If You Know Where We're Headed, Show Me the Map
Primary care takes up 70% to 80% of a student's time, yet it generates only 7% of a O.D.'s income. What's the solution?
WALTER D. WEST, O.D., F.A.A.O., Chief Optometric Editor
We've all seen dramatic changes in the direction of optometry as a profession as well as an expansion in our scope of practice. In 1975, optometry was about vision care, spectacle sales, contact lens fitting and the hope of increasing the scope of practice to include primary care. By the mid-80s, optometry in my home state of Tennessee had expanded the scope of practice to include primary care in an exemplary fashion. All 50 states currently enjoy this expansion of scope and optometrists are now certified to practice some level of primary care. So what impact has this expansion of scope had on optometry?
Determining the impact
I would say that unfortunately, the expansion to our scope of practice has had far less of an impact on the profession of optometry than everyone expected. As I regularly speak to groups of senior optometry students and residents, I take the opportunity to ask, for example, what percentage of the time that they're in optometry school do they spend on learning how to diagnose, treat and manage primary care patients. The response that I regularly receive indicates that students spend 70% to 80% of their time in the four years of optometry school with a focus on primary care.
If you actually measured the number of credit hours in the curriculum of optometry schools this estimate might vary, but probably not by much. You can only imagine the looks of shock and disbelief that I see in an audience when I tell these "70% to 80% primary care students" that the average optometric practice only generates 7% of its gross income from providing primary care services, while 65% of the average practice's gross income comes from the sale of spectacles and contact lenses. The silence is deafening -- as it should be.
In continuing the discussion and focusing on the time and money that these students have invested in their optometric education, I ask them how they feel about their potential return on investment. More shock and disbelief.
Gathering up hope
But let's look at the other side of the issue. Those practices that are generating an average of 7% from providing primary care were, to a large degree, set in their ways of providing optometric care before the expansion of the scope of practices to include primary care. The demographics of those practices have been and continue to be comprised of patients who primarily seek vision-related care.
So maybe there's hope that the percentage of income generated from primary care will increase dramatically among the newly graduated optometrists whose training was 70% to 80% primary care and who will be more proactive in identifying opportunities to provide primary care. Let's also hope that these optometric graduates will actively seek the knowledge and understanding of their true worth in setting their fees for professional services and that they'll seek a commanding knowledge of how to code and bill for those services, thereby allowing them to advance optometry as it currently exists into the primary care profession that many of us know it can be.
With open arms
Now let's face another reality of optometry in its current state: How are all of the things we just listed going to happen with our newly graduated optometrists toiling away in discount stores?
Make a place for a new graduate student in your practice and proactively provide primary care to your patients. Raise your fees to the true level of your value and help ensure the future of optometry we all want our profession to be; otherwise the map for optometry's future isn't a course for the horizon, but rather a circle that takes those of us who are in the profession of optometry to a place we've already been.
Optometric Management, Issue: November 2004