optoblog.com

I’ve mentioned Jay Parkinson, M.D. before, and in fact, he has left a comment on this blog before.

Now he is transitioning into kind of a franchise system.

When we think of traveling outside the office, its usually just to do screenings at the old folks home, but I’m not talking about that. What if the industry made available light, portable and cost-effective exam equipment in a nice kit? What if you kept your Wal-Mart job 4 days a week but provide home eyecare one day a week? Would you want to provide home eyecare full-time?

I’m just thinking out loud here. Does anyone think there is a way optometrists can deliver home eyecare? If we can, should we?

**Update: I saw in Review of Optometry’s edition of Women in Optometry June 2008, that Dr. Tamara Hill-Bennett, O.D. makes house calls 80% of her practice. Since I couldn’t find a link to the article, here is a copy (PDF, 490 KB).

So I found out that I didn’t have to apply with 1800’s referral network, ProNet, for my practice located inside a Wal-Mart vision center because I’m already in the system because of the alliance between 1800Contacts and Wal-Mart. You won’t believe how awesome this is. First of all, no more telephone calls. It’s all fax now. Huge time saver for the opticians who need to keep busy helping my patients get checked out so they can pay my every-day-low-price exam fee.

And then today, 1800Contacts had a customer on the phone whose prescription expired, so they called my Wal-Mart vision center, and the customer was patched through to talk to an optician. The patient scheduled an exam for Saturday. How sweet is that?!!

So when I first announced that I was going to shift the focus of this blog to be pro Wal-Mart and tell people about my experiences in this setting (which I will someday get around to), I was flooded with spiteful comments. The first thing one commenter, “John Smith,” did was to try and dig up dirt on me and report me to the Utah optometric board.

On my VisionHealth EyeCare practice website, he saw that I linked to Wal-Mart.com’s contact lens sales section. He (mistakenly) believes this to be in violation of Utah law and (if he can be believed) filed a complaint to the board.

Let me quote the allegation that “John Smith” made:

In the state of Utah, optometrists are strictly prohibited from marketing or advertising for the mercantile establishment. This includes websites.

Now, I don’t know how they do things in Virginia, Ru-I mean “John Smith,” but here in Utah we have no such rule. I could see such crazy rules coming out of communist states like California or even psychotic-optometry-rule states like Nevada, but not in a freedom-loving, gun-and-God-clinging state.

Another commenter decided to sell us on 1800optometrist, which got me to thinking that hey, I’m providing those links to Wal-Mart.com for free. Why not annoy R-I mean “John Smith” even more and potentially make some cash at the same time by linking to 1800 Contacts!?!

It was simple. I found out about it while reading at 1800’s website, registered, and voila’, I have cool links on my practice website for patients to conveniently order contacts and save money while doing it. If they buy stuff, then 1800’s ad manager sends me a check to say thanks for the referral. While I was browsing 1800contacts, I also registered for ProNet so they will send me referrals when someone’s Rx expires.

Here’s what the ads look like (and if you are by chance a non-optometrist reading this article, please click on this link the next time you need to reorder contacts):

So, if you are like “John Smith” and think that I am caught in a Link Gate scandal, then here is the website for Utah DOPL’s complaint department. But believe me that I’ve searched all the documents found online with the Utah DOPL, and John Doe’s alleged Utah rule is made up out of the same magical stuff that new grads grab onto if they want to start their own solo private practice: wishful thinking.

Those of you new grads scampering to find a job might want to check out the Wal-Mart located in Brigham City, UT. They’ve only been having fill-in doctors lately, so I’ve heard they are looking for someone permanent who could stick around and grow the practice.

Contact the Vision Center manager at the Brigham City Wal-mart, and she could put you in touch with the District manager who makes all the decisions.

So my old cui congressus, the Armed Forces Optometric Society (AFOS), decided to show off a bit. They sent a letter demanding that 1800 Contacts cease and desist a certain practice on their website. 1800Contacts changed the practice in question, and then AFOS published their letter with great triumph in their April 2008 newsletter.

AFOS to 1-800Contacts Letter

The item in question is apparently that when someone selected a ship to FPO/APO (military speak for Fleet/Army Post Office), the 1800 website indicated that they did not require verification of the contact lens prescription. The letter was sent on March 28, 2008, and by the April 2008 edition of the AFOS newsletter, 1-800 had changed their website to indicate that FPO/APO address still required verification.

Okay, now if I were the optometrist to find out about the FPO/APO verification snaffu, then I would have maybe shot off a private e-mail or a phone call, probably stating the same thing about believing that the policy could be in violation of FCLCA. But then I wouldn’t be thinking like Big Optometry. Organized Optometry needs a win. After the AOA suffered a humiliating loss to 1-800 over the whole FCLCA, they need to throw it back in 1-800’s face. Even though military eye docs don’t sell contacts, AFOS must grandstand the point that they scored big against the eeeevil 1-800 Contacts.

Okay, here’s my question. Did AFOS seek out every other online retailer of contact lenses to check their policy about prescription verification of FPO/APO ship-to addresses? Did they send all of the other retailers letters about “a legal oversight” and publish these concerned memos in their next newsletter?

So ever since I announced my new direction on this blog, my readership has increased tremendously. Now, I don’t have advertising on my blog, and I didn’t do it as a publicity stunt, but nevertheless, what happened happened.

All you commenters who want to dissuade me, you can’t. You should probably start your own blog at wordpress.com called ILoveSoloPrivatePracticeAndSoShouldEveryoneElseAndIHateYouIfYouDisagree. That way you can counteract the “faulty reasoning” and “manufactured reality” that I’m feeding the uniformed optometry students because I’m “jaded” and “so opinionated.”

Let’s reiterate. I love being a Wal-Mart Optometrist. I believe it’s the future of primary care optometry. If you disagree, start your own blog.

The Independent Urologist has an excellent post about surviving your first 1-2 years of private practice, should you be insane enough to try. I think he makes a great point, you need much more money in working capitol than capitol equipment. That was part of my problem, I ran out of money, had to get a job 4 days a week outside the practice just to pay the bills, and that left much less time available to grow my own practice.

My financing company wouldn’t give me very much money as working capitol. They capped it as a percentage of the total loan. You’ll note that a urologist has less equipment costs than an optometrist with an optical. If I were to do it again, I would find out all the companies like Altair that give you frames on consignment. I also wouldn’t buy fancy digital phoropters and Officemate Exam Writer. I would go cheap as possible on everything- bootstrap. That’s the only way you’ll survive until the break even point.

And I wouldn’t hire a practice consultant that takes $13,000 of your borrowed money either. Practice consultants will make you think that if you build it, they will come. It’s pretty expensive flavor-aid to be drinking. You’ll get all the information you need from internet searches and free resources like the Management and Business Academy. Also, a good buying group like C&E Vision has excellent resources to help you see what numbers you should be putting up.

By the way, did you know Wal-Mart docs have the Optometric Business Academy? I hope that you didn’t really think that vendors (like Ciba, Essilor, Topcon, and Transitions) only look out for private practice docs.

Also the IU notes that while he now has a positive cash flow, he estimates that he has lost ~$200,000 in income by starting up his own practice. If you start off practicing in Wal-Mart, then you have income from the get-go. I know of doctors working for other optometrists for ~$50-60K pre tax salary for a few years with the hope of buying into the practice. Even if they are allowed to eventually buy in, what about all the income lost? They could have been making $120K+ pre tax net while working with Wal-Mart.

When I was in the United States Public Health Service detailed to the [American] Indian Health Service, they had started to transform the rules of uniform wear. Back in the day, PHS officers would just wear their uniform to work one day a week. When I arrived, the rule was now everyday.

And now in the further transformation of the corps, new memos have been handed down from RADM Steven K. Galson, M.D., M.P.H., Acting Surgeon General. Among them are:

• PPM 07-015 Phase out of the Service Blue Uniform, dated 28 August, 2007

The Service Blue uniform, also known as the Salt & Pepper, will be phased out and no longer be an authorized uniform of the PHS. Although a final date has not been established, the PPM specifies that this date shall not be later than 1 August, 2009. The Office of the Surgeon General recognizes that this policy has the potential to create consternation among officers.

• PPM 07-014 Wear of the Navy Uniform Sweater, dated 28 August, 2007

Presently, the sweater authorized for wear by our officers is that worn by the U. S. Army, utilizing PHS soft shoulder boards as insignia of rank and the name tag worn on the other authorized uniforms. There will be a transition towards wear of the sweater authorized by the U.S. Navy. The shoulder boards used will remain unchanged. Instead of the traditional name tag, this sweater requires the use of a leather patch with the officers’ name, rank and the letters USPHS embossed in gold. This new patch will be readily available at any Navy uniform store. Effective 1 January 2008 PHS officers are authorized to wear this sweater; however, they may continue to wear the Army sweater until 31 December 2008.

• PPM 07-013 Weekly Wear of the Battle Dress Uniform, dated 28 August, 2007

This PPM allows PHS officers to wear the Battle Dress Uniform (BDU) one day a week. I have designated Friday as the authorized day for wear of the BDU. Formerly use of this uniform was restricted for wear in austere settings, typically when responding to events such as natural disasters.

• PPM 07-012 Personal Appearance/Grooming Standards, dated 28 August, 2007

In the past, PHS officers were authorized to maintain a properly groomed beard in accordance to existing standards. Effective 1 January, 2008 beards are no longer authorized. Procedures will be established to accommodate those officers who cannot shave for medical reasons. In these cases there will be guidelines as to how the facial hair is to be groomed. Moustaches will continue to be authorized and groomed in accordance to existing standards.

Wow, so my favorite uniform, the historic Salt and Pepper, is being phased out. I’m glad the Acting Surgeon General acknowledges my consternation about this news. It has been our unique uniform ever since the Navy phased it out a long time ago. I’ll bet that the PHS is now phasing it out to be more in line with the Navy so that other service branches don’t think we’re some kind of weirdos who forgot how to dress properly.

For posterity’s sake, here’s me in 2005 when I was still on active duty in my favorite PHS uniform.

Now, for those of you who know anything about the Indian Health Service, clinics are usually located in very remote places, so many of the US PHS officers and civil service doctors/staff are a pretty relaxed group of people. A good bunch of them are out-doorsy types. Nobody puts on airs. And the people we serve are your humble American Indians whose culture has endured so many wrongs. I’m just curious to hear about what the effect of wearing BDUs once a week and uniforms every day will have, if any.

There are many Native American veterans, particularly Marines. They could be comfortable with others wearing uniforms, but I’m not sure how the majority of the people feel about receiving care from someone in uniform. Is this an issue or a non-issue?

CooperVision’s newest lens, the Biofinity, is now available at Wal-Mart. They’re selling it for something like $49.87 (it’s a one month lens).
I guess my private practice is no longer the exclusive provider of Biofinity in the Cache Valley area.

I just was contacted by Review of Optometry. Apparently, they didn’t want any comment from me, but they were hoping that I knew the name of an optometrist in Utah that is vocal about 1-800 type stuff (apparently not me, just any other Utah O.D.). So, Utah ODs if you want to comment on the whole 1800/Wal-Mart story, let me know so that l can pass on your information to Review of Optometry.

But I thought that if by some miracle R.Opt. makes a link to my site, I’d better update more about what I’ve discussed with others about the whole partnership with 1-800 and Wal-Mart since my original post. Of course, this has been a hot topic at Wal-MartOD.com and at other sites like the highly secretive society of ODwire (which I don’t read anymore because, hey, it’s a secret).

So in my last post, you read the e-mail that I immediately sent back to Wal-Mart HQ the moment I heard about the news. The next day I went to work, and to my utter amazement, my vision center manager thought the partnership was pretty cool. Why? Apparently, Wal-Mart currently buys their contacts directly from each company, so this partnership is supposed to make the process faster for the patient. It is also supposed to help lower costs since 1-800 and Wal-Mart can combine their buying power to ask for a deeper discount from the individual contact lens manufacturers.

Then the district manager called and expressed the same opinions, but also added that Wal-Mart would save money by transferring the expensive maintaining of walmart.com’s online contact lens sales to 1-800’s website. She also said that 1800 has a huge brand recognition. If you walk-up to someone on the street and ask them where one could go to buy contacts, something like 40% will say 1-800-Contacts.

So this tells me that Wal-Mart is using 1-800 as their sort of high recognition buying group. In my practice, I order most lenses through a buying group like Lensco, but then some lenses I just purchase through the manufacturer, and hard lenses I get through Valley Contax ( I know Lensco does hard lenses also, but Valley has the I-Kone and my alumni’s C.A.D. design.)

So is it a sin for Wal-Mart to get itself a buying group? Of course not, unless that buying group happens to belong to the Spawn of Satan. Okay, all kidding aside, I wrote the following follow-up e-mail to Dr. Patel:

…I would gladly be willing to recant anything I’ve said about 1800 CONTACTS if they would join the Vision Council of America, prominently display the “Check Yearly. See Clearly.” logo (checkyearly.com), erase from their site any directions for consumers to subvert doctor recommended expiration dates, and withdraw their lobbying efforts for government mandates on 2-year expiration dates.

You should include that as part of your bargain with them.

So, just because 1800 sells contacts online doesn’t make them my enemy. It’s their coaching of consumers to badger doctors about prescription expiration dates and worse, their lobbying for laws to mandate to doctors a minimum 2-year expiration date (which succeeded into become a Utah state law).