optoblog.com

Kevin, M.D. says that

The retail clinic era is over, and … pharmacy-based clinics are doomed to fail.
Corporations are finding out what primary care doctors already know: it’s hard to make money only doing office visits.

Ophthalmologists make bank doing procedures. I guess the problem with the retail medical clinic is that the doctor is paid so much. I guess optical shops are lucky that optometrists aren’t as high up on the whole pay scale totem pole.

I have to wonder about the optometric profession, though. The student loan debt percentage delta outpaces optometrist’s pre-tax net percentage delta. How much longer will anybody want to apply for optometry school?

I guess we need Obama to bailout the optometry schools. Socialized medicine, here we come. Thanks for reading, comrades.

In my first edition of Answers to Your Search Questions – Part 1, I answered 20 questions…as a public service. I’m at it again in Part 2. Again the idea is that people have come to my site from a web search, looking for answers. I am now going to explicitly answer them (explicitly as in specifically and openly-not the other way you were thinking about).

1. “Biofinity contacts” – Okay, I made a huge mistake by thinking that someone was out to get Biofinity, and I’ve never been able to live it down. It’s by far the most hit blog entry on my site. Big egg on my face. I should take the post down, but I hear that’s bad form, so I just made another post retracting my error. Please, let’s just put all this behind us. It’s not like I forgot to pay $130K in taxes or something (oh, wait, that’s rewarded in this country).
2. “optometrist blog” and “optometry blog” – Nothing to say here. I don’t even have one snarky comment.
3. “can you get rich working as a walmart optometrist” – No, but to be fair, you can’t get rich being any kind of optometrist.
4. “getting around vsp at walmart” – I find it hard to believe an optometrist would want to be this unethical; however, you could try getting paneled to VSP at a private practice. Then advise VSP that you need to update the practice location address (to your Walmart location but you don’t say that). Eventually they will discover your deceit when they figure out that you aren’t selling any eyewear, but at least you stuck it to them for a little while. You should also do the same for EyeMed. Then you should go rob a bank and kidnap someone for ransom.
5. “2008 better than oasys contact lenses biofinity” – I would say that in the year 2008 Acuvue Oasys sold more pairs than Biofinity, so you could make an argument that it’s better. On the other hand, Biofinity just came out with 1 week extended wear and it’s a one month lens whereas in the U.S., Oasys is a two week lens, so Biofinity comes out on top for cost-effectiveness. I would say try them both and see what you think. Ask your eye doctor if extended wear is right for your eyes in these lenses.
6. “http://health.groups.yahoo.com/group/optometrysucks/message/1424” – This isn’t a web search but it does show that someone in that Yahoo group linked to me. I’ve said before that I don’t condone this group, or rather, it’s name. Optometry definitely doesn’t suck. If you aren’t in it, be aware of it’s problems before getting in so that we have less whiners.
7. “acuvue oasys vs biofinity” – I normally wear Ciba Night and Day, but I’ve tried both of these. I’ve even done Biofinity on extended wear. I like it. Anyway, see above. Ask your eye doctor if extended wear is right for your eyes and contact lens material.
8. “officemate eyecare software crack” – You know, the yearly fee to keep Officemate up and running is around $1200. I’m sure you could pay some kid less than that to come up with a crack. But then, why stop there? I hear robbing banks and kidnapping for ransom will also help you have more money to spend.
9. “s codes in optometry and dilation fees” – The last billing expert I heard said that you can’t charge extra for dilation. S codes are awesome. I use them all the time.
10. “how to make the most out of being optometrist” – Start a blog for your personal therapy. Make sure you get plenty of time away from work. When you get sick and tired of explaining presbyopia or saying “which is better,” then try to imagine what you will be doing after work. You’ll say the same things over and over again so much that you could say them on autopilot, leaving you to think about other stuff, like your next blog entry.
11. “optometrist wedding favors” – Okay, that’s just weird. Can’t you let them be just a person on their wedding day? Why do you have to remind them of work?
12. “bad things about being an optometrist” – I think there is a Yahoo groups site about this.
13. “what do eye doctors think of their jobs” – I can’t speak for everybody, but I like it. There are much worse jobs.
14. “optometrist lifestyle” – We run around in private planes, eat caviar, and schmooze with celebrities and politicians. When we’re not doing that, we’re working in a dark room, saying the same things over and over.

Okay, that will do. As I collect more data, I’ll be sure to respond in future editions.

You may not realize it, but I know the web page you visited just before coming to my site. So for example, if you went to Google and did a search for “optometry blog,” I see in my logs that you just came from the site “http://www.google.com/search?hl=en&fkt=1859&fsdt=5568&q=optometry+blog&btnG=Google+Search”
(By the way, I’m number one on the list today. You could be if you bothered to blog.)

It’s really interesting to see what search terms get people to my site. I think it would be even more interesting to analyze and respond to questions implied by people’s search keywords. As a public service, I will now respond to actual search terms and attempt to answer any implied questions. Seriously, I am not making these up. It is not a comprehensive list, but these particular ones make good blogging fodder.

1. “career switch from optometry” – I hear ya’, brother, but do you really want to throw away four extra years of school and over $150K? Is optometry really that bad?
2. “do optometrists make lots of money?” – Yes, they put a question mark in their search. No, we don’t is the short answer, but more on specifics down the list.
3. “why become an optometrist” – Only because you love it, but that begs the question: How do you know if you would love it unless you already became an optometrist?
4. “easiest optometry school to get into” – Okay, first of all, this person hopefully won’t get into optometry school, but I think it’s safe to say that the answer to the quesiton is Pacific University because, hey, they took me. (That was a joke.)
5. “walmart optometrist average salaries” – There are only a few optometrists in the country actually employed by Walmart. In many states that scenario is illegal (stupid government interference.) Walmart optometrists working on a contracted lease only make what they get from exam fees, so it’s not a salary because you aren’t guaranteed an income. The Optometric Business Academy publishes a yearly survey of Walmart and Sam’s Club affiliated optometrists and the median gross fee income is: $161K for 2007 and $167,473 for 2008. Keep in mind your net will be at least 20% less.
6. “optometry debt” – I don’t have any statistics, but most of my class was around $100-150K and that was 2003. Now a days it’s becoming debatable whether the loan debt is worth your potential income. The actual numbers for indebtedness for 2005 averaged for all schools is $125685 (from ASCO under data and surveys).
7. “AOA optometry dues too high” – Yes, I agree. Next question.
8. “average number of new patients seen for start up optometric practice” – Um, try zero.
9. “how to become an optometrist” – First, get good grades in high school. Then get good grades at college (state universities are just fine). Schmooze influential faculty members your first two years of college to get a good recommendation letter for your optometry school application. Take the OAT and get a good score. Then apply for optometry school your third year of college. Get an interview and do really well. Get accepted to optometry school. Take out $150K in student loans. Get good grades in optometry school. Take the NBEO and pass all sections. Graduate. Get a state license when your NBEO passing scores are released. Do temp work from May to July of your graduation year (I made frozen dinners). Start practicing around July of your graduation year. Wow, you know, for all the same work you could have entered a career field that pays better or entered a field that pays just as much but requires less time and loan money.
10. “what should you know about optometry” – well, for starters see the previous question. You should also know that you are paid according to how many exams you do. You can only do so many exams, and people will only be willing to pay so much for an exam, so already you are limiting yourself. If you want to make some real money you need to consider a career field that allows you to sell an infinite amount of widgets to anyone, anywhere in the world.
11. “How to make optometrist buy from you.” – As I’ve said before, that shouldn’t be too hard. He or she chose to became an optometrist so they are easier to fool.
12. “what pays better, a pharmacist or optometrist” – They pay the same, but the pharmacist doesn’t have $150K in student loan debt. People point out that pharmacists have to work late hours and weekends, but optometry is quickly heading in that direction.
13. “when did eye exams become so expensive?” – Ever since the optometrist hired a practice consultant. (Again, what is the deal with putting a question mark in a web search?)
14. “optometry school worth it” – Only if you want to be an optometrist. A better question would be which optometry school makes it the most worth it.
15. “how much school does an optomitrist have” – Bad spelling aside, the short answer is eight years post high school.
16. “laws against 1800 contacts” – Yah, there should be a law that says someone else can’t take my business away from me without my permission. The government needs to fix all my problems. Where’s my binky?
17. “are prompt pay discounts for medical exams legal” – The previous billing expert I listened to said yes. The one before him said up to a reasonable amount like 10%. The true answer should be I should be able to charge whatever I want to whoever I want, but thanks to the government and insurance contracts that is not possible.
18. “what to take in high school to become an optometrist?” – Take whatever the heck you want. Who cares about high school? College is the new high school. By the way, why take the extra effort to type in a question mark in a search box?
19. “what retinoscope looks like” – Shh! It’s a secret.
20. “optometrist jokes” – I would refer you to some excellent, witty cartoons sketched on a mouse pad by a charming optometrist.

Well, that concludes the first edition of Answers to Your Search Questions. I’ll release more later, so stay tuned.

Every year the great folks at Mount Ogden Eye Center throw a shindig for all the optometrists within their market area. They schmooze us with a fancy, delicious lunch at Sherwood Hills Resort and then treat us to a free round of 9-hole golf (with cart).

Of course they learned us stuff during the lunch (something about multi-focal IOLs and Intralase, I recon), but with the golf, they have prizes for the longest drive on one hole and the closest to the pin on the par-3 hole.

And guess who got the prize for the closest to the pin! Yep, me. And I have three witnesses. So I got a prize for free stuff at the club house.

Of course, don’t ask me about my 3-put on that hole, and also don’t ask me about my sixty-something score for nine holes, either.

Anyway, I highly recommend that all the optometrists in northern Utah attend next year.

Any readers of this blog entry entitled “The Perks of an Optometry Career” need to read my “Do Not Become an Optometrist” entry or my “Should YOU Open a Private Practice?” entry.

How does the perk of working every Saturday sound? How do you like getting home many nights at 8:00 PM, (just in time to tuck your kids into bed)?

Unless an optometrist is employed by a big chain or there is some extreme emergency, hours are generally restricted to Monday through Friday with no on-call duty needed.

That’s not true in today’s market. Only government workers get Saturdays off now. More and more private practices offer extended hours and Saturday hours to stay competitive in today’s market. People don’t take time off work anymore just for routine eyecare (but of course they’ll do it for the dentist, but not you…a lowly optometrist).

Oh, and other doctors don’t have to worry about their scope of practice being legislated away.

And how do you like having a cap on potential income? You can only see so many patients a day. Get rich selling an unlimited number of widgets that everyone wants. Only become an optometrist because you love it…but, that begs the question how do you find out that you love optometry without going to expensive optometry school? By the way, when I went to optometry school (PUCO 2003), it cost about $22,000 per year for tuition, including fourth year when you’re not even at school because you are on preceptorship. Last I heard it’s up to $27,000 per year.

So my question is, at what price point does optometry school become unfeasible?

There was an interesting article written at the AmateurEconomist.com about “Why Doctors Are Not Good Businessmen.”

Hat tip to Kevin, M.D. who commented on this story and said,

“This is why the private practice model of medicine is dying. More practices are being bought by hospitals where the physicians are salaried. This relieves the burden of administrative tasks and supervising ancillary staff, so that the doctor can focus on medicine.”

Rob at VSP says that “[private practice doctors] provide the best care.” Well, if I’ve got the weight of a business on my shoulders, doesn’t that detract from patient care? Additionally, in our field where the private practice doctors sell what they prescribe, can you totally rule out any conflicts of interest which potentially detract from patient care?

Again, independent doctors of optometry in a Wal-Mart setting don’t have the conflict of interest and their administrative duties are much less than private practice.

What’s funny to me is that every CE event I’ve been to always has some talk about why optometrists should start the “medical model” in their practice and watch the money role in. Well, how is adding more third party payers going to help you make more money? Primary care medicine is dying according to Kevin M.D., and yet the roboconsultants are telling us to join more insurance panels. I think getting rid of insurance companies in your practice is the way of the future.

The roboconsultant woos you buy saying that for one case of dry eye you can milk an insurance company for $500-$800 in office visits and procedures. Well, do you do that for every dry eye patient, even the poor self pay patient or the patient with insurance but poor benefits? I would think that doing it just for those with good insurance would be unethical as well as probably insurance fraud.

I think the more your appointment book is filled up, the more you should be able to charge for your services. It’s the old supply and demand of free economics. I think a better system would be for patients to have to front the money to pay the doctor for office visits at the time of service. The patient would have to get reimbursed what they can from their insurance company. Maybe then insurance companies would be forced to have a faster turn around time on processing claims for their patients and be watched more closely for just rubber stamping a denial based on some frivolous billing exercise (or at the least the patient has to worry about it instead of me.) I simply provide the best care for the patient, recommending only the products and services that they need, since now I don’t have to worry about getting paid.

Since starting my practice inside a Wal-Mart Vision Center, I’ve kept track on a spreadsheet the daily gross and the number of exams. I also track a few other items like glasses vs. contacts vs. medical visits, DNKAs, follow-ups, walk ins, and appointments scheduled.

I thought it might be nice to share with you all a pattern I’ve noticed about which days are better to work than others, listed best to worst.

2008 so far (January to April I worked Mon 10-7, Wed 10-7, Friday 10-7, and Saturday 9-5, and May to present I worked 5 days a week, Tues 9-6, Wed 10-7, Thursday 10-7, Friday 9-5, Sat 9-3):

1. Tuesday
2. Wednesday
3. Saturday
4. Monday
5. Friday
6. Thursday

2007 from April to December I worked four days a week (Monday 10-7, Wednesday 10-7, Friday 10-7, and Saturday 9-5):

1. Wednesday
2. Monday
3. Friday
4. Saturday

In 2007 Mon, Fri, and Saturday were almost identicle in revenue earnings, but Wednesday gross averaged $98 more than the other days. In 2008 so far Tuesday and Wednesday (TuW) are close and so are Saturday and Monday (SaM). TuW gross averages $71 more than SaM, and SaM averages $79 more than Thursday.

In 2007 my private practice appointment book would fill up fast on Tuesdays and not so much on Thursdays. At the Wal-Mart, they told me I’d missed quite a few walk-in opportunities on Tuesdays, but not many on Thursdays.

Anyway, my take home message is this:

• I advise O.D.s looking for fill-in work to stay away from Thursdays and Fridays and try to get in on the action for Tuesday and Wednesday. (Conversely, if you are an optometrist looking to hire fill-in work, then switch what I just said.)
• If you need to take a random day off, Thursday or Friday is a safe bet

Your mileage may vary. For instance, from what I’ve heard, everywhere else in my district (Salt Lake to Ogden area) is gangbusters on Saturdays. I think that in my Northern Utah town the people like to go play on Saturdays and not worry about having to spend time at the doctor’s office. We notice that Saturdays are better in the winter than the summer because our area has lots of good hiking, boating, and other summer fun activities nearby.

I’m a little disappointed that more eye doctors aren’t blogging yet. It has been around since ~2001, and blogging went mainstream in 2004.

To try to make it easy for an optometrist or ophthalmologist to get started blogging, I created eyedoctorblogs.com. Go on over and sign up and let’s give feedback to each other and the industry.

Be sure to read the About page and the Terms of Service.

I keep hearing this type of comment: “I don’t understand you. I’ve read your blog when you were in private practice versus now. I don’t think you know what you want out of life.”

They seem to be saying that I’m a flip flopper and must be some unhappy individual who is lost. You can’t discredit me because I’ve experienced three major forms of practice. Someone who has experienced government, private, and various flavors of commercial is not a lost soul, but rather he is an experienced voice.

I implore all students and new O.D.s to listen to my words. If you would like the security of government work and don’t mind living in remote locations, then by all means be a government optometrist. If you want to be able to live in more populated areas, than choose commercial practice over private and choose Wal-Mart over all other commercial options.

In my previous posts advocating private practice and demonizing commercial, I had been drinking the private practice cool-aid that I’d been served since optometry school. Some of the disparaging remarks against commercial hold true for many brands of opticals, but not Wal-Mart.

Private practice is too risky. Sure, you know or have at least heard about successful private practice businesses, but you can’t assume that things would go well for you if you were to hang up a shingle. The money it takes now days to start cold could be better invested in Vegas. It’s a crapshoot, heavy on the crap because the frame vendors, the lens suppliers, ophthalmic equipment companies, the financing company, the advertising people, the landlords, the employees and more all get their money from you. But when do you get paid? Paying all of those people doesn’t automatically bring patients in the door. And when will you actually get enough patients to break even? That could be never, you know. You may just have to close shop when the money dries up, like I did.

Wal-Mart makes it risk free. There will always be patients coming to your door. Your success is only limited by the number of hours you are willing to work. That’s why if you want to be rich, make and sell widgets. If you want to do eyecare, work for the government or Wal-Mart, depending on where you want to live.

Anyway, just because I’m giving advice from my experience doesn’t mean I’m somehow lost or unhappy. I have family, religion, and a great job inside a Wal-Mart Vision Center. Of course I’m happy.

Ouch. This hurts.
It makes me want to cry. 😉
But seriously, didn’t I say that optometrists have a PR problem? Sure, you could argue the cartoon itself is fun and games, but the reader comments about it are not.