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I worked for the USPHS, detailed to the IHS, for 2 years. I would have stayed longer, but I wanted to live in Utah or Idaho. The positions available in these two states were filled with young optometrists that appeared to me like they weren’t going to move away anytime soon, so I made my move to go into private practice and then later into Wal-Mart practice.

Looking back on my decision to leave, it would have been much better for my financial situation to stay. In fact, I am going to argue that for any optometrist, the financial rewards for practicing optometry are equal to and most likely better in the Commissioned Corps than in the private sector.

Government optometry work seems to get little attention in optometry school. Most everyone has delusions of grandeur about how comfortable their living will be while working in private practice. Of course, that dream turns into a nightmare when they work for another optometrist paying them little more than a resident but with the hint or promise of a buy in which later fizzles out.

Many people think of government optometry only when they want to go into the military just to get their school loans paid off and then get out. Many do not stay because promotion in the military is limited. Many years ago the USPHS used to have an automatic promotion schedule, but that has been replaced by merit promotions. A recent transformation of the commissioned corps of the USPHS has made it harder to get promoted just for showing up; however, your chances of getting promoted to O-6 (equivalent to a Colonel or a Navy Captain) are much better in the USPHS than other uniformed services.

For an estimate of what monetary compensation you might get in the USPHS, I’ve made this table. It’s a little tough to understand unless you are used to military pay systems. They have what is called base pay which is calculated from your rank and years of service. But then other types of pay like Housing Allowance and Subsistence which are variable depending on where you live. You also get pay for being an optometrist: Optometrist Special Pay and Optometrist Retention Pay which helps equal your pay to private sector optometrists. You can get even more money by getting your FAAO and by hopefully getting loan repayment. Also you get up to $1000 reimbursement per year for travel and tuition expenses for continuing education.

My PHS pay estimate is based on a theoretical advancement in rank. Promotion is not guaranteed nor is it on a set timetable. There has been cases where an officer was frozen at O-5 and wasn’t allowed to be promoted to O-6. I also assume that one stays 30 years in the corps. You can get out as soon as 20 years, but your retirement compensation is less.

Now, I’m no accountant or financial planner, but I believe that my PHS pay estimate table shows that compensation inside PHS is probably better than what you can expect to achieve in the private sector as an optometrist. A private sector optometrist would have to invest ~$24,000 a year just to get the same retirement that a 30-year PHS optometrist gets.

Anyway, this should dispel the myth that PHS optometry pay isn’t comparable to private or commercial optometrist pay. I’d say it’s better based on my calculations.

Now, what can you expect if your join the USPHS? There are a small few who work in the FDA and Bureau of Prisons. You could also work your way up and do non-clinical duties at USPHS headquarters. But the majority of PHS optometrists work in the Indian Health Service. You can work in the IHS as a civil servant or direct tribal hire, but for a career IHS optometrist it is most advantageous to go the commissioned corps route. Same job as an optometrist but different pay system.

Where can you work? Well, here is a map.

But a better way is to browse through the PHS-IHS directory regularly updated here. But not every place has an opening, so you need to look at the current Vacancy Announcement (a.k.a. Recruitment Announcement) regularly updated here at the IHS Optometry web page.

You can find optometry job announcements in IHS by going to their website job page and then selecting “Optometrist” in the Professional Categories pick list. I find that this page isn’t updated as quickly as the IHS optometry page, though.

In my next few posts, I’ll talk about non-monetary benefits of working for PHS-IHS, tips and tricks for applying with the PHS-IHS, more about rank advancement, and the Loan Repayment Program.

For more information about calculating pay in the USPHS system, see these sites:

• USPHS.gov benefits overview
• Military Pay Calculator
• Military Basic Pay table or USPHS Basic Pay Table
• Basic Allowance for Housing is the biggest variable, estimated in table it at ~1200.
• Basic Allowance for Subsistence now at $202.76

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Since starting my practice inside a Wal-Mart Vision Center, I’ve kept track on a spreadsheet the daily gross and the number of exams. I also track a few other items like glasses vs. contacts vs. medical visits, DNKAs, follow-ups, walk ins, and appointments scheduled.

I thought it might be nice to share with you all a pattern I’ve noticed about which days are better to work than others, listed best to worst.

2008 so far (January to April I worked Mon 10-7, Wed 10-7, Friday 10-7, and Saturday 9-5, and May to present I worked 5 days a week, Tues 9-6, Wed 10-7, Thursday 10-7, Friday 9-5, Sat 9-3):

1. Tuesday
2. Wednesday
3. Saturday
4. Monday
5. Friday
6. Thursday

2007 from April to December I worked four days a week (Monday 10-7, Wednesday 10-7, Friday 10-7, and Saturday 9-5):

1. Wednesday
2. Monday
3. Friday
4. Saturday

In 2007 Mon, Fri, and Saturday were almost identicle in revenue earnings, but Wednesday gross averaged $98 more than the other days. In 2008 so far Tuesday and Wednesday (TuW) are close and so are Saturday and Monday (SaM). TuW gross averages $71 more than SaM, and SaM averages $79 more than Thursday.

In 2007 my private practice appointment book would fill up fast on Tuesdays and not so much on Thursdays. At the Wal-Mart, they told me I’d missed quite a few walk-in opportunities on Tuesdays, but not many on Thursdays.

Anyway, my take home message is this:

• I advise O.D.s looking for fill-in work to stay away from Thursdays and Fridays and try to get in on the action for Tuesday and Wednesday. (Conversely, if you are an optometrist looking to hire fill-in work, then switch what I just said.)
• If you need to take a random day off, Thursday or Friday is a safe bet

Your mileage may vary. For instance, from what I’ve heard, everywhere else in my district (Salt Lake to Ogden area) is gangbusters on Saturdays. I think that in my Northern Utah town the people like to go play on Saturdays and not worry about having to spend time at the doctor’s office. We notice that Saturdays are better in the winter than the summer because our area has lots of good hiking, boating, and other summer fun activities nearby.

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I’m a little disappointed that more eye doctors aren’t blogging yet. It has been around since ~2001, and blogging went mainstream in 2004.

To try to make it easy for an optometrist or ophthalmologist to get started blogging, I created eyedoctorblogs.com. Go on over and sign up and let’s give feedback to each other and the industry.

Be sure to read the About page and the Terms of Service.

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This physician had an interesting case about a patient who put super glue in her eye by mistake,and then he used Colace, scissors, cotton-tip applicators, and a hemostat to solve the problem.

Hat tip to Kevin, M.D.

Would any of you reassure the patient and patch the eye for a couple days while it works itself loose? I mean, as long as the patient doesn’t need to use that eye for a couple days? Of course, I think what the ER doctor did is the best approach, but what CPT code could you use besides foreign body removal?

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I’ll go a little off topic today. In the summer I like to grill as often as possible. I thought I would share my favorite grilled chicken recipe:

Use frozen chicken breast and marinate for 4-5 hours at room temperature in a Ziplock bag using McCormick’s Grill Mates Southwest Marinade.
Grill on low heat for about 10-15 minutes per side.
Near the end, apply Kraft’s Honey Barbecue Sauce and then previously cooked bacon (or deli-sliced hickory smoked ham will do if you don’t have the time to fry up the bacon).
After another minute, apply Tillamook or Cache Valley colby jack cheese on the top, let melt, and then serve.

Voila’. Bon Appetit.

It’s similar to something I’ve had at Chili’s.

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