optoblog.com

Over at Student Doctor Networks – Optometry Forums some undergrad started a thread about me.

Am I real? Yes. Maybe you could have read more than just one of the 340+ posts on my blog? Maybe you could have looked at the side bar and seen the link to my twitter feed and my practice website?

Do I hate optometry? Nope. I like it fine. Sure, I’d rather be a rock star, but that will have to wait for now.

Did I make a whole bunch of inflammatory blog posts? Yes. But I can’t please everybody. I like Walmart optometry more than private practice for numerous reasons, but not the least of which is I feel like less of a salesman and more like the doctor I was trained to be. I think you can get that in other settings too, but I don’t want to work for the government anymore. I’m not academic enough to be a professor, and I don’t want to be an OMD’s “super-tech.”

In private practice, everyone else got paid…except me. The frame reps, the contact lens distributors, and labs, the staff, the landlord, , the bank, the equipment vendors…they all get their money up front or first thing. You, the doctor, get paid last…if at all. Risky.

if you like taking risks, then why not take a better bet in a different profession selling or manufacturing widgets with less restriction on maximum possible income?

Undergrad, if you really want to be a private practice optometrist, go ahead. I won’t stop you. I would ask you why you would gamble so much when you could practice in a setting with MUCH less risk. It does work out well for lots of O.D.’s, but that doesn’t mean it will work well for you.

By the way, I don’t think pointing these things out should be labeled “negative.” It’s reality. There are pluses and minuses to every profession. Undergrad, I don’t want to sugarcoat your potential career choice. I once thought I was going to be an architect because I wanted to design houses. I actually talked with an architect and found out very few architects design houses because most people buy their plan from a catalog. Most architects design banks and rest-stop bathrooms and other utilitarian buildings. That’s not what I would be happy with, so I switched majors. I’m thankful that architect shot straight. If you don’t believe me, then I hope you talk with an optometrist that you can trust who will also shoot straight.

Now, knowing more of the risks and potential negatives, if you still want to be an optometrist, then at least you’re not going into this blind. You won’t be able to say, “Why didn’t anyone tell me it would be this way?”

Anyway, I’ve spoken enough about this subject. I need to get back to writing/selling the next great screenplay so I can have a retirement.

I’m instituting a new feature: Hate Comments. You know, the comments that don’t get published because they fail my unapologetically arbitrary moderation process.

It turns out there could be gems of literary wisdom for the ages in some of these unpublished comments. Let’s read the nuggets and gems just pouring out of this deleted comment:

Author : Johnny (IP: 66.142.***.*** , adsl-66-142-***-***.dsl.crchtx.swbell.net)
E-mail : forgetyou19@hotmail.com
URL :
Comment:
first of all, David Langford is a sore loser in optometric field…..”happily rents a place in Wal-Mart” ????……after 8 years of school (maybe more for you, who knows), and works “happily” in the cubicle of Wal-Mart ??!!!…you’re embrassing !!!!……having opticians watching your every move and determining your working hour ??!!!….take title OD off of your last name Langford….biggest loser like you don’t deserve it…..if you can’t encourage people into OD career, then don’t lead them to your sorry ending ways.

Wow. First, I didn’t lose in the optometric field. It was private practice. And if a bright, nice guy like me can fail in opening cold, you young pups coming out of optometry school could also. It should give you pause because while I don’t think I’m any better than you, why would you assume you are better than me? Your O.D. degree doesn’t guarantee anything. And that loss was just a single battle in my life. I’m winning everywhere else (family, church, hobbies, current job, etc), so I don’t think you can fairly call me a loser.

Second, Johnny, look in your local phone book and see how many commercial vs. private practice optometrists there are. Your comments are disparaging almost 1/3 of the optometrists in the nation. Your use of cubicle is interesting because almost 99% of all optometrists work in a room about 11’x13′ (and in the dark half the time). You don’t even know that I set my own hours. What’s embarrassing is your spelling of the word embarrassing.

Let me address who I think Johnny is. His IP address from Southwestern Bell indicates he’s probably in the states of Arkansas, Kansas, Missouri, Oklahoma, or Texas. So, it’s possible that he could be an optometry student in Houston, Tahlequah, or St. Louis. Judging by the maturity and knowledge revealed by his writings, I would guess that it’s more likely he’s an undergrad, possibly high school student, planning on becoming a private practice optometrist.

Johnny, I would say that you should go for it. Go big or go home. I’m sure you can do it, Johnny, because I have faith in your ability to communicate and win friends and influence people.

To the rest of you undergrads that are asking yourself, “Should I be an optometrist?” Let me ask you some questions:

1. Do you like sitting in the dark half the day?
2. Do you like explaining the same thing over and over and over again to everyone you meet?
3. Do you like to wear slacks and collared shirts all day, everyday?
4. Do you like to work Saturdays? (More and more private practices are now in addition to commercial.)
5. Do you want to pay more in school loans than it’s worth to be in said profession?
6. Do you have a favorite town you want to settle in? Because I’ll bet it’s already saturated with eye doctors.
7. Do you like having shortened lunch time because the last patient went long?
8. Do you like getting scowled at whenever you run a few minutes behind?
9. Do you like knowing you could be sued and maybe your career over if you mess up even once? (Not that you will, but it’s possible.)
10. Do you like to whine at ODwire.org? (But seriously, check out this link for more considerations in choosing optometry as a career.)

For those of you eye doctors who are out there, on your own, man or woman against the world (i.e. Private Practice), you may get some assistance from this website:  theopticalvisionsite.com

It appears to have lots of useful information regarding running your practice and other stuff they never get around to in optometry school.  You may want to bookmark it or subscribe to their site feed.

According to Al Cleinman, VSP is hurting the very private practice doctors that it purports to help.

How ironic. Al has a whole bunch of posts about VSP. I would have to say that the only people VSP is trying to help are the execs at VSP. Of course they don’t care about the doctors. When they feed you the line that they are there to help traditional private practice doctors, it’s simply a marketing gimmick. And of course they don’t care about the patients either, otherwise they’d let them have freedom of choice to see any doctor they want, including a [gasp] Wal-Mart doctor.

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?

So Rob’s Blog has this to say to people about getting yearly diabetic eye exams. As if optometrists in a commercial setting don’t do the same thing, he tells a big lie here:

…these [private practice] doctors consistently have the longest relationships with their patients and provide the best care.

Rob, people aren’t buying what you’re selling anymore. I see VSP beneficiaries out of network all the time in my Wal-Mart setting. I guess they aren’t loyal to a practice setting, but rather they factor in price and convenience while assuming, correctly, that any doctor they see in my area is competent.

Oh, and I remember when Intel in the Hillsboro/Beaverton, Oregon area was buying your VSP, and then they switched to EyeMed. Does that mean they thought your private practice network of doctors couldn’t “provide the best care?”

But I see what he’s trying to do. Any roboconsultant will tell you that you need to differentiate yourself from the competition; however, I take exception when he lies.

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.

Brian Rowley was in the class above me in optometry school, and I just saw him at the UOA Meeting. It seems he is in the newspaper as a karmic baseball fan.

He also was interviewed for KSL TV, and they showed it on SportsBeat Sunday which you can view completely here on their SportsBeat iCast. On Saturday they showed this teaser:

I’d say that’s a pretty good practice builder for an up and coming optometrist. At the Park City meeting, he told me that his practice will soon need a new building with more exam lanes. Dr. Rowley had to work commercial optometry for a while before taking over his current thriving practice. So you see, optometry students, it is possible to make a successful solo private practice…if you are willing to roll the dice, take the gamble, spin the wheel, bet the farm, etc.

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.