Optometric Management Tip # 219 - Wednesday, March 29, 2006
Medical Optometry: Is There a Downside?
Talk with a group of optometrists today about the latest trends in the profession and
youíll hear about the increased emphasis on medical eye care. New grads and seasoned
practitioners alike; everyone is embracing diagnosis and treatment of eye disease; in
some cases as if it is the savior for all of what ails optometry.
My personal position on medical eye care in my own practice is very positive. I became
certified to treat eye disease in my state when the legislation was passed many years ago.
Iím in group practice with three other doctors and we all actively diagnose and treat
everything from infections to glaucoma. We all obtain a considerable amount of continuing
education in this field. No doubt about it, prescribing pharmaceuticals for the eye is an
important part of optometric practice.
From a business standpoint, medical eye care can be a financially rewarding addition to our
other services, but there is also a potential drawback.
Driving the medical trend
There are many good reasons why optometrists are increasingly pursuing management of ocular
- Training. Professional training drives what happens in practice and it has now been
many years since optometry schools, internships, externships and residencies started
teaching medical eye care at the practitioner level. The concentration in this area
keeps improving, but there are now enough graduates who experienced these programs that
it shapes what they do. This specialized training extends into continuing education courses,
journals, text books and simple sharing within group practices.
- Medical insurance vs. vision plans. Fed up with the extremely low fees allowed by
vision plans, doctors realize that medical insurance also covers eye care services if
there is a medical diagnosis. Medical insurance usually pays at a much higher fee level.
- Technology. Optometrists aspiring to provide the highest level of care invest in
advanced instrumentation for their practices. Most of this new technology is focused on
diagnosis and management of eye disease. As ODs are armed with more information, disease
is detected earlier and managed more aggressively.
- Ego and status. ODs have always been sensitive about being misunderstood by the public
and the medical community. Because one aspect of our care involves a product with a retail
and fashion orientation, optometry is sometimes viewed as non-medical. Some optometrists
emphasize the medical model in order to overcome the retail perception and to educate others
about what we can do.
So, is there a downside to medical optometry? Not directly maybe, but concentrating on eye
disease can pull your focus away from optical dispensing and that can lead to a loss of
significant potential revenue. Revenue is not everything, of course, and each practitioner
must do what makes him or her happy, but our premise for this article is the business
standpoint and the primary goal in business is revenue. If weíre honest, personal income
is a very strong goal for most of us.
Many ODs think they can practice both medical and optical care, and some actually do it.
That would be ideal. Unfortunately, as is the case in any business, it is difficult to
pursue two diverse services and do both well. There is only so much time and the CEO can
only work on so much.
In many cases, the optical department in a medically oriented eye practice is mediocre.
There is often a lack of attention from the top and the staff develops a complacent attitude
about customer service. Optical is not fun and exciting, but it is a medical adjunct to
functional vision. A necessity. The doctor who loves treating eye disease usually could
care less about the latest designer frame style or about policies to create sales of second
pairs. In some cases, the doctor proudly states that he has no interest or knowledge of
optical dispensing, preferring to delegate all aspects of that to the staff. Iím big on
delegation, but that approach severely limits practice growth and revenue.
Optometric practices that earn top revenue have great optical departments and generate an
amazing amount of revenue from eyeglasses. Without surgical fees, a primary care practice
is limited to what it can bill for diagnostic procedures alone. That may seem like good
revenue, but it pales when compared to what a practice can produce when it offers excellent
clinical and optical service. Consider what you get paid for procedures like office visits
and visual fields. Itís satisfactory, but itís not big money and it all depends on you to
do the work.
Vision plans may be so dominant that it can affect the philosophy of the doctor and staff.
You may feel like medical procedures produce excellent revenue because you compare it to the
exam fees paid by vision plans. You may feel like optical is not that profitable because you
have not broken away from providing what the plan covers. What many ODs donít seem to know
is that patients will still pay for services and products that they really want, even if itís
not covered by a plan. We have to make those services and products available and attractive.
Donít place all your energy into eye disease and billing and coding. Embrace optical as well.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management