stake. It goes far beyond whether or not you can make enough money to pay your bills. Private practice as we know it could be changed forever as corporate optometry becomes even more powerful. Nothing good can come from corporations making decisions that impact our professions. If you don't believe me, just look at what managed care has done to us. I sincerely wish you all the best in your career, and would not expect you, or anyone to be a martyr.

 

[cpw]

Traditionally, corporate docs are not as involved in the state associations, nor are they active in the AOA. There are exceptions, but the majority of membership in the AOA is made up of docs not in corporate locations. As more docs are forced into these settings, we lose people who are committed to the advancement of our profession. We lose lobbying power. We risk losing ground in our scope of practice efforts.

My school stressed active participation and even had us walk streets with state rep candidates who were pro-OD. Texas is very grassroots in their legislation.

I'm an active and current due paying member of the AOA, FOA (Florida), and HCOA (local county ODs)

 

[Ben Chudner]

My school stressed active participation and even had us walk streets with state rep candidates who were pro-OD. Texas is very grassroots in their legislation.

I'm an active and current due paying member of the AOA, FOA (Florida), and HCOA (local county ODs)

I had no doubt that you were active. You are in the minority, however.

 

[Hines302]

Ben, If you can have a successful practice... and many other OD's can run a sucessful practice... why can't everyone else?

Those OD's who are doing something write and have found away to survive must be doing something right. My point being... that it is possible!... and even tho it might be a tough road... its NOT impossible. What are these OD's doing right and everyone else doing wrong? It must be something... why one practice can thrive inspite of retail and another one can die at the hands of retail.

So we have to ask the question... are recent OD grads unwilling and unprepaired to run their own practice? Is this more the issue??

 

[KHE]

I don't get the impression that the comment about judging you was directed at me, but just in case it was, rest assured that I am not judging your decisions in any way. I completely understand where you are coming from. I was in the exact same situation and made some of the exact same decisions.

But your story is a microcosm of whats going on in optometry with new and recent graduates. Not able to find viable private practice opportunities, and becuase of that turning to corporate practice to avoid getting yourself further into debt.

And you turned to corporate practice not because you're lazy, or greedy, or dim, or unable to delay gratification, or expecting everything to be handed to you on a silver platter, as some older ODs will claim.

You did it out of necessity, because as I've said many times before, I'm sure your goal in your 3rd and 4th year was not to be working for Lenscrafters.

It KILLED me to have to leave my private practice friends. It was the two doctors I externed with. An ideal setting in a great town, a husband and wife team, huge office, nice patients, fabulous staff... but I was only there one day a week. It was also a 47 mile drive EACH WAY from my house.

I lost sleep for a week making the decision to leave to work full time in a commercial setting. I was a stress case !! (ask my fiance he'll verify that I was fairly schizo for two solid weeks) I cried when I had to tell them goodbye... lost sleep... and lost weight. This doctor was my mentor and one of my best friends in Florida .. and for what it's worth he still is... he's going to be at my wedding in Oahu. (with an invite list of less than 20 people) He's family.

But, I didn't want to be a martyr, default on my loans, and go into even MORE debt just because I'm not a huge fan of corporate practice.

I don't think it's fair that I'm being judged for decisions I made by people who don't know me or my circumstances.

Feel free to call me in five years....