Viability of opening up a practice cold

[Lemon125]

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Hi guys,

After reading a lot of posts from this board, I've gotten a feel for the status of the field and its future (thanks to Jason K, KHE, etc). Because of this, I am really debating whether to enter the field or not. Though the future doesn't look that bright and has a negative feel, I still have hope in the field, despite having lower expectations of my income. However, I have a family member in optometry school right now who would open a practice with me if I choose to pursue this field. I'm wondering how viable opening a practice cold with them is. I realize private practice is basically the only way to make a decent income and that we would both work part time at other places, have it be Walmart or another retail corp, to fill in the gap of income before the practice builds up.

Do you guys think it's a good idea to try? I will most likely be out of school with 150k in debt. We have complete trust in each other, so there's no issue with that. I'm just wondering if it would be financially doable or not.

Thanks.

 

[Shnurek]

Sure its doable, KHE was in for over a million dollars. But you may be near retirement age before you pay off all your debt depending how old you are.

 

[Jason K]

Sure its doable, KHE was in for over a million dollars. But you may be near retirement age before you pay off all your debt depending how old you are.

Dude, I wish you would not make comments on things you really don't understand. KHE was not "in it for over a million dollars." First off, he didn't open cold, he bought into an existing practice - two VERY different things. Second, he never once stated he bought into that practice for anywhere near a million dollars. You guys get these fantastic ideas in your head and then base your decisions on them. That's how people end up in professions that are dead-end streets despite being repeatedly told of the problems.

To answer the the OP's question - I think you'd be clinically insane to open cold out of school these days. Some of it is because of the pile of crap that optometry is becoming. The rest of it is because it is a much bigger jungle to get lost in as a new grad today compared to 20 years ago. The insurance/coding/billing knowledge that is required to squeeze the meager pay out of insurance companies for the services you provide is far more complicated today than ever before, and it's only going to get more complex. It's easy for someone to say "Oh, that doesn't matter, you just get yourself a billing person. Easier said than done. They're not going to work for you for free and anyone worth having in your practice is going to cost some cash. As a cold start, you're not going to have piles of money laying around to pay for an insurance/billing person to handle all the crap that will hit your wall on a daily basis. You'll likely be doing it yourself and it's a steep learning curve. ODs get virtually nothing of value when it comes to practical billing/coding/insurance stuff in optometry school. I don't know of a single person in my graduating class who opened cold and didn't live to regret it. It didn't used to be this way. 25 years ago, opening cold was nothing unusual. Now, you'd just have to be crazy. Sucks, but it is what it is. Welcome to optometry.

 

[Lemon125]

Ah, so even if the costs are split between the two of u s, it's still not really something that we can do huh? Depressing.

 

[Jason K]

Ah, so even if the costs are split between the two of u s, it's still not really something that we can do huh? Depressing.

If you're talking about opening cold with a partner, that's an even higher plane of insanity. Opening cold is just about never done on a FT basis these days. You might open a day or two per week while you work somewhere else to pay the bills. It's hard enough to attract enough patients for one doc, let alone two.

KHE did not open cold. He bought an existing spot in a 2 doctor practice after one left the practice. That is an entirely different situation from a a cold start. In my opinion, if one were going to buy a practice, buying into an existing group is probably the safest bet right now. Opening cold is certainly not - rural, urban, or anything in between.

 

[Shnurek]

In my opinion, if one were going to buy a practice, buying into an existing group is probably the safest bet right now. Opening cold is certainly not - rural, urban, or anything in between.

Yeah, play it safe like this guy...go commercial near one of the biggest optometry schools in the nation. Then come on SDN to bitch about optometry.

I did not clarify that KHE bought in but I was trying to show the relation between debt and the huge amount of time it takes to pay off so yes in a way I agree with Mr. Play it safe. But on a sidenote I know a guy that graduated from my school, opened cold, albeit in a different state and is now very successful. Pm me for more info if you wish.

 

[Lemon125]

That's what I meant. Opening up with a partner, but also working part time at another place. Working at the practice 3 days a week and 4 days at another place.

 

[q1we3]

Yeah, play it safe like this guy...go commercial near one of the biggest optometry schools in the nation. Then come on SDN to bitch about optometry.

I did not clarify that KHE bought in but I was trying to show the relation between debt and the huge amount of time it takes to pay off so yes in a way I agree with Mr. Play it safe. But on a sidenote I know a guy that graduated from my school, opened cold, albeit in a different state and is now very successful. Pm me for more info if you wish.

Good for him/her!!! It is always nice to hear success stories of recent graduates..By the way I don't think Jason ever mentioned where he practiced. How do you know? Are you saying he is located near ICO?

 

[Shnurek]

By the way I don't think Jason ever mentioned where he practiced. How do you know? Are you saying he is located near ICO?

It says Chicago under his name and he has mentioned it as well.

 

[optsuker]

Always possible if you do your homework, work hard, and have a little luck.

Opening cold with 2 new grads might be more difficult that doing it solo. Trying to service 2 student loans and finance a new practice would be daunting. Working away from the practice would be a must, but energy spent away from your own practice usually extends the period before you become successful.

If you're looking to practice with your family member who's a few years ahead of you, the ideal situation would be to find an older OD who would take on your relative, and then retire upon your arrival.

 

[Jason K]

Yeah, play it safe like this guy...go commercial near one of the biggest optometry schools in the nation. Then come on SDN to bitch about optometry.

Again - making comments on things you don't know correct information about. I'm not sure how many times I can say this - I'm not in Chicago. I'm not even near Chicago. It also says I went to Ohio State on my profile. I didn't. Do you really think I'd use my actual info on this thing? I'm in a medium-sized city by US standards and while it is saturated, there are far more saturated places in US. And no - I'm not near an optometry school. But you can keep believing that you'll be safe from the sinking ship by moving in next to a family of Caribou, Shnurek. Let us know how that works out for you.

You guys can believe what you want, but if I were you, I'd put my faith in ODs who have been out in the trenches and seen what the realities are. It's up to you if you want to listen to a first year student or other pre-opts regarding the realities of optometry. Confirmation of pre-existing notions and conceptions seems to be the prevailing function of this site. I think most pre-opts come one here to hear what they want to hear and they'll take it from whomever is willing to dish it out. Given the cluelessness of many 4th year students I've worked with regarding the realities, I'd be little hesitant to put my faith in someone who's been a student for a few months. That's just me. It's totally up to you, though.

I did not clarify that KHE bought in but I was trying to show the relation between debt and the huge amount of time it takes to pay off so yes in a way I agree with Mr. Play it safe. But on a sidenote I know a guy that graduated from my school, opened cold, albeit in a different state and is now very successful. Pm me for more info if you wish.

http://finance.yahoo.com/news/small-business-doctors-going-broke-101200127.html

Then you need to be a little more careful about what you say on this thing. The post was about the viability of opening cold. You come back and say "Sure it's doable, KHE was in for over a million dollars?" Wrong on two accounts, both the amount of money and the type of practice. Pre-ops read this stuff and take it at face value. If I didn't know better and I read that, I'd think that he dropped a million dollars into a cold start and was kicking ass. That's certainly not what happened. He found a very unusual opportunity, partly by chance, and took good advantage of it. Regardless, those types of opportunities are practically unheard of. The future of optometry, whether you like it or not, is in commercial crap. If you don't like that fact, then you're going to be unhappy in your chosen field. Private practice is dying and it's not even limited to optometry.

As the article above points out, physicians all over the US are getting screwed by Medicare cuts and many of them are having trouble keeping their doors open. What's that you say? You'll just drop Medicare? Doesn't matter - all the medical carriers set their reimbursements against Medicare schedules. In my opinion, the only docs who are going to be safe long-term will be the ones who bill primarily self-pay patients for services that Medicare normally doesn't cover. Doctors of all kinds (except maybe for the dentists) are dropping to a lower rung on the socioeconomic ladder. That's perfectly ok with Obama since we already make too much to begin with. In case people haven't figured it out yet, Obama is trying to "governmentalize" the US in every possible way. Doctors in his ideal medical world will be nothing more than paid government workers. If you think optometry isn't at a significant disadvantage relative to just about any MD, you're dreaming.

I guess maybe we should all just embrace the changes he's trying to make. I know some horrendously overweight, lazy, slovenly government workers who earn 3X what they should and will draw a decent pension one day. Maybe that's what we have to look forward to - a bunch of fat, sloppy doctors who draw government salary. Obama would be thrilled if the entire US population wore government-issued overalls to work - each pair monogrammed with the worker's function. That's what we're heading towards with him at the helm. He's basically a leftist radical in a suit and tie.

 

[love4eyes]

Those realities are quite alarming, especially the "impending 27.4% Medicare pay cut for doctors." What are the doctors doing to address those possible issues?

 

[euphaire]

Those realities are quite alarming, especially the "impending 27.4% Medicare pay cut for doctors." What are the doctors doing to address those possible issues?

I guess you didn't read the article. According to the article JasonK posted, some are making patients visit them on several trips instead of just one to avoid being paid a small lump sum by insurance, some are rejecting patients with questionable coverage, and some are taking additional jobs such as consulting in hospitals.

 

[Shnurek]

Those realities are quite alarming, especially the "impending 27.4% Medicare pay cut for doctors." What are the doctors doing to address those possible issues?

The crisis has been averted for now and ODs are in fact actually going to get paid more: http://newsfromaoa.org/2012/01/06/m...or-now-ods-expected-to-see-2012-pay-increase/

Jason you can keep rambling bro but not everyone has to share your opinion.

 

[Jason K]

The crisis has been averted for now and ODs are in fact actually going to get paid more: http://newsfromaoa.org/2012/01/06/m...or-now-ods-expected-to-see-2012-pay-increase/

Jason you can keep rambling bro but not everyone has to share your opinion.

You really need to understand the value of looking at the source you're reading. You just posted an article written by....wait for it.....the AOA. As we all know, the AOA is making great strides to reinforce optometry. And by that I mean, it's doing absolutely everything it can to reinforce the antithesis of private practice, commercial optometry. If you think ODs are somehow going to be better off based on some garbage that the AOA just put out, have at it. The rest of the medical world will live in reality, though. The reality is, the fees that doctors are able to charge for services have been dropping and will continue to drop in the future - period. You're buying into nothing more than government-created smoke and mirrors. Get back to me when practicing ODs actually see an increase in revenue from these changes. Know anyone who bought an OCT/GDx/HRT recently? Why don't you go tell them about the "pay increases" after we saw an abrupt slash in reimbursements we can expect for those procedures, cutting it down to half of what it used to pay instantly. Keep living the dream, Shnurek. You'll wake up one day... maybe it will be in an igloo next to an inuit family in the Yukon.

So in the eyes of Shnurek, a 1st year OD student, it's "crisis averted." In the eyes of just about every practicing OD/MD/DO/DPM etc in the US, it's just plain old "crisis." Keep believing the AOA, though - they put out nothing but the truth. Be sure to pay those dues once you graduate also, Shnurek.

 

[love4eyes]

The crisis has been averted for now and ODs are in fact actually going to get paid more: http://newsfromaoa.org/2012/01/06/m...or-now-ods-expected-to-see-2012-pay-increase/

Jason you can keep rambling bro but not everyone has to share your opinion.

@euphaire: I read the article. I guess I should have been specific on the the question. No worry, I got the answer from Shnurek. Thanks.

@Shnurek: Thanks for the article.

 

[319671]

yup, we shouldnt believe the aoa, but an anonymous poster on an internet forum

 

[Jason K]

yup, we shouldnt believe the aoa, but an anonymous poster on an internet forum

Actually, no, you should believe imemily (or one of her 350 aliases....sorry, 123 aliases), a mindless preop who has demonstrated on countless occasions that she doesn't have a clue what she's talking about.

Keep on dreamin' boys and girls. Reality will set in one day. For some of you, it will be before you drop 200K on a profession that's sinking. For others it will be after you do so. I'll let you figure out who the lucky ones will be.

 

[CL Doc]

Actually, no, you should believe imemily (or one of her 350 aliases....sorry, 123 aliases), a mindless preop who has demonstrated on countless occasions that she doesn't have a clue what she's talking about.

Keep on dreamin' boys and girls. Reality will set in one day. For some of you, it will be before you drop 200K on a profession that's sinking. For others it will be after you do so. I'll let you figure out who the lucky ones will be.

I'm starting to think Shnurek is a pseudonym for someone at the AOA.

 

[vieromanxx]

I'm starting to think Shnurek is a pseudonym for someone at the AOA.

👍
among other things...

 

[Shnurek]

I'm starting to think Shnurek is a pseudonym for someone at the AOA.

No actually I'm just a politically active first year student. But anyways, the AOA has given ODs physician status on Medicare. What has the AOS done? I used to be a bit pro-AOS after reading a bunch of ODWire stuff but everyone just complains and complains and doesn't do much (see: jasonk). The AOA takes action (see: capital hill) and the hindrance of board certification just halted the progression of our profession temporarily. Dentists have board cert. and only ~40% of them are certified. Doesn't mean ODs should not be allowed to have board cert. If you don't want it, then don't get it.

 

[CL Doc]

No actually I'm just a politically active first year student. But anyways, the AOA has given ODs physician status on Medicare. What has the AOS done? I used to be a bit pro-AOS after reading a bunch of ODWire stuff but everyone just complains and complains and doesn't do much (see: jasonk). The AOA takes action (see: capital hill) and the hindrance of board certification just halted the progression of our profession temporarily. Dentists have board cert. and only ~40% of them are certified. Doesn't mean ODs should not be allowed to have board cert. If you don't want it, then don't get it.

If all the PRACTICING ODs who opposed the AOAs board certification plan quit the AOA, there would be no AOA!

Don't lecture me on MY profession, I've been doing this longer than you've been alive.

 

[Tippytoe]

. Know anyone who bought an OCT/GDx/HRT recently? Why don't you go tell them about the "pay increases" after we saw an abrupt slash in reimbursements we can expect for those procedures, cutting it down to half of what it used to pay instantly. .

Yes. I have an HRT (retina/glaucoma instrument) and I saw my reimbursement slashed from $120 per pt down to $47.50 per patient (OVERNIGHT). That, my friends, is a 40% cut overnight from your friends at Medicare (which was followed by Medicaid, BCBS, United Health care.....and everyone else because they all follow medicare).

Medicare exam fees have risen slightly over the past 10 years....by about $5.00 per exam. How much have expenses risen in the last decade? Not sure, but definately more than $5 worth. (Hint: Gas was $1.55 in 2000.)

The fact is more people in America are not working than are working...........and everyone expects free health care. We are a fat and lazy nation. When a crazy liberal like Obama gets in office, and has no clue how the real world economy works, they make up some silly crap like "everyone deserves free health care" without regard to how the hell it will be paid for. (Should you really spent $2 million dollars to extend a half dead person life for 6 months?).

Liberals (and republicians for that matter) like to take it out of doctor's pockets because we are the easiest to steal from. The public has no sympathy for us. And no politician is going to ask old people to pay more and maybe get off their fat ass and take care of themselves.

So it's safe to say, virtually all doctors, including ODs WILL be paid less in the future. The difference as I see it is that other types of doctors have at least a little leaverage. MDs can chose not to accept Medicare and when enough old folks complain, something will be done (either the govt will MAKE docs see MCR pts or they will pay enough to keep
the lights on). Dentists........don't even think about it. They have kept themselves immune from most insurance crap. This is why many ODs envy dentists and recommend that field for their kids. Don't believe me?-- go over to the dental section.

With ODs, any reasonable person (if there is such a thing in gov't) will be able to look and see there are xx thousand excess ODs so there is no need to pay them more. They will work for whatever we offer because $25,000/yr flipping dials is still better than flipping burgers at McDonalds (a little better anyway).

We have zero levarage. The AOA has been impotent for the last 25 years since they have been bought off my Walmart and VSP. Beside, the AOA has zero control of opening of Optometry schools.

 

[Jason K]

No actually I'm just a politically active first year student. But anyways, the AOA has given ODs physician status on Medicare. What has the AOS done? I used to be a bit pro-AOS after reading a bunch of ODWire stuff but everyone just complains and complains and doesn't do much (see: jasonk). The AOA takes action (see: capital hill) and the hindrance of board certification just halted the progression of our profession temporarily. Dentists have board cert. and only ~40% of them are certified. Doesn't mean ODs should not be allowed to have board cert. If you don't want it, then don't get it.

Shnurek, you're a perfect drone that will buy into the AOA's brainwashing, just like they intend. It's kind of funny how the percentage of ODs with AOA membership drops steadily after graduation. Kind of makes you think that people figure things out after practicing for a while. But please, keep telling us practicing ODs about the realities of our profession.

The AOA used to be a friend to practicing ODs. So did VSP. They are no longer. If you don't know that yet, you will. Like all things in life, sometimes it just takes some experience to figure things out.

BTW, the AOS just successfully SUED the AOA (indirectly), and rightfully so. If you think BC is something that will help ODs, you're again buying into the garbage put out by the AOA. Gee, I wonder if the AOA would stand to gain if suddenly 35K ODs had to pony up several thousand more dollars periodically to maintain their patient base? Hmmmmmm......doesn't sound like a conflict of interest there at all.

When a residency-trained MD/DO/DMD/DDS gets board certified in a specialty, he's is stating to the public that he's undergone extensive training that sets him apart from his non-board certified peers. When an OD who has already passed NBEO shows up to take another expensive hurdle put in front of him without any training before said hurdle, it makes a mockery of the BC system. Furthermore, it makes optometry look like the little brother who's jumping up and down having a tantrum when his mom tells him he can't go out and play with big brother's friends:

Child: "But I want to be Board Certified too, mom....I want it, I want it, I want it!!"
Mom: "But son, it's meaningless for you. It carries no function and will only serve to create disparity among your peers."
Child: "I don't care - the AOA says I need it so I want it and I want it now - give it to me!!"
Nearby MD: "What a complete tool...."

We're optometrists. We're a profession that provides primary eye care. We're not specialists - even if we did residencies. We can't afford to be specialists since there aren't enough patients as it is, let alone in limited practices - period. Trying to make ourselves into something we're not, just to line the pockets of the ABO/AOA or to make ourselves feel like a "big kid" is ridiculous. Maybe that's why just about all practicing ODs are strongly opposed to BC... just maybe.

If you're a residency-trianed OD who's happily moving along in practice and the guy down the street from you (non-residency trained) decides to get board certified, do you think that might put you at an unfair disadvantage? The public will be misled into thinking that the BC doc is more highly trained and more qualified, just like in the medical system. It's misleading - that's why the courts shut it down.

BC is meaningless for a profession like optometry without specialties - that's probably why less than 1% of general dentists are BC. What's that you say? The AOA is just trying to carve out the possibility to have our own specialties, just like our MD buddies? That's a great idea. Let's see how people do when they can no longer see primary care patients and they're limited to their specialty. When you become an orthopedic surgeon or an orthodontist, you are no longer permitted to perform the functions of a primary care doc. Think about that for a second in the context of massive oversupply.

 

[q1we3]

Shnurek, you're a perfect drone that will buy into the AOA's brainwashing, just like they intend. It's kind of funny how the percentage of ODs with AOA membership drops steadily after graduation. Kind of makes you think that people figure things out after practicing for a while. But please, keep telling us practicing ODs about the realities of our profession.

The AOA used to be a friend to practicing ODs. So did VSP. They are no longer. If you don't know that yet, you will. Like all things in life, sometimes it just takes some experience to figure things out.

BTW, the AOS just successfully SUED the AOA (indirectly), and rightfully so. If you think BC is something that will help ODs, you're again buying into the garbage put out by the AOA. Gee, I wonder if the AOA would stand to gain if suddenly 35K ODs had to pony up several thousand more dollars periodically to maintain their patient base? Hmmmmmm......doesn't sound like a conflict of interest there at all.

When a residency-trained MD/DO/DMD/DDS gets board certified in a specialty, he's is stating to the public that he's undergone extensive training that sets him apart from his non-board certified peers. When an OD who has already passed NBEO shows up to take another expensive hurdle put in front of him without any training before said hurdle, it makes a mockery of the BC system. Furthermore, it makes optometry look like the little brother who's jumping up and down having a tantrum when his mom tells him he can't go out and play with big brother's friends:

Child: "But I want to be Board Certified too, mom....I want it, I want it, I want it!!"
Mom: "But son, it's meaningless for you. It carries no function and will only serve to create disparity among your peers."
Child: "I don't care - the AOA says I need it so I want it and I want it now - give it to me!!"
Nearby MD: "What a complete tool...."

We're optometrists. We're a profession that provides primary eye care. We're not specialists - even if we did residencies. We can't afford to be specialists since there aren't enough patients as it is, let alone in limited practices - period. Trying to make ourselves into something we're not, just to line the pockets of the ABO/AOA or to make ourselves feel like a "big kid" is ridiculous. Maybe that's why just about all practicing ODs are strongly opposed to BC... just maybe.

If you're a residency-trianed OD who's happily moving along in practice and the guy down the street from you (non-residency trained) decides to get board certified, do you think that might put you at an unfair disadvantage? The public will be misled into thinking that the BC doc is more highly trained and more qualified, just like in the medical system. It's misleading - that's why the courts shut it down.

BC is meaningless for a profession like optometry without specialties - that's probably why less than 1% of general dentists are BC. What's that you say? The AOA is just trying to carve out the possibility to have our own specialties, just like our MD buddies? That's a great idea. Let's see how people do when they can no longer see primary care patients and they're limited to their specialty. When you become an orthopedic surgeon or an orthodontist, you are no longer permitted to perform the functions of a primary care doc. Think about that for a second in the context of massive oversupply.

Sadly, I have to agree with that. I have been doing more & more research on the politics of optometry in the US and it seems like it is being run by people who are completely unaware of the real issues of optometry.

Yes, AOA did great things for optometry in the very distant past. But, this BC fiasco is just so stupid. I plan on doing a residency in pediatrics or geriatrics, but there is no way I would be able to survive by seeing only those types of patients, I also must be a primary care OD. Hence, beats the whole purpose of being BC and so called "specialist". How about we shift are attention to preventing new schools from opening and raising the standards on types of applicants that are being accepted?

And what about the insurance companies like VSP? How come people who go to Costco for eye exam still be covered under VSP as a "out of network" .? If you have VSP only place that would cover you should be PP. These insurance companies who say that they support private practice, in reality are helping the commercial giants.

We are heading to commercial like pharmacy. Be knowledgable and realistic about what optometry is, knowing these issues will help you make informed decisions in the future and maybe avoid commercial

 

[Shnurek]

How about we shift are attention to preventing new schools from opening and raising the standards on types of applicants that are being accepted?

You can't prevent new schools from opening but yes the NBEO should raise their standards for the national board exams. And also states have their own filtering mechanisms that prevent many under-par ODs from practicing in those states e.g. Florida with their practical.

I think Board Cert is good because its a test you only take every 10 years and so what if the AOA gets money? They progress the profession forward. It prevents those old ODs from still practicing 1970's optometry where they miss easy stuff like macular deg. , other retinopathy, just refer everything out and never use their BIOs.

 

[Jason K]

And also states have their own filtering mechanisms that prevent many under-par ODs from practicing in those states e.g. Florida with their practical.

The practical in states like Florida, North Carolina, and South Dakota have nothing to do with competence. They are in place to limit the numbers of ODs who practice within their state. Those states understand, perhaps better than the rest of the country, that too many ODs within their borders sink their doctors.

I think Board Cert is good because its a test you only take every 10 years and so what if the AOA gets money?

Spoken like someone who does not understand what BC is or what it's intended to do. Perhaps more importantly, it's spoken like someone who's never had to live on his own and pay his own bills. Trust me, Shnurek, in a few years when you've got 15-20 people reaching into your pocket each month, you'll care about that few thousands dollars.

They progress the profession forward.

It absolutely doesn't - it's moving us sideways at light speed.

It prevents those old ODs from still practicing 1970's optometry where they miss easy stuff like macular deg. , other retinopathy, just refer everything out and never use their BIOs.

It does not do this either. "Old ODs practicing 1970s optometry" will simply study for the test, which will be far too easy in the first place, pass it, and move on with their 1970s optometry. The only difference will be that they will have parted with several thousand dollars in examination fees and perhaps several more in travel expenses.

But it'll be great - those AOA "higher-ups" will be able to stay at even nicer 5 star hotels on paying members' dimes.

Did Dori Carlson just speak at SUNY or something? I can't believe the blind allegiance to that criminal organization - it's honestly terrifying. Dream on about the rosy future of optometry if you please, but to be ignorant of the scam that the AOA is trying to pull on ODs is dangerous. You need to read up. Maybe you should PM q1we3. He may be a pre-op, but I think he has a better understanding of the situation than you do.

 

[319671]

it must be really nice up there in your head jason k. filled with misery and resentment.

 

[Jason K]

it must be really nice up there in your head jason k. filled with misery and resentment.

No misery, no resentment, just a regret for entering optometry. Don't worry, you'll be right there with the rest of us soon enough. I only wish I could be in your head when the lightbulb goes off.....on second thought, maybe not - I'd probably bump into Justin Beiber and Elmo in there anyway.