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Medical Forum / General / Vision / October 2007Optometry School choices and funding
My daughter is considering applying to the following schools SUNY Optometry in NYC Pennsylvania College of Optometry in Elkins Park, PA New England College of Optometry in Boston Any pros or cons to any of these schools ? We are closest to NYC. SUNY costs are $15k per year. The other two schools are about $30k per year. I've paid her way for the first four years of college. Nothing really left to fund another four years of school, unless I start selling body parts on eBay. What is the best way to fund four years of Optometry school ? Steve > My daughter is considering applying to the following schools > [quoted text clipped - 11 lines] > > What is the best way to fund four years of Optometry school ? Loans are traditional. It's not like she is getting a master's in history, which will qualify her for almost nothing. An OD should be able to get a job fairly quickly. You may have to sign for the loans, though. Best idea is to contact the financial aid people at the schools. The deal may be the same, or else the more expensive schools may have more scholarships (or not). Your daughter can also get a job to help pay her way thru school, it's a time honored tradition. > Your daughter can also get a job to help pay her way thru school, it's > a time honored tradition. The professional schools discourage outside jobs, especially the first year or two. Sure it can be done, but most med/dent/opt students don't. With admission in hand, it's easy to borrow money. Maybe too easy. -MT She can farm characters in WOW and when they are level 70, she can sell them on ebay. I think they are worth about fifty pounds per character, so if she works hard on it she can make quite a lot in very short time. I used to do it and made quite a lot too. Sorry. Rishi Giovanni Gatti (Zetsu), Lena102938, and Otis Brown are trolls who haunt s.m.v. Rishi has published, and is trying to sell worthless books. Otis is pathologically dishonest and actually hurts people. Following his advice can induce double vision in those not working closely with an eye doctor. Lena102938 uses anti-eye doctor rhetoric as a substitute for ANY actual information. It seems she now has to wear glasses and has developed a pathological (and ILLOGICAL) resentment toward the industry that "foisted these glasses upon her." You'd do well to ignore them and wait for responses from the caring, compassionate eye doctors who DO also participate in this site. |Your daughter can also get a job to help pay her way thru school, it's |a time honored tradition. She has worked every summer, but $9 per hour only goes so far. >What is the best way to fund four years of Optometry school ? As a current OD, I'd tell her to find a different profession. |>What is the best way to fund four years of Optometry school ? | |As a current OD, I'd tell her to find a different profession. Why ? What do you dislike about your current situation ? Steve tOn Sun, 21 Oct 2007 23:06:33 GMT, Steven Stone <xxspfleck@xxcitlink.net> wrote: >|>What is the best way to fund four years of Optometry school ? >| >|As a current OD, I'd tell her to find a different profession. > >Why ? >What do you dislike about your current situation ? Too much school for too little pay! I was at a continuing education meeting a few weeks ago and overheard some colleagues talking behind me. When one of them stepped away, I asked the other one -- a gentleman I know if what I thought I heard the other one say was true. Yep -- (some) people are now leaving Optometry school with 30-year loans/close to $200K in debt. And this makes sense -- tuition at this school is close to $25K/year (x 4 years). Add in housing, food, car, clothing, insurance, etc. a person needs to get loans for when they are going to school full-time for 4 years and yes this makes sense. That's like a mortgage. And local ODs want to pay people like $250/day for part-time work with no benefits. Get real. Go to your local phonebook in any urban area -- call all the ODs in there -- I bet you won't find ONE that is willing/busy enough to take on an associate on a full-time basis. So the choices are to take even more loans to start a practice cold/buy an existing one, work two days here/one day there, or go commercial. Vision plans are wanting to cut the reimbursement rates while gas, housing, etc. has gone through the roof. A local city has switched vision plans to one that wants to now reimburse us $40 for an exam. There's a guy down the street who used to work as a Walmart OD who bought an existing practice and is charging $39 or $49 for an eye exam to cash patients! Great for the public because that lowers consumer prices -- horrible for the private practice OD. When you make $40 on an exam, you either have to (1) make a pathetic salary, (2) cram patients in and out as fast as you can or (3) stick it to them with glasses/contact lens add-ons. No thanks. And as far as medical eye examinations, HMOs are gobbling up all the PPO users around here. Pediatricians are getting screwed too -- making $80K a year for working 50 hours a week after doing at least 9 years of school after high school??? Get real. I lucked out -- I left school debt free and walked right into an existing practice. We have made a decision to not target the bottom-feeders and charge for exams what Medi-Care says they are worth -- about $130. And Medi-Care's reimbursements are considered DISCOUNTED off of what a normal eye exam is worth. We take hour exam slots, dilate our patients and fully educate them. This is unlike the 15-minute WalMart exams that a lot of people are used to. The vast majority of ODs are not going to be so fortunate. Tell your daughter to look into medical school, work her a.s off and be a subspecialist -- people like neurological surgeons, endocrinologists, orthopedics are the only ones making good money now. Plumbers make as much as many ODs do. The only people who should be ODs are those that FULLY understand what they are gonna be getting into -- that they are gonna be doing a lot of school, leaving with a lot of debt and not making much money. All the brightest students who used to go into medical school/optometry school are now getting their business degrees instead because they can make twice the starting money as an OD with half the schooling. When they are deciding what they want to do and they see that being an OD requires 4 years of professional school AFTER getting their college degree to start at $50K a year gross! When a decent house is going for at least $600K around here! They say NO WAY. As a result of all this, I have been seeing a tremendous demographic shift. Native-born Americans are getting economically eliminated from these jobs by foreigners who are more than willing to get paid beans. Foreign-trained ODs/MDs are more than happy to emmigrate from wherever where they are to America where they are more than pleased that they can make $50K a year being an OD because where they come from they only make $10K a year. Like I said earlier, great for the consumer at least financially, horrible for the OD or those Americans considering being one. [snip] That was a really exceptional and comprehensive response ... if a bit disheartening. As a popcorn-eating bystander (really?), thanks :-) Neil |Too much school for too little pay! Thanks for being up front on the subject. Steve > |Too much school for too little pay! Negative Nellies need not aply. > Thanks for being up front on the subject. You have to think outside the box on this. Where is it written she has to go to OD school right now. With her degree right now, she can get a full time decent paying job, save some money and then go on to OD school. being close to NYC, while she's working she can take some part time classes, where she can receive credit toward classes an optometry college. Also, SUNY schools are excellent and are honored by employers around the US. > |Too much school for too little pay! > > Thanks for being up front on the subject. Here's some info on pay: http://www.payscale.com/research/US/Job=Optometrist/Salary The site also has info on pay for other careers. We take hour exam > slots, dilate our patients and fully educate them. Do you really mean that you must take one hour to examine a patient? You must be doing a lot of reading, texting, or what have you on the side. And what do you mean by "fully educate" them? Are you giving out diplomas at the end? Most eye/vision problems need only a very few minutes to "educate" about, if any. If you dilate a patient, you have at least a half hour to see another patient while he/she dilates. Don't tell me you sit there and lecture the patient while they are dilating... I've found that dilating is a great time saver (for me, not for the patient). They can go look at frames, have a cappucino, or whatever while I'm seeing the next patient. After they're dilated, they only need a quick (what, 2 minutes) fundus exam/photography/whatever and they are out the door. What else can you do with a dilated patient? I don't get this hour exam slot idea. For a dilated exam, you shouldn't need more than 15 or 20 minutes of your time (granted, the patient will spend an hour or more, but YOU don't need to!). w.stacy, o.d. "William Stacy, O.D." <wstacy@obase.net> wrote in message news:5ZdTi.47480> > What else can you do with a dilated patient? Many years ago when I was about 16 years old, I was given refraction exam after the dilation by an ophthalmologist (I am amblyopic and my parents wanted me to an MD). Needless to say the glasses were useless, and I never wore them. > We take hour exam >> slots, dilate our patients and fully educate them. > >Do you really mean that you must take one hour to examine a patient? No. What I wrote is what I meant: Our patients get one hour time slots for comprehensive eye examinations. >You must be doing a lot of reading, texting, or what have you on the >side. And what do you mean by "fully educate" them? Depends on the patient. A person returning with no change in their glasses prescription may get 30 seconds. A first time glaucoma patient may get a half-hour. >If you dilate a patient, you have at least a half hour to see another >patient while he/she dilates. Don't tell me you sit there and lecture >the patient while they are dilating... I don't "sit there...dilating", but I also don't see another patient while that first patient is dilating. This prevents Joe Teenager who takes 10 minutes to dilate from having to wait 30 minutes until I get a break from the 90 year old lady who is slow to examine. >I don't get this hour exam slot idea. For a dilated exam, you shouldn't >need more than 15 or 20 minutes of your time (granted, the patient will >spend an hour or more, but YOU don't need to!). Patient is usually not with me for the entire hour: Typically patient is with me for about 15-30 minutes initially, then they are dilated and/or pick out frames with the office staff. After they dilate and pick out frames (about 15 minutes), they return for the DFE. That may take 5 minutes or 15 minutes to finish up. > >If you dilate a patient, you have at least a half hour to see another > >patient while he/she dilates. Don't tell me you sit there and lecture [quoted text clipped - 6 lines] > to wait 30 minutes until I get a break from the 90 year old lady who > is slow to examine. I expect to be sent to the waiting room while dilating. The doctor will either see another patient or do some other sort of work. Does dilation take 10 minutes or 30? I thought it was somewhere in between, but I know it varies. I once got three double sets of drops. I don't dilate well. >I don't get this hour exam slot idea. Also: Patients come late. Some patients take 15 minutes to fill out new patient info sheet/insurance sheet and health history form. >>I don't get this hour exam slot idea. > >Also: Patients come late. Some patients take 15 minutes to fill out >new patient info sheet/insurance sheet and health history form. 8:30am patient just got done filling out paperwork, getting autorefracted and pulse/BP taken at 8:50am. Glad I got that hour slot. > >I don't get this hour exam slot idea. > > Also: Patients come late. Some patients take 15 minutes to fill out > new patient info sheet/insurance sheet and health history form. It's just simple time management. New patients should be told to come in 15 minutes early. The patient isn't told this, of course. Nobody expects to have a 10AM appointment with most medical doctors, and have the doctor in the exam room at 10AM. > >What is the best way to fund four years of Optometry school ? > > As a current OD, I'd tell her to find a different profession. Do you have any suggestions, or better yet, explanations? I've been told that ODs do a lot better than most people with advanced degrees, like history, anthropology or art. >> >What is the best way to fund four years of Optometry school ? >> >> As a current OD, I'd tell her to find a different profession. > >Do you have any suggestions Yeah, something that doesn't require 4 years of post-graduate work to make a starting salary of $50K. The only way to *reliably and consistently* make more than that is to go commercial. You should be able to make more than that graduating with a marketing or business degree straight from college. > or better yet, explanations? Let me put it this way: How much should a person who has gone to 4 years of college, then 4 years of post-graduate work and accumulated sizeable student loans ($100K-$200K) make to make that investment "worth it". In other words, why should someone spend that much time in school to make as much as one could being a plumber, FedEx driver, car salesman, etc.? I mean it's not all about the money, but get real... When you got the people with the best grades and are the brightest students who are looking at potential occupations, optometry no longer stands out as a great one IMHO. These guys are gonna go into business, be medical subspecialists, law, etc. rather than optometry. Also, optometry schools have been graduating many more students than are needed and about three new schools are coming out in the near future (Western in Pomona, CA; a school in AZ; a new school in TX) which is going to further saturate the market and result in lower quality of optometrists. Again, all IMHO. To be fair, part of the problem is that ODs (like a lot of other professions) want to congregate in the urban areas. I can't remember where it was, but a bunch of local soon-to-be ODs graduating from the school around here were asked where they planned on wanting to practice -- about 50% of the 90+ students said "Southern California". I should have pointed them to Disneyland because that is where they belonged -- in FANTASYLAND! Great -- get a job in So Cal -- there will be 10 ODs for every job and then the people hiring the ODs can pay them $10/hour. > I've been told that ODs do a lot better than most people with advanced > degrees, like history, anthropology or art. |You should be able to make more than that graduating with a marketing |or business degree straight from college. [quoted text clipped - 6 lines] |years of post-graduate work and accumulated sizeable student loans |($100K-$200K) make to make that investment "worth it". My nephew graduated from college with a business degree. He is managing a bookstore for a national chain found in most malls, starting at $37K annual. A friend is in a trade union. He is 60 years old. He works with sheet metal. The union managed his pension and others in the union into oblivion. He does residential roofing on weekends to feed his family. He doesn't get much union work because non union is less expensive. Another friend manages his families small motel. He does okay. There is lots of money in rooms that rent by the hour in urban areas. Many people do okay as plumbers and electricians. The plumber down the street has almost the biggest brick house on the block, always new cars in the driveway. The guy who owns a local auto repair shop, charges fair prices, has a bigger brick house than the plumber, on 8 acres of land. Need your oil changed ? Thanks and good luck, Steve > In article <9l1oh35ghn61n3jcps7m60hmmh37cuh...@4ax.com>, > anonym...@example.org says... [quoted text clipped - 32 lines] > Thanks and good luck, > Steve Optometry is a good career, especially for women. What makes it good is that working in a commercial situation you can be flexible with your hours so that you can manage the other aspects of your life and still maintain a career. All you need is a partner who can work some time at your practice for you. For example, my wife has been an optometrist for 26 years and when our children were born she dropped her working time down to 2-3 days per week and the rest of the time she cared for the kids. At that time I had a conventional M-F mid- management job at a medical products company. Later on, I got fed up with the Dilbert-like aspects of working at a Fortune 500 company and quit and went to Optometry school myself. I already had earned a PhD degree in physiological optics when I was younger and in graduate school so the training aspects, aside from the clinical training, came easily to me and I already had a good background in the area. Now we are both practicing together and between the two of us (working 8 days a week total with two of us) at a commercial location we gross $200+ per year. We live in the mid- west so that income goes a long way. Now let me make a few bullet points here before this response gets too long: - some ODs will bad-mouth commercial optometrists as doing fast exams and poor quality work. Thats BS. The OD does whatever quality exam he wants to no matter what his practice location is. I know for a fact that we do higher quality work that some of the private docs working in our area. This profession is going commercial and its an irresistable force. You can join it and adapt to it, or you can whine about it and make up false claims about it. - a hugely important trend in the market is the impact of refractive surgery. I picked up a few days working at a refractive surgeons office in our area 2 years ago and I was shocked at how many of my (former) patients were going there. Now I see kids for exams while there parents smile at me and tell me they have gotten LASIK. this is a trend that is shrinking the market for optometrists unless they learn to adjust. Optometrists who have depended on primarily refractions and glasses or contacts for their income are fighting form a dwindling number of patients. Its more and more important for optometrists to switch to medical management systems and practice the full scope of our professional licensure by treating glaucoma, dry eye, etc. by billing medical insurance programs and having the appropriate equipment to manage those patients. Your daughter will be trained on all those aspects of optometry in school and she will need that to be successful in the future. - The lack of benefits that optometrists have (no retirement, no health insurance, etc.) makes it critical that they wisely invest a portion of their income into that area. and its expensive. - The health care system in the US is about to change. The impact for optometrists is unknown but I think it will be positive. In the end I would give a qualified Yes to earning an optometry degree. Now is a time of change in the profession but I wouldn't chime the death bells just yet. Just keep your eyes open and adjust for the future. >> Optometry is a good career, especially for women. Thank you for sharing some positive thoughts on this career. An article in one of my regions newspapers suggested that the results of refractive surgery may not always be a life time solution. As people age their vision will change, and they will once again have to see the surgeon or opt for glasses or contacts. [snip] >Now we are both practicing together and between the two of us (working >8 days a week total with two of us) at a commercial location we gross >$200+ per year. Read: You are easily replacable; no job security. >some ODs will bad-mouth commercial optometrists as doing fast exams >and poor quality work. Thats BS. Stereotypes generally have a lot of truth to them. Additionally, commercial optometry *in general* "make you" prescribe certain types of progressives or contacts based on what they sell. >The OD does whatever quality exam he wants to no matter what his >practice location is. I know for a fact that we do higher quality >work that some of the private docs working in our area. Right, cuz "nobody cares for eyes like Pearl(tm)" huh? Or even worse... America's worst^H^H^H^H^HBest. >This profession is going commercial and its an irresistable force. Did you LIE on your optometry school interview? And your comment about National Health Care later on just smacks of socialism. Go ask docs in the UK who are on these panels how great their quality of lives are (they get paid beans). > Additionally, commercial optometry *in general* "make you" prescribe > certain types of progressives or contacts based on what they sell. As do many private OD's with optical shops, no?  SignatureScott Reverse name to reply On Oct 23, 11:04 am, Scott Seidman <namdiestt...@mindspring.com> wrote: > As do many private OD's with optical shops, no? I am one of those. We sell whatever we want, and I would prefer to have as few disgruntled customers and patients as possible. Sometimes you actually do get what you pay for. "Dr. Leukoma" <drg@leukoma.com> wrote in news:1193169434.224298.316120 @i38g2000prf.googlegroups.com: > On Oct 23, 11:04 am, Scott Seidman <namdiestt...@mindspring.com> > wrote: [quoted text clipped - 4 lines] > have as few disgruntled customers and patients as possible. Sometimes > you actually do get what you pay for. My OD actually walks me over to his optical shop while I'm dilating so I can pick out frames. He seemed real insulted when I opted not to use his shop. SignatureScott Reverse name to reply "Dr. Leukoma" <drg@leukoma.com> wrote in news:1193169434.224298.316120 @i38g2000prf.googlegroups.com: > We sell whatever we want So do the chains, except the "we" is the corporation. You haven't selected a few lines of contact lenses that you prefer to stick with? SignatureScott Reverse name to reply >"Dr. Leukoma" <drg@leukoma.com> wrote in news:1193169434.224298.316120 >@i38g2000prf.googlegroups.com: > >> We sell whatever we want > >So do the chains, except the "we" is the corporation. And the "we" that ends up making this corporate decision is a MBA rather than an OD. >You haven't selected a few lines of contact lenses that you prefer to >stick with? Sure, but the doctor should make that decision not a bean counter/non-health care provider. > Sure, but the doctor should make that decision not a bean > counter/non-health care provider. And as a doctor, you wouldn't try to use all your purchasing power to yield you the biggest discount you could get? Differences in your markup have absolutely no impact in the decision about what lines you deal with? Your interest in maintaining an optical shop has everything to do with providing your patients with the best possible care, and absolutely nothing to do with cash flow through your practice? Reminds me of an old comedy routine-- I think by WC Fields, in some movie. He asks a women if she'd sleep with him (in some euphemistic vernacular) for some outrageously large sum of money, and she agrees. He then ask if she would do the same for $5, to which she replies along the lines of "What do you think I am?" The response is "we already know what you are-- now we're haggling over price"! If you weren't making enough money off your optical shop, you wouldn't be maintaining an optical shop. That makes you something of a bean counter. SignatureScott Reverse name to reply >> Sure, but the doctor should make that decision not a bean >> counter/non-health care provider. > >And as a doctor, you wouldn't try to use all your purchasing power to yield >you the biggest discount you could get? I certainly might. >Differences in your markup have absolutely no impact in the decision >about what lines you deal with? No. Don't be silly. Given two equally good choices that I can both charge fair prices for, I will usually choose that which makes me the most money. I could make a ton more money by prescribing inferior private label old technology contact lenses, but I don't. I could make a ton more money by routinely prescribing "house brand" progressives versus premium ones, but I don't. >Your interest in maintaining an optical shop has everything to do with >providing your patients with the best possible care, and absolutely >nothing to do with cash flow through your practice? I want to do both: Provide the best patient care and make a good living rather than provide mediocre patient care while making a great living. I'm talking about the difference between "Do what's best for the patient THEN maximize profits" versus "Maximize profits". >If you weren't making enough money off your optical shop, you wouldn't be >maintaining an optical shop. That makes you something of a bean counter. It's about setting priorities and JOB #1 of a corporation is to maximize profits for the stockholders. > I could make a ton more money by prescribing inferior private label > old technology contact lenses, but I don't. I could make a ton more > money by routinely prescribing "house brand" progressives versus > premium ones, but I don't. Once a patient is happily fitted, do you make it a point to make them aware about the savings they could achieve by buying exactly the same lens mail order, and then following up with routine exams? SignatureScott Reverse name to reply >> I could make a ton more money by prescribing inferior private label >> old technology contact lenses, but I don't. I could make a ton more [quoted text clipped - 4 lines] > aware about the savings they could achieve by buying exactly the same > lens mail order, and then following up with routine exams? By the way, I'm not trying to assert that there's anything wrong with making the most profit you can--I'm just pointing out that everyone draws a line somewhere between maximum benificience to the patient and the money they make, and complaints about where chains draw that line ring just a little hollow. Again, if the chains are REALY TRULY all that bad for the patient, police your field. SignatureScott Reverse name to reply > >> I could make a ton more money by prescribing inferior private label > >> old technology contact lenses, but I don't. I could make a ton more [quoted text clipped - 15 lines] > Scott > Reverse name to reply Mr, Scott. You, posting here my point of view. Sure, I can not use so good language. >> >> I could make a ton more money by prescribing inferior private >> >> label old technology contact lenses, but I don't. I could make a [quoted text clipped - 20 lines] > You, posting here my point of view. > Sure, I can not use so good language. I also just say it in context, and until the point is made, then I stop! SignatureScott Reverse name to reply > >> >> I could make a ton more money by prescribing inferior private > >> >> label old technology contact lenses, but I don't. I could make a [quoted text clipped - 26 lines] > Scott > Reverse name to reply Scott, I understand that But "He took the time to explain that progressives are the Swiss Army Knives of the glasses world, " It is not true for everybody. Progesives design has a lot of astigmatizm and it is a Physics. you can not get around it. They are comfy, but they spoil vision of people with20/20 and starting presbiopia. But they are the top sellers .Person with readers just takes the readers off. with progressives does not take them off (i am about the person who starts with 20/20) And as a result hyperopia and good customer for OD,Who can not buy readers from the shelf. (i do not mean you, i think you are a minus -) Companies promote it because of a prise. They can argue with me here as much as they want. They " can not change the nature" PS : just a question: you mention in another post EOG and that you using it at you job. Do you conduct EOG by itself or with EEG ? I mean is your field neuroscience ? > Progesives design has a lot of astigmatizm and it is a Physics. > you can not get around it. I barely notice mine. > They are comfy, but they spoil vision of people with20/20 > and starting presbiopia. They do not spoil vision. Vision is the same after you remove them. > But they are the top sellers .Person with readers just takes the > readers off. with progressives does not take them off Because progressives are glued on with cyanoacrylate? > And as a result hyperopia and good customer for OD,Who can not buy > readers from the shelf. OTC readers have only one power. -MT > > Progesives design has a lot of astigmatizm and it is a Physics. > > you can not get around it. > > I barely notice mine. Also we do not see our blind spot and even n_o_s_e > > They are comfy, but they spoil vision of people with20/20 > > and starting presbiopia. > > They do not spoil vision. Vision is the same after you remove them. Your vision > > But they are the top sellers .Person with readers just takes the > > readers off. with progressives does not take them off > > Because progressives are glued on with cyanoacrylate? cyanocrylate it is a man's things, also as a screwdriver, I can successfully use masspectrometer, but would prefer microwave and the other hi tech devises with one button "start" ,screwdriver with instructions in what direction screw and unscrew. > > And as a result hyperopia and good customer for OD,Who can not buy > > readers from the shelf. > > OTC readers have only one power. > > -MT >> I barely notice mine. > > Also we do not see our blind spot and even n_o_s_e But you said this - if it doesn't bother me it shouldn't bother you. >> They do not spoil vision. Vision is the same after you remove them. > > Your vision My measurements. >> > But they are the top sellers .Person with readers just takes the >> > readers off. with progressives does not take them off People with progressives are perfectly free to take them off. -MT >> I could make a ton more money by prescribing inferior private label >> old technology contact lenses, but I don't. I could make a ton more [quoted text clipped - 4 lines] >about the savings they could achieve by buying exactly the same lens mail >order, and then following up with routine exams? Yes, but all my patients tell me that the money they would save is outweighed by the convenience of ordering them through me right in the office and having them shipped to their house. >Differences in your markup have >absolutely no impact in the decision about what lines you deal with? Your >interest in maintaining an optical shop has everything to do with providing >your patients with the best possible care, and absolutely nothing to do >with cash flow through your practice? If you define "optical shop" as a place to be fitted with ophthalmic devices, then yes, the best possible care. If you mean a "profit center" then no, it's primarily cash flow and profit. The independents are biased towards the best care, the big box opticals are biased heavily towards profits. >If you weren't making enough money off your optical shop, you wouldn't be >maintaining an optical shop. That makes you something of a bean counter. The under fifty or so crowd prefer one stop shopping- they're generally not willing to go to one office for the exam and travel a mile or two to see the optician. If you don't provide ophthalmic lens service, it's unlikely you'll get many exams. Robert Martellaro ~~~~~~~~~~~~~~~~~~ Optician/Owner Roberts Optical Wauwatosa Wi. ~~~~~~~~~~~~~~~~~~ "Science is a way of trying not to fool yourself." - Richard Feynman > The independents are biased towards the best > care, I'll repeat my point by asking the question I asked earlier. After a 25 year old end up successfully and happily fitted with the right contact lens, do the independents point them to the less expensive mail order sources of those lenses? So long as the prescribing OD follows them up regularly and there's no changes, wouldn't it be in the best interest of the patient to get those exact same lenses in the least expensive way possible? I'd wager that you don't. I'm not saying that you should. You put in the time and used your considerable expertise to make your patient comfortable, and you hope that the patient continues to reward your fine service by purchasing lenses from you. Nothing wrong with that, but I would hardly think the level of care would go down appreciably if they mail ordered the lenses once correctly fit. I can understand the bit about patients not liking practices that don't offer complete optical services, though. I'm a little different from most people, in that my place of employ offers a very nice optical shop with a much more substantial discount than my OD offers. My OD is my doctor, and I don't see any reason to stop seeing him-- but I will if he continues to try to guilt me into using his optical shop! SignatureScott Reverse name to reply > I'll repeat my point by asking the question I asked earlier. After a 25 > year old end up successfully and happily fitted with the right contact [quoted text clipped - 17 lines] > I don't see any reason to stop seeing him-- but I will if he continues to > try to guilt me into using his optical shop! I think you have to be careful here, Scott, though I take your point. While I agree with the underlying premise of your argument, I don't think that glasses, or contact lenses, are fungible widgets the way PC software, books, gardening tools, or digital photography equipment is. In the latter category, service -- to the informed consumer -- may be irrelevant. I know what I want. I know how to use it. I'm not concerned about service after the sale. I'm simply buying on price. But ... glasses and contacts ... ISTM there's /some/ distinct and important value added by having the practitioner dispense, verifying that the final product received is an /exact match/ of the product prescribed and ordered, and that it is fitted and working properly ONCE fitted. Fitting, with glasses, can make a fairly significant difference in the visual outcome of the consumer, particularly as the degree of refractive error rises. I recall /frequently/ hearing about "bad batches" of contact lenses. I've CERTAINLY seen, first hand, that what's received (eg, glasses or contacts) OFTEN does not match what was ordered. To that extent, a competent and meticulous dispensing eye doctor seems FAR more likely to catch these problems on the front end than your average consumer. So ... I don't think you can reduce THIS case to something as black and white as "...if you don't tell him that his contacts are available for less money, are you really providing the best advice to the customer?" [paraphrasing. NOT your words]. The BEST service to the customer is the best quality of product, with the best quality of service behind it (as appropriate for THAT product and THAT customer) with the fastest delivery time. The old maxim, in retail, is that there are three components to retail: quality, price, and speed. Pick two. How the calculus works really MUST, I would argue, depend on the nature of the product or service itself, AND on the needs, knowledge, capacity, and/or ability of the individual consumer. The best practitioner, IMHO, would do the math for each instance. In YOUR case, for example, I would guess that you are QUITE capable of either ascertaining, adapting to, or making adjustments to, any slight discrepancies between product prescribed and product received. You might also be willing to send the glasses -- ordered from an Internet site -- back for a revision once you DID notice that they were made wrong. Others may have less ability to notice the error, and -- once they DID -- less tolerance for the extended wait time, and the likely red tape necessary to require a Return Merchandise Authorization, etc., etc. See what I mean?? Neil >> The independents are biased towards the best >> care, [quoted text clipped - 6 lines] >the patient to get those exact same lenses in the least expensive way >possible? My clients are aware that they could save ten to fifteen percent if they purchased their CLs online. For some reason they still prefer to buy them from me, and I'm just the CL fitter, not the prescribing doctor. I guess my clients are ignorant when it comes to financial affairs. >I can understand the bit about patients not liking practices that don't >offer complete optical services, though. I'm a little different from most >people, in that my place of employ offers a very nice optical shop with a >much more substantial discount than my OD offers. Either your employer subsidizes the shop or they're cutting corners. If the latter, they might get away with sloppy work if you're age 40 or younger. If you're older than 50 it's a slippery slope, and just a matter of time until you get burned. From what I've read in this thread, I'd guess you're younger, and/or wear a mild single vision Rx. >My OD is my doctor, and >I don't see any reason to stop seeing him-- but I will if he continues to >try to guilt me into using his optical shop! Don't tell me! Take the doc to the side and tell him or her to cut it out. Robert Martellaro ~~~~~~~~~~~~~~~~~~ Optician/Owner Roberts Optical Wauwatosa Wi. ~~~~~~~~~~~~~~~~~~ "Science is a way of trying not to fool yourself." - Richard Feynman > Either your employer subsidizes the shop or they're cutting corners. > If the latter, they might get away with sloppy work if you're age 40 > or younger. If you're older than 50 it's a slippery slope, and just a > matter of time until you get burned. From what I've read in this > thread, I'd guess you're younger, and/or wear a mild single vision Rx. My employer is the largest employer in this city. They are a full functioning hospital, with a full functioning ophthalmology dept, with a full functioning optical shop. On top of the normal shop, about twice a year, they drag in representatives from about a six or ten frame manufactures, and hold a big fashion show with a selection at least three or four times as big as any I've ever seen in any other shop. After browsing to my hearts content, I walked up to the Safilo rep, and told him what I was looking for, and how I hadn't found it despite looking in three shops, and how it differed from what I was seeing. He went to a case, one of about two dozen cases he had with him, and pulled out about 4 frames, one of which was exactly the type of thing I was looking for. I tried that frame on in at least two different sizes, all on hand. The number on the temple piece is 140CA7390 Flexolite OTZ2, if that means anything. I took the frames to the optician, and handed him my first ever bifocal prescription. We discussed three or four different options for progressives, ranging from an inexpensive office lens to the latest- greatest-most-expensive-minimal-distortion-correcting-for-Listing's-eye- torsion options. I don't remember which ones he ultimately recommended, but they are watermarked (or whatever the lens equivalent is) with a circle (might be a down-facing Lambolt C-- its hard to tell with my glasses off!) with a vertical line through the lower portion sitting over a capital A. He took the time to explain that progressives are the Swiss Army Knives of the glasses world, good at many things, but not exactly super great at any particular thing, and that if I couldn't get used to them I'd have the option of replacing them with a lined bifocal, but I should give them the old college try. Despite the huge throngs of people at this frame fashion show, I didn't feel rushed, and I felt like I had his undivided attention. The description/selection/measurements probably took about twenty to thirty minutes. Prior to getting progressives, I was tremendously annoyed at constantly removing my glasses to read--much more annoyed than I ever had been with glasses, which I've been wearing since 4th grade. That problem is gone. I imagine since my employer uses a self-insured PPO scheme they feel compelled to offer their own employees at least as good a discount in their own shop as has been negotiated with Pearle by the insurance company that manages our PPO, which is considerably bigger than the discount they seem to have negotiated with my OD. Couldn't tell you if its subsidized, but its sort of moot, as we're self insured. The frames, the salaries, the work in the shop, the insurance payouts, all get subtracted from the same kitty, in effect. I know the chair of this ophth department, and have been at a number of meetings with him. I know that he's very committed to good patient care, and I also know that he does what he can to keep the cash flowing in the right direction through his department. My wife has some real problems, and has been seen by her regular MD in this group for about 8 or ten years, and by two different subspecialists in that department. I'm very happy with her care there. I'm less impressed by the admin staff, and I'll probably let him know that the next time I see him, but that's not a medical issue. SignatureScott Reverse name to reply >> Either your employer subsidizes the shop or they're cutting corners. >> If the latter, they might get away with sloppy work if you're age 40 [quoted text clipped - 5 lines] >functioning hospital, with a full functioning ophthalmology dept, with a >full functioning optical shop. You got the A-team, and a staff discount to boot. >On top of the normal shop, about twice a >year, they drag in representatives from about a six or ten frame [quoted text clipped - 14 lines] >greatest-most-expensive-minimal-distortion-correcting-for-Listing's-eye- >torsion options. That's probably the Hoya ID lens, designed around Listing's Plane (which describes the eyes movement rotationally). Expensive, but one of the best lenses for high plus, minus, cyl, add powers, and first time progressive wearers. Try it next time. You'll really start to see how poor some of these progressives function once the add power gets above about +1.75. >I don't remember which ones he ultimately recommended, >but they are watermarked (or whatever the lens equivalent is) with a >circle (might be a down-facing Lambolt C-- its hard to tell with my >glasses off!) with a vertical line through the lower portion sitting over >a capital A. That's the Solamax. Wider near zone but a narrow distance zone. >He took the time to explain that progressives are the Swiss >Army Knives of the glasses world, good at many things, but not exactly >super great at any particular thing, I like that. Kind of like life in general- a series of compromises. >and that if I couldn't get used to >them I'd have the option of replacing them with a lined bifocal, but I >should give them the old college try. Despite the huge throngs of people >at this frame fashion show, I didn't feel rushed, and I felt like I had >his undivided attention. The description/selection/measurements probably >took about twenty to thirty minutes. Yup. Measure twice and cut once. Get it right the first time. >Prior to getting progressives, I >was tremendously annoyed at constantly removing my glasses to read--much >more annoyed than I ever had been with glasses, which I've been wearing >since 4th grade. That problem is gone. Depending on the degree of myopia, removing the glasses for close tasks can be a real advantage, especially as you get older. >I imagine since my employer uses a self-insured PPO scheme they feel >compelled to offer their own employees at least as good a discount in >their own shop as has been negotiated with Pearle by the insurance >company that manages our PPO, which is considerably bigger than the >discount they seem to have negotiated with my OD. Good for him. I don't discount my services, aand neither should the doctor, at least to the degree that Pearl does. Of course Pearl does this to get the eyeglasses work. I believe in retail it's called a loss leader. >Couldn't tell you if >its subsidized, but its sort of moot, as we're self insured. The frames, >the salaries, the work in the shop, the insurance payouts, all get >subtracted from the same kitty, in effect. Keep it in house and control the quality. The administrator was probably tired of hearing all the complaints about the second-rate care they were getting from the chains. >I know the chair of this ophth department, and have been at a number of >meetings with him. I know that he's very committed to good patient care, [quoted text clipped - 5 lines] >I'll probably let him know that the next time I see him, but that's not a >medical issue. You'll probably have to get in line. Good luck! Robert Martellaro ~~~~~~~~~~~~~~~~~~ Optician/Owner Roberts Optical Wauwatosa Wi. ~~~~~~~~~~~~~~~~~~ "Science is a way of trying not to fool yourself." - Richard Feynman > So do the chains, except the "we" is the corporation. You haven't selected > a few lines of contact lenses that you prefer to stick with? Of course, but based upon my criteria, which I suppose you assume to be mostly about what's good for my pocketbook as opposed to the satisfaction of the patients needs. That's kind of like me making the assumption that your research and publishing is all about the grants. >> So do the chains, except the "we" is the corporation. You haven't >> selected a few lines of contact lenses that you prefer to stick with? [quoted text clipped - 3 lines] > satisfaction of the patients needs. That's kind of like me making the > assumption that your research and publishing is all about the grants. Now, now-- I never said "all", or even "most". The only idea I want to get across is "some". If a contact lens line made absolutely no sense for your pocketbook, you wouldn't consider it. I suspect that an OD just can't have experience with every line out there, and can serve their patients better by choosing a select few and getting really good with them. My hackles get a bit raised when I hear OD's knocking those in their own profession who opt, for some reason or other, who choose to work in an optical chain. I've had private OD's and chain OD's through my life, and I've found good people and jokers in both areas. I suspect the private OD's meet many patients who have had bad experiences with the chain OD's, so the opinion gets a little colored. The tens of thousands of patients who are very satisfied with the chain OD's fall right out of the picture, because they don't migrate to the private OD's. Sort of like MD's-- secondary and tertiary care providers meet patients that their Primary Care providers couldn't handle-- but the specialists don't necessarily think that all primary care providers aren't fit to practice, they just realize that the practices are set up different ways-- and in this case, the training is different as well. If there's something particularly evil about the nature of the chain OD's, by all means, police your field. I know its possible-- look at all the ethical discussions that arose in optometry surrounding comanagement! SignatureScott Reverse name to reply > >> So do the chains, except the "we" is the corporation. You haven't > >> selected a few lines of contact lenses that you prefer to stick with? [quoted text clipped - 33 lines] > Scott > Reverse name to reply I prefer the "freedom" of private practice. I do have the option of prescribing any lens. My preference is for new and better technology. I wear contact lenses, and I wear progressive spectacle lenses. I get vouchers for free lenses for my personal use, and I try them. I can easily perceive differences in contact lens materials, and in the vision quality of the progressive lenses. I then make recommendations based upon my experience, and listen for patient feedback. Often, the feedback reinforces my own experiences with the products. If I get too many non-adapts to a particular type of progressive lens, I simply quit using it. I also see patients who take my prescription and make a purchase from one of the chains, but who return dissatisfied. They don't know if it is my prescription or the product. More often, it is that the product has been improperly fitted, or else the optical aberrations are annoying because the lens is old technology. Newer technology in contact lenses has provided an unprecedented leap forward in ocular health and comfort. The same thing is happening in spectacle lenses where better quality equals fewer aberrations and a more natural visual experience, as opposed to always fighting with the eyeglasses. The AR coatings no longer flake, and you can rely upon scratch resistant coatings to do what they claim. It is usually the case in the chains that the OD has control over (a) the exam, and (b) the selection of contact lenses, but not (c) the brand or type of spectacle lens, lens measurement, etc., unless specifically stated on the prescription. I personally have nothing against ODs who practice in chain settings, but I do know the experience of not being able to control the "merchandising" aspects of the business and it would be frustrating for me. It is pretty much an axiom that profit margins as a percent of costs are always greater on low-price optical goods. Those frames that don't get sold wind up getting returned and resold at a deep discount where they can be marked up many times over cost. The same goes for inexpensive polycarbonate lenses. You just have to make it on volume, and volume is increasingly the name of the game because of insurance. > If there's something particularly evil about the nature of the chain > OD's, by all means, police your field. Nothing evil, just the usual laws of supply and demand. The chains sell glasses, and contacts. The OD is not the focus, they just supply the prescription. The OD is often just out of school, and doesn't have the money to set up a private practice right then. The OD's in private practice are often older and more experienced, and the eye exam is the focus of the office, even though the money might be in the glasses and contacts. I have a relative who owns a couple of optical shops. They sell the glasses first, and then ask the customer for their prescription. Normally they don't have one. No problem, there's an OD right next door who takes primarily walkin patients. He is paid by the shift. He has two requirements for the job: have an OD license and speak fluent Chinese (all the customers are Chinese). My relative holds the leases on the OD shops, and owns all the equipment. > I have a relative who owns a couple of optical shops. They sell the > glasses first, and then ask the customer for their prescription. [quoted text clipped - 3 lines] > Chinese (all the customers are Chinese). My relative holds the leases > on the OD shops, and owns all the equipment. That's pretty much how it is. Dear Steve, Anon E. Muss is accurate and correct. Before she makes that commitment of money and effort have her read: http://health.groups.yahoo.com/group/optometrysucks/ So she is prepared for these issues. Best, Otis > On Sat, 20 Oct 2007 19:39:12 GMT, Steven Stone > > <xxspfl...@xxcitlink.net> wrote: > >What is the best way to fund four years of Optometry school ? > > As a current OD, I'd tell her to find a different profession. On Oct 21, 7:52 pm, "otisbr...@pa.net" <otisbr...@pa.net> wrote: > Anon E. Muss is accurate and correct. Jealous? Two things you've never been... Go back to eating your popcorn, Neil. > On Oct 21, 7:52 pm, "otisbr...@pa.net" <otisbr...@pa.net> wrote: > [quoted text clipped - 3 lines] > > Two things you've never been... On Oct 21, 8:13 pm, "otisbr...@pa.net" <otisbr...@pa.net> wrote: > Go back to eating your popcorn, Neil. No, no, Otis. I'm serious. Honest ... accurate ... correct ... logical ... reasonable ... responsive .... These are all qualities that do not apply to you. I could see why you might be jealous. On Oct 21, 10:52 pm, "otisbr...@pa.net" <otisbr...@pa.net> wrote: > Dear Steve, > [quoted text clipped - 10 lines] > > Otis By all means, she should decide on her lifes ambition on an idiot (Otis Brown) and an internet website. Think about it. On Oct 21, 7:52 pm, "otisbr...@pa.net" <otisbr...@pa.net> wrote: > Before she makes that commitment of money > and effort have her read: > > http://health.groups.yahoo.com/group/optometrysucks/ By the way, Otis .... That site has A TOTAL OF 974 members. Assuming, arguendo (I'm certain it's not the case) that ALL of these people are active and unhappy as OD's (as opposed to, say, lurkers, or ... trolls ... like yourself), what percentage of licensed U.S. optometrists does that represent? You've ALWAYS had sample size issues ... among many other issues .... but ... could you help us out in this case? I'll take a quick stab at it: Use this data: http://bhpr.hrsa.gov/healthworkforce/reports/factbook02/FB501.htm Following established trends, there are probably some 36,095 licensed optometrists in this country (and you, who practices medicine WITHOUT a license, but I digress) today. So ... you have the opinion of 2.7% of licensed optometrists represented in this online bitch room. My, but it takes a special kind of ... um .... diminished capacity to parade THAT around as significant. But you fit the bill, dear boy ... you fit the bill ;-) > Following established trends, there are probably some 36,095 licensed > optometrists in this country exactly. thats about 1 optometrist for every 8000 US citizens. the number of general ophthalmologists is dramatically lower so that the primary eye-health practitioners for most people are optometrists. I think this puts us in a good position for the future. when a nationalized health care program of some sort takes over-- its inevitable folks-- we will be in a good position to benefit. I recommend Optometry as a career, but not using the old private practice model that was widely accepted and used decades ago.
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