Where to Practice Thread

[jymezg]

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This question has been in the back of my mind for sometime so I figured I start a thread to get some ideas. I have no prefrence for where I end up at this point so I'd like to get some input for those in practice and those who have already decided where they will be starting out.

I'd like to hear thoughts/input on:

Scope of practice in area
Types of practices that do best in the area
Saturation
Pt demographics
Cost of living
Rural/Urban Pros/Cons
etc

Basically looking for an overall picture of areas and their respective pros/cons to sorta get a feel on where I will start looking into. Any constructive input is welcome, Thanks

 

[KHE]

This question has been in the back of my mind for sometime so I figured I start a thread to get some ideas. I have no prefrence for where I end up at this point so I'd like to get some input for those in practice and those who have already decided where they will be starting out.

I'd like to hear thoughts/input on:

Scope of practice in area
Types of practices that do best in the area
Saturation
Pt demographics
Cost of living
Rural/Urban Pros/Cons
etc

Basically looking for an overall picture of areas and their respective pros/cons to sorta get a feel on where I will start looking into. Any constructive input is welcome, Thanks

And again......none of those things are particularly relevant when it comes to determining the relative success of a practice.

The key, as I've said dozens of times on here is to find an area where ODs can be admitted onto medical insurance panels. That's the number one thing. All else is secondary.

 

[cloud99]

OK then, so where can OD's be admitted onto medical insurance panels?

 

[KHE]

OK then, so where can OD's be admitted onto medical insurance panels?

There is no way to determine this other than to pick a place you're interested in, find out who the top 5 or 6 medical health providers are in the area and then phone up those plans and ask if they are credentialling NEW optometrists.

 

[stonegoat]

There is no way to determine this other than to pick a place you're interested in, find out who the top 5 or 6 medical health providers are in the area and then phone up those plans and ask if they are credentialling NEW optometrists.

...Or come to Canada and you won't have to worry about insurance BS.

 

[KHE]

...Or come to Canada and you won't have to worry about insurance BS.

Or have to worry about precribing patanol.

 

[stonegoat]

Or have to worry about precribing patanol.

Actually, the majority of provinces in Canada have TPAs, including BC, where I practice. The great thing about Canada is that there are FAR FEWER ophthalmologists per capita, so as an optometrist, you'll actually use your TPAs.

KHE, I am having a US OD come visit my practice this fall. He is considering associating with me, and it's really not a big deal to make it happen, so my post is relevant on this forum, despite your bias.

 

[KHE]

Actually, the majority of provinces in Canada have TPAs, including BC, where I practice. The great thing about Canada is that there are FAR FEWER ophthalmologists per capita, so as an optometrist, you'll actually use your TPAs.

KHE, I am having a US OD come visit my practice this fall. He is considering associating with me, and it's really not a big deal to make it happen, so my post is relevant on this forum, despite your bias.

I was aware that some provinces had some level of TPA access now, though it's been about 15 years since I left Canada so needless to say, I don't keep up on the political issues of optometry in Canada very much.

Can you provide a brief outline of the state of TPAs in Canada right now?

What topical medications can/can not be used by ODs?
Glaucoma?
Steroids?
Orals?

Any restrictions on any of them, such as consultation with MDs required etc. etc.?

 

[stonegoat]

I was aware that some provinces had some level of TPA access now, though it's been about 15 years since I left Canada so needless to say, I don't keep up on the political issues of optometry in Canada very much.

Can you provide a brief outline of the state of TPAs in Canada right now?

What topical medications can/can not be used by ODs?
Glaucoma?
Steroids?
Orals?

Any restrictions on any of them, such as consultation with MDs required etc. etc.?

Privelages vary from province to province. Most provinces allow all topicals, however, some restrict glaucoma meds, or require consultation with an OMD. No provinces currently have orals, however, orals will be in the formulary in Ontario. I'm in my seventh year of practice, and I can count on my fingers the number of times I wished I could prescribe an oral medication.

I don't think there are many ODs anywhere that have the opportunity to manage more ocular disease/trauma than ODs in rural Canada. Ophthalmologists are usually a considerable distance away, or are too busy to see non-urgent patients in a timely manner. I was on-call at the hospital in the first town I practiced in, and received several MD referrals/day. In my current location, I receive at least one MD referral/day.

KHE, for whatever reason, you are always somewhat antagonistic towards my posts.....why??? I'm not trying to undermine your posts, I just want to inform those asking that there are other practice options out there.

 

[KHE]

KHE, for whatever reason, you are always somewhat antagonistic towards my posts.....why??? I'm not trying to undermine your posts, I just want to inform those asking that there are other practice options out there.

Stone,

I think it's safe to say that while there are a number of Canadians who use SDN and Waterloo comes up frequently, most of the students who do use SDN are Americans or people looking to/expecting to practice in the USA.

I'm not antagonistic towards your posts per se but I think that far too often you leave out the fact that you practice in rural Canada. You've mentioned it before, yes but you've also thrown around some income numbers or practice demographics without specifying that:

a) It's in Canadian dollars (which right now, isn't a big deal given the status of the American dollar but often times it results in an inaccurate view of the income potential.

b) The tax situation in Canada is considerably different than here in the USA.

c) That you practice not just in rural Canada, but in RURAL Canada. There's a big difference between "Saskatoon" rural and "Churchill" rural.

I think most people don't truly appreciate where you're coming from and end up with a distorted view of potential situations.

 

[stonegoat]

Stone,

I think it's safe to say that while there are a number of Canadians who use SDN and Waterloo comes up frequently, most of the students who do use SDN are Americans or people looking to/expecting to practice in the USA.

I'm not antagonistic towards your posts per se but I think that far too often you leave out the fact that you practice in rural Canada. You've mentioned it before, yes but you've also thrown around some income numbers or practice demographics without specifying that:

a) It's in Canadian dollars (which right now, isn't a big deal given the status of the American dollar but often times it results in an inaccurate view of the income potential.

b) The tax situation in Canada is considerably different than here in the USA.

c) That you practice not just in rural Canada, but in RURAL Canada. There's a big difference between "Saskatoon" rural and "Churchill" rural.

I think most people don't truly appreciate where you're coming from and end up with a distorted view of potential situations.

a) Yes the Canadian dollar is usually valued less than the US dollar, however, here in Canada we purchase things in Canadian dollars.

b) I only pay about 25% tax over-all. I have a good accountant and everything wew do is legal. How does that differ from yourself?

c) I practice in a town of about 13,000, with a trade area of about 60,000. It's considered "rural", but the town has all the ameneties of a larger centre. FYI, Saskatoon is a city, and as such, any practice there would not be considered rural. Also, some people, like myself, would never want to practice in a larger centre. I love the fact that world-class skiing, kayaking, mountianeering, hunting, fishing, etc are all less than 25 km from my house.

Perhaps the situation is ****ty for optometry in all but a few select places in the US. That would certianly be my impression from what I read in this forum. There are over 200 Canadians studying in the US, and my "goal" is to inform those individuals who want what I have, that it is 100% attainable. For the select few ODs in the US who have always dreamed of living a high quality life in a great country...maybe they will step out of their comfort zone and check out the opportunities north of the border.

 

[KHE]

a) Yes the Canadian dollar is usually valued less than the US dollar, however, here in Canada we purchase things in Canadian dollars.

Of course, but you can't come on a board frequented mostly by American students and say things like "I make $300000" without specifying that it's $300000 in Canadian money, that the tax rate is a lot higher and the cost of most things in Canada is higher and that you practice in a very rural setting. There's absolutely nothing wrong with any of that, but again, you can understand how without clarifying it, it can cause confusion on a board frequented by mostly American students.

b) I only pay about 25% tax over-all. I have a good accountant and everything wew do is legal. How does that differ from yourself?

13%.

c) I practice in a town of about 13,000, with a trade area of about 60,000. It's considered "rural", but the town has all the ameneties of a larger centre. FYI, Saskatoon is a city, and as such, any practice there would not be considered rural. Also, some people, like myself, would never want to practice in a larger centre. I love the fact that world-class skiing, kayaking, mountianeering, hunting, fishing, etc are all less than 25 km from my house.

I know what Saskatoon is. I didn't articulate that point well. What I meant to say was that someone living 20 km outside of Saskatoon is in a different type of "rural" than someone living 20 km outside of Churchill.

Perhaps the situation is ****ty for optometry in all but a few select places in the US. That would certianly be my impression from what I read in this forum. There are over 200 Canadians studying in the US, and my "goal" is to inform those individuals who want what I have, that it is 100% attainable. For the select few ODs in the US who have always dreamed of living a high quality life in a great country...maybe they will step out of their comfort zone and check out the opportunities north of the border.

Of course it's attainable. It's attainable here too and it's not as hard as many people make it sound.

 

[stonegoat]

Of course, but you can't come on a board frequented mostly by American students and say things like "I make $300000" without specifying that it's $300000 in Canadian money, that the tax rate is a lot higher and the cost of most things in Canada is higher and that you practice in a very rural setting. There's absolutely nothing wrong with any of that, but again, you can understand how without clarifying it, it can cause confusion on a board frequented by mostly American students.



13%.



I know what Saskatoon is. I didn't articulate that point well. What I meant to say was that someone living 20 km outside of Saskatoon is in a different type of "rural" than someone living 20 km outside of Churchill.



Of course it's attainable. It's attainable here too and it's not as hard as many people make it sound.

13%?? Wow. No wonder the US runs a multi-trillion dollar defecit.

 

[jefguth]

I'm in my seventh year of practice, and I can count on my fingers the number of times I wished I could prescribe an oral medication

If we had orals I'd be prescribing Doxy Doxy Doxy all day long!😀

 

[jeh198]

13%?? Wow. No wonder the US runs a multi-trillion dollar defecit.

My thoughts exactly. What the heck did you write off?? your soul??!

 

[rodomon]

Depends on what you want out of life.

Do you want to live near beach/mountains/desert/forest? A city or a small town? Warm weather all year round or seasons? Somewhere with an awesome pro/college football/basketball team, or perhaps opera or shopping malls or parks? A great place to raise a family or a great place to party? Near your family or as far away as possible?

As for optometry, group/solo/university/military/etc practice? Private or corporate? Fast spec refractions, CL / low vision / glaucoma / etc specialty, more medical emphasis? Do you want to be on call at the local hospital for any eye stuff or do you want to go home and not have to worry about that?

And, of course, tons of other considerations I haven't included.

Also, since it's highly unlikely you can find one place with everything you want, what are you going to sacrifice? If you like beaches, are you going to live in a nasty hot desert to make another $10,000 per year? If you like money, are you willing to practice procedures that you would rather not perform but which pay well?

For me, getting on medical plans and practicing to the full scope of my training would be nice, but the demographics of where I live are more important to my quality of life than the extra money and other benefits. If I can find a place with both, great, but if not, I know which I'm willing to eschew.

If you're not sure of what you want, you can often give a couple of different options a try throughout your life, although sometimes the transition can be rough.

So, yeah, what do you want, and what are you willing to give up?

 

[eyestrain]

Haha. Canadian fight!

 

[KHE]

No matter where you practice there will be competition, you need to know how to get your name out there and be a recognized name/brand in the community.

Would you care to share a few tips, pearls, or little nuggets to thing about?

 

[PBEA]

Would you care to share a few tips, pearls, or little nuggets to thing about?

13% ?

wtf! is that bull about

I do not believe you

 

[JAZZEYE]

Haha. Canadian fight!

 

[KHE]

13%?? Wow. No wonder the US runs a multi-trillion dollar defecit.

I want to revisit this issue here because I think it's generated some confusion and it seems that this thread has been resurected which has resulted in a couple of PMs from people specifically asking about this.

Just to make sure we're comparing apples to apples here, Stone....

When you say you spend 25% in taxes overall, what are you considering in that?

Federal income tax?
Provincial Income tax?
CPP?
EI?

All of it? Just federal?

What?

 

[jefguth]

I want to revisit this issue here because I think it's generated some confusion and it seems that this thread has been resurected which has resulted in a couple of PMs from people specifically asking about this.

Just to make sure we're comparing apples to apples here, Stone....

When you say you spend 25% in taxes overall, what are you considering in that?

Federal income tax?
Provincial Income tax?
CPP?
EI?

All of it? Just federal?

What?

That would probably, on my own situation, is 25% for everything. Self-employed do not pay into EI, although we will soon have the option of doing so.