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So ever since I announced my new direction on this blog, my readership has increased tremendously. Now, I don’t have advertising on my blog, and I didn’t do it as a publicity stunt, but nevertheless, what happened happened.

All you commenters who want to dissuade me, you can’t. You should probably start your own blog at wordpress.com called ILoveSoloPrivatePracticeAndSoShouldEveryoneElseAndIHateYouIfYouDisagree. That way you can counteract the “faulty reasoning” and “manufactured reality” that I’m feeding the uniformed optometry students because I’m “jaded” and “so opinionated.”

Let’s reiterate. I love being a Wal-Mart Optometrist. I believe it’s the future of primary care optometry. If you disagree, start your own blog.

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Private Practice is not dead, nor will it ever die, but I personally think solo private practice is going the way of the Dodo. This primary care physician makes a great case for how to save primary care (hat tip to Kevin, MD), but you’ll notice he has a multi-doctor practice to do it.

You have to have a low overhead. So… doesn’t solo private practice have the highest overhead? And, yep, Wal-Mart doctors only have 10-20% overhead.

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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.

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Okay, so there has been lots of feedback about the new direction I’m taking. First, when I wrote that I was going to be writing future posts “demonizing private practice,” what I was trying to say is that I used to idolize it, but now I have removed solo private practice from a pedestal that it doesn’t deserve. I’ve posted before that I think that this mode of practice is endangered. Large group practice will probably make it since they can offer specialty care not found in commercial, but you can’t just plop a few doctors into the same town all at once, so new group practices will rise up from the ashes of solo practices trying to survive by evolving, and new solo private practice will cease to emerge.

So the message to optometry students is that private practice optometry isn’t the pinnacle of our profession- it’s just another way of practicing. Choose your mode of practice based on your goals. Do you really want to be a “savvy businessperson” with all the headaches of running your own practice? If so, get out of optometry and start a business where you can make some real money since optometrists have a cap on their income potential since we can only see so many patients a day.

Anyway, most of the criticism to my recent post has been words to the effect of “your exam fees are so low it disgraces the profession.” Um…why are your exam fees so high? Oh yeah, your overhead is ridiculous. Let’s say your solo private practice pretax net is $118,800. That means your practice had to gross around $396,000 (a generous 30% net-to-gross ratio), $475,200 (25%), or $594,000 (at 20%).

The Wal-Mart doctor just has to gross $132,000 or $148,500, depending if the lease is 10 or 20 percent. No problem. Oh, and the Wal-Mart doctor can gross $11,000 a month just working 4 days a week. And he doesn’t have to kill himself explaining to every single person that enters his practice why his glasses cost so much and why his exam fees are so high.

So, your ridiculously high exam fee, caused by ridiculously high overhead, is part of the problem with rising health care costs in this country while Wal-Mart optometry is helping people to save money and live better.

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Since it is an election year, everyone has been bringing up the high cost of health care. The liberal democrats, Clinton and Obama, are promising reforms which would inevitably fail and/or turn our country into a socialist/communist state. Then I read an article in Rush Limbaugh’s April 2008 newsletter entitled, “Health Care Diagnostics: Why Doesn’t Anyone Talk About Lower Costs?”

Rush brings up an ABC John Stossel report about Dr. Robert Berry who stopped accepting insurance, including Medicare and Medicaid. His office visits are as low as $40, yet his salary is typical of a primary care physician.

Well, I wish Rush would have also shared what hundreds of Wal-Mart optometrists do. We deliver eyecare for a fraction of the private practice fees. Private eyecare practices in my market of Cache Valley, Utah offer routine eye exams from $70-125. My Wal-Mart practice offers the same routine eye exam for $45-55.

Insurance companies have created this health care conundrum. Employers or individuals who buy into vision insurance are really getting scammed. My $45 exam is about what most vision insurances pay doctors anyway. So…why give any money to the middle man? And then there are a couple snobby vision plans that only let private practice doctors on their panels. The beneficiaries of these plans get doubly ripped off because sure, the exam might be covered, but when they want premium coatings or progressive lenses, they get stuck paying the balance over the basic lens. At private practice opticals, this balance can be more than the total price they might pay at Wal-Mart. So again, what good is paying money into this vision plan?

Buying vision insurance makes about as much sense as buying oil change insurance or hair cut insurance. The only people that win are the insurance companies, unless you got the coverage at no cost to you and can use your plan at Wal-Mart so that even if you do have to pay over a balance, at least you will get the best price.

In my former private practice my wholesale cost for lenses were just barely under the retail price of Wal-Mart lenses. As a doctor concerned about the welfare of my patients, I can’t continue to sell overly expensive products when Wal-Mart sells the equivalent premium products 30-50% less than what I could in my own optical shop.

So Rush, please add to your list of professionals doing what they can to control rising health care costs the excellent professionals at Wal-Mart Vision Centers.

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