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I’ve come across some websites you may be interested in:

• Local Eye Site

Interesting because it allows all people who work in the eyecare field to use the same site for forums, job search, and buy/sell equipment or practice. I especially like how it is open so that anyone can read what has been posted without being registered. Registration is free if you want to post something.


• Wal*Mart OD

See what your main competition is up to. You won’t be able to post anything, though, because registration is limited to Wal-Mart doctors like me.

• Association of LensCrafters Leaseholding Doctors (ALL Docs)

See what the Lenscrafters eye doctors are up to at this website. From the looks of it, half the site is dedicated to their National Meeting which includes “recreational and social events to help unwind.” A.K.A. providing plenty of booze so you can get hammered and make funny faces while being photographed for their website.

But seriously, what professional organization doesn’t spend all your dues and sponsors’ donations in support of this glorified purpose?

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There was an interesting article written at the AmateurEconomist.com about “Why Doctors Are Not Good Businessmen.”

Hat tip to Kevin, M.D. who commented on this story and said,

“This is why the private practice model of medicine is dying. More practices are being bought by hospitals where the physicians are salaried. This relieves the burden of administrative tasks and supervising ancillary staff, so that the doctor can focus on medicine.”

Rob at VSP says that “[private practice doctors] provide the best care.” Well, if I’ve got the weight of a business on my shoulders, doesn’t that detract from patient care? Additionally, in our field where the private practice doctors sell what they prescribe, can you totally rule out any conflicts of interest which potentially detract from patient care?

Again, independent doctors of optometry in a Wal-Mart setting don’t have the conflict of interest and their administrative duties are much less than private practice.

What’s funny to me is that every CE event I’ve been to always has some talk about why optometrists should start the “medical model” in their practice and watch the money role in. Well, how is adding more third party payers going to help you make more money? Primary care medicine is dying according to Kevin M.D., and yet the roboconsultants are telling us to join more insurance panels. I think getting rid of insurance companies in your practice is the way of the future.

The roboconsultant woos you buy saying that for one case of dry eye you can milk an insurance company for $500-$800 in office visits and procedures. Well, do you do that for every dry eye patient, even the poor self pay patient or the patient with insurance but poor benefits? I would think that doing it just for those with good insurance would be unethical as well as probably insurance fraud.

I think the more your appointment book is filled up, the more you should be able to charge for your services. It’s the old supply and demand of free economics. I think a better system would be for patients to have to front the money to pay the doctor for office visits at the time of service. The patient would have to get reimbursed what they can from their insurance company. Maybe then insurance companies would be forced to have a faster turn around time on processing claims for their patients and be watched more closely for just rubber stamping a denial based on some frivolous billing exercise (or at the least the patient has to worry about it instead of me.) I simply provide the best care for the patient, recommending only the products and services that they need, since now I don’t have to worry about getting paid.

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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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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 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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Here is the scenario. One doctor can own a Wal-Mart contract (or a Sam’s Club contract for that manner) for more than one location at the same time. Wal-Mart usually decides to do this if the locations are struggling with volume and/or having a hard time finding someone to fill the location.

Can the doctor physically be at two places at once or work eight days a week? No, so he hires someone. Let’s call the multi-contract owner Dr. Fingers and the two doctors who work for the contract owner we’ll call Drs. Desperate and Disgruntled. Wal-Mart needs three locations filled: Bountiful, Ghetto, and Rough Diamond.

So let’s say Dr. Fingers works Bountiful and hires Dr. Desperate at the Ghetto location and Dr. Disgruntled at Rough Diamond. The contract is similar to “I’ll pay you 70% of your gross receipts.” Dr. Desperate says fine because she just needs a job and doesn’t care about a long term commitment because she’s willing to relocate in a moments notice. Dr. Disgruntled is in a bind because he really wants to live in the city of Rough Diamond forever, but he doesn’t want to pay Dr. Fingers 30% of his gross receipts, especially when he finds out that Dr. Fingers is only paying Wal-Mart 10% or if the contract is some ridiculously low flat fee not even based on receipts.

So what happens? Usually Dr. Disgruntled will leave and try to find his next best ideal location. Dr. Fingers will probably have to funnel in and out doctors every couple years. The vision centers stagnate and never grow because the doctors who work there have no vested interest in growing the practice since they know they won’t be there long term since Dr. Fingers takes so much of their money.

I believe that it is a mistake for Wal-Mart to give any doctor a contract for more than one location just so he can suck cash from other doctors for no reason other than, “Hey, I own the contract.”

Now, I can see how some of you might say, “But what if you had a multi-doctor parnership share multiple locations equitably?” Well, you’d still have the problem of the last location not growing because the doctors rotate every day, and then which of the doctor partners would volunteer to work at the last location on its poor performing days?

It’s better for the vision centers, the doctors, and even the community to have each doctor own the contract for the vision center that they work in.

“But what about vacation days?” you say. Well, wouldn’t it be cool if each area could have it own full time fill-in person? Maybe the fill in person could always keep 100% of his receipts and not have to pay rent to subsidize the days when there isn’t an opportunity to work? I don’t know, I’m just thinking out loud here. Or you can probably find a private practice doctor who needs supplemental income to work for you.

“But our store needs someone, and we can’t find anyone, so thank Heaven for Dr. Fingers,” you say. Well, that’s a short term solution that defeats you in the long run. None of your sub-contracted doctors would be motivated to grow the practice (an thus increase vision center sales) like a contracted doctor would. This scenario will just stagnate you at mediocrity. If you must hire Doctor Fingers, I think the terms should explicitly say that Wal-Mart has the option to not renew Dr. Fingers contract at the satellite location if they can find a permanent doctor when the contract expires in three years. I don’t care if Dr. Fingers is taking a “risk.” He has three years to recoup his “risk.” Take it or leave it, Fingers.

But let me restate. Multi-location contracts for a lone doctor who invariably gets greedy and pockets cash for not doing any work: BAD. Allowing a doctor to own the contract where he actually works in order to change it from slow to crazy-busy: GOOD.

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I always wanted to do a podcast, but I’ve never gotten around to it because who wants to hear me ramble? I can say things more succinctly by writing them. I think a podcast is interesting when it’s a small group discussion or an interview with interesting people. I’ve never gotten around to recording either scenario, so I never published a podcast…until now.

In a previous post I linked to a YouTube snippet of the CEO of 1-800 CONTACTS, Jonathan Coon, giving a speech to Wal-Mart optometrists. Posting the entire video from the DVD would take too much bandwidth, but I managed to scrape the audio to share with you. So it’s not really my podcast, but it is a step in the right direction.

Again, if I get a legal letter from 1-800 or Wal-Mart demanding that I remove the content, I will of course comply; however, they did send this DVD to every Wal-Mart optometrist, and some of those optometrists also work in private practice settings. Also, this presentation defends 1-800 CONTACTS and Wal-Mart’s partnership better than anything I’ve heard. So, I think you will agree that every optometrist who is interested should listen to this talk (or watch it if you can borrow it from your nearest Wal-Mart Vision Center).

Enjoy. (Click the player below or download manually or subscribe to it in iTunes or subscribe to Optoblog’s site feed or podcast feed to automatically get it in your favorite podcatcher.)

 

 1-800 CONTACTS and WAL-MART DVD audio [46:43m]: Play Now | Play in Popup | Download (89)

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It is interesting that some private practice docs can’t seem to tell the difference between Kleenex and Puffs- I mean 1-800Contacts and other retailers of soft contact lenses. This article was written in October 2006, but certain items are worth repeating in 2008:

…optometrist Wiley Curtis, of Arlington, Texas, represented the AOA’s position, tempered by his own experience. “Over the course of this year, I have tracked 18 contact lens orders placed with 1-800 Contacts,” he says. “I am saddened to report that the first 17 orders were all filled by the company without any verification contact with my office, in apparent violation of the FCLCA.”

After the hearing, 1-800 Contacts looked into this accusation. “Our records from the last 12 months to this doctor’s office show 192 phone calls, three faxes and eight total hours on the phone with his staff,” says Kevin McCallum, 1-800 Contacts’ senior vice president of marketing and operations. “We received 117 orders from this doctor’s patients. All 117 orders received a successful verification request.”

This actually happened while the congress was hearing testimony about the FCLCA. Apparent AOA stooge, Dr. Curtis, alleged that 1800Contacts broke the law, so the 1-800Contacts team stayed up all night to research, and the next day at the hearings they provided evidence to the contrary.

I only first heard about this event when I listened to Jonathan C. Coon, CEO of 1-800 CONTACTS, speak to all the Wal-Mart Optometrists on April 27th at our all-travel-and-expenses-paid meeting in Nashville, TN. He had given pretty much the same speech on a DVD sent to all Wal-Mart vision centers earlier this year after the announcement of Wal-Mart and 1-800’s alliance. Here is a significant clip. Please watch.

I wish everyone could see the entire half hour speech, but the above video clip combined with the aove AOA-is-stupid story show why optometrists blindly dislike 1-800 Contacts. I hated 1-800 blindly because that is what the organized optometrist establishment taught me to do. After learning the facts, there is no reason for any optometrist to dislike 1-800, unless that optometrist also hates all their other competitors. I don’t because I’m friends with most of the other optometrists in town and 1-800 is making my life easier now.

For these reasons, I would like to officially and publicly retract the negative comments I made about 1-800 Contacts in this previous post. It was a knee jerk response conditioned by organized optometry, for which I am ashamed.

I admire Mr. Coon and his core team for everything they’ve done to become a very successful business. I think that private practice optometrists, like the above Dr. Curtis, are just jealous. Incidentally, Mr. Coon in his speech said that after presenting the facts about Dr. Curtis’s patient orders to 1-800 Contacts, 1-800 asked him and the AOA to stop making wrongful [slanderous, defaming] accusations or privide their evidence. He has yet to bring evidence or retract his statements.

Don’t be blinded, everybody. Go to your nearest Wal-Mart Vision Center and ask to watch the 1-800 Contacts DVD.

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So I found out that I didn’t have to apply with 1800’s referral network, ProNet, for my practice located inside a Wal-Mart vision center because I’m already in the system because of the alliance between 1800Contacts and Wal-Mart. You won’t believe how awesome this is. First of all, no more telephone calls. It’s all fax now. Huge time saver for the opticians who need to keep busy helping my patients get checked out so they can pay my every-day-low-price exam fee.

And then today, 1800Contacts had a customer on the phone whose prescription expired, so they called my Wal-Mart vision center, and the customer was patched through to talk to an optician. The patient scheduled an exam for Saturday. How sweet is that?!!

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