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 By Neil B. Gailmard, OD, MBA, FAAO, Editor March 29, 2006 - Tip #219 
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Medical Optometry: Is There a Downside?


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Talk with a group of optometrists today about the latest trends in the profession and you'll 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. I'm 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 disease.
  • 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 what?

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 we're 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.

Optical suffers

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. I'm big on delegation, but that approach severely limits practice growth and revenue.

Big 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. It's satisfactory, but it's 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 don't seem to know is that patients will still pay for services and products that they really want, even if it's not covered by a plan. We have to make those services and products available and attractive.

Don't place all your energy into eye disease and billing and coding. Embrace optical as well.


Best wishes for continued success,

Read Past Tips Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week


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Send questions and comments to neil@gailmard.com.

Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.

Please Note: The views expressed in Management Tip of the Week do not necessarily reflect those of the sponsor.

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