Clarification

We really appreciate all of the feedback we've received thus far. It always surprises me when my internet ramblings attract attention outside of my own.

This blog was started because I challenged an internet blowhard to outline for students how he became so successful. That challenge was not accepted. So I challenged myself. Furthermore Swell and I use blogs as a method of recording our life journey.

The internet is an interesting phenomena. It seems to allow those with little to no experience to claim expert status on any number of issues. I do not claim to be an expert on optometry. Private practice. Or anything else this blog will discuss. I am simply learning.

This blog will serve to outline the decisions we will have to make over the next year and how we came to make the decisions we did. I fully realize that what we decide may not be what is appropriate for others but I hope that I can instill hope in students that it is possible to pursue private practice. That it is possible to pursue other non-patient care interests with an optometric degree. That it is possible to use commercial practice to your advantage.

Its funny that I've only made four posts and I've already been "called out". I don't know if I'm a "major pro commercial flamer" or not. (Apparently someone has changed the meaning of the word flamer...) I do see commercial optometry as a viable mode of practice in today's optometry. I feel that we used this mode of practice to our benefit and will continue to do so. Please don't read that we hate those who choose to practice this way. We respect them as colleagues and hold no ill will toward them. It is simply time for us to face new challenges. There are many out there who, in their quest for acceptance or in an effort to hide inadequacies, will take every opportunity to yell and scream about how commercial practice is destroying our fine profession. They can continue to do that. I will not.

Commercial is not my concern.

My future patients are my concern.

Insurance is my concern.

Cash flow is my concern.

I'm tired of optometry. I've been tired of optometry since my second year of optometry school. Not because I dislike it just because I like something else more. I still have a passion for eye care but not at an individual patient level. The only way I can bring myself to stay in traditional optometry is to challenge myself with something new. Practice ownership.

This will be Swell's practice but I will play a role in it. We will be partners but she'll be the primary optometrist. I fully expect to be working commercial or, hopefully, public health work as my primary source of income.

We don't expect to remain anonymous. In the next week many of you will know our real names and our location. Our intent with pseudonyms is simply to prevent people from googling our given names and stumbling upon this blog. I will stand by every word I type but am always open to having my mind/opinion changed.

The picture associated with this blog is one of my favourite pictures of Swell and I. It is a tribute to my pseudo-anarchist punk youth and was taken on a very, very smelly train in Egypt. It pokes fun at the anonymity of this blog and is intended to represent the idea that our journey could be the journey of any recently graduated optometrist. We are nobody special. We just are.

I know I am long winded. Any paper I've ever submitted to anyone has been returned with the comment to cut not just words or sentences but pages. The internet gives me the freedom to ramble and I hope that within the ramblings you can gain some insight and enjoyment. I really hope that all y'all continue to visit and follow us. I've enabled anonymous comments now so if you don't want to put your name to your comments thats fine. No worries. I promise not to be offended. I welcome dialogue and know that I can learn from all of you.

Thanks again!

Sears

Today I’m sitting in a Sears optical grateful that we’ve started down the path to practice ownership. I realize it will be a long and difficult path but no matter what happens it will surely beat this.

Now many of you who’ve read other things I’ve written may be in shock. While I don’t agree with those that spew hatred and anger at commercial optometrists, commercial optometry – especially like this – is just not my cup of tea. It has its place and I’ve milked it for all its worth. It really is time to move on.

To supplement my income I signed on with a company that provides temporary fill-in optometric services. They had an opening for today; I wasn’t working anywhere else so I agreed to fill in at this Sears Optical.

Half of you probably didn’t even know Sears had an optical.

It used be a division of Cole Vision.

Cole Vision was, of course, purchased by Luxottica so Sears optical is now part of the wonderful Luxottica family.

Sears opticals are generally hidden in the back of the store near the electronics.

Today I’m working across the aisle from the refrigerators and next to the hearing aid people.

Sears opticals are generally small. This is no exception.

The area the Optometrist leases is tiny. Maybe 10 feet by 5 feet jam packed with antiquated equipment, a small counter and a sink.

I could not see myself parking my car in the mall parking lot, walking through the door to Sears and spending the next 8-10 hours in this little dungeon day after day.

After day.

The optometrist who leases this practice has been here for years.

I’ve never met the man but according to his degree on the wall he graduated in 1985.

22 years ago.

And he has a tiny little hovel that doesn’t belong to him.

Not my cup of tea.

But more power to him. He can have the Sears patients. I don’t want them.

Not because they’re not good people but because they are Sears people. I heard somewhere once that the only way Sears optical survives is because they accept the Sears credit card. I don’t know if it’s true or not but I do know that most of the people I’ve encountered at Sears optical are here for the quickie exam and whatever glasses are on sale this week ($99 for a complete pair this week - including progressives). Good for them.

I don’t want to see those people.

I look forward to the challenge that private practice will be. Not only the challenges that come from complex cases but the challenge that owning a business will present.

Staffing issues. Building issues. Insurance issues. It will be a challenge that I couldn’t find working in a hovel for 22 years.

I hate the mall.

I hate going to the mall for any reason at any time.

It is a very slow day so I felt like getting up and moving around. Rather than pace my 10X5 room I headed out into the mall.

I walked past a Lenscrafters, a Pearle Vision, and an ECCA optical. So there are at least 4 opticals in this mall.

Three of them owned by Luxottica!

Crazy.

The private practice I work at one day a week has mostly Luxottica frames for sale.

And takes Eyemed.

If at all possible we’re not going to sell Luxottica frames.

Or take Eyemed.

Why support the company that is slowly taking over the entire industry?

We’ll see what reality holds as currently I’m just living in a theoretical/idealistic world.

Thursday is our introductory meeting with the consulting group. We’ll be getting a package in the mail today or tomorrow and will receive a phone call on Thursday going over all of the information in the package.

I’ll let you know.

First Meeting

Swell and I recently went to Vision Expo West.

It was in Las Vegas.

We had two main goals in going to Vision Expo:
1) Finish our required continuing education for this year
2) Visit with family who met us in Vegas from their home in Canada.

A side benefit of our trip to Vegas was having the ability to talk to a representative from an optometric consulting firm about the services they offer to new start-up optometry practices.

Shortly after our return home I received a call from this firm and we set up a telephone meeting with one of the co-founders to go over, again, the services they offer and to answer any questions we had.

That meeting occurred yesterday.

It was scheduled for 10 am. At 10:03 am I was getting a little upset that they weren't more punctual.

At 10:05 am my phone indicates I had a new voicemail.

Apparently much like a watched pot and boiling water, a watched phone doesn't ring.

I quickly phoned them back and I spoke with the co-founder of the company for 35 minutes.

It was basically a sales pitch for what they do.

Swell and I have many concerns about going into business for ourselves. The primary concern is money. We don't live lavish lifestyles.

We have one car. It was a gift. (Well, we have two cars but one is back west slowly rusting away and it is a 1970).
We have basic cable (I suppose we could cancel that and save some money every month).
We don't buy a lot of clothes or things.
We just need money for our student loan payments and our household expenses.

And to travel.

We must have money to travel.

As I typed the above sentence I could hear hundreds of private practice optometrists scream out in unison that Swell and I don't deserve vacations, that we have no right to expect to travel. They expect us to scrape by for the good of the profession. To devote our lives, our every waking breath to the betterment of the profession.

I'll reiterate we need money to travel. If private practice can't afford us that we won't be private practitioners.

We're not asking for vacations in Hawaii, or ski trips to Switzerland. We need money to visit Swell's elderly grandparents and her mentally ill Aunt in the hell on earth known as Bucharest, Romania.

Once a year.

At least.

We also need money for me to be able to up and travel to conferences that I want to attend. Like the WCO in London next April.

These are necessities.

Anyway back to the phone call.

The catch phrase for this consulting firm is that being a private practice owner is like climbing a mountain. You can't climb a mountain without first starting down the trail. As you start down that trail the consulting firm will be there right by your side. Hand in hand.

So romantic.

Brought a tear to my eye.

I was told that private practice is the best way to maximize:
Income
Equity and
Freedom

Other modes of practice will allow you to maximize at most two of the three.

He asked what time line we were thinking of. It was the first time we've said this aloud to anyone else.

September 1.

Ideally on September 1, 2008 we will unlock the doors to our purchased practice and start seeing patients. If we are unable to find a practice worth purchasing in the very near future we will start down the path to a cold opening.

Which is far more scary but at the same time far more exciting.

To buy a practice is to buy a history. Having worked in many practices in my short career I'm not sure I want some of that history. How do you change policies and procedures without alienating the existing patient base? How do you take a refractive practice and build it into more without turning existing patient's off? In a perfect world a practice would be available that did things very similarly to the way we would want to do things.

Its not a perfect world.

Opening cold is fraught with problems. Most of them - in my non-business savvy mind - money problems.

Cash flow.

We can't sit around seeing a patient here and a patient there. We need to be able to grow the practice quickly. Ideally being able to take a part-time associate on in 2-3 years.

So we can practice less.

So the co-founder was happy that we were open to either purchasing or opening cold. From the tone in his voice I think he prefers opening cold. He was also happy that our time line is set. Furthermore he was happy that Swell and I have defined our roles in this adventure.

Me = the heavy. The hire/fire guy. The meet with leasing people, etc.
Swell = day to day operations. She is, after all, the one who will be working in the practice. I'll be working elsewhere to support it (especially if we open cold). She is excited about working with an optician (or by herself) to develop the optical. She's looking forward to decorating a practice. And most importantly she's looking forward to building relationships with the patients and treating their vision and eye care needs. (How is that for a Pacific University statement? Vision AND eye care. Two different things.)

Importantly we were told that in the first part of the program the consulting firm will be by our sides. As we meet with finance people. As we look at leases. They will help us analyze locations and cities. They will offer advice on all facets of the journey. As he said, "Anything you would do to get this practice bought or open we'll now do together."

This is important to us. I've always been of the mind that we should let professionals do what their good at while we do what we're good at. I'm not an MBA. I'm not a financial guy so I need all the input I can get.

It was a sales meeting.

And I was sold.

As I type this Swell is faxing our deposit in and we've taken our first steps down the path, toward the mountain called private practice.

Wednesday = Private Practice Day

In my most recent optometric incarnation Wednesday is my private practice day. I have the privilege to work one day a week at a local private practice. It is eye opening.

It is different than the other 3-4 days a week where I am at commercial practices.

Better?

Different.

This is not my first experience with private practice.

For that we would have to travel all the way back to the fall of 2001. One of my fourth year "externships" was with a private practice somewhere east of the Mississippi.

This optometrist has owned his practice for decades. He owns his own building and while I was there he opened a satellite location. He scoffs at so called low-ball vision plans and made it a point to tell the students to seriously consider how much it costs to see a patient (overhead, etc.) and what the vision plans were offering. In many online internet circles his optometric face would be cheered and applauded.

He is in private practice.

He charges for everything.

Everything.

And his fees are astronomical.

I was speaking with the mother of one of his patients during the daughter’s VT session one day. She referred to the owning OD as a "used car salesman".

He is incredibly intelligent. Very skilled. Up to date.

But everything he does has to be a sales job.

You need a GDX, visual field, and poly AR glasses.

Your child needs 52 weeks of vision therapy.

They may very well have needed these things but his approach was abrasive. He turned people off. Many were happy to leave and not return. Staff turnover was high because he didn't pay as much as others.

I learned a lot of optometry while I was there.

I was challenged more than I've ever been challenged. I chased autistic kids around the room trying to do retinoscopy.

I sat on the floor doing eye exams because that was the only place it would work.

I learned a lot about practice management as well.

I learned what NOT to do.

Just because one is in private practice doesn't mean they are worth holding in high regard. One's character is what needs to be looked at.

One's ethic.

One's professionalism.

My second experience with private practice came following graduation. Where we were living it was difficult to find an optometry career so I had to take a number of jobs.

One of these jobs was at a private practice while the owning OD took 3 months of maternity leave.

She worked right up to the day before she gave birth and I was there the next Monday. It, too, was a learning experience.

This private practice was located in a mall. (It no longer is but at that time it was.)

This private practice was built on insurance.

VSP to be exact.

If there were no VSP there would be no practice.

I would see upwards of 16 patients some days. 15 of them would be VSP.

Nothing wrong with seeing insurance patients but I learned that it’s probably not wise to have the bulk of your income coming from one place. I also realized that this private practice was very commercially driven. That is the exams were refractive exams and the goal was to sell spectacles.

Nothing wrong with that but I failed to see how this practice stood out from the crowd of other optometric practices. The only difference I could see between this practice and the commercial practice down the hall was that the OD kept the profits from the sale of the spectacles.

I worked at a few other private practices during the two years immediately following graduation. Some were older practices with old equipment but a loyal patient base; others were newer practices with newer equipment and a non-loyal patient base. Most of the practices I visited were surviving by doing basic optometry – refractions and red eyes. Not many had visual field machines, OCTs, etc. They were refractionists and treaters of red-eyes. And they were succeeding in what I would consider a saturated market. They found their niche and they were filling it.

Upon our return from the Middle East I found this private practice job. The owner was looking for someone one day a week. I jumped at the chance to be away from commercial practice at least a little.

Today I’ve seen one patient.

I’ll be leaving in an hour.

One patient.

This practice has been open for 20 plus years although the current owner has only been here for 5 or 6 years.

Why did I only see one patient?

Because I’m not yet credentialed on any of the practices insurance panels.

They cannot find anyone willing to pay cash to see me.

This is another private practice that survives by taking a million insurance plans.

There is nothing wrong with this. It’s a style of practice.

And the owner works with it.

It’s not the style of practice Swell and I see ourselves working in.

Our dream practice will, of course, take insurance but we won’t be on every plan known to man. We will try to capture some private pay patients but we’ll work smart rather than hard.

Swell’s current job is happy that only 10% of their gross is insurance based. If we were that practice we would drop every insurance immediately. Although insurance only makes up 10% of their gross it takes up a very large portion of their time. Time that could be better spent with their private pay patients. Time that could be better spent doing other things.

The practice’s view is that “Thank goodness we take insurance or else we’d have 10% less money.”

So I have some experience in private practice. Not a lot but enough to have seen things I like and to have seen things I don’t like.

We’ll take from our experiences and hope to build something we can be proud of. Somewhere where our patients are treated well. Somewhere where our patients receive quality care.

We will be a doctor’s office.

We will be an optical.

We will be a low vision center.

We will be a vision therapy center.

We will do what we can, refer what we can’t.

And we realize, realistically we won’t be all of the above all at once. We’ll start with the doctor’s office and the optical and hope to become successful enough to add other areas to our practice. Not because we’re looking for revenue generators but because we enjoy them and we want our patients to receive the best care possible.

Tomorrow is our phone meeting with the consultants. They will outline their services and I’ll report back with what our next step will be.

Background

This is a blog that will be of little interest to most.

It is a self-serving blog.

It is a blog that will be updated sporadically at best.

It is a blog that will give little insight while striving to be eye opening.

My little slice of the internet will seek to educate but it will fail.

My little slice of the internet will seek to set falsehoods straight but instead it will reaffirm them.

My little slice of the internet will tell the story of two people who detest capitalism but wil try to open a business that makes money.

Not any old business.

No.

The business will be an optometric practice.

The business, the office, the store, the hope, the future will open in 6 months. Or 1 year. Or 2 or 10.

It will open when it opens. It will close when we go bankrupt.

Or when we die.

Or never.

First the characters in this horror story.

Swell is the most beautiful optometrist to ever grace the planet.

Good looking and smart. I married her because of the smart part only.

She, and I, graduated from Pacific University College of Optometry in May 2002. Over 5 years ago.

Can you believe it? I can’t.

Unbelievable.

We were married exactly one week after graduation.

One week to the day.

Swell is called Swell because I’m trying to maintain some semblance of privacy here, although with a little digging it would not be at all difficult to figure out who we are and where we live. C’est la vie. I don’t care if people know I wrote this although I don’t want them to google my proper name and come up with it.

Swell is also called Swell because she swells.

Literally.

She is stricken with a disease called Heriditary AnigoEdema (HAE). Learn this disease as you are sure to never meet someone with it.

It will, therefore, be on optometry boards.

Long story short Swell’s complement system is out of whack.

Unstoppable. Once started it runs amuck thereby causing uncontrolled swelling.

Anywhere and everywhere. It’s funny.

Except it could kill her.

But it won’t.

The FDA will soon approve treatment for HAE. Right FDA?

Swell has been a practicing optometrist since shortly after our honeymoon. She started working as an optometrist in a commercial practice in Washington State.

For $200 a day.

Yes. $200 a day.

She worked at this practice and others for 2 years. She worked primarily at a Wal-Mart and a Lenscrafters her first two years of practice.

Her pay went up.

Slightly.

Swell graduated with very little student loan debt. Her parents were/are very hard working and she is an only child. She owes $26,000 in total.

Hard working and Romanian. Swell immigrated to the USA when she was 9 and 3/4. She came for the freedom and stayed for the food.

My parents are also hard working. Very hard working. And Canadian.

I have 3 siblings.

And $150,000 in student loan debt.

That’s right. $150,000.

I immigrated to the USA when I was 22. I came for the optometry school and stayed for the girl.

When I started optometry school the Canadian dollar was about $0.65 of the American. I borrowed Canadian and paid American.

I’m earning American now and paying Canadian.

The Canadian dollar is equivalent to the American dollar.

In other words I got screwed.

I started working four months after graduation as I had to wait for my work permit. I too worked in Washington State. I worked at multiple Wal-Marts, a Lenscrafters, multiple private practices, a start-up commercial optical (that was bankrupt in less than a year), multiple Binyon’s (Eye Care Centers of America), the local optometry school, and a Sears.

My shortest commute during this time was probably 20 minutes from our apartment.

My longest?

2 hours.

One way.

All for the joy of saying I worked in a private practice.

And for the money.

Although the money wasn’t much.

It did allow me to drive my bus though. My 1970 VW Microbus.

That’s right. I’m a hippie trapped in an optometrist’s body. That has caused me a lot of trouble. But we don’t need to talk about that.

After two years of floundering in and around Washington state we picked up and moved to the Southeast USA so that I could get my MPH.

Our first day in our new city we had a job interview.

We went.

It was a commercial practice. We saw the sign that said $19 eye exams and said: “We don’t really want to do this do we? We’re too good for this aren’t we?”

The pay was almost double what we were making in Washington State.

We took it.

Swell for a year and a half, me for two and a half years.

Swell walked out of this job.

More than once.

It’s not what you dream of doing when you’re filling out your optometry school applications. Seeing a million walk-ins. Having the staff, the patients and your boss yell at you constantly. It’s not fun.

But it pays. And that’s what we were looking for.

Working part-time I was able to pay cash for my graduate school tuition.

It wasn’t cheap either.

For about a year I supplemented my income by going to inner city middle schools and doing basic refractive testing and dispensing free spectacles.

It was worse than doing the cheap commercial exams. But that’s a public health story not an optometry story.

I graduated with my degree. Swell found a new job. Seeing a few patients a day and selling glasses the rest of the day. That’s right. Despite being a “doctor” she was expected at this new job to pre-test patients, check insurance, sell glasses and to be grateful she was “allowed” to work at all.

Lesson: Other optometrists don’t like you. They don’t play nice. And they want to take advantage of you.

Especially if you’re a woman.

And cute.

There is more to this story but it’s not worth rehashing. So I won’t.

You might ask: “Why didn’t you two go into private practice right out of school? Why would you stoop to working commercial optometry for the first four years out of school? You are sell outs. Lazy. Rotten good for nothing losers who do nothing but make a mockery of the rest of us great and talented optometrists. You should be beaten within a diopter of your life with a Maddox rod.”

My answer? “Calm down. Secondly we didn’t want to.”

Easy enough answer.

We didn’t want to. We didn’t know what area of the country we wanted to live in let alone what city. We didn’t have any optometric business skills let alone the guts to open a practice. We didn’t come across a practice worth buying in our, admittedly, short look. And we were happy to work for someone else. We were content with being employees – although we were independent contractors for the most part. We were newly married and optometry was neither our first nor second love in life.

It was our job.

I suppose our career but we were too carefree to know the difference.

Or to care.

I graduated with my masters degree in May, 2006. In January 2007 we found ourselves teaching optometry to Palestinian optometry students in Nablus, West Bank.

It was great.

It was fun.

It was rewarding.

It didn’t pay enough.

Or else we’d still be there.

While there I helped write a paper that will be published in the November 2007 edition of Clinical and Experimental Optometry. I also wrote and submitted another paper that is under second review for the Journal of Optometry.

Both Swell and I are published optometrists. She is co-author of a paper that was published in the Behavioral Optometry Journal a few years ago.

Both published.

Both commercial optometrists.

A dichotomy of sorts.

We came back to the Southeast USA after our time in Palestine, and Egypt, and South Africa (A presentation I wrote was accepted to be presented at a conference in Durban), and Romania.

We came back and found commercial optometry jobs.

Again.

After many tears of frustration Swell has decided that this is not the place for us.

I couldn’t agree more.

We need to leave this part of the country.

And fast.

But leave for what? The overly saturated Pacific Northwest where you make nothing as an employed optometrist?

Canada?

That is a good question.

We’ll soon see. I can tell you this though. We will not move unless we have a practice to move to. We’re tired of working for someone else.

Note I didn’t say we’re tired of commercial optometry.

We’re simply tired of being told what to do and how to do it.

Commercial optometry afforded us many opportunities that a private practice would not.

We’ve seen the world.

Literally.

We’ve made money. We’ve been free to up and quit our jobs without any feelings of guilt.

We’ve told our employers: “You know what? I’m not coming to work next month and if you want to fire me I don’t care.”

And we did. And they did. And we didn’t care.

I was able to get more edumacation.

And I loved it.

So we will buy or open a practice.

Soon.

When we find one.

On Thursday I have a phone meeting with a well-known optometric consulting group who will outline the program they have to help business idiots (me) learn how to run a business. We will then start looking – hard – for a practice to buy as we need the cash flow. If we can’t find one within a year or so we will open cold.

And starve.

Our lives are not optometry.

Our lives are others. Optometry is merely a tool we can use to serve them.

Our patients.

And the world at large.

My time in optometry is coming to a close but I will help Swell run her practice as I pursue other (public health) interests.

Join us on our journey from employed commercial optometrists to practice owners who hate money but need to make it.

It will be a wild ride.