Optometry as a Career Choice

[Jeremy Ernstes]

I've heard the stories about America's Best and the other corporate beasts..... I suppose Visionworks is the same? Anyone know anything about them? I'm a luxottica "bobble head" now, just wondering if the grass was any greener at the other box store.

[Joe DiGiorgio, O.D.]

Steve,

You are a guy with a lot of experience, and seem to have a good perspective on the eyecare marketplace.

How could you see private O.D.s with decent practices, being able to make an effective opportunity for new grads, so that the grads would actually find this as an attractive option? Most O.D.s probably don't have the business savvy to do this effectively, yet they could have great single doctor practices which could be a great opportunity, perhaps initially on a part-time basis, for young docs to further develop a nice private practice opportunity.

You have said elsewhere in this topic, that some O.D.s may not be profitable no matter what occupation they had chosen to pursue. You, on the other hand, would probably be successful at whatever profession or location you were/are/will be involved with. You could probably be a great practice consultant.

So what could you, consultant Nelson, recommend for these new docs, if they want to try to get a private practice opportunity?

Sincerely,

Joe D.

[Mike Sandy]

So what could you, consultant Nelson, recommend for these new docs, if they want to try to get a private practice opportunity?

Great question. What Would Private Practice Steve Do?

[Steven Nelson]

Steve,

You are a guy with a lot of experience, and seem to have a good perspective on the eyecare marketplace.

How could you see private O.D.s with decent practices, being able to make an effective opportunity for new grads, so that the grads would actually find this as an attractive option? Most O.D.s probably don't have the business savvy to do this effectively, yet they could have great single doctor practices which could be a great opportunity, perhaps initially on a part-time basis, for young docs to further develop a nice private practice opportunity.

You have said elsewhere in this topic, that some O.D.s may not be profitable no matter what occupation they had chosen to pursue. You, on the other hand, would probably be successful at whatever profession or location you were/are/will be involved with. You could probably be a great practice consultant.

So what could you, consultant Nelson, recommend for these new docs, if they want to try to get a private practice opportunity?

Sincerely,

Joe D.

My ego thanks you and wishes it could say that it's owner didn't learn these lessons by screwing it up the first time.

In all seriousness, I think the biggest problem with ODs in general is that they don't really do their homework in terms of where to practice and a lot of things fall down from there. In order to be able to provide a competitive opportunity, you need to be in a practice that is growing beyond your ability to sustain alone. Many ODs try to expand in an effort to grow their practice, but that's sort of the backward approach. New people don't grow a practice and in most cases initially they merely take the heat off of the "main guy" so that they can continue to grow the practice by seeing and wowing those new patients with the same formula that built it to begin with. When you don't have that growth curve, you can't really offer a salary that can begin to compete with the other alternative.

I think that unless you're in an area with high demand, most practices would actually be best served by just one doctor and a highly trained optical staff. If I were back in private practice, I would focus largely on medical care and make sure that the word is out that my optical staff is unparalleled. I would also focus on more specialty services like specialty contacts etc. You need to be able to serve the masses, but really ANYONE can do that and it's hard to carve out a niche in "ordinary". A big boost to being able to absorb a future partner is having a high net per patient...I don't mean sticking it to anyone, but a little bit of fundus photo here, a little ortho-K there, a few keratoconus fits and you're doing something DIFFERENT.

You also need to decide up front what you're looking for. Do you want an employee or do you want a partner? I think that if someone is "buying in" to a practice, that's justification for a lower salary but what a lot of docs do is start off with that low salary to see how it goes and they string people along with unfulfilled promises. You might be able to get a really good OD for $40K, but there are only so many Scott Caughells to go around. I guess the best advice for a private OD is to make sure they're in an area that can support growth and aggressively grow it and be willing to pay someone what they're worth...either in terms of dollars or practice equity.

To be honest, I think that most practices that think they need to expand simply suffer from intractible inefficiency. A change to EMR, better tech usage and/or a second lane of equipment would actually do a hell of a lot more to grow a practice than a second doctor.

Just my two cents.

[Joe DiGiorgio, O.D.]

Good reply Steve. "Lessons a big box doc learned at the school of hard knocks" A good title for for a practice management lecture, and perhaps the segway to a consulting practice.

Excellent point that the practice should services, staff, efficiency and excellence in service.

So if this doc has a great one-doctor practice, how could the savvy new-grad sell him/her self that he or she could add value to the senior doc, maybe at the 2 or 3 day per week level? And then possibly working in a 2nd practice, or OMD location for the balance of the week.

Do you think this could be an opportunity for young docs to incubate the practice management experience and entrepreneurial spirit, so that the exceptional young doc can become an owner either in the current practice, or eventually at another location? ( I am not advocating to cannibalize patients from the primary location--do no harm, and burn no bridges)?

"Nelson Consulting" that concept may have legs.

Sincerely,

Joe D.

[Steven Nelson]

If I were a new grad (oh...to know what I do now), I would try to find a practice that doesn't do what I have an interest in. If you're really into path, I would pitch to practices that either have a path volume that the current doctors have a hard time servicing OR EVEN BETTER pitch to a practice that's largely refractive so that you're bringing something to the table they currently DON'T do. If the latter is the case (really the best case scenario IMHO), make sure you know all aspects including demographic info for the area, how to bill, etc (it also wouldn't hurt to have the insurance credentialing process started before you go so that you can present yourself as truly being ready to go).

You really don't want to bring homework for the people you're trying to convince to hire you, so you really need to be able to present a "business plan" that shows real growth (I don't really mean "numbers" of patients as much as I do types and revenue generation as a result) as a direct result of you. The thing is that you really need to present yourself as an asset they would miss. If you're trying to just fit in with the norm, welcome to Ordinaryville population virtually everyone.

I would also like to take this opportunity to give advice to students that might read this...LEARN SOMETHING UNIQUE. One thing it took 10yrs of practice to learn is that there is a HUGE market in specialty contact fittings. What's better is that there's no competition from ophthalmology and no legislative restriction. Our main job and the main expectation from the public is to make them see. Yes, path is sexy but you'll never be the "main guy" unless you get absorbed into a mega practice and the future is in Optometry (medical care is an important aspect, but there's LOTS more to optometry than disease). There is almost no competition anywhere in areas like low vision, specialty fittings, binocular vision etc.

Let's say you CAN bring in a totally different population of patients, THAT'S a marketable aspect. Especially if you're bringing in things like $300 contact fittings and potential referrals from PCPs that don't currently consider it and even OMDs in certain cases.

Man, these posts really make it sound like I know what I'm doing.

[Jorge F PerezVelasco]

Great job Paul. Optometry is a good profession but I think Paul has highlighted the main problem with it being the difference between perception and reality. As long as you go in knowing what to expect then it is fine. Even corporate practice is fantastic if you know what to expect.

We are taught by practice management experts that as OD we should under promise and over deliver to our patients. Optometry as a profession does not do this but rather does the reverse. Optometry is not as glamorous, as lucrative or gives you as much independent and freedom as advertised. But then again it is all relative.

Unfortunately, most OD don't know what they have gotten themselves into until it is too late. The field is a major commitment in time, effort and money. Not something easily started nor easily dropped.

[Steve Howard]

I guess we can add your name to the list of folks that think this is exclusive to corporate practice. Let me take that illusion away with the following:

hoosiereyedoctor.com

Any doctor can make their practice anything they choose and I see plenty of private practices advertising "eye exam and 2 pairs of specs for $99". For that matter, in the State of Texas a corporation can't affiliate with an OD in any fashion so any implication or advertisement like that would be illegal.

I could have gone to medical school as well and went with my OD acceptance letter instead and I don't regret the decision one bit. This can be a frustrating profession, but it can also be a tremendously rewarding one both financially and personally. I'm a firm believer that those doctors with struggling practices would have the same problems in Medicine or Dentistry.

As for oversupply, it's a geographical problem. There isn't an oversupply, there is merely an oversaturation in certain areas. Large, metropolitan areas can only handle so many ODs yet that seems to attract us like moths to a flame. I don't support the decision to open more schools because I think they're not necessary, but our problem has nothing to do with too many ODs, it's got everything to do with the fact that they all want to live in one place. There are literally thousands of areas where there are no ODs. They might be rural areas, but there out there and this same problem exists for any business. It's simple economics.

Dr. Nelson, I respectfully disagree with the notion that there is no oversupply problem with optometry.

I agree there are certain rural areas where one could set up shop and do well but most of these are so remote and very undesirable by any healthcare practitioner. I grew up in the Texas panhandle, one of the least desirable places for new graduates unless one grew up there.

Both larger cities, Lubbock and Amarillo, are full of ODs and OMDs, and all the surrounding smaller towns with enough population are also well supplied. In comparing ODs to family docs or internists who are not in oversupply, they aren't encouraged to find some little nook and cranny location where there is room for another doc, whereas with optometry it is becoming a necessity.

Yea, here in Houston, there definitely is an oversupply. If 25% of ODs retired tomorrow, the healthcare industry wouldn't be effected at all. The OMDs in my area routinely see 70-100 patients/day.

There aren't many ODs seeing more than 40 patients/day. Many are seeing like 10 patients/day. There simply isn't enough patients seeking the help of ODs as supply would allow. With all the vision plans out there driving patients into OD practices, why don't we have individual ODs seeing 70-100 patients/day?

The answer is we have to share these patients with so many other ODs. This is an argument nobody will ever win, but I thought it would be fun to discuss.

[Paul Farkas]

New optometry colleges are opening their doors this month in Arizona, California and Texas.

[Steven Nelson]

Dr. Nelson, I respectfully disagree with the notion that there is no oversupply problem with optometry.

I agree there are certain rural areas where one could set up shop and do well but most of these are so remote and very undesirable by any healthcare practitioner. I grew up in the Texas panhandle, one of the least desirable places for new graduates unless one grew up there.

Both larger cities, Lubbock and Amarillo, are full of ODs and OMDs, and all the surrounding smaller towns with enough population are also well supplied. In comparing ODs to family docs or internists who are not in oversupply, they aren't encouraged to find some little nook and cranny location where there is room for another doc, whereas with optometry it is becoming a necessity.

Yea, here in Houston, there definitely is an oversupply. If 25% of ODs retired tomorrow, the healthcare industry wouldn't be effected at all. The OMDs in my area routinely see 70-100 patients/day.

There aren't many ODs seeing more than 40 patients/day. Many are seeing like 10 patients/day. There simply isn't enough patients seeking the help of ODs as supply would allow. With all the vision plans out there driving patients into OD practices, why don't we have individual ODs seeing 70-100 patients/day?

The answer is we have to share these patients with so many other ODs. This is an argument nobody will ever win, but I thought it would be fun to discuss.

I think we're talking semantics. Any urban area will have a saturation problem and that applies to ANY profession whether it be optometry, medicine, dentistry or even retail oriented industries. I think you have to realize that supply and demand are REAL economic principles and just recognize that if you decide to set up shop in an area where there are already too many providers of your type, you'll be begging for scraps. The way around this is to find areas in demand and you don't have to go to "undesirable" areas to do it. I would think that one of the main characteristics of undesirable would be the inability to make a living. The other way around this is to do something outside of the norm. Specialty practices are hard to build, but they're about the only way to set yourself apart from the norm.

Don't get me wrong, I do not endorse in any, way, shape or form the opening of new schools. These were opened in response to what is perceived as a demand and if you factor in those rural areas, it's probably a valid analysis. The problem is that flooding the market with new graduates won't necessarily make ODs move there. It will only serve to further burden the already overpopulated areas. It will also serve to possibly lower admission standards (and subsequently produce less than qualified providers) because I've never read any stastic that suggests that there is a significant volume of QUALIFIED applicants being denied at our current institutions which in my mind is the only valid justification for opening a new school.

[Ken Elder]

I think we're talking semantics. Any urban area will have a saturation problem and that applies to ANY profession whether it be optometry, medicine, dentistry or even retail oriented industries. I think you have to realize that supply and demand are REAL economic principles and just recognize that if you decide to set up shop in an area where there are already too many providers of your type, you'll be begging for scraps. The way around this is to find areas in demand and you don't have to go to "undesirable" areas to do it. I would think that one of the main characteristics of undesirable would be the inability to make a living. The other way around this is to do something outside of the norm. Specialty practices are hard to build, but they're about the only way to set yourself apart from the norm.

We went through this exercise a couple of years ago on these forums. I defy anyone to name any part of the country where any person can not get a routine eye exam within 2 days and within a 45 minute drive. The only place we determined that we couldn't was a tiny patch in rural southwestern New Mexico.

Every other location, north, south, east and west, no matter how remote we were able to phone providers listed in the yellow pages and get appointments within 2 days and most of the time we were offered same day appointments.

To be fair, we did not try to do this with PCPs, ophthalmologists or dentists. However, given past experiences it stands to reason that it would be unlikely that we would have the same level of success.

So again, how is that NOT a COMPLETE oversupply of providers?

[Steven Nelson]

We went through this exercise a couple of years ago on these forums. I defy anyone to name any part of the country where any person can not get a routine eye exam within 2 days and within a 45 minute drive. The only place we determined that we couldn't was a tiny patch in rural southwestern New Mexico.

Every other location, north, south, east and west, no matter how remote we were able to phone providers listed in the yellow pages and get appointments within 2 days and most of the time we were offered same day appointments.

To be fair, we did not try to do this with PCPs, ophthalmologists or dentists. However, given past experiences it stands to reason that it would be unlikely that we would have the same level of success.

So again, how is that NOT a COMPLETE oversupply of providers?

With your having been a former educator, I'm surprised at your assertion that this is any way a valid study. I'm not saying we need more ODs and I'd be happy if the rest of you retired tomorrow, but it's too often put out there that our current numbers make it not possible to make a good living in this profession and I just think that's not the case. I think we're creating a trend that it could be the case in the future, though.

[Ken Elder]

With your having been a former educator, I'm surprised at your assertion that this is any way a valid study. I'm not saying we need more ODs and I'd be happy if the rest of you retired tomorrow, but it's too often put out there that our current numbers make it not possible to make a good living in this profession and I just think that's not the case. I think we're creating a trend that it could be the case in the future, though.

Steven,

Clearly this isn't a scientific study and I never claimed it was. However, it seems to be pretty powerful anecdotal evidence considering that of all the readers on here this forum, not a single person could suggest an area of the country where a routine eye exam could not be obtained within 2 days.

We can try it again if you want....

Anyone out there know of any areas of the country where there is a backlog of demand for routine eye care?

[Sean Claffie]

I think we're talking semantics. Any urban area will have a saturation problem and that applies to ANY profession whether it be optometry, medicine, dentistry or even retail oriented industries. I think you have to realize that supply and demand are REAL economic principles and just recognize that if you decide to set up shop in an area where there are already too many providers of your type, you'll be begging for scraps. The way around this is to find areas in demand and you don't have to go to "undesirable" areas to do it. .....


....Don't get me wrong, I do not endorse in any, way, shape or form the opening of new schools. These were opened in response to what is perceived as a demand and if you factor in those rural areas, it's probably a valid analysis. The problem is that flooding the market with new graduates won't necessarily make ODs move there. It will only serve to further burden the already overpopulated areas.

If the proponents of these new schools are asserting that more optometrists are needed for the public good in certain underserved areas, can we conclude that their diligent research has actually revealed specific areas? If so, why not simply publish the studies and let the supply of optometrists shift locals to satisfy the demand? This "problem" would be solved within months, not years.

[Steven Nelson]

If the proponents of these new schools are asserting that more optometrists are needed for the public good in certain underserved areas, can we conclude that their diligent research has actually revealed specific areas? If so, why not simply publish the studies and let the supply of optometrists shift locals to satisfy the demand? This "problem" would be solved within months, not years.

I doubt they've done that much research and we all know what opening these schools has been about. I feel that they've manipulated the data to suggest there will be a shortage to get the boards of the individual institutions on board with building OD programs. I've said for a long time that the only justification for a new school would be if there is a volume of qualified applicants that are having to choose other careers because they can't be accepted at the current schools. It's my understanding that application numbers are the lowest they've been in years and when you combine that with a necessity for a new school to pay the bills it's a recipe for disaster.

I don't think we've got some disastrous oversupply problem, but I also don't think it's a great idea to CREATE one either.

[Jeremy Ernstes]

cant fill your book for the week? gonna have to take that teaching position at your local college of optometry! oh joy!.... blah! am i so cynical that i've only been out of school one year and i'm already sensing the oversupply?

[Ken Elder]

cant fill your book for the week? gonna have to take that teaching position at your local college of optometry! oh joy!.... blah! am i so cynical that i've only been out of school one year and i'm already sensing the oversupply?

So what are you doing about it?

[Steven Nelson]

cant fill your book for the week? gonna have to take that teaching position at your local college of optometry! oh joy!.... blah! am i so cynical that i've only been out of school one year and i'm already sensing the oversupply?

Not to be the smart guy in the room or anything, but have you considered moving to where there are fewer doctors?

[Jonathan Warner]

And where would that be? Along the Mexican border?

Drats! I don't speak Spanish.

[Jeremy Ernstes]

i'm in cincinnati right now, and admittedly its not too bad here. not too many ods banging on the doors trying to set up shop down the street. i hope this gives you a little chuckle too... instead of moving to where there are fewer docs, i'm trying to move to the tampa area where we seem to be a dime a dozen. nothing like having a sears, pearle, walmart and visionworks all on one corner...

[Steve Howard]

And where would that be? Along the Mexican border?

Drats! I don't speak Spanish.

Exactly. But think on the bright side, if you opened on the border you probably wouldn't have to be open on Saturday, Sunday, Easter, New Years day and evenings to scrounge for patients.

[Armaan Arain]

Great read, very insightful and exactly what I've been hearing and reading up on optometry.

After doing some searching in Illinois maps and checking registered optometrists on aoa.org, I've found a 11,000 population town with only 4 optometrists within 25 miles, they must have some nice practices. But, go out 50 miles from that town and the number jumps out to 20. Granted that some of those 20 that came up are from the semi-large suburbs near the town.