Jan 2nd, 2008
Should YOU Open a Private Practice?
People open or buy private practice optometry offices all the time, but should you? Are you the one who should be doing such a thing?
My advice is that if you feel the urge to start a private practice optometry services and optical business, then you should probably see a qualified psychologist. No seriously, chances are something is wrong with you- at the very least delusions of grandeur.
IF it turns out that you don’t have a diagnosable mental condition, then you should read this article by the president of Matsco, a financing company that helps idiots like you start a private practice optometry office. Then ask yourself if you’ve got what it takes- what this article says it will take.
Then if you think you have what it takes, then you must be mental. You’ve probably never done anything other than go to school. Have you ever even owned your own independent business before? I would say if you have a proven track record of business experience and the attributes talked about by Allison Farey, then proceed with caution in your crazy idea.
But first answer this: if you actually have experience running a successful business, why wouldn’t you keep doing that? You can sell millions of widgets but you can only see a limited number of patients each day. (Patients who either faint or become incensed when they hear how much your private practice charges for an exam.)
Some practice consultants out there may feed you with all sorts of garbage along the lines of “if you build it, they will come” and “you simply charge $120 for a $500 quality exam,” and other feel-good sayings combined with 20-year-old tactics and strategies (as they rob you blind with their exorbitant fees). Stay away from them. If you are an undergrad reading this, do yourself a favor and become a pharmacist. If you are already in optometry school, then seek employment in a respectable setting like government work. If you prefer the private sector, then seek out a good HMO or decent chains like Wal-Mart, Shopko, and LensCrafters.
Private practice optometry is dead. Or it’s at least vestigial, kind of like your appendix. It’s probably good for something, but no one knows what. Even though some scientists claim to know what it’s good for, no one cares-except when they excise it for giving them some trouble.
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That’s definitely an interesting take. Starting a business is HARD HARD HARD. Although, at least in the Bay Area, things like Yelp! are making it a lot easier to get new patients. I’ve talked to many who started their own practice and get tons of new patient traffic from it.
Wal-Mart - a “decent” chain? Are you kidding me?
No, I’m not kidding.
Mr. Langford,
Are you speaking from personal experience? Are you a private practice optometrist?
That’s DOCTOR Langford to you, pal.
And take your time while browsing my site, and I’m sure you’ll figure out the answer to your questions, but just for you I’ll type extra slow in my future posts.
Well DOCTOR Langford,
That is a very unprofessional response to two very simple questions. Any particular reason why you are so defensive and feel that you have to insult me?
Anyone with half a brain tied behind their back could pay enough attention to the rest of the content on this site, including the “About this Site” page, and have the answer to your questions.
But since you seem especially lackluster, here are the answers (typed very slowly):
I do speak from experience, and one of my jobs is solo private practice.
And who’s defensive? I’m on offense, BDG. Or maybe I’ve been reading too much Ann Coulter…
But maybe I could have responded to your question differently. Here’s my top five:
5. Um…[crickets chirping in background]…next question, please.
4. [Roll eyes and ignore dumb questions]
3. Let’s see. Do you have a tendency to leap before you look in other facets of your life or just in my blog?
2. Let me guess. You have never read a single other post on my blog except this one, and yet you decide to enter the conversation in this way. That’s great, dude.
1. Excuse me, but are you going to waste everyone else’s time by asking the wrong questions instead of contributing to the topic at hand?
If you want professional and courteous, then bring something to the table (like a response to the topic at hand) and extend to the rest of us the courtesy of an identity. Anonymous inquisitors deserve to be riled. It’s not like anyone knows that YOU are the perpetrator of asking a question so obvious that if this were op school, we’d all be turning to our friend next to us and making that not-this-idiot-again-with-the-stupid-questions look.
I can’t have possibly hurt your pride, since you are entirely anonymous. You don’t exist. So stay anonymous and no one gets their feelings hurt.
David:
I have not checked you blog in a while because I have been too busy working my private practice and trying to make a positive impact on our profession.
Private practice optometry is not dead.
Wal-Mart is not a decent chain.
Don’t be so hard on anonymous posters, makes you look bad.
Mike
It’s Dr. Acuvue-is-a-one-month-lens. Hello again.
Look, I would love to read a blog about how all the new grads should go out and start a private practice because they will make so much money they won’t even have to think about declaring bankruptcy. Then it would be fun to read about how Wal-Mart doctors kill patients every year because they’re such bad doctors for working there.
But those two topics are not written because it’s just not true. The only thriving optometric practices are established ones. If the new guy has no hope of breaking even within a couple years, why would anyone in their right mind try it?
I predict that financing companies will soon stop loaning money to cold-start practices. Soon, the only start-ups that they can feasibly finance will be for those doctors who currently work commercial practice nearby and could potentially draw a large portion of those patients to the new start-up.
So when there aren’t any more cold starts- just running starts, that will be a nail in the coffin of private practice.
Life is pain for private practice optometrists, and any one who tells you different is a frame rep or a practice consultant handing you a tall glass of Flavor-aid.
“Life is pain for private practice optometrists, and any one who tells you different is a frame rep or a practice consultant handing you a tall glass of Flavor-aid.”
I don’t disagree with that quote. I am sure you wish you realized that before you drank the glass of Flavor-aid and asked for more.
Don’t blame others or an industry for your bad decisions.
Last I checked, the OD who opened cold in the Wellsville, South Cache area about 5 years ago is doing just fine.
Private practice is not dead if done right. The schools need to do a better job with educating new grads on practice managment. They need to bring in real OD’s not ivory tower types or practice managment consultants. Anyone thinking of opening a new practice needs to know the community and marketplace, talk to business leaders, other OD’s, and tap into all the small business resources there are.
I could go on but I won’t. I want to remain positive. I wish you and your family all the best and I hope that you come to love the profession of optometry.
Mike
PS I still like AV for a month, I guess I didn’t drink the Flavor-aid from the rep.
Keep an AV Lens for a month? Did someone miss that day in class?
So even if the patient is NOT showing signs of ocular problems that you can see with your slit lamp (e.g. neovascularization, etc), it doesn’t matter. The AV is a two-week replacement lens, per the FDA and the manufacturer.
Can we safely assume you’re NOT examining the lens surface with an electron microscope to rule out surface damage to the lens? Uh, you don’t? Did you know the manufacturer does so, when applying for FDA approval? No, you didn’t know that? Do you do all the other tests required by the FDA to obtain approval for a certain modality of wear? You didn’t, and didn’t even know they existed? Hmmmm…
Bottom line: you’re leaving yourself vulnerable to a lawsuit if the patient SHOULD develop problems in the future that MAY be associated with not recommending lens replacement at the FDA-approved interval, even IF the problem WASN’T directly caused by their failure to replace lenses. It’s prima facie evidence of failure to practice to standard of care….
For example, patient experiences a central axis corneal ulcer at the 3rd week (heck, even at the first week), and learns the FDA recommends 2-week replacement. The doctor is screwed, and left standing defenseless, as violating FDA’s standards for which the manufacturer seeked FDA approval means you’re prescribing off-label, i.e. experimental use.
If there’s one thing you NEVER want a jury to hear, it’s the suggestion that you’re EXPERIMENTING on your patients!
Lawyers for the plaintiff LOVE it when doctors do that; it’s the equivalent of admitting guilt, and makes for an open-and-closed air-tight case. Better pony up to settle out of court, as there’s no defense. FWIW, it also means your malpractice carrier will no doubt drop your coverage in the future, as prescribing off-label is a violation of most policies. If you get dropped, you’d find it impossible to obtain liability coverage in the future, and that means an end to your career.
Sure, the odds of this happening are very low, but is it worth it to jeopardize your career, just to be Mr. “Nice Guy Who Tells People They Don’t Have to Replace Lenses”? Good luck with THAT!
Hey Dr. Dave. The whole AV dispute is from another post.
I agree with you that it should be a two week lens, but not based principally on avoiding a lawsuit.
I don’t think you could claim it’s malpractice since a huge amount of doctors tell their patients one month instead of two weeks. If enough doctors do that, the defense could probably site that it’s a standard of care or at least an acceptable off label use.
Again, I don’t agree with it. Still, I could see the argument that if neo or some other complication arises and you don’t change the regimen to 2 weeks and/or switch to a high O2 lens, then you would be setting yourself up for trouble.
I thought this was a thread about private practice?
If you still want to talk about the AV replacement, go to the thread from last year as the other person suggested. I think I referenced the literature that comes with the AV product and approved by the FDA. It said wearing and disposal should be determined by your eyecare professional. Since I am an eyecare professional, I determine the schedule. Some I recommend 2 week disposal, some shorter, some longer. The point is, I don’t blindly follow what the AV Rep tells me. I use my professional judgment. If the FDA has said “AV is not to be worn longer than two weeks” please let me know where to find it. I can’t see it in the insert that comes with the product.
“The Eye Care Professional should determine the wearing and replacement
schedule, based upon the patient’s history and their ocular examination, as
well as the practitioner’s experience and clinical judgment.”
From the package insert for the AV Oasys. I could not find the insert for the AV2 but I think it is the same.
That’s a very good point, Mike. But my clinical experience has been that a clear majority of patients wearing AV2 for one month develop k-neo, so I make a point to prescribe it for just 2 weeks.
I don’t feel that I’m blindly following a rep by doing so. Most patients when I tell them about their k-neo are somewhat distraught. Their first question is, “Will it go away?”
On new patients, I recommend 2 week replacement since I want to try avoiding that conversation in the future.
Check out http://www.ODwire.org if you want to bad mouth private practice, that’s the place to go. Look forward to seeing you there d[*****]bag.
[Editor's note: So if I want to say anything negative about private practice, I can't do it on my own blog?
And I think my previous postings have shown my contempt for the secretive discussion at odwire.
Oh, and I almost forgot, I didn't know optometrists had the word d[*****]bag in their vocabulary. I’ll bet this commenter is really a frame rep. By the way, the above commenter’s IP address information is:
71.172.189.28
IP Location: United States New York Verizon Internet Services Inc
Resolve Host: pool-71-172-189-28.nwrknj.east.verizon.net]
Dave,
How about building your practice at Wal-Mart, saving up a bunch of money, and then in 5-10 years opening up right across the street from them and take all your patients with you.
That’s the wave of the future in optometry. Use the commercial locations for awhile. Then when you are financially in a position to do so (and sick of working in a blue smock) take all your patients to your new, state of the art ,private location that will allow you more freedom.
Alot of us have had bumpy starts in this business. Get yourself back on your feet with WM and then consider private practice again. You really don’t want to be involved with a company that is in bed with 1-800-contacts for the rest of your career.
Good luck.
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