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Any readers of this blog entry entitled “The Perks of an Optometry Career” need to read my “Do Not Become an Optometrist” entry or my “Should YOU Open a Private Practice?” entry.

How does the perk of working every Saturday sound? How do you like getting home many nights at 8:00 PM, (just in time to tuck your kids into bed)?

Unless an optometrist is employed by a big chain or there is some extreme emergency, hours are generally restricted to Monday through Friday with no on-call duty needed.

That’s not true in today’s market. Only government workers get Saturdays off now. More and more private practices offer extended hours and Saturday hours to stay competitive in today’s market. People don’t take time off work anymore just for routine eyecare (but of course they’ll do it for the dentist, but not you…a lowly optometrist).

Oh, and other doctors don’t have to worry about their scope of practice being legislated away.

And how do you like having a cap on potential income? You can only see so many patients a day. Get rich selling an unlimited number of widgets that everyone wants. Only become an optometrist because you love it…but, that begs the question how do you find out that you love optometry without going to expensive optometry school? By the way, when I went to optometry school (PUCO 2003), it cost about $22,000 per year for tuition, including fourth year when you’re not even at school because you are on preceptorship. Last I heard it’s up to $27,000 per year.

So my question is, at what price point does optometry school become unfeasible?

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So Rob’s Blog has this to say to people about getting yearly diabetic eye exams. As if optometrists in a commercial setting don’t do the same thing, he tells a big lie here:

…these [private practice] doctors consistently have the longest relationships with their patients and provide the best care.

Rob, people aren’t buying what you’re selling anymore. I see VSP beneficiaries out of network all the time in my Wal-Mart setting. I guess they aren’t loyal to a practice setting, but rather they factor in price and convenience while assuming, correctly, that any doctor they see in my area is competent.

Oh, and I remember when Intel in the Hillsboro/Beaverton, Oregon area was buying your VSP, and then they switched to EyeMed. Does that mean they thought your private practice network of doctors couldn’t “provide the best care?”

But I see what he’s trying to do. Any roboconsultant will tell you that you need to differentiate yourself from the competition; however, I take exception when he lies.

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I keep hearing this type of comment: “I don’t understand you. I’ve read your blog when you were in private practice versus now. I don’t think you know what you want out of life.”

They seem to be saying that I’m a flip flopper and must be some unhappy individual who is lost. You can’t discredit me because I’ve experienced three major forms of practice. Someone who has experienced government, private, and various flavors of commercial is not a lost soul, but rather he is an experienced voice.

I implore all students and new O.D.s to listen to my words. If you would like the security of government work and don’t mind living in remote locations, then by all means be a government optometrist. If you want to be able to live in more populated areas, than choose commercial practice over private and choose Wal-Mart over all other commercial options.

In my previous posts advocating private practice and demonizing commercial, I had been drinking the private practice cool-aid that I’d been served since optometry school. Some of the disparaging remarks against commercial hold true for many brands of opticals, but not Wal-Mart.

Private practice is too risky. Sure, you know or have at least heard about successful private practice businesses, but you can’t assume that things would go well for you if you were to hang up a shingle. The money it takes now days to start cold could be better invested in Vegas. It’s a crapshoot, heavy on the crap because the frame vendors, the lens suppliers, ophthalmic equipment companies, the financing company, the advertising people, the landlords, the employees and more all get their money from you. But when do you get paid? Paying all of those people doesn’t automatically bring patients in the door. And when will you actually get enough patients to break even? That could be never, you know. You may just have to close shop when the money dries up, like I did.

Wal-Mart makes it risk free. There will always be patients coming to your door. Your success is only limited by the number of hours you are willing to work. That’s why if you want to be rich, make and sell widgets. If you want to do eyecare, work for the government or Wal-Mart, depending on where you want to live.

Anyway, just because I’m giving advice from my experience doesn’t mean I’m somehow lost or unhappy. I have family, religion, and a great job inside a Wal-Mart Vision Center. Of course I’m happy.

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Brian Rowley was in the class above me in optometry school, and I just saw him at the UOA Meeting. It seems he is in the newspaper as a karmic baseball fan.

He also was interviewed for KSL TV, and they showed it on SportsBeat Sunday which you can view completely here on their SportsBeat iCast. On Saturday they showed this teaser:

I’d say that’s a pretty good practice builder for an up and coming optometrist. At the Park City meeting, he told me that his practice will soon need a new building with more exam lanes. Dr. Rowley had to work commercial optometry for a while before taking over his current thriving practice. So you see, optometry students, it is possible to make a successful solo private practice…if you are willing to roll the dice, take the gamble, spin the wheel, bet the farm, etc.

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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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