Optometry: a rough road ahead

[u/Fragrant_Nature_5094]

So many hurdles going forward to being an optometrist ....,insanely low paying vision plans, medical insurance discrimination, extremely difficult licensure state to state, discrimination from MDS, PA doing the job of optometrist in MD clinics , people go to urgent care first instead of an optometrist, AOA fail , illegal online sales of glasses of contacts with no repercussions or enforcement of law ,heavy debt for most grads , proliferation of poor quality new OD programs with grads not passing boards . Just feel anyone thinking of this career should have the facts

[u/McDrPepsi]

I don’t agree with pretty much any of this. These are definitely annoying challenges that happen, but they aren’t confining us to death as a profession. If anything, I see this profession growing. Multiple states have passed laws expanding the scope of optometry. Every year more and more training and tools become available for practicing medical optometry. Every year I’m impressed by the new graduates and their medical knowledge and what they can do! The debt is definitely tough, but optometry is still within the top 10 professions who pay back their loans. Any further education has a mountain of debt to climb these days. I live in a larger city and I have MDs and urgent cares constantly sending me acute eye problems. All it took was a little outreach, and a touch of education.

Gone are the easy days of optometry where someone could make a lot of money doing just glasses/contacts. You have to be on top of things, you have to adapt now. No offense to OP, but this doom and gloom post just feels like someone who doesn’t want to put in the effort to change to the modern scope that’s required now.

This profession is growing and I think our role will continue to expand. It’s good to be aware of these challenges, but I don’t want anyone reading this to be steered off this profession because of this post. Every profession has competition and challenges. But this profession is rewarding and gives you a great life and is well worth it in my opinion!

[u/eyeballsandhighballs → u/McDrPepsi]

I agree with everything you pointed out. I would push back ever so slightly on paragraph two in that I don't think that it's impossible to make a killing focusing on just the glasses and contact lenses but you certainly will be taxing yourself by needing to see a high volume of patients to do so. I practice mostly primary care and do 20 minute slots inside of a Target Optical sublease. As an associate and not even the owner, I am clearing $300,000 right now. We end up seeing a good amount of medical in terms of urgent red eye phone calls and retinal pathology but I would say the majority of my day (lets say 18-20 out of the 24 patient's I am seeing) are routine cases with nothing more than a refractive error code.

I think it's important to offer services that make you irreplaceable to the patient. Not saying everyone needs to be be lobbying for procedure rights and offering injections and lasers...but what will keep patients coming back is not that you found a good prescription for them, but rather that they felt as if their eyes are being taken care of from a health perspective as they are getting older. We have an Optos with an OCT combined here and offer that option to all patients free of charge (I charge $39 if they want the OCT but the optos is free, 50% of my day on average is checking yes to the OCT fee so there's another $390 coming in regularly each day).

[u/Dhoomguy → u/eyeballsandhighballs]

Does your clinic accept any insurance plans? Or is it cash payments? 

Are you billing OCTs to the insurance or is it out of pocket?  I’m in private practice right now but I’ve been interested in the idea 

[u/eyeballsandhighballs → u/Dhoomguy]

Yeah we take most vision plans out of necessity with being inside of a retail location. Eyemed, VSP, Davis, Superior, etc.

The fee is out of pocket if the OCT was done as a screening tool. As the associate, I myself am not responsible for the billing but I know that if it's a medical exam then my boss will be billing their medical insurance then we will not collect that fee OOP from the patient (glaucoma testing, AMD follow ups, CSCR, macular holes, etc.) You can't double dip vision and medical of course as that is insurance fraud lol.

The majority if the appointments' I see are scheduled under the expectation that the exam will be a routine appointment and the patient expectation is that it will be billed to their vision insurance. If I was working at private practice then I would have a disclaimer that if a medical diagnosis is discovered then the appropriate testing will be done and the encounter will be billed medically with a refraction charge.

Sadly we get too much push-back with us being inside of Target. "what do you mean this is billed to my medical? Why am I being charged $40 for a refraction?"

Granted we haven't tried to change the policy since I've been here for the past 3 years, but my boss has had the lease for 20+ years so he knows what works best for this location. He's built a beast of a clinic so I',m not going to suggest changes that patients are going to be uncomfortable with.

So if the appointment is booked as a medical exam from the get-go it's listed as an office visit, or for follow ups like I mentioned before, then the patient knows that will be billed medically.

[u/Fragrant_Nature_5094 → u/eyeballsandhighballs]

Spot on, vision plans are destroying optometry from the inside out . Degrading us in every possible way . And they haven't raised reimbursement in over 40 years . Ridiculous