WHy are there so few optometry schools?

[xmattODx]

Your missing the point. We are talking about infants... not diabetics. Free eye exams to infants is good because it helps establish that eye care is important... because as we all know by doing these types of exams we will find infants with vision disorders. These disorders will then have to be treated.... through paid exams and treatments.

Also.. this might lead to a spring board for mandatory eye exams for school children.. etc.

We need to stop thinking about immediate benifits and start thinking about the long term. Think about it as an investment in the professions future... cause thats what it really is... and thats the point you are missing.

I'm not going to belabor this point but no other healthcare profession gives away their services to all people regardless of their income. Infant See is not a screening program it is giving away the first exam for free. All it will do for the profession's future is cause people to say: "Hey, they give stuff away for free. Must not be all that important." Look at it from a public health stand point. You'll reach a different conclusion. My skills are worth something and, therefore, require payment.

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[prettygreeneyes]

I really like the general idea of the InfantSee program, but I think that it could have been implemented better. Instead of advertising it (which I can't really say that I've ever seen adverstising, but anyway) as a free exam for all children under 1 year "regardless of income level", we should focus more on the importance of the actual eye exam itself. This should be more a public health campaign to let parents know that eye exams aren't just for kids who can actually read letter, but for the little ones too! The benefits of detecting a vision problem early are HUGE, and all parents should know just how important these exams really are! Educate parents that that a lot of insurances will cover an eye exam, and if you are on of those individuals who does not have any sort of insurance whatsoever, then call one of these InfantSee participating providers and talk with the optometrist about how to make this affordable (not free) for you. I don't think the words, "FREE, FREE, FREE" should have ever been mentioned.

On a side note, xmattODx, do you have any experience with actual participants in this program? I would think that if you were to find a problem in the intial eye exam of a little one, and in subsequent (paid) visits you corrected it, don't you think you'd have a loyal family for life?

 

[Hines302]

I totally agree with your prettygreeneyes... excellent observation. Using the word FREE is not good.. and would only harm the image of the profession furthur... and in essence have the opposite affect than what i believe it is ment for.

I have never seen this progarm "adversited" or made known to the general public either besides on the website WebMD. However again, I do agree with you and I apologize if that was not clear in my previous postings.

 

[xmattODx]

On a side note, xmattODx, do you have any experience with actual participants in this program? I would think that if you were to find a problem in the intial eye exam of a little one, and in subsequent (paid) visits you corrected it, don't you think you'd have a loyal family for life?

I'm not an Infant See provider. What types of conditions am I going to be treating that I find in an Infant See exam? Most things of concern in an Infant See exam are going to be referred, no? (other than gross refractive error) My contention is that I'd have a loyal family for life if I helped an infant in some way and they paid for the exam.

Your idea of advertising the importance of an exam but not giving away our services seems wise to me. People don't value that which they don't pay for.

 

[prettygreeneyes]

I'm not an Infant See provider. What types of conditions am I going to be treating that I find in an Infant See exam? Most things of concern in an Infant See exam are going to be referred, no? (other than gross refractive error) My contention is that I'd have a loyal family for life if I helped an infant in some way and they paid for the exam.

Your idea of advertising the importance of an exam but not giving away our services seems wise to me. People don't value that which they don't pay for.

You'll have to forgive my ignorance regarding the actual exam for the infant, as I'm not in opt. school yet! I assumed that if you discovered something like a "misalignment" in the eyes or a high prescription, you could resolve that yourself through vision therapy or glasses. I'm not sure how early those things can be started, so bear with me! From what I remember in Neurobiology, if the brain "senses" that one eye is not functioning as well as the other, it will essentially "ignore" the bad eye and rely heavily on the "good eye" causing problems down the road. But, I probably am way off base with this stuff... good thing I'm not treating patients now!!! I just don't like how many patients I see coming in who are having their first eye exam at 10 and 12! Mom thought that since the eyes don't "look" bad, ie not red, etc, then nothing was wrong. I hear things about "amblyopia" a lot at the practice I work at, but I don't know what that is...

 

[Hines302]

Link to the video featured on WebMD:

http://www.webmd.com/content/pages/24/112716.htm

This is a great discussion... can anybody else make any additions or changes to the list below... about what changes need to be made to the profession to cope with the challenges we face?

Things that need to be done:

- Reduce Enrollment at private Optometry School -- This is turn will keep the quality of applicants high
- These private schools should become associated with Public Universities to help bring down the cost of tuition.

- The AOA should work with organizations that represnt OMD's in order to define a working relationship amoung both professions. (Optomestic.. I know)
- Additional Hospital Based Residencies for those OD's who wish to practice more "Medical Optometry"

- OD's should be encouraged to become part time instructors - lecturering at Physician Assistant School across the country. PA's are the primary care health professionals of the future and will be responsible for most primary care patient interactions.

- The AOA should become more associated and work more closely with State and Local Optometric Associations
- The AOA should start an agressive PR compaign to inform the public of what OD's do and the importance of Healthy Vision (not just 20/20 vision)
- Develop more programs like infant see... and promote them
- The AOA should encourage the members that own private practices to incorpoate this type of PR in there own advertising
- Work with contact lense and other eye care companies to add "see an eye care professional before use or these products" -- this will help keep their product at a premiume -- ie: looks more like a medical product than a cosmetic product.

- Strive for a National Uniform Licence - and thus a uniform scope of practice


Feel free to make comments or suggestion... (im just a student... class of 2010... this is just my 2 cents)

 

[KHE]

Your missing the point. We are talking about infants... not diabetics. Free eye exams to infants is good because it helps establish that eye care is important... because as we all know by doing these types of exams we will find infants with vision disorders. These disorders will then have to be treated.... through paid exams and treatments.

Also.. this might lead to a spring board for mandatory eye exams for school children.. etc.

We need to stop thinking about immediate benifits and start thinking about the long term. Think about it as an investment in the professions future... cause thats what it really is... and thats the point you are missing.

So then why not give away a kids first few trips to the dentist for free to "establish that oral hygiene is important?"

InfantSee is a DISASTER. It is certainly not a good investment in the future of the profession. While the intentions may have been good, how does it help the profession to give away its services? As you move through your schooling and out into the real world, you will find that optometry already does FAR TOO MUCH OF THIS.

People will piss and moan about ODs doing exams for $49 at Walmart, but OH! Let's GIVE THEM AWAY FOR FREE to some of the most difficult patients to examine.

So lets see....we are going to examine infants, who are difficult to examine in order to determine whether they have conditions that could affect their vision for the rest of their lives.

And for this we will charge......NOTHING?? What a load. If anything, we should charge twice as much.

And when is it going to end? Are we going to give away infant exams ad infinitum or will we start charging 5, 10 , or 20 years down the road? What if a parent brings in a kid at the age of 18 mos, or 2 years? Is it free then?
Or only in the first year of life?

Should pediatricians do exams for free in the first year?

InfantSee may have been well intentioned but the road to Hell is paved with good intentions, and all it will do is plant in the publics mind that the exam SHOULD be free.

 

[xmattODx]

- Reduce Enrollment at private Optometry School -- This is turn will keep the quality of applicants high

I couldn't agree with this statement more.

- The AOA should start an agressive PR compaign to inform the public of what OD's do and the importance of Healthy Vision (not just 20/20 vision)

This is also very important, but probably not going to happen

Strive for a National Uniform Licence - and thus a uniform scope of practice

This is very important but not going to happen.

I would also say that state associations need to hold off on scope expansion until we have uniform scopes between states and can move from state to state without these asinine hoops to jump through.

In regard to increasing medical optometry through hospital based residencies. Its not necessary and for all of you students who think you're going to see disease all day every day...

 

[jchod]

That's what I was thinking. I don't see how the number of dentistry schools has any bearing on this conversation.

Are you serious??

 

[jchod]

How often does the typical person see their dentist? How often does the typical person see their optometrist? And what do you spent (or what does your insurance spend) each time you visit each. Not only will you find that dental visits are much more frequent, but their reimbursments are also much larger. Hell, many middle class people (with insurance) have never even had an eye exam - I'm sure just about everyone sees a dentist at least every few years!

From what i've heard, dentistry was facing a similar situation to optometry in the 80's. Their solution; reduce the number of new graduates.

Let's see I see patients AT LEAST one time a year, often four or five. I am paied between 75 and 150 for a routine exam, and forget if I do and procedures and or testing. I don't get what your point is . . .

 

[jchod]

Things that need to be done:

- Reduce Enrollment at private Optometry School -- This is turn will keep the quality of applicants high
- These private schools should become associated with Public Universities to help bring down the cost of tuition.

- The AOA should work with organizations that represnt OMD's in order to define a working relationship amoung both professions. (Optomestic.. I know)
- Additional Hospital Based Residencies for those OD's who wish to practice more "Medical Optometry"

- OD's should be encouraged to become part time instructors - lecturering at Physician Assistant School across the country. PA's are the primary care health professionals of the future and will be responsible for most primary care patient interactions.

- The AOA should become more associated and work more closely with State and Local Optometric Associations
- The AOA should start an agressive PR compaign to inform the public of what OD's do and the importance of Healthy Vision (not just 20/20 vision)
- Develop more programs like infant see... and promote them
- The AOA should encourage the members that own private practices to incorpoate this type of PR in there own advertising
- Work with contact lense and other eye care companies to add "see an eye care professional before use or these products" -- this will help keep their product at a premiume -- ie: looks more like a medical product than a cosmetic product.

- Strive for a National Uniform Licence - and thus a uniform scope of practice


Feel free to make comments or suggestion... (im just a student... class of 2010... this is just my 2 cents)

Wow, I think there need to be far more OD schools and at that, I think there needs to be and update in the OD curriculum (much less optics and VT)

 

[Hines302]

Matt and KHE,

I can not believe you guys can not see the benefit’s of InfantSEE. We have to stop thinking about immediate rewards and start thinking about the investment in the future. It is this type of thinking that has landed Optometry where it is today.

Negative Points of InfantSEE
-- Not being reimbursed for an infant eye exam

Positive Points of InfantSEE
-- Excellent PR for the profession and stresses the impotence of Healthy Vision
-- Excellent PR for your practice
-- The opportunity to diagnose possibly serious vision disorders in infants - who in tern will then have to followed by an OD (and maybe concurrently with an OMD) through Paid Exams and Treatments
-- If you actually diagnose a series problem - you may earn the families loyalty for life and in return the word of moth refers from you being "great eye doctor" may increase
-- Even if you don't diagnose a series problem - you are introducing possibly new patients to your practice. Think of it as an open house.
"Hey mom, when is the last time you had an eye exam".
"You know doctor, I should get my other children and eye exam... or my husband"
"What Doctor... you can follow diabetic and glaucoma patients... I should tell my relatives"
-- Even if you get 1 out of 10 families because of InfantSEE isn't it worth it.
-- Earn referrals from Pediatricians or Family Doctors through your participation
-- and lastly... because maybe its a good program and you are being a nice guy in participating.

I can not believe how many doctors complain on these boards. You complain about not having enough patients and not being able to make your practice stand out... but when the opportunity comes around to introduce new patients to your practice and generate some PR.... you do nothing but critisize it! Unbelievable.

Please tell me were you plan you plan on opening practices... so I can open right across the street.

 

[prettygreeneyes]

. . . Anyone who thinks that ther are too many graduates or that reducing the number of yearly graduates is going to secure their job or make them more porductive is, in my mind, very naive!!! Look how many dentists graduate each year!! Just be good at what you do. If you are really that good and love your job, you'll get the patients and make the money. Stop whining about that ther needs to only be a few hundred new ODs each year, THEN it'll be better.

You think WE'RE naive because we think that less graduates = more jobs? As long as commercial optometry and the "walk-in" nature of optometry flourishes, how can you argue that there aren't too many? If there were 100 total available jobs, and 400 total graduates (a conservative estimate to be honest), the competition for those jobs is going to be stiff. (Hopefully, some of those four hundred will create their own jobs by starting their own private practices, but that's another story!) If we reduced the number of graduates to 300 or even 200, tell me how that wouldn't make getting those jobs easier? Hell yes I want there to be less graduates. Hell yes I'll "whine" until that happens. Actually, I won't whine, I will be proactive in advocating for smaller classes at the very least, preferably less opt. schools altogether! If that means increased competition to get into school... GOOD! That will only result in better optometrists. I'm not worried that I won't be good enough. I know that I will attract the patients and make the money. If I don't, I don't deserve this profession. However, I don't want to see optometry head the way of the SuperWalmarts exclusively because of individuals who want to see more and more optometrists graduate every year. As long as the current number of graduates flood the market each year, and have no choice but to head to commercial optometry because there simply are no other jobs, I will argue and scream from the mountain tops that there are just too many optometrists.

I'm not sure where you are in your optometric career... school, practicing, retired. You should check out ODwire.org if you haven't already. They talk a lot about this very subject. I'm sure there are a lot better people to argue this point than me!!!

 

[KHE]

Matt and KHE,

I can not believe you guys can not see the benefit’s of InfantSEE. We have to stop thinking about immediate rewards and start thinking about the investment in the future. It is this type of thinking that has landed Optometry where it is today.

Negative Points of InfantSEE
-- Not being reimbursed for an infant eye exam

Positive Points of InfantSEE
-- Excellent PR for the profession and stresses the impotence of Healthy Vision
-- Excellent PR for your practice
-- The opportunity to diagnose possibly serious vision disorders in infants - who in tern will then have to followed by an OD (and maybe concurrently with an OMD) through Paid Exams and Treatments
-- If you actually diagnose a series problem - you may earn the families loyalty for life and in return the word of moth refers from you being "great eye doctor" may increase
-- Even if you don't diagnose a series problem - you are introducing possibly new patients to your practice. Think of it as an open house.
"Hey mom, when is the last time you had an eye exam".
"You know doctor, I should get my other children and eye exam... or my husband"
"What Doctor... you can follow diabetic and glaucoma patients... I should tell my relatives"
-- Even if you get 1 out of 10 families because of InfantSEE isn't it worth it.
-- Earn referrals from Pediatricians or Family Doctors through your participation
-- and lastly... because maybe its a good program and you are being a nice guy in participating.

I can not believe how many doctors complain on these boards. You complain about not having enough patients and not being able to make your practice stand out... but when the opportunity comes around to introduce new patients to your practice and generate some PR.... you do nothing but critisize it! Unbelievable.

Please tell me were you plan you plan on opening practices... so I can open right across the street.

I would love to have you open an office accross the street from me. You seem to have an unusual desire to perform complex examinations free of charge. It would be nice to have a place to send people who don't think my time is worth even $10.

Giving the exam away for free does not in any way shape or form stress its importance to the public. If anything, it undermines it. Again, why not give away free dental care for the first few years of a childs life to stress the importance of oral hygiene? If you want to have a PR campaign attempting to educate the public, that's fine and dandy, but giving away your service is not going to suddenly make the public realize its value.

RE: being a nice guy by participating...you can rest assured that I give away thousands of dollars of free care every year to indigent populations. However, I do not give it away to people who are well off. For some reason, you have a desire to do just that.

 

[Hines302]

I would love to have you open an office accross the street from me. You seem to have an unusual desire to perform complex examinations free of charge. It would be nice to have a place to send people who don't think my time is worth even $10.

Giving the exam away for free does not in any way shape or form stress its importance to the public. If anything, it undermines it. Again, why not give away free dental care for the first few years of a childs life to stress the importance of oral hygiene? If you want to have a PR campaign attempting to educate the public, that's fine and dandy, but giving away your service is not going to suddenly make the public realize its value.

RE: being a nice guy by participating...you can rest assured that I give away thousands of dollars of free care every year to indigent populations. However, I do not give it away to people who are well off. For some reason, you have a desire to do just that.

So I guess the 7,000 doctors who participate in this program are getting screwed over. I guess they are all blind (no pun intended ) and that the AOA as manipulated them into participating in this program.

Maybe there is a reason that most of those 7,000 doctors all have thriving private practices... and you are complaining about a program in a profession that you dont even practice in anymore.

 

[KHE]

So I guess the 7,000 doctors who participate in this program are getting screwed over. I guess they are all blind (no pun intended ) and that the AOA as manipulated them into participating in this program.

Maybe there is a reason that most of those 7,000 doctors all have thriving private practices... and you are complaining about a program in a profession that you dont even practice in anymore.

Have you visited all 7000? Are you sure they are all thriving? I would bet $100 that the vast majority of them are NOT because thriving practices do not give their services away for free. At least not the ones that I worked in. However, the ones that I worked in that were struggling were full of "buy one get one coupons" and "free this or that with purchase of this or that" Some of the doctors I am sure are being "charitable" but the majority of them are likely looking for some kind of "gimmick" to bring patients in, and I think that's how you are thinking about it. You are looking at it as a loss leader. And there is nothing wrong with using a loss leader to bring people in. That's a common business strategy. But loss leaders are generally things that have LITTLE value.

And I admire your passion and your desire to try to think creatively to bring patients in.

However, as someone who has been out there in the trenches, you will just have to take my word that giving away your services is NOT the way to instill into the public that the service you are giving away has value and is important.

 

[xmattODx]

Matt and KHE,

I can not believe you guys can not see the benefit’s of InfantSEE. We have to stop thinking about immediate rewards and start thinking about the investment in the future. It is this type of thinking that has landed Optometry where it is today.

Negative Points of InfantSEE
-- Not being reimbursed for an infant eye exam

Positive Points of InfantSEE
-- Excellent PR for the profession and stresses the impotence of Healthy Vision
-- Excellent PR for your practice
-- The opportunity to diagnose possibly serious vision disorders in infants - who in tern will then have to followed by an OD (and maybe concurrently with an OMD) through Paid Exams and Treatments
-- If you actually diagnose a series problem - you may earn the families loyalty for life and in return the word of moth refers from you being "great eye doctor" may increase
-- Even if you don't diagnose a series problem - you are introducing possibly new patients to your practice. Think of it as an open house.
"Hey mom, when is the last time you had an eye exam".
"You know doctor, I should get my other children and eye exam... or my husband"
"What Doctor... you can follow diabetic and glaucoma patients... I should tell my relatives"
-- Even if you get 1 out of 10 families because of InfantSEE isn't it worth it.
-- Earn referrals from Pediatricians or Family Doctors through your participation
-- and lastly... because maybe its a good program and you are being a nice guy in participating.

I can not believe how many doctors complain on these boards. You complain about not having enough patients and not being able to make your practice stand out... but when the opportunity comes around to introduce new patients to your practice and generate some PR.... you do nothing but critisize it! Unbelievable.

Please tell me were you plan you plan on opening practices... so I can open right across the street.

You've never really addressed the point. Why won't we get family loyalty be diagnosing a serious condition but charging for the exam? Why can't we express the importance of exams but charge for them? Why do we, as optometrists, need to give our services away to get people to take them seriously? The interesting thing about public health interventions is that there are a million different opinions on how to design and run a program.

If you were given something for free does that make you think it is valuable or not? If it is able to be given for free, I assume it holds little value. Has Infant See done any monitoring and evaluation of its program? Has it increased the number of infants who have an exam? Has it increased the stature of optometry in the eyes of the public? Has it made the exam appear valuable? This would be a very easy study to conduct but I'm sure it won't be conducted. Optometry public health programs for the most part are poorly thought out and poorly conducted. Infant See, and VOSH type programs included.

When I open my practice next year I hope it doesn't stand out because I work for free for all income groups, I hope it stands out for other reasons.

 

[xmattODx]

Never mind I thought better of it.

 

[KHE]

Never mind I thought better of it.

Its interesting that this topic is on here because I just had an experience very relevant to this discussion.

I agreed to cover a friends private office this morning while he's at a CE conference. The very first patient I saw today was a 42 year old guy in for "the first eye exam of my life" since he can't read anymore.

To instill the importance of routine eye care, should I have given this exam away for free?

 

[xmattODx]

Its interesting that this topic is on here because I just had an experience very relevant to this discussion.

I agreed to cover a friends private office this morning while he's at a CE conference. The very first patient I saw today was a 42 year old guy in for "the first eye exam of my life" since he can't read anymore.

To instill the importance of routine eye care, should I have given this exam away for free?

It is interesting. I've long been a proponent of "free" public health measures but as I've learned more I realize that people place no value on "free". I'm about to start work today. I'll see probably about 25 comprehensive exams today ranging in price from $29-$39 depending on if they found the online coupon or not. At this price people put very little value in my advice and my skills, if I were doing it for free I can't see them taking any of my advice, rather they would see it as a step to getting glasses. The glasses have the value not me because the glasses are "expensive" not my services.

I've spent the last year doing free "eye exams" in middle schools. It was a useless waste of time. The kids there saw no value in what I was trying to tell them. They put no value in their FREE glasses as there was no sacrafice on their part or their parents to get them. We would see kids who had received free glasses the year before and they would be broken, lost, or left at home. These are 20/200 kids. It's amazing.

In a study done by Preslan and Novak, in the U.S. (Baltimore), they found that even after removing all financial and transportation barrier for eye care after a primary school screening and providing free specs. only 30% of children wore glasses and 80% failed the school screening 1 year later. (as reported in: Robin, A.L., et al., The Utilization of Eye Care Services by Persons with Glaucoma in Rural South India. Transactions of the American Ophthalmological Society, 2004. 102: p. 47-55)

Why didn't they have better results with this program? No value placed on the results?

 

[cpw]

I had a kid come in when I was at UHCO on the "failed the school screening" bus with the school nurses for the elementary school. (along with about 20 other kids)

The child assigned to me was -9.00 !! I didn't believe my ret at first since he was 20/80 but DAMN! Poor kid.

After a long talk with the school nurse (no parents were there) the little boy got his free glasses and a note home for mom and the teacher that he needed to wear his RX ALL THE TIME! I also did follow up phone calls with the school nurse and mom to make sure he came back in a month to see how he was tolerating the Rx. (and see if we needed to change) We never saw him again.

I don't fault the free glasses or the programs. I fault a parent whose kid can't see , tells the parent they can't see, and theh parent does nothing about it. There are plenty of government programs and charity organizations out there to get you vouchers for free exams and glasses if you qualify. Here in my office I see at least one charity case a week. (more if they send them to me and i have room in the schedule)
Although, I've seen my fair share of people abusing the system too. ("charity" case where mom was wearing a gorgeous Italian leather jacket and daughter had on 200 sneakers with her private school uniform)

 

[stompy]

Have you visited all 7000? Are you sure they are all thriving? I would bet $100 that the vast majority of them are NOT because thriving practices do not give their services away for free. At least not the ones that I worked in. However, the ones that I worked in that were struggling were full of "buy one get one coupons" and "free this or that with purchase of this or that" Some of the doctors I am sure are being "charitable" but the majority of them are likely looking for some kind of "gimmick" to bring patients in, and I think that's how you are thinking about it. You are looking at it as a loss leader. And there is nothing wrong with using a loss leader to bring people in. That's a common business strategy. But loss leaders are generally things that have LITTLE value.

I would agree that a $100 wager between KHE and Hines might help settle the disagreement. When money is involved, people usually take things more seriously, don't you think?

 

[stompy]

Although, I've seen my fair share of people abusing the system too. ("charity" case where mom was wearing a gorgeous Italian leather jacket and daughter had on 200 sneakers with her private school uniform)

That's just horrible.

 

[Hines302]

I would agree that a $100 wager between KHE and Hines might help settle the disagreement. When money is involved, people usually take things more seriously, don't you think?

I will disagree with both Matt and KHE on this point forever, and I am sure they feel the same way. I am afraid any more comments on this issue will lead to nothing more than us talking in cirlces.

 

[stompy]

I will disagree with both Matt and KHE on this point forever, and I am sure they feel the same way. I am afraid any more comments on this issue will lead to nothing more than us talking in cirlces.

I understand your reasons for holding back.

However, one of my intentions is to actually see results from an investigation into how all 7000 optometry practices are doing relative to the practices that aren't involved in the program. Are the number of practices that "thrive" and participate this program proportional to the number of practices that also "thrive" but don't participate in this program?

It's rather unfortunate there wasn't a "showdown" if you will. I'm slightly disappointed.

On another hand, it's also "just too bad" because when there are two "firm" opposing forces in an organization (optometry for example), it's hard to get things done and agendas to move forward (whether it's for better or for worse).

O well, but life goes on.

 

[gsinccom]

I understand your reasons for holding back.

However, one of my intentions is to actually see results from an investigation into how all 7000 optometry practices are doing relative to the practices that aren't involved in the program. Are the number of practices that "thrive" and participate this program proportional to the number of practices that also "thrive" but don't participate in this program?

It's rather unfortunate there wasn't a "showdown" if you will. I'm slightly disappointed.

On another hand, it's also "just too bad" because when there are two "firm" opposing forces in an organization (optometry for example), it's hard to get things done and agendas to move forward (whether it's for better or for worse).

O well, but life goes on.

very good points stompy.

Hines it appears now that Matt and KHE don't disagree with you other than the "free" aspect of the program. You must learn to compromise too as they have done. Otherwise no progress will be made.

on another note, I would like to also hear Jchod's explanation behind wanting more OD schools. That doesn't make sense to me. I do though think he makes a good point about curriculum.

 

[Hines302]

In regard to the 7,000 doctors that have thriving practices... I may have gotten a ahead of myself....but here is my point

Those 7,000 doctors are AOA doctors. The average salary for an AOA doctor is 130K(or somewhere around there for a private practice doctor). That is the number that the AOA reports... which we all agree is high and bias.. because it is mostly based on there AOA membeship.

However... the average OD salery overall is 88K... regardless of there AOA affiliation. My point being that on average AOA affiated doctors earn more that regular non AOA affilated doctors.

Why is this??? Is this a direct result of their AOA membership. No... However maybe its because these doctors are willing to think outside of the box.. and embrace different non traditional buisness practices. They are willing to invest in private practice and take risks... and investments.. into their and the professions future. Thus.. paying off in the long run. Just like the InfantSEE program... and programs like VOSH.

 

[KHE]

I will disagree with both Matt and KHE on this point forever, and I am sure they feel the same way. I am afraid any more comments on this issue will lead to nothing more than us talking in cirlces.

We will agree to disagree.

When I practiced, I worked in a few really nice, thriving private practices and a few really struggling ones. The thriving ones did not give away anything. However, the struggling ones were filled with "buy one get one free this or that" and "free this or that with purchase of this or that" as I said before.

Hypothetically, what happens if you do a free InfantSee exam and find that a child does indeed need glasses? Are the glasses then free as well? If they are not, have you not just done the whole "free eye exam with a purchase of a pair of glasses thing" that we have tried so hard to get away from?

I will stand by my position that the way to convince the public that something is important and valuable is NOT to give it away for free.

 

[Hines302]

This leads to another good point. Why can we find thriving private practices in the middle of OD saturated markets?? Because... its there approach to buisness!!! Being successful is not a direct result of market saturation... (although it does have an effect)... being successful is more a result of your approach to buisness

I personally worked for a private practice who was located in the suburbs of a large city. There were tons of commercial establishments within a 3 mile radius (Sears, Walmart, Costco, RxOptical, EyeGlass World) plus two OMD offices with opticals. But this practice is growing despite of that... (3 doctros all taking home 200K+ a year).

My point is.. they are smart... good at what they do... and had a very good approach to buisness. (also InfactSEE participants I might add). They are able to thrive despite market conditions.

 

[Hines302]

We will agree to disagree.

When I practiced, I worked in a few really nice, thriving private practices and a few really struggling ones. The thriving ones did not give away anything. However, the struggling ones were filled with "buy one get one free this or that" and "free this or that with purchase of this or that" as I said before.

Hypothetically, what happens if you do a free InfantSee exam and find that a child does indeed need glasses? Are the glasses then free as well? If they are not, have you not just done the whole "free eye exam with a purchase of a pair of glasses thing" that we have tried so hard to get away from?

I will stand by my position that the way to convince the public that something is important and valuable is NOT to give it away for free.

KHE...

Your blowing my point out or proportion. InfantSEE is a "NO COST PUBLIC HEALTH SERVICE" (A direct quote from infantsee.org).

To talk about anything else other than giving an eye exam at no cost to an infant is irrelevant to our discussion... (this includes talks of free glasses, diabetics.. etc)

InfantSEE has been featured in USA Today and WebMD. This is excellent PR!!

 

[KHE]

In my experience, the success of a private practice has little to do with the number of ODs or OMDs in a given area.

In my experience, it is directly proportional to the ability of the doctors in an area to be admitted to and properly bill medical insurance plans.

This leads to another good point. Why can we find thriving private practices in the middle of OD saturated markets?? Because... its there approach to buisness!!! Being successful is not a direct result of market saturation... (although it does have an effect)... being successful is more a result of your approach to buisness

I personally worked for a private practice who was located in the suburbs of a large city. There were tons of commercial establishments within a 3 mile radius (Sears, Walmart, Costco, RxOptical, EyeGlass World) plus two OMD offices with opticals. But this practice is growing despite of that... (3 doctros all taking home 200K+ a year).

My point is.. they are smart... good at what they do... and had a very good approach to buisness. (also InfactSEE participants I might add). They are able to thrive despite market conditions.

 

[Hines302]

very good points stompy.

Hines it appears now that Matt and KHE don't disagree with you other than the "free" aspect of the program. You must learn to compromise too as they have done. Otherwise no progress will be made.

on another note, I would like to also hear Jchod's explanation behind wanting more OD schools. That doesn't make sense to me. I do though think he makes a good point about curriculum.

gsinccom.... I agree we do need comprimise. However, we are mearly discussing things on an online forum. Obviously if we were actually in a committee dicussing these issues... my approach would be different.

However, neither one of these OD's (one of which who doesnt even practice anymore) has not done anything to help their profession. They do nothing but complain and critisize. When I brought up the point earlier about "how do we start to fix things" in regard to my previous points.... niether one of them offered any constructive ideas or offered any plans of action. They just critisized programs like InfantSEE and VOSH.

 

[KHE]

KHE...

Your blowing my point out or proportion. InfantSEE is a "NO COST PUBLIC HEALTH SERVICE" (A direct quote from infantsee.org).

To talk about anything else other than giving an eye exam at no cost to an infant is irrelevant to our discussion... (this includes talks of free glasses, diabetics.. etc)

InfantSEE has been featured in USA Today and WebMD. This is excellent PR!!

Nothing wrong with having a PR campaign outlining the importance of infants vision examinations? But why does it have to be free?

WHy is the main selling point of this particular program that its FREE??

 

[KHE]

gsinccom.... I agree we do need comprimise. However, we are mearly discussing things on an online forum. Obviously if we were actually in a committee dicussing these issues... my approach would be different.

However, neither one of these OD's (one of which who doesnt even practice anymore) has not done anything to help their profession. They do nothing but complain and critisize. When I brought up the point earlier about "how do we start to fix things" in regard to my previous points.... niether one of them offered any constructive ideas or offered any plans of action. They just critisized programs like InfantSEE and VOSH.

Time out...

A couple of things:

I still practice part time, first of all.

Secondly, I never criticized VOSH.

Thirdly, I must have missed your post where you solicited plans of action. What exactly were you asking?

 

[xmattODx]

However, neither one of these OD's (one of which who doesnt even practice anymore) has not done anything to help their profession. They do nothing but complain and critisize. When I brought up the point earlier about "how do we start to fix things" in regard to my previous points.... niether one of them offered any constructive ideas or offered any plans of action. They just critisized programs like InfantSEE and VOSH.

Let's wait a minute here. You don't really know me as far as I know. Do you know anything about me? How do you know what I've offered the profession? I did criticize VOSH and InfantSEE. Would you like to know why? InfantSEE we've discussed.

VOSH - well you can read my theis in 6 weeks and that should answer that question but the short of it is:
1) Traditional VOSH trips are discouraged by the WHO - in black and white they say they are well intentioned but do no good.
2) They do not support the developement of optometry, or sustainable eye care in the countires they visit.
3) They do not offer continuity of care.

I could go on but I've hijacked this thread enough. You should realize that what is written on an internet forum does not give you insight into a person's entire life or career.

What should we do for the profession. Stop scope expansion. Get an organization who is willing to do PR that doesn't include giving our services away and support organizations like WCO who are supporting the development of optometry in low/middle income countries.

 

[Hines302]

Time out...

A couple of things:

I still practice part time, first of all.

Secondly, I never criticized VOSH.

Thirdly, I must have missed your post where you solicited plans of action. What exactly were you asking?

oh... it must have been Matt that crtisized the VOSH program. I am trying to keep all of these post straight.

KHE I understand where you are coming from... however let me stress that the wording for InfantSEE is not "FREE" but rather a "no cost public health service".

I agree that not all programs can be set up like InfantSEE... because you cant give away everything. However, people pay attention to "FREE" things. This program has gotten so much attention becuse it is "no cost".

I will agree to disagree on this point. I was going to leave it alone... but I was called out... so I felt the need to respond.

This has been a good and enjoyable conversation. My other points I made earlier are listed below. My question was how do we go about putting some of these needed changes into action??

------------------------------------------

Reduce Enrollment at private Optometry School -- This is turn will keep the quality of applicants high
- These private schools should become associated with Public Universities to help bring down the cost of tuition.

- The AOA should work with organizations that represnt OMD's in order to define a working relationship amoung both professions. (Optomestic.. I know)
- Additional Hospital Based Residencies for those OD's who wish to practice more "Medical Optometry"

- OD's should be encouraged to become part time instructors - lecturering at Physician Assistant School across the country. PA's are the primary care health professionals of the future and will be responsible for most primary care patient interactions.

- The AOA should become more associated and work more closely with State and Local Optometric Associations
- The AOA should start an agressive PR compaign to inform the public of what OD's do and the importance of Healthy Vision (not just 20/20 vision)
- Develop more programs like infant see... and promote them
- The AOA should encourage the members that own private practices to incorpoate this type of PR in there own advertising
- Work with contact lense and other eye care companies to add "see an eye care professional before use or these products" -- this will help keep their product at a premiume -- ie: looks more like a medical product than a cosmetic product.

- Strive for a National Uniform Licence - and thus a uniform scope of practice

 

[stompy]

I go eat lunch and look at what happened...interesitng read I might add.

 

[KHE]

What is the goal of InfantSee? Is it to provide a "no cost (free) public health service" to prevent blindness in infants? If it is, then fine. Give away all the free exams that you want.

But if another goal is to instill the importance of eye exams in pediatric populations, and act as a PR campaign for optometry then giving it away for free is not going to instill importance in the eyes of the public.

Regarding your list:

I agree with just about everything, but I think too much of it is wishful thinking.

Ie: I would not count on private optometry schools to reduce enrollment anytime before the earth crashes into the sun.

In my opinion these are by far and away the most pressing issues facing ODs today:

1) Inability of ODs to be admitted onto medical insurance plans in huge portions of the country

2) The continued reliance on the sale of optical materials as the primary revenue generator in private practices. (This is strongly related to #1)

3) Poor primary care training in OD schools. That is to say, OD schools do a great job teaching you about diabetic retinopathy. They do a lousy job of teaching you about diabetes.

oh... it must have been Matt that crtisized the VOSH program. I am trying to keep all of these post straight.

KHE I understand where you are coming from... however let me stress that the wording for InfantSEE is not "FREE" but rather a "no cost public health service".

I agree that not all programs can be set up like InfantSEE... because you cant give away everything. However, people pay attention to "FREE" things. This program has gotten so much attention becuse it is "no cost".

I will agree to disagree on this point. I was going to leave it alone... but I was called out... so I felt the need to respond.

This has been a good and enjoyable conversation. My other points I made earlier are listed below. My question was how do we go about putting some of these needed changes into action??

------------------------------------------

Reduce Enrollment at private Optometry School -- This is turn will keep the quality of applicants high
- These private schools should become associated with Public Universities to help bring down the cost of tuition.

- The AOA should work with organizations that represnt OMD's in order to define a working relationship amoung both professions. (Optomestic.. I know)
- Additional Hospital Based Residencies for those OD's who wish to practice more "Medical Optometry"

- OD's should be encouraged to become part time instructors - lecturering at Physician Assistant School across the country. PA's are the primary care health professionals of the future and will be responsible for most primary care patient interactions.

- The AOA should become more associated and work more closely with State and Local Optometric Associations
- The AOA should start an agressive PR compaign to inform the public of what OD's do and the importance of Healthy Vision (not just 20/20 vision)
- Develop more programs like infant see... and promote them
- The AOA should encourage the members that own private practices to incorpoate this type of PR in there own advertising
- Work with contact lense and other eye care companies to add "see an eye care professional before use or these products" -- this will help keep their product at a premiume -- ie: looks more like a medical product than a cosmetic product.

- Strive for a National Uniform Licence - and thus a uniform scope of practice

 

[Hines302]

I agree with just about everything, but I think too much of it is wishful thinking.

Ie: I would not count on private optometry schools to reduce enrollment anytime before the earth crashes into the sun.

I don't believe in wishful thinking....

Landing on the moon was considered "wishful thinking" at one time also. (although.. maybe NASA's task is a lot easier than the one Optometry is facing )

KHE... you have some very good points. I have read your story.. and concerning insurance's... i will have to take your word for it. Thanks for your input

 

[KHE]

I don't believe in wishful thinking....


KHE... you have some very good points. I have read your story.. and concerning insurance's... i will have to take your word for it. Thanks for your input

Don't take my word for it. If you have a particular area of the country that you want to practice in, you need to do a lot of research about this issue before you give even one nickel to any school or college of optometry.

That goes for every potiential OD student out there.

 

[Hines302]

VOSH - well you can read my theis in 6 weeks and that should answer that question but the short of it is:
1) Traditional VOSH trips are discouraged by the WHO - in black and white they say they are well intentioned but do no good.
2) They do not support the developement of optometry, or sustainable eye care in the countires they visit.
3) They do not offer continuity of care.

I would like to read your paper when it is completed. However, VOSH is a different program than InfantSEE... mainly because VOSH's main purpose to help people in 3rd world contries... who cant afford it.

And while I can not comment on your points (only to say that VOSH have established perminate eye care clinics in some countires)... i will say that VOSH makes a huge difference to that one individual who is given eye glasses or eye treatment as a result of VOSH.

 

[Hines302]

Don't take my word for it. If you have a particular area of the country that you want to practice in, you need to do a lot of research about this issue before you give even one nickel to any school or college of optometry.

That goes for every potiential OD student out there.

KHE... any advice on how to conduct this research? Would you mind sharing in what part of the country (state and city) that you couldnt get accepted onto plans? Thanks

 

[xmattODx]

I would like to read your paper when it is completed. However, VOSH is a different program than InfantSEE... mainly because VOSH's main purpose to help people in 3rd world contries... who cant afford it.

And while I can not comment on your points (only to say that VOSH have established perminate eye care clinics in some countires)... i will say that VOSH makes a huge difference to that one individual who is given eye glasses or eye treatment as a result of VOSH.

I never stated that VOSH and InfantSEE were the same. I said that Optometric Public Health interventions have been poorly concieved and implemented in the past. How many permanent VOSH clinics are staffed year round?

You should note that I don't spew off things that I haven't studied or thought a lot about. I know a lot about InfantSEE and even more about VOSH style programs and, unfortunately, InfantSEE is a failure for optometry and VOSH style programs are a failure for the developing world. Yet rather than try to implement more benficial public health programs Optometry continues down the same road despite overwhelming failures. It seems to be a trend in all aspects of professional optometry, that is, pursuing failure.

 

[Hines302]

Yet rather than try to implement more benficial public health programs Optometry continues down the same road despite overwhelming failures. It seems to be a trend in all aspects of professional optometry, that is, pursuing failure.

Wow....

I will conceed that you probablly know much more than me concerning, InfantSEE, VOSH, and Optometry in general. You may have your own opinion on these issues as well... as you have demonstrated by calling these prograns and the profession "a failure".

So my next question to you Matt is how do we fix these things? What are your plans of action. How have you tried to better the profession? Have you worked to impliment new programs or fix exisiting ones that you consider to be "failures" like InfantSEE or VOSH?? I would be very interested to know.. so that I may be able to do the same when I graduate in 2010.

 

[xmattODx]

So my next question to you Matt is how do we fix these things? What are your plans of action. How have you tried to better the profession? Have you worked to impliment new programs or fix exisiting ones that you consider to be "failures" like InfantSEE or VOSH?? I would be very interested to know.. so that I may be able to do the same when I graduate in 2010.

One has very little power. It takes many to implement change. Step 1 is always to be educated. I'm near the end of step 1. I'll let you know about steps 2 through X as I do them.

The profession of optometry is not a failure. We do, however, pursure failure. Continued scope expansion will be our doom. Mark my words.

 

[Hines302]

One has very little power. It takes many to implement change. Step 1 is always to be educated. I'm near the end of step 1. I'll let you know about steps 2 through X as I do them.

The profession of optometry is not a failure. We do, however, pursure failure. Continued scope expansion will be our doom. Mark my words.

Wow... we agree on something I to belive that the push for additional scope expanision is not the solution... and that it will do more harm than good. Maybe in the future... but not at present.

I look foward to working with you in the future

 

[gsinccom]

One has very little power. It takes many to implement change. Step 1 is always to be educated. I'm near the end of step 1. I'll let you know about steps 2 through X as I do them.

The profession of optometry is not a failure. We do, however, pursure failure. Continued scope expansion will be our doom. Mark my words.

I don't think we need to push for this either but please explain why this will be the doom of the profession if it continues. thank you.

 

[gsinccom]

What is the goal of InfantSee? Is it to provide a "no cost (free) public health service" to prevent blindness in infants? If it is, then fine. Give away all the free exams that you want.

But if another goal is to instill the importance of eye exams in pediatric populations, and act as a PR campaign for optometry then giving it away for free is not going to instill importance in the eyes of the public.

Regarding your list:

I agree with just about everything, but I think too much of it is wishful thinking.

Ie: I would not count on private optometry schools to reduce enrollment anytime before the earth crashes into the sun.

In my opinion these are by far and away the most pressing issues facing ODs today:

1) Inability of ODs to be admitted onto medical insurance plans in huge portions of the country

2) The continued reliance on the sale of optical materials as the primary revenue generator in private practices. (This is strongly related to #1)

3) Poor primary care training in OD schools. That is to say, OD schools do a great job teaching you about diabetic retinopathy. They do a lousy job of teaching you about diabetes.

I agree with one and two but please explain why as an OD I should be trained as an MD...that is why I'll be going to OD school and not MD school? Do DDS/DMD, PAs, or Chiros have as extensive all inclusive training as MDs...I don't think so they fill a niche in the system too, so why for the OD to you suggest more extensive training?

I notice our friend Ben Chudner hasn't gotten in on this thread...hmm?...

 

[KHE]

I agree with one and two but please explain why as an OD I should be trained as an MD...that is why I'll be going to OD school and not MD school? Do DDS/DMD, PAs, or Chiros have as extensive all inclusive training as MDs...I don't think so they fill a niche in the system too, so why for the OD to you suggest more extensive training?

I notice our friend Ben Chudner hasn't gotten in on this thread...hmm?...

For many reasons....

Ophthalmologists are by default, knowledgable about clinical medicine. Optometrists are not. Why would a primary care doctor want to refer to an OD who may well be able to detect diabetic retinopathy, but has no real grasp of the underlying pathophysiology of diabetes, or its pathophysiologic effects on other organ systems. Ophthalmologists have this knowledge base. Optometrists by and large do not.

So if optometry wants to integrate itself better into the health care delivery system and be part of the health care delivery team, it needs to integrate itself better into primary care medicine.

What niche is optometry going to try to fill that's not already filled by ophthalmology in terms of medical management of eye conditions?

 

[KHE]

KHE... any advice on how to conduct this research? Would you mind sharing in what part of the country (state and city) that you couldnt get accepted onto plans? Thanks

You need to research what the top 5 or MEDICAL plans are in the area that you want to practice in.

Then you need to phone those plans up and ask if they are credentialling new ODs. You can ask them directly, or just lie to them and tell them you're a doctor and you want them to send you an application.

If they refuse, you need to find out why.

If you find that you can not be enrolled in these plans, you may want to consider another location to practice in.

If there are some ODs in the area who ARE on medical plans, do NOT make the mistake that I made in assuming that you will be able to get on the plans as well.