IndianaOD

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Than a short answer to your question is no I would not like that much. I think I've given my perspective enough, so I'm not going to beat a dead horse. I think anyone interested in this thread has heard enough to satisfy questions they might have, so I'm checking out of this one. Hope I was helpful. I regret that you feel I was less than truthful.

How much "real" doctor work do you do in your setting? I'm talking besides doing the spin and grin.

For reference I have a growing glaucoma base and have a GDx, visual field, retinal camera etc.

Our office routinely sees and gets referred headache cases, diabetics, Vision Therapy, red eyes, and other eye disease.

Do you actually use your training and treat these people or refer them all out?

Personally, I would die do refractions all day. All our patients get dilated.
 

PeteRose

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In short, I refer some of what you just mentioned out. I don't apologize for it one bit. I am entirely honest with my patients as to the limits this type of practice poses. If they can receive better care for a condition than what I can provide within the constraints of this practice, I absolutely don't hesitate to find that care for them. I make sure they get the best care possible. Of course I treat any an all red eyes and prescribe daily. I am completely at ease monitoring retinopathy. No offense to you IndianaOD, but I'm not sure why any OD would refer retinopathy to another OD when that OD can't do a single thing to remedy it. Those go to retinal specialist with me. I do punctal occlusion, I've never referred a foreign body in my tenure, I've only referred two red eyes ever (one was pseudomonas just last month and the other a herpetic ulcer), and just did a bit of vision therapy today. I do not treat glaucoma as I don't feel I have the equipment to properly manage and I peronally find it tedious.

I find great satisfaction in "general optometry". From the outset I never had any desire to be an ophthalmologist or to work in a disease referral center. If you consider ophthalmology "real" Dr. work, then I don't do much of it. Had I wanted to I would have gone to med school. And I personally enjoy refracting. Contrary to some opinions, the main reason folks come to most of us that they want to see well. We should absolutely embrace the fact that refraction is our niche and we should do it well. I think refraction is some of the most "real" optometry we do. And I think any of you with experience know, there are people who can't do it all that well. Just my opinion. Now, IndianaOD, it sounds as if you are in an entirely different setting and you have concrete reasons for dilating every patient, especially if they have been referred to you by other ODs. I certainly don't dilate every patient and don't find a compelling reason to do so. Heck, we didn't dilate every patient in our 2 hour exams we did in opt. school. If I have a middle aged patient who I've seen last year and they have no complaints, I don't dilate and I think that is probably standard of care. Today for example, I've dilated over half of the patients I've seen (I have two in waiting as we speak). I could be mistaken, but I think that is probably average or above for most practices. I certainly respect your opinion if you don't agree.

I suspect we went to the same fine institution and our training is similar. We might even know each other. I just choose not to go to work each day and do what you do when you go to work. If I felt I was in some way slighting my patients I would certainly change. By every indication I have, my patients are satisfied with my care. I suspect you are happy with your situation and I'm indeed happy for you. If you choose to think me a ***** or something I'm really not offended. I honestly found this board yesterday and am amazed at the hostility I have encountered for just stating the fact that I work commercial, I like it, and I practice with integrity. Much of the hostility is from students who have never performed a single real eye exam. My only purpose in writing is to give them another perspective than they are getting from schools where many of their proffs couldn't make it a day in practice and from diehards who think every optometrist should be injecting every patient with fluorescein. I'm neither of those and optometry has provided me a good life. Didn't think my comments would cause a ruckus. Only trying to help. If I'm not helpful just say the word and I'll go back to ebay or something. But judging from the number of private messages I'm getting, many of these students are appreciative of a differing point of view.
 

Eyegirl2k7

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Wow, a lot has happened since I last checked out this thread.

I am most certainly not a liar regarding my Visionworks experiences (but everyone is entitled to their opinion, including the gentleman here who comes so close to calling me one) Neither are my friends--including one who recently chose being DEPORTED back to Canada over continuing with the company when she began to feel suicidal.

PeteRose, I can only conclude that ECCA must be VERY different from one state to another or that you exist in some strange parallel dimension. I worked thankless, 10 hour shifts in a low income location. I saw near 40 patients a day on most days often with no lunch---on Saturdays, if nine pts came in at once when the schedule was completely full--I would still be seeing the nine patients no matter how much I protested. The ECCA handbook calls that "resource scheduling." I worked in the territory's busiest location and never saw one dime in incentives.

The staff treated me with extreme disrespect, and as a whole they were poorly trained, and poorly educated. I used to get dizzy from one girl's constant alcohol laced breath. I had no support from the company--the territory director here is from WALMART--and it shows. When a patient called the state board on me for a trumphed up claim (he is now in jail for attempting to scam several new doctors) I could not get the TD or the company's malpractice lawyers to return my phone calls. That was when I applied for independent malpractice coverage.

Yes, ECCA provides quite a few benefits. But they're not anything above or beyond what Lenscrafters provides. Incidentally, I've found I pay the exact same amount for my new BCBS PPO ($120/month) INDEPENDENTLY as I paid through the Visionworks "Benefit program." for their BCBS PPO.

When I see their commercials on TV I flinch involuntarily.
 

KHE

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Wow, a lot has happened since I last checked out this thread.

I am most certainly not a liar regarding my Visionworks experiences (but everyone is entitled to their opinion, including the gentleman here who comes so close to calling me one) Neither are my friends--including one who recently chose being DEPORTED back to Canada over continuing with the company when she began to feel suicidal.

PeteRose, I can only conclude that ECCA must be VERY different from one state to another or that you exist in some strange parallel dimension. I worked thankless, 10 hour shifts in a low income location.
For the most part there's nothing "wrong" with working in a commercial environment anymore than there is working in a private environment. However, this has been my experience during my tenure in commercial practice as well as the experience of most of the colleagues I have in my cohort:

In commercial practice, if the optical is doing well or is doing as well as the corporate entity THINKS it should be doing, you will for the most part be left alone, and yes you can make decent money as some other posters on here have alluded too.

However, the problem with commercial practice comes when the optical is NOT doing well or is not doing as well as the corporate entity, optical manager, regional manager, district manager, or whatever other manager you can think of THINKS it should be doing.

THAT is when you will start getting the "suggestions" to see more patients, take more walk ins, "recommend" more multiple pairs, "recommend" certain brands of contact lenses, "recommend" more lens add ons, expand your hours, lower your fees, and don't dilate so many people. Again, the optical can be performing fantastically, but if someone in "management" thinks it should be doing better, look out.

If you choose to not comply, or to go against the grain at all then you will find that the "independent doctor of optometry next door" is SO independent that they won't even be working in the building.

Now for some personal reflections:

The PeteRose has mentioned that they like their situation because they do "just optometry." He claims that he doesn't sell, hire, do administration or file and he likes it that way.

As a private practice owner, I don't sell, hire, or file either. The administration that I do is minimal. I pay someone to do all that crap for me. I just reap the benefits at the end of the month when I get to cash the bosses' (me) paycheck. And that paycheck, even in my worst month as an owner has been more than twice the salary that PeteRose is describing that he makes and that doesn't even include the benefits of practice ownership such as travel and entertainment and all sorts of other business related perks and deductions.

I point that out not to brag, or toot my own horn but to point out that an ownership role is really the only way to make the "big" money in this business. Yes, that takes some risk as well but with that risk comes the rewards. Unfortunately for PeteRose, he has likely maxed himself out with respect to earning potential. It sounds like he's making decent money and I won't speak for him but I am willing to bet money that he's close to maxing himself out with respect to the amount of money he can make. The only other thing he can do to make more money is to see more patients HIMSELF. Not only is he limited in how many patients he can see in a day, but his corporation will not increase his salary any further when they can hire someone else to work for the same money. Why would they?

So for those considering the commercial route, proceed with caution.
 

PeteRose

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Good points KHE. All of what you said is true. I understand there are good and bad commercial experiences. I feel mine is good. You are correct to assess that I have likely maxed out. I suspect fees will eventually go up and my compensation will as well someday. But its true that commercially you max out at a point. My point is that I will have saved so much over those first few years that my peers were struggling to establish themselves, that investments and compounded interest will put me ahead later in the game. After 6 yrs at this I already have more than enough to pay off my loans tomorrow if desired and have real estate and retirement investmensts that are profitable. Had I bought into private practice earlier none of this would have been possible. Now at 31, I have no debt and quite a few assets and I have good enough financial footing that I could start a practice without near the risk that I would have had a few years ago. I also know my likes and dislikes much more than I did then. I'd put the amount of money I've been able to save after graduation against anyone I graduated with. Yes, a successful private OD will make more money near retirement than a commercial one. However, the commercial one, if disciplined in his investments, will have so much more capital in the end. Of course money isn't the only consideration. I happen to enjoy the freedom and low stress my job provides. Its not for everyone. But to imply that somehow private docs are the only ones with the big bucks flies in the face of everything I have been able to achieve over my career thus far. And for the record, from an investment standpoint, there are way better investments than an optometry practice.
 

KHE

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I suspect fees will eventually go up and my compensation will as well someday.
That's a dangerous assumption. Even if fees "go up" there is no real reason to think that your employer is going to pass that fee increase along to you. Why would they? Particularly when you are making $130k and they can almost certainly find some hungry OD willing to do the work for less. Doctors working in employed situations in the three states I have practiced in are making no more money today than they were the year I graduated.

Had I bought into private practice earlier none of this would have been possible. Now at 31, I have no debt and quite a few assets and I have good enough financial footing that I could start a practice without near the risk that I would have had a few years ago. I also know my likes and dislikes much more than I did then. I'd put the amount of money I've been able to save after graduation against anyone I graduated with. Yes, a successful private OD will make more money near retirement than a commercial one. However, the commercial one, if disciplined in his investments, will have so much more capital in the end.
I respectfully disagree with that statement. A well run private practice can net an owner well in excess of $300k in total compensation. If I need $100000 a year to live off, my private practice affords me the luxury of putting away $200k. Even if I want to PISS AWAY an additional $100k, I would still have $100k to put away. If I'm working commercial and making $130k, I only have the luxury of putting away $30k. Which scenario would you rather have?

Of course money isn't the only consideration. I happen to enjoy the freedom and low stress my job provides. Its not for everyone. But to imply that somehow private docs are the only ones with the big bucks flies in the face of everything I have been able to achieve over my career thus far. And for the record, from an investment standpoint, there are way better investments than an optometry practice.
I also respectfully disagree with that statement. The "investment" return in a practice comes not from the appreciating value of the practice because you are right, the amount that I ultimately sell the practice for will not be orders of magnitude higher than what I paid for it. However, having owned that practice for the course of my career will have brought in a much higher compensation than I would have received had I NOT been the owner and it is that additional compensation that I can direct towards other investments. THAT is one of the main benefits of ownership. And that benefit is there even if I just shutter the practice and sell off the hard assets.
 

PeteRose

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Yes, private practice will bring a higher income later in the game, but my point is that commercial will bring more gains early on. No one, or nearly no one, will make $300 or even $200 Net profit in a private practice straight out of school. And if they say they are after 5 years they are fudging the numbers because they are still purchasing the business and the building (if they are smart). Simply financial principals would tell you that one comes out better later if they save more on the front end, which I think we all would agree is the benefit to commercial practice. Refer to this article for an economics lesson:
http://finance.yahoo.com/retirement/article/102429/How_the_Young_Can_Get_Rich


Now let me share 3 examples of commercial optometry:

1. Man serves in the navy for five years after optometry school . Gets out with no debt. Takes a lease at a new Lenscrafters in a growing mall where he is the only optical. Then gets another lease at another Lenscrafters. Has two Lenscrafters throughout the 90’s and has a few employee Dr.’s as well. He NETS give or take $400,000 per year throughout the 90’s. In 1998 he sells the “practice” just in the nick of time before an ECCA store was put in each mall and took all the business. I don’t have the exact numbers on the sale so I won’t say, but the figures I’ve heard indicate it was a “lot“. During those years he bought up land all over TN. He now owns thousands of acres and his assets total several million. He is 50 yrs. old. How do I know this? He is in the office adjacent to me this very minute. He works at ECCA three days a week, not because he needs to but because he enjoys seeing patients and says he loves it here cause he has not hassle to manage anything.

2. Man moves from Iran in his early 20’s. Goes to school and becomes a mechanical engineer. Doesn’t like it so uses all his savings to go back to optometry school. Gets out of optometry school at age 40 with no money. Works commercial for 10 yrs. In that 10 years he and his brother buy property in his home country that appreciates 400%. They are in the process of building high rise apartments on that property. They also own outright two plots of lakefront property. They had three but sold the least desirable last week for $400K. This Dr. also owns several rental properties and his personal estate is valued at one million dollars. This man is also 50 yrs old. He also works with me here at ECCA and plans to work a few more years and move to Belize where he plans to open a free clinic for the poor and live out his days. He has only been an optometrist for 10 years.


3. Man I worked with for 3 years when I graduated school used his earnings to secure a loan to buy a liquor store. He has since expanded the store twice. He used that store to secure loans with another investor to buy a Comfort Suites hotel. Following the same progression he bought a Cracker Barrell, a Melting Pot Restaurant, a luxury loft apartment building, multiple real estate holdings, and is currently building a Holiday Inn that connects to a convention center. Oh yea, and he bought his wife who is also an optometrist a private practice that makes very little profit, but they both enjoy doing optometry still. Like #1 and #2, he also has millions and is 36 yrs old.


I tell you these examples of people I know very well who went commercial. They are not fabricated in any form. Did optometry get them rich? No, except in case of #1, but his investments made him mega-rich. But what they had in their favor was enough capital to make wise investments. I would contend that they could not have duplicated this success in private because they would not have the earning potential and extra capital straight out of school. I don’t have near the risk tolerance #3 has, but I am following slowly in the steps these men have taken. Just 3 weeks ago, right before the market tanked, I sold some real estate and pocketed nearly $100K cash from the sale. I have other real estate that I have been buying over the past few years along with IRAs, 401K, annuities, etc. Again, not tooting my own horn, but simply trying to let these students know that you can do optometry because its your passion, but you might want to look elsewhere for long term investments. When KHE says the only way to make “big bucks” in the profession is private ownership, I think I just gave three concrete examples to the contrary. More money early on means more investment opportunities in investments that are way more profitable than an optometry practice. Please don’t think I’m saying not to buy an optometry practice. I may someday decide to buy one myself. But I can assure you if I do it will be a cash purchase rather than ransoming my entire life and my family to the federal government and to a business loan for an optometry practice.

Obviously brevity is not my strong point. Hope this information is helpful to someone.
 

KHE

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Yes, private practice will bring a higher income later in the game, but my point is that commercial will bring more gains early on. No one, or nearly no one, will make $300 or even $200 Net profit in a private practice straight out of school. And if they say they are after 5 years they are fudging the numbers because they are still purchasing the business and the building (if they are smart). Simply financial principals would tell you that one comes out better later if they save more on the front end, which I think we all would agree is the benefit to commercial practice. Refer to this article for an economics lesson:
http://finance.yahoo.com/retirement/article/102429/How_the_Young_Can_Get_Rich

.
You may not make that kind of profit straight out of school if you open cold and have no clue what you're doing. But if you DO have some concept of what needs to be done (that is to say, you actually do a bit of research before you graduate) then there is no reason that you can not hit the ground running even with a cold start up.

The other option is an outright purchase, which is the way that I went and my practice has made me a multi six figure income right from the first day I walked in. It is THAT money I use to invest in other ventures or projects and it is also that practice that allows me some of the perks of business ownership which I recommend you consult your CPA over. ;)
 

PeteRose

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So KHE, you had no education loans and you had hard cash on hand the day you graduated to buy your practice? If so then you have been extremely blessed in life. I guess I was assuming most of the students here have substantial education loans and would have to borrow large sums to buy a practice. If borrowing hundreds of thousands or, in some cases, a million to buy a practice is required, then even with a high six figure income your net worth is in the negative for many years. A $200K salary doesn't carry as much weight when you are $500K in the hole as a $100K salary with a positive net worth. That's what I meant by fudging the numbers. Of course the $500K in the hole is an investment that will likely pay dividends in the end, but my argument is that there are much better investments worth going into debt for than an optometry practice. But if you were able to make a cash purchase with no debt out of opt school and make high six figures year one, then I salute you and wish I were in your shoes.
 

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This is indeed and interesting conversation, and it is nice to see mature discussion, rather that childish bickering for a change.
I own a private practice which I purchased almost 3 years ago. In Canada, private practice easily exceeds commercial in almost all practice senerios..even associated will tend to make more in private practice. However, it is the other "perks" of owning your own business that make it even better, such as significant tax sheltering. Also, I run all of my expenses (frames, lenses, etc) through an Avion credit card, so that I get one reward point for every dollar I spend. The rewards are intended to be used for air travel, and a cross -country trip requires about 30,000 points. Since I accumulate around 40,000/month I will never pay for a flight again. I also can use the points for shopping....which came in handy last Christmas.

Last, but certianly not least, I get daily referrals from the GPs in my community, and get a nice bottle of ice wine every year from the hospital emergency department, since I see so many patients for them.....I doubt that woud happen if I was a commercial Dr. Am I wrong?

J
 

PeteRose

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Last, but certianly not least, I get daily referrals from the GPs in my community, and get a nice bottle of ice wine every year from the hospital emergency department, since I see so many patients for them.....I doubt that woud happen if I was a commercial Dr. Am I wrong?

J
:laugh: Stonegoat, we get our gifts from the ophthalmology practices cause we refer so much. Lots of fruit, cheeses, and sweets, but no wine yet. Oh, and we get nice cookies every year from the Lion's club cause we do charity exams for them. And the chick-fil-a in our mall brings us free chicken sandwhiches sometimes too. And the movie theater is all the time bringing around promotional movie passes to sneak previews! Not very many GP's sending us folks, you are correct about that. However, we do have lots of independant opticals in the area that don't have ODs who send us patients cause we are cheap. This happens all the time. It started when I found a disease, don't remember which one, in the eye of a buddy of one of the owners. Now he and several others send all their customers to us cause they trust us. They have learned over time that we will send them back with a script without selling to them. Would my corporate people be happy to hear that? Not sure, but its the right thing to do.

Oh, and I almost forgot our biggest referral source. There is a DMV across the hall from our office in our mall. Everyday they send us people who flunk driving eye tests. I couldn't begin to tell you how many of those forms I've completed over the years. We could stay in business on those patients alone.
 

PeteRose

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And I almost forgot the mall emplyee discount I get at Subway, the music store, and on my cell phone bill. I can't beat those frequent flyer miles though. That's a good perk.
 

IndianaOD

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And I almost forgot the mall emplyee discount I get at Subway, the music store, and on my cell phone bill. I can't beat those frequent flyer miles though. That's a good perk.
I don't think a professional should be touting those as perks. :eek:

Do you mind letting us know what you charge for a routine exam? There are some major problems I have with commercial.

1. The unprofessional image it gives us. When people see us in wally and malls they have a hard time thinking we do more than glasses and contacts.

2. Devaluing our services. A doctor with 8 years + of education should be charging reasonable fees. The dentist in our building charges around $300 for 5 minutes of work for a routine exam. Honestly it makes me angry when the first thing walmart shoppers see is $40 eye exams. Eye exams should start at $80 minimum. In my area only the commercial places allow the low ball vision plans to survive. Why? We charge a low (IMO) $82 for a private pay exam. $138 for a medical 92004. Why are the commercial ODs so much lower? It hurts us all. A moderate level hair cut is about the same or more than that!

3. Referring many things out. OMDs love it, hurts us BAD.

4. Most commercial docs are not involved in furthering the profession. Even the regional Wally recruiter said less than 10% of wally ODs are AOA members. At our latest legislative dinner there was 1 commercial OD out of the 30 ODs present.
 

KHE

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So KHE, you had no education loans and you had hard cash on hand the day you graduated to buy your practice? If so then you have been extremely blessed in life.
No of course not....I had above average loans but whether you end up working in commercial or private practice you're going to have loans.

And I did not have cold hard cash to buy a practice. Lots of loans, lots of shuffling of savings, lots of begging stealing and borrowing and ultimately it came down to owner financing. I was fortunate in that I bought into a thriving practice so I made huge money right from the get go. But that huge money came with a huge loan. However, even after paying off my loans I still take home waaaay more than $130k.

A $200K salary doesn't carry as much weight when you are $500K in the hole as a $100K salary with a positive net worth. That's what I meant by fudging the numbers. Of course the $500K in the hole is an investment that will likely pay dividends in the end, but my argument is that there are much better investments worth going into debt for than an optometry practice.
I disagree with this. Firstly, a practice that nets a doctor $200000 is almost certainly NOT worth $500000. However, for the sake of an argument, let's assume that that's the note you have.

$500000 for 7 years at 8% comes out to a monthly payment of approximately $7700. My marginal tax rate for the past three years has hovered around 16%. 16% of $200000 is $32000. That means that after taxes of $32000 I have $168000 left over. Subtract out $7700 per month ($92400 for a year) leaves $75600 left over.

Now take your $100000. Using the same marginal tax rate of 16%, that leaves you $84000. That's a mere $8400 extra dollars a year, but only for the first 7 years!

At the end of 7 years, I would be pulling an extra $84000 PER YEAR and in ADDITION to that I would have a business that is worth at least $500000.

And again, a practice netting $200000 is almost certainly NOT worth $500000.


But if you were able to make a cash purchase with no debt out of opt school and make high six figures year one, then I salute you and wish I were in your shoes.
You can easily find my story searching through the archives here on SDN and I can assure you that I was no where close to making a cash purchase and making 6 figures coming out of optometry school.
 

PeteRose

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KHE,
You are indeed a formidable debate opponent and I really enjoy your thoughts and your intellect. I can certainly tell why your practice is successful. I hope I haven’t come across argumentative or mean spirited. I really am here to learn like everyone else, and I greatly appreciate your sharing.

I suppose I gave the purchaser the benefit of buying the building along with the practice and bundled in student loans to boot, so I guess I thought $500K was on the low end. But you are correct that the loans are a wash both ways. I also, for the sake of argument, made the commercial guy make way less than I suspect a starter would make in a good commercial setting. It’s much lower than mine was as I stated. It appears from this post that my commercial setting is an above average one. It also appears that your private setting is better than most. All of my peers that graduated with don’t have near the situation you landed. Most of them who have bought practices don’t pull in six figures even six years later because they are so saddled by debt and their patient base is not where near yours is. As I’m sure you know, most OD’s don’t typically go out on top, so most take a lot more work at first. Maybe I’m way off base, but my experience from discussing these matters (and I think you can tell I enjoy to) is that in the average private to commercial comparison there is a greater than $8400 difference each year because I don‘t think that 90% of first year private OD‘s don‘t $200K from the get go, and I think at least 75% of commercial do (maybe we should do a poll). But I am more than willing to admit that I could be wrong. And I’m certainly willing to admit that there likely is a quality of life issue in your favor in most cases. And I have to concede that with the numbers I gave you, you are correct that the $8400 difference, while significant over a seven year period, won’t equal the $500K or more you are assuming the practice to be worth if the $8400 is just invested in regular stuff like mutual funds or something (Maybe I‘m arrogant, but I think I could make $8400 grow a ton over a 7 year period). But now lets consider one more thing. If you have the practice and don’t own the building, you are making the assumption that you’ll find a buyer some day (we all know many that can‘t ). You are also making the assumption that this hypothetical practice will do well and grow or maintain. If at the end of the day it flops (which we all know those that have), you have dept and no practice or a very lousy one. However, commercial guy can find work any day of the week he wants anywhere in the country and no debt. To get to where you are you had to take on very large debt. We didn’t even add a house into the equation which would just tack on. Maybe a more real comparision (which I still think is biased toward the private guy) would have been to make both of them making $120K. I fear my $100K headstart I gave you was way too generous. Anyway…

Now you mentioned earlier that I have maxed out and I concede that I may have. But maxed out does not account for inflation. I am indeed certain that if I continue in my same path that in 20 years I won’t still be making $140K a year. Inflation would indicate that I would make the same in today’s dollars, but not 2028 dollars. You say, “how do you know the corporate people will pass increased fees on to you?” Because if they don’t over time I quit and go elsewhere and they have to hire a new “sucker” right out of school and will have to pay them an attractive salary to get them in the door and so it goes…. So if in 20 years I am making the equivalent of $140K I will still be making more than the average optometrist makes. Do you really think there is an optometrist at Sears somewhere still making the $60K he was making in 1990? If so its only his fault and I’d like to be his employer.

I guess the point I’m trying to convey, especially to students, is that you don’t have to have over a half million dollars in debt at first ($120K school loans, $300K practice, $200K house, etc… modest estimates I think ) Ownership is not for everyone. Yes, as KHE has shown it can be lucrative if done right, but you have to have the stomach for it and you have to accept the fact that you will live in town X most of your adult life. If you can handle debt, same town, and lots of management ups and downs, then by all means you should do it. If debt, or at least debt in a practice, scares you don’t do it. Or at least postpone it. As I mentioned, I am in much better shape professionally and financially than I was when I graduated. If I wanted to buy a practice now it would be no big deal. Back then it would have been. I just happen to enjoy what I do and can’t imagine going through the hassle of all that goes into private.

Seriously, KHE, thanks for your insight and for indulging me in this exercise. I’m having fun! And I think these are beneficial considerations for students who care to read.
 

PeteRose

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KHE,
wait just one minute. I didn't follow my own advice. I let you off the hook too easy. Let's finish the example through to retirement, which was my initial point to begin with. Lets say I use my $8400 extra dollars for seven years but continue to invest the same amount over a 32 year period until retirement. at 10% gain I have at retirement of $2,035,868.70

Now lets say after that seven you now have $8400 that you can invest and you get the same 10% return but you can only invest this for 25 years because of my 7 year head start. You retire with $999,738.36

That's over 1 million dollars difference in my favor!

Yes you have a practice that may or may not be worth the difference at that point, but the point is I have taken on no debt.

That is the economics lesson I have been trying to convey. More money, even if just a little, wins out big in the long run. These numbers can be calculated easily on any online compounding calculator.
 

stonegoat

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I know it's different in Canada, but I know I wouldn't be happy only making 140K/year after 20 years. Honestly, I've only owned my practice for less than three years, and already make well over 200k/year...after debts are paid..not including "perks". If you want the satisfaction of fullfilling your vision of what a practice should be, right down to the paint colour, and want the opportunity to make fantastic money...in line with what OMDs make....then embrace the business of your own private practice. It's worth the few "headaches".......as I suspect that commercial Docs have their own "headaches" as well.
 

IndianaOD

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If the economy stays this way in the future, earnings will count more than savings for sure.
 
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panzer

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If the economy stays this way in the future, earnings will count more than savings for sure.
So people wouldn't be able to save anymore as salaries go down?

By the way, for those who switched, did you switch to Luxottica / Lenscrafters? What was the pluses that made you switch to there???

It seems there is very little pre-opt crowd here...:laugh:
 

KHE

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KHE,
wait just one minute. I didn't follow my own advice. I let you off the hook too easy. Let's finish the example through to retirement, which was my initial point to begin with. Lets say I use my $8400 extra dollars for seven years but continue to invest the same amount over a 32 year period until retirement. at 10% gain I have at retirement of $2,035,868.70

Now lets say after that seven you now have $8400 that you can invest and you get the same 10% return but you can only invest this for 25 years because of my 7 year head start. You retire with $999,738.36

That's over 1 million dollars difference in my favor!

Yes you have a practice that may or may not be worth the difference at that point, but the point is I have taken on no debt.

That is the economics lesson I have been trying to convey. More money, even if just a little, wins out big in the long run. These numbers can be calculated easily on any online compounding calculator.
Huh?? :confused::confused::confused:

If you invested as you described, you would have that amount of money at the end of your 32 years.

But, even if I didn't save one red cent while paying off the initial practice acquisition debt for 7 years, at the end of my first 7 years once that $7700 per month debt load is paid off, I won't have $8400 PER YEAR to save, I'll have $7700 PER MONTH to save. Over the course of 25 years using the same 10% that you gave leaves me with a grand total of over 10 million dollars PLUS I would have the value of the practice to sell.

I think I'm missing the point you're trying to make here.
 

KHE

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KHE,
You are indeed a formidable debate opponent and I really enjoy your thoughts and your intellect. I can certainly tell why your practice is successful. I hope I haven’t come across argumentative or mean spirited. I really am here to learn like everyone else, and I greatly appreciate your sharing.
Thank you for your kind words. You have also made many accurate and legitimate points regarding commercial practice. To be clear, I am mostly ambivalent about commercial practice. Also, I don't really consider the discourse we have had to be a debate because I'm not really trying to convince you that "I'm right." I'm simply trying to post the other side for the benefit of students and pre-opt students.


I suppose I gave the purchaser the benefit of buying the building along with the practice and bundled in student loans to boot, so I guess I thought $500K was on the low end. But you are correct that the loans are a wash both ways. I also, for the sake of argument, made the commercial guy make way less than I suspect a starter would make in a good commercial setting. It’s much lower than mine was as I stated.
In fairness, most people working commercial are going to be earning a lot less than you and most people working in private practice are going to earn less than I. I'm fortunate that I purchased a well run, thriving practice and my partner is a valuable asset. Most practice purchases involve solo practices, which mine was not.

Most of them who have bought practices don’t pull in six figures even six years later because they are so saddled by debt and their patient base is not where near yours is.
I would respectfully suggest then that your collegues are doing something wrong. If you are unable to pull in at least a six figure income for yourself 6 years after starting/purchasing a practice, something is off.

As I’m sure you know, most OD’s don’t typically go out on top, so most take a lot more work at first. Maybe I’m way off base, but my experience from discussing these matters (and I think you can tell I enjoy to) is that in the average private to commercial comparison there is a greater than $8400 difference each year because I don‘t think that 90% of first year private OD‘s don‘t $200K from the get go, and I think at least 75% of commercial do (maybe we should do a poll). But I am more than willing to admit that I could be wrong. And I’m certainly willing to admit that there likely is a quality of life issue in your favor in most cases.
Maybe, but what works for me may not work for you or anyone else. I ENJOY running my business. Yes, sometimes it is a monster pain in the neck and sometimes I DO have the fantasy of just wanting to see my patients and go home but the positives of being a business owner have far outweighed the negatives. Fortunately, most of the negatives I can delegate away. ;)

But now lets consider one more thing. If you have the practice and don’t own the building, you are making the assumption that you’ll find a buyer some day (we all know many that can‘t ).
I disagree with that. You can ALWAYS find a buyer for anything. You just have to set the price right. Many people can't find a buyer because their asking price is nowhere near in line with what the practice is actually worth. I looked at more than a few practices that has asking prices so high, the salary the owner doctor was drawing wouldn't even cover the note for the purchase much less allow the purchaser (me) to live and eat and have clothes on my back. People like that are going to have a very hard time selling their practices because the fact of the matter is is that it's just a viable deal.

You are also making the assumption that this hypothetical practice will do well and grow or maintain. If at the end of the day it flops (which we all know those that have), you have dept and no practice or a very lousy one.
Well, if my practice flops, at least I'm the one who made it flop. And if it ever does, I can always get a job working commercial. :D

However, commercial guy can find work any day of the week he wants anywhere in the country and no debt. To get to where you are you had to take on very large debt.
With risk comes reward.

We didn’t even add a house into the equation which would just tack on. Maybe a more real comparision (which I still think is biased toward the private guy) would have been to make both of them making $120K. I fear my $100K headstart I gave you was way too generous. Anyway…
Housing does not enter into the equation. Whether one works in a commercial environment or owns a private practice, you still need a house.

Now you mentioned earlier that I have maxed out and I concede that I may have. But maxed out does not account for inflation. I am indeed certain that if I continue in my same path that in 20 years I won’t still be making $140K a year.
Be cautious with that line of thinking. In all three states I have ever practiced in, the current going rate for a per diem doctor is around $350-$400 per day. That is the exact same rate that was being paid in the year I graduated which was 2000. During my 4th year, I recall graduates from the class of '99 and '98 complaining that they were getting paid $350 per day which was the same that graduates from the class of '94 and '93 were making.

I guess the point I’m trying to convey, especially to students, is that you don’t have to have over a half million dollars in debt at first ($120K school loans, $300K practice, $200K house, etc… modest estimates I think ) Ownership is not for everyone. Yes, as KHE has shown it can be lucrative if done right, but you have to have the stomach for it and you have to accept the fact that you will live in town X most of your adult life.
You do have to have the stomach for it, and yes, you pretty much have to want to be part of a community and not lead a nomadic existence. If you are full of wunderlust and want to move to a different state every 5 years, then private practice ownership is not for you.

If you can handle debt, same town, and lots of management ups and downs, then by all means you should do it. If debt, or at least debt in a practice, scares you don’t do it.
My advice to students is to not be debt adverse. Debt is a part of life, and a part of any successful business. You do think Bill Gates didn't take out a loan to start Microsoft? If so, consider reading his biography. Anyone know how many times Walt Disney went bankrupt before making it? Look that up too....the answer might surprise you.

Debt has to be managed in the same way assets are managed. Conservatively and thoughtfully.


Seriously, KHE, thanks for your insight and for indulging me in this exercise. I’m having fun! And I think these are beneficial considerations for students who care to read.
I hope you continue to contribute. I personally disagree with a lot of what you are saying but they are all legitimate points and again, what works for me may not work for others. Your philosophy may fit well with other students' and it's important that they hear that they do in fact have options.
 

IndianaOD

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So people wouldn't be able to save anymore as salaries go down?

By the way, for those who switched, did you switch to Luxottica / Lenscrafters? What was the pluses that made you switch to there???

It seems there is very little pre-opt crowd here...:laugh:
I'm saying that saved income will grow slowly and be worth less. Hasn't even been keeping up with inflation lately. Not to mention many people have seen 1/4 of their savings disappear in the last month.
 

drbizzaro

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I'm saying that saved income will grow slowly and be worth less. Hasn't even been keeping up with inflation lately. Not to mention many people have seen 1/4 of their savings disappear in the last month.
you mean with mutual funds and stocks?
 

drbizzaro

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Who here is knows the incentives plan for the following people at ECCA:
1) TD (territory director)
2) GM (general manager)

I know it is something like: if they make their goal, they get a bonus of 10,000.00 for a TD, and the GM gets to keep 100 bucks or so. If anyone knows please let us know, as I'm curious to know.
 
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panzer

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Yes, that and regular bank savings and CDs. Compound interest adds up more slowly lately.
It if funny we are so dependent on such money as, if you ask any financial guru, doesn't really exist but is basically "speculation money" or maybe a gambling credit if there is such a term.
 

drbizzaro

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It if funny we are so dependent on such money as, if you ask any financial guru, doesn't really exist but is basically "speculation money" or maybe a gambling credit if there is such a term.
it is gambling
 

Aznfarmerboi

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You guys definitely deserve better. I dont want to sound like I am gloating (I am not as our situation is bad too), but at least retail in pharmacy guarantees you a salary of (~120k) with the more hours you work regardless of RX, the more you get paid (If you work 60 hours, 160k, 80 hours 240k + premium overtime and holiday pay).

What got me most was no lunch breaks? Is this even legal. . . I can at least tell my patients that I am on lunch (and some retails actaully close down half an hour or have overlapping rphs).

Best of luck.
 

Mixin Marc

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You guys definitely deserve better. I dont want to sound like I am gloating (I am not as our situation is bad too), but at least retail in pharmacy guarantees you a salary of (~120k) with the more hours you work regardless of RX, the more you get paid (If you work 60 hours, 160k, 80 hours 240k + premium overtime and holiday pay).

What got me most was no lunch breaks? Is this even legal. . . I can at least tell my patients that I am on lunch (and some retails actaully close down half an hour or have overlapping rphs).

Best of luck.
Honestly, everyone deserves a lunch. I'm glad your setup is working good for you in the pharm industry. I think the companies like Visionworks get away with it because various states will say that people only need 15 minutes of break every 8+ hours, and the GMs will state that you will attain the 15 minutes of break. ie. they will say that if you are walking to pick up a file, it is 1 minute of non-working, and after 15 patients, that would equal 15 minutes of break. Which is honestly BS!
 

VisualSpirit

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I have read this entire thread. As a result, I've gone through a myriad of emotions...fear, shock, amusement, anger, relief, and most of all, RESPECT!

I want to thank PeteRose for his candor and for sticking up for his viewpoints. I also appreciate his opposers, but as a pre-opto student, it is just this type of discussion that I NEED to help me make accurate and informed decisions about my future career. I don't think it's ever too early to start planning.

So, thanks to all. I have to say that I am heavily leaning toward the commercial/make money first/invest in other opportunities/build long-term wealth-while practicing optometry as my base side of things.

But it was because of this thread that I was able to make that decision.

Thank you, thank you, thank you. Your goals were accomplished.
:laugh: :thumbup: :)
 
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panzer

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You guys definitely deserve better. I dont want to sound like I am gloating (I am not as our situation is bad too), but at least retail in pharmacy guarantees you a salary of (~120k) with the more hours you work regardless of RX, the more you get paid (If you work 60 hours, 160k, 80 hours 240k + premium overtime and holiday pay).

What got me most was no lunch breaks? Is this even legal. . . I can at least tell my patients that I am on lunch (and some retails actaully close down half an hour or have overlapping rphs).

Best of luck.
I think it depends upon the pharmacy and most probably the amount of scripts you are doing as I never really saw my pharmacist take breaks since he was the only one working [except in the afternoon when we changed shifts for 1-2 hours but then who would need a break that early in the shift?] so you are wrong in that case, Sir!

I do agree about walmart that they take half-hour breaks but then walmart might pay less than a walgreens?


PS In retail, if one pharmacist is working, then how can you go to lunch with pharmacy open LEGALLY?
 

Eyegirl2k7

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Hmm, maybe I should have been a pharmacist...t
 

drbizzaro

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Hmm, maybe I should have been a pharmacist...t
my personal opinion is that optometry is much better... but that's just from talking with my friends who have worked as pharmacists for over 3 years...
 

4Eyes

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This isn't 100% on-topic, but I thought I'd throw out my experiences. I'm a 2008 graduate, so I'm definitely a newbie, but I have dipped my toes in the waters of both retail and private practice.

I work part-time at an established private practice with one other OD. It's not sooo high volume that it can become a two doctor practice overnight, so I am part-time there until we build it up. In the meantime, I am working at a JC Penney Optical (US Vision) part-time to pay the bills.

I was fully prepared to loathe the Penneys gig. But really, it hasn't been bad at all. They don't tell me when to work, they don't tell me how long I can take with my patients, and I'm not pressured to sell anything. The opticians don't have to be licensed, but I'm very fortunate to work with three very sharp, knowledgeable ladies with years of experience. My exam is the exact same both places.

I do have a handful of complaints with Penneys: I don't like not having a field machine. That is the biggest difference between Penneys and the private practice (though, truth be told, after I'm a partner in the private practice, I'll definitely be looking to invest in a better one, among other things). Though for screening purposes I'd prefer the GDx, which neither practice has (yet). :( As a new doctor just starting out, I probably wouldn't be able to afford all the great (but expensive) ancillary equipment right away, regardless of practice modality. But I would look to add it bit by bit. If I intended to stay at Penneys, I would look at purchasing some of this stuff to use there, but it is only temporary.

As for building my reputation as an eye DOCTOR in this town, it helps that the OMDs here are, for the most part, GREAT to work with (there's one OMD office that steals patients, but pretty much no one refers to them for that very reason). They know what I'm trying to do with the private practice, and they understand my limits at Penneys. I'm still able to treat the red eyes, dry eyes, etc. I send letters to all my diabetic patients' GPs/endocrinologists, which seems to impress my patients big time (I was surprised at this...I really thought it would be more commonplace), and hopefully, it will send a message to their physicians as well.

The only other real beef I have is one day I got a notice to throw away all CL solution samples other than Complete and Boston. Because they have some kind of agreement with AMO. I promptly threw this notice away because it's not their business to tell me what to give to the patients. I told the office manager what I was doing because I didn't want HER to get in trouble, but she didn't mind at all.
EDIT: Got a revised letter stating that the solution thing was meant for optical, and the doctors can use whatever they want. :p

I think I got pretty lucky with my retail experience, though I look forward to the day I am at the private practice 100% of the time. I feel like I'm really on the same page as that doctor. I'm sure all the private docs here have a lot of integrity, but after one of my rotations in school, it's not something I take lightly. I was temporarily put off by private practice when a private OD (just an example) would make patients believe they NEED new glasses when nothing has changed about the SRx except a 3 degree axis shift when they have -0.25 or maybe -0.50 diopters of cyl. But of course it doesn't have to be that way.
 
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panzer

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So did you work in retail or office optometry before you jumped in the field?
 

gochi

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Actually, many of the problems happened with the female OD's! Visionworks treated this one OD girl so bad that she left because of harrasment! I'm not sure if it was sexual or not, but it was from upper management.
Wow, I did not know OD's faced harassment while working for corporate entities.

Could it just be a female thing?
 

Mixin Marc

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I just found out Visionworks has this horrible promotion of 2 designer frames for 59 bucks (and they say you get a FREE eye exam)

how disgusting!

I personally know some of the EWS and Managers at Visionworks, and at their last manager meeting they said that "no one should give a 5H1T about the doctors because they get paid too much", and that they should work them to death.
 

DrSpontaneouz83

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I agree that this has been an incredibly informative discussion. As I would ideally like to own a private practice soon after graduation, I truly do not know the business fundamentals for successfully running a practice. I assume you can hire private practice ODs to show you the ropes with a tutorial? But for financial safety, I may find myself doing a couple years of retail or hopefully working in an OD/OMD group practice.

Thanks again for the insight into the different levels of pracitce and look forward to reading more about "how to start up a successful private practice."

Out of curiosity, say you do work commericial, is the best case scenario being the lease holder? Is that anything similar to having the same responsibilities as a private practice OD?

Thank you!
 

Meibomian SxN

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I just found out Visionworks has this horrible promotion of 2 designer frames for 59 bucks (and they say you get a FREE eye exam)

how disgusting!

I personally know some of the EWS and Managers at Visionworks, and at their last manager meeting they said that "no one should give a 5H1T about the doctors because they get paid too much", and that they should work them to death.
Wow, that's cheaper than America's Best Contacts & Glasses! They do the 2 for $69 & your exam is free routine.

These corporate places will continue to exist because they offer that high starting income that many students, who are swimming in debt, can not refuse. :scared:
 

Tippytoe

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what does visonworks and america's best pay their OD's?
Yes. Yes. They are the best company to work for in America. You can easily make $300,000 net per year. And you will only have to work 2 days per week: Mon, and Thursday from 10 am to 3 pm. Saturdays are optional but you are guaranteed to make at least $4,000 on that day.

Additionally, they will provide you with a 401 K, stock options, 4 weeks vacation, 1 week CE-related time-off, and sixteen paid holidays (including the opening of the Panama Canal Aug 15th each year).

Also if you are not married, they will provide you with your own private 'escort' each night at your company maintained luxury condo where you can relax in the 10-person hot tube and wet bar. Each morning a limo will arrive to take you to your 'private' VisionWorks office.

If you opt to have the company provide the staff for you, they will recruit and train the top Ivy-league students from their prospective optometric technician colleges throughout the nation to be at your beck-and-call.


America's Best is the same.....except you only make $290,000/year there.

Good luck.
 

Shnurek

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Stop trolling.
 

thiaeyemd

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Why would you go to optometry school if you would "die doing refractions all day". That just doesn't make any sense to me...
 

20DOC20

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I'm a subcontractor at a Visionworks where the OD owns the lease.

It's a pretty good job and I like the other OD.

It's a bit fast for me though. I see a patient every 30 minutes without a tech. I do get lunch, so that's good.

There used to be a clause in the lease that the OD cannot refuse walk-ins, but I'm not sure that's still in effect.

I'm shielded from much of the office politics and I'm sure there's a lot going on between the leasing OD and ECCA that I'm not even aware of. There's some competition on between Visionworks and the OD on fee-for-service plans that have a max benefit. The OD has told me that Visionworks will ignore the OD fees and will try to ursurp the entire benefit, so to circumvent this, the OD makes certain the insurance company gets her claim before Visionwork's submits theirs.

The practice is much slower than it was eight years ago. (I worked there before). We had been seeing 3 an hour with a tech. People used to get REALLY angry about having to wait, even as little as ten minutes, and I wonder if that's the reason there aren't nearly as many returning patients as one would expect. Could be the economy.

The number one complaint I get from patients is that I'm slow, but you know ... I bust my behind to get a dilated exam done in 30 minutes, much less a dilated toric contact lens exam, much less a cycloplegic exam on a feisty child. I average 37 minutes per exam, and after about 4 patients, the fifth gets to wait, and wait. I just tell them that there's only one of me and I can only go as fast as I can go and that's as good as I can do. It's frustrating for me. I honestly try my best. I wish I could set my own schedule. I'd set them at 40 minute increments.

I suspect ECCA is behind the 30 minute eye exam thing. I can't imagine an OD willingly doing dilated eye exams (other OD dilates, too) at 30 minute increments without a tech. Even with a tech, that's hard.

That said, being a private contractor for another OD who owns the lease isn't bad. It has it's pros and cons like anything. I'm paid well. The staff are great. I'm respected. Downside is that it can be a stressful. It's just not a perfect world and that's the main problem I suppose.

Personally ... I would not want to be an employed OD of Visionworks (or America's Best) and I would not be interested in purchasing a lease from ECCA. That's just me though. I'm a control freak and it would be hard for me to be in the other OD's position.

We do excellent eye care though!
 
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20DOC20

7+ Year Member
Jun 19, 2010
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Optometrist
This is a little off-topic, but one time I worked at a private-practice as a fill-in for a week for a Doc who was vacationing. He'd seen that I'd once worked regularly at a Binyon's location (now Eyeworks).

On day one at this place, they'd crammed patients in at 15 minute intervals without having the patients fill out a health questionnaire and without a tech! It was a nightmare scenario ... and I've been an OD for well over a decade ... after the first hour, the waiting area was overflowing. Let's just say there was a room full of very angry patients. I had to get them done by lunch because the afternoon was scheduled the same way!

During lunch, I told the optical manager to reschedule the entire week and place exams at 30 to 40 minute intervals or I was going home! I was so boiling hot mad and asked WHY DID THEY DO THIS??? I told them it was crazy, bad business and completely unnecessary.

He said, "Well, you said you worked at a Binyon's. We thought you could see four patients per hour."

I said, "We saw three exams per hour and one check and that was with two techs and one person checking people in!"

Again, I told him to rework the schedule or I quit. He reworked the schedule.

Stand up for yourselves. They have a lot of money to lose if you walk.

There are a two of Universal Laws:

An object in motion tends to stay in motion & an optical cannot make money without a doctor being present.