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.

[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]

From the package insert for the AV Oasys. I could not find the insert for the AV2 but I think it is the same.

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.

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!

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.