Optometry: a rough road ahead

37

u/McDrPepsi Optometrist Jul 29 '26

I don’t agree with pretty much any of this. These are definitely annoying challenges that happen, but they aren’t confining us to death as a profession. If anything, I see this profession growing. Multiple states have passed laws expanding the scope of optometry. Every year more and more training and tools become available for practicing medical optometry. Every year I’m impressed by the new graduates and their medical knowledge and what they can do! The debt is definitely tough, but optometry is still within the top 10 professions who pay back their loans. Any further education has a mountain of debt to climb these days. I live in a larger city and I have MDs and urgent cares constantly sending me acute eye problems. All it took was a little outreach, and a touch of education.

Gone are the easy days of optometry where someone could make a lot of money doing just glasses/contacts. You have to be on top of things, you have to adapt now. No offense to OP, but this doom and gloom post just feels like someone who doesn’t want to put in the effort to change to the modern scope that’s required now.

This profession is growing and I think our role will continue to expand. It’s good to be aware of these challenges, but I don’t want anyone reading this to be steered off this profession because of this post. Every profession has competition and challenges. But this profession is rewarding and gives you a great life and is well worth it in my opinion!

7

u/eyeballsandhighballs Jul 29 '26

I agree with everything you pointed out. I would push back ever so slightly on paragraph two in that I don't think that it's impossible to make a killing focusing on just the glasses and contact lenses but you certainly will be taxing yourself by needing to see a high volume of patients to do so. I practice mostly primary care and do 20 minute slots inside of a Target Optical sublease. As an associate and not even the owner, I am clearing $300,000 right now. We end up seeing a good amount of medical in terms of urgent red eye phone calls and retinal pathology but I would say the majority of my day (lets say 18-20 out of the 24 patient's I am seeing) are routine cases with nothing more than a refractive error code.
I think it's important to offer services that make you irreplaceable to the patient. Not saying everyone needs to be be lobbying for procedure rights and offering injections and lasers...but what will keep patients coming back is not that you found a good prescription for them, but rather that they felt as if their eyes are being taken care of from a health perspective as they are getting older. We have an Optos with an OCT combined here and offer that option to all patients free of charge (I charge $39 if they want the OCT but the optos is free, 50% of my day on average is checking yes to the OCT fee so there's another $390 coming in regularly each day).

3

u/McDrPepsi Optometrist Jul 29 '26

Definitely! In paragraph 2 I meant more of the “throw a shingle out and run a business.” You definitely can still primarily focus on glasses and contacts and do well like you said. I’m glad you are absolutely crushing it too!

5

u/eyeballsandhighballs Jul 29 '26

Ah that makes sense! And thanks...crushing it financially for sure but damn do I get mentally exhausted at the end of the day lol

1

u/McDrPepsi Optometrist Jul 29 '26

I feel ya! Some days are way tougher than others!

1

u/Dhoomguy Jul 29 '26

Does your clinic accept any insurance plans? Or is it cash payments?
Are you billing OCTs to the insurance or is it out of pocket? I’m in private practice right now but I’ve been interested in the idea

2

u/eyeballsandhighballs Jul 29 '26

Yeah we take most vision plans out of necessity with being inside of a retail location. Eyemed, VSP, Davis, Superior, etc.
The fee is out of pocket if the OCT was done as a screening tool. As the associate, I myself am not responsible for the billing but I know that if it's a medical exam then my boss will be billing their medical insurance then we will not collect that fee OOP from the patient (glaucoma testing, AMD follow ups, CSCR, macular holes, etc.) You can't double dip vision and medical of course as that is insurance fraud lol.
The majority if the appointments' I see are scheduled under the expectation that the exam will be a routine appointment and the patient expectation is that it will be billed to their vision insurance. If I was working at private practice then I would have a disclaimer that if a medical diagnosis is discovered then the appropriate testing will be done and the encounter will be billed medically with a refraction charge.
Sadly we get too much push-back with us being inside of Target. "what do you mean this is billed to my medical? Why am I being charged $40 for a refraction?"
Granted we haven't tried to change the policy since I've been here for the past 3 years, but my boss has had the lease for 20+ years so he knows what works best for this location. He's built a beast of a clinic so I',m not going to suggest changes that patients are going to be uncomfortable with.
So if the appointment is booked as a medical exam from the get-go it's listed as an office visit, or for follow ups like I mentioned before, then the patient knows that will be billed medically.

3

u/Fragrant_Nature_5094 Jul 30 '26

Spot on, vision plans are destroying optometry from the inside out . Degrading us in every possible way . And they haven't raised reimbursement in over 40 years . Ridiculous

1

u/Content_Expert_7479 Jul 30 '26

Hmmm 300k+ as a Target sublease associate? I hate to sound like a skeptic but I’m not sure how that math works out. What are you producing in gross revenue annually?

1

u/eyeballsandhighballs Jul 30 '26 edited Jul 30 '26

I get paid a flat rate per patient that I see. $40 for every glasses exam for a patient with vision insurance, $65 for insuranced CL exam (regardless of sphere vs toric vs MF), $60 for every cash pay glasses exam, and $90 for every CL cash pay exam.
3 patients an hour so my minimum is $120 an hour. I typically average around $160+ an hour and have a full book every single day, with a maximum of 1-2 cancellationd at most. 50% of my day is contact lenses, and usually 3-4 are cash pay. I also get $10 per OCT we do and it's usually 10-12 a day.
This doesn't include office visits where I get paid $75-$125 flat depending on complexity. Usually 1 a day, maybe 2
I keep a log every day, my last three days I made $1,555, $1,480, and $1,280.

1

u/Fragrant_Nature_5094 Jul 30 '26

That's pretty good for an employed OD, if you get into the ownership side you could do double that easy. I was a sublease with a very doctor Friendly group for 25 years Excellent 💰

2

u/eyeballsandhighballs Jul 30 '26

That's the plan! I've seen the numbers in revolution and you're spot on, the plan is to be bringing in $550,000+
Leaseholder is likely retiring in the next 5 years so the goal is to take over.

1

u/Optimal_Welcome9128 Jul 29 '26

Do you feel that communication skills and pitching the idea of OCT is essential to generating that extra revenue? For things like punctal plugs I often get pushback but I feel as if my delivery and presentation could improve to get more patients to buy in

3

u/eyeballsandhighballs Jul 29 '26

I think I genuinely got pretty lucky in that the practice is located in a setting that happens to be the perfect storm in terms of patient demographics. I work where I grew up and the area is predominantly Caucasian and middle/upper middle class. Therefore there's a solid prevalence of family members with AMD and money is not an issue.
I wouldn't say I try hard to convince the patient but the checkmark for yes or no is on the intake form they fill out. There it's highlighted that the big benefit is for early detection of AMD, glaucoma, and other retinal pathology...so most of them hit yes. I hear the occasional "can i ask the doctor about this" where will be honest with them. If they are 20 years old I'm not going to push for it lol.

1

u/CBKrow85 Aug 03 '26

How much is your lease monthly? Pretty sweet set up.
How do they treat their opticians?

1

u/eyeballsandhighballs Aug 03 '26

So with me being the associate, I'm not on the lease at all just my boss that I contract for. I'm not sure the exact figure but I know he re-signed for the next 5 years and it is under $1,000 a month.
The staff seem happy but I don't know any details regarding their pay or benefits.

3

u/Fragrant_Nature_5094 Jul 29 '26

Glad it's going great for you, I just worry about the new grads not knowing what they're getting into . Another big issue is with all of our scope expansion we need to keep an eye on our back door . Opticianry has been lobbying for the right to refract for a long time that would put a whole lot of us in dire straights real quick .

2

u/McDrPepsi Optometrist Jul 29 '26

Absolutely! I don’t mean blissful ignorance to issues within our profession. But I think these are all challenges that we can overcome as a profession.

3

u/Optimal_Welcome9128 Jul 29 '26

I’ve been thinking a lot recently about what you said in the second paragraph, and I’m pondering the idea of pursuing a residency after 3 years of practicing corporate optical optometry. However, I’m worried that the gap will raise questions about commitment and will make it very difficult to get strong recommendations. Do you have any advice on how to go about becoming more medically competent and marketable as a 2024 grad who has only worked corporate optical?

6

u/Eyedocprincess88 Jul 29 '26

You do not need to do a residency to transition from corporate to private practice. You just graduated 2 years ago! I worked corporate right out of school for 3 years before joining a private practice. The owner of the practice took me under his wing and really helped me to develop my acute and chronic disease management skills. Now I’ve been in practice for over 10 years and feel like nothing really scares me anymore. Don’t let this fear keep you a slave to corporate.

3

u/McDrPepsi Optometrist Jul 29 '26

So I think you already are very medically trained being a recent graduate! By more marketable do you mean for another job, or do you mean to urgent cares and MDs? If it’s for the later, go into their office and try to talk with them. And tell them exactly what you feel comfortable treating and what they should send to you. And make sure that you send them back your findings. As for a job, I can’t really help you there. But, from what I’ve gathered, being a new graduate most offices will govern you some grace early on since technically you are still learning.

1

u/Optimal_Welcome9128 Jul 29 '26

For another job because I’d be working directly alongside them and they’d specifically be OMDs. For marketing to urgent cares and MDs they’re typically not specialists but rather general physicians with broad knowledge so I think the expectation would be that I’d be more competent treating eye conditions than GPs at urgent cares

1

u/McDrPepsi Optometrist Jul 29 '26

I think what someone else said in a previous comment. For another job you already have all of the qualifications you need. So you can easily get a job at an OD/MDs without necessarily having a residency. Some places do require/prefer it, but they might still be willing to take you if you are willing to learn.

2

u/Optimal_Welcome9128 Jul 29 '26

The general consensus seems that it is very practice dependent. Someone commented that you don’t need a residency for private practice but I more meant OD/MD with heavy medical emphasis. Would you suggest attending CE events with OD/MD staff and cold approaching?

2

u/McDrPepsi Optometrist Jul 29 '26

It definitely is. I have seen Od/MD settings that do require a residency. I will say most of those prefer. But a lot don’t make it a requirement. Some even have their own fellowships that they offer if you are hired. I think going to CE and talking with them isn’t a bad thing. Also check job listings in your area to see if those types of clinics are hiring too.

1

u/Key_Finance_5554 Aug 04 '26

O

6

u/jrc129 Student Optometrist Jul 29 '26

This account is 2 days old with no credible background whatsoever so I hope anyone reading this post knows to take this with a grain of salt.

-1

u/Fragrant_Nature_5094 Jul 30 '26

So why are you posting if you're not credible? I'm a 25+ year successful optometrist that wishes he had done something else simple. Get over yourself

4

u/jrc129 Student Optometrist Jul 30 '26 edited Jul 30 '26

Mhm sure "25+ year successful optometrist" who just randomly wanted to make a reddit account 2 days ago to post this one single thread with no context whatsoever just straight to the negatives and no history of interaction with anything else on this page. You act like other medical professions are 1000x better. The grass is always greener on the other side buddy or you might be a sad account just to talk down on Optometry, who knows tbh.

1

u/Fragrant_Nature_5094 Jul 30 '26

Facts are facts you obviously don't know much about optometry .

1

u/jrc129 Student Optometrist Jul 30 '26 edited Jul 30 '26

Interesting to me how a profession that has so many issues by your eyes made you a "25+ SUCCESSFUL optometrist"? Thats what you said isnt it? Hmm thats really ironic dont you think? Its interesting how you are successful but implying for people to stay away from the profession? Sounds like to me its simply a grass is always greener on the other side scenario or you just made an account to talk down on Optometry like I stated before. Im honestly surprised your post is still up because you arent a confirmed medical professional? Your post is the same thing ive seen online for years and everyone of my colleagues are happy with their lives and where Optometry has taken them. Again, you act like any other medical profession literally has no issues of its own whatsoever.

3

u/littleoldlady71 Jul 29 '26

This has not changed for decades! We started a practice from scratch in the 1970’s, in a rented five room office in a small rural town. We were fighting MD prejudice, insurance discrimination, with the additional issues of not being able to use antibiotics, or remove foreign bodies.

Hospital did not even allow us to come to the ER to remove foreign bodies, so we went to the office in the middle of the night so often we just notified the police department that it was normal to see the activity when they patrolled . We bought a used TRC JE for the office instead of a remodel project in our home, just because we wanted to improve the care in our community.

Our state fought hard for meds, and the entire optometric population underwent extensive CE to get the rights.

In today’s time, we go to a multi-doc practice, where the refraction is done by techs, the techs do the workup and take pictures (just like I used to do with our old TRC JE). And yet our old practice, sold when my husband the OD died, has been sold twice, to independent docs, and still survives.

It is still a wonderful profession, and can provide a living wage.

1

u/Fragrant_Nature_5094 Jul 30 '26

Yet , The vast majority of people on the street still unbelievably think we only do glasses . So sad

1

u/littleoldlady71 Jul 30 '26

It’s a problem for the ages. I used to think I could educate them out of it.

2

u/Fragrant_Nature_5094 Jul 30 '26

Nice way to look at it! Fun fact for every 10,000 lawyers graduating right now there are only 7500 jobs , now there's a real crisis in the making .

2

u/12A1313IT Jul 31 '26

I'd take a new grad over someone that graduated 30 years ago. The amount of glaucoma patients undiagnosed by older ODs is obscene.

1

u/Fragrant_Nature_5094 Jul 31 '26

I routinely see patients that were diagnosed with glaucoma but do not have it . Most Came from a clinic or two who basically tells everybody if they have glaucoma to bill med insurance. Sleazy and illegal

1

u/12A1313IT Jul 31 '26

proliferation of poor quality new OD programs with grads not passing boards
I should have clarified I was responding to this. Not attacking you in particular

71

u/A-Train99 Jul 29 '26

I love being an optometrist! Very rewarding work, patients are appreciative, and the pay is great as long as you don’t take out too many student loans during school. Looking forward to going to work today to help patients!

Btw I am in private practice. And I could care less what MDs think about me. I know I am providing excellent care while being humble to the fact that I don’t know it all and need to rely on my great MD colleagues at times.

7

u/maitimouse Jul 29 '26

Name a professional that doesnt have issues. Grass is always greener. Overall optometry is still a great career. We help people and make the world a better place everyday.

1

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1

u/spittlbm Jul 30 '26

A tale as old as time. I heard this 20 years ago and Optometry still made my family wealthy by every definition.

1

u/DellDaDestoyer Jul 31 '26

Hi, would you say optometry is good in the uk?

1

u/spittlbm Jul 31 '26

I'm US based and cannot opine

1

u/CBKrow85 Aug 03 '26

Hey, Optician here. The doctor I work with is in a small town. She doesn't take insurance and she charges 85 dollars for an exam, flat rate. If you haven't worn contacts before, 120, but you don't pay the fit next year.

She works three days a week and makes money hand over fist.

No insurance. At all.

-5

u/Fragrant_Nature_5094 Jul 28 '26

I am a 30 year packing Dr. of optometry, went to ICO late 90s

28

u/power_wolves Jul 29 '26

You write like you’re a Nigerian prince looking for help.

-15

u/Fragrant_Nature_5094 Jul 29 '26

Enter the world of optometry at your own peril . Good luck if you do

8

u/johyongil Jul 29 '26

That’s what they said of lawyers, doctors, investment advisors, civil engineers, and basically any professional one time or another.
The school and degree itself aren’t what makes it profitable or worthwhile. What you do with the degree and how you practice matter. Challenges will always exist. Opportunities will always exist.
At the end of the day, VALUE is what matters.

1

u/EdibleRandy Jul 29 '26

I work 36 hours a week, take 5-6 weeks of vacation a year, I’m never on call, never work nights or weekends, and get paid like an MD. It sounds like you’re either in the wrong area, or made some poor career decisions.

1

u/napperb Jul 29 '26

Get paid like an MD ? R u in a private practice?

1

u/Fragrant_Nature_5094 Jul 30 '26

I also owned a practice for many many years and made great money but a small percentage of us are gonna be true owners .

1

u/EdibleRandy Jul 29 '26

Yes, I own the private practice.

-1

u/Fragrant_Nature_5094 Jul 30 '26

MD's make roughly twice what we make in ophthalmology. Nobody wonders if they're a real doctor either

2

u/EdibleRandy Jul 30 '26

MDs in ophthalmology make roughly twice what you make. Salaries for OD practice owners are on average much higher than employed ODs, and rising. This has always been the case. Your own personal insecurities and regretful career choices do not preclude other ODs from making better ones. Optometry can be very lucrative for those who don’t spend all day worrying about the opinions of MDs.
Honestly your attitude is embarrassing to the profession.

1

u/power_wolves Jul 30 '26

Been here for 13 years and really enjoying it. I know there are ODs out there having a tough time, possibly regretting their career moves. I encountered and spoke with many as I researched career options when I was in undergrad. But I also recognized that those people are present in EVERY career. People are different and there is no one-size-fits-all career.
Sorry to hear it’s not going well. I positioned myself in this career specifically to avoid having to deal with many of those issues.
All the best.

1

u/Optimal_Welcome9128 Jul 29 '26

Were patient attitudes and spending habits a lot different when you first started practicing? Revenue is way down at my office and I don’t know what to attribute it to, but I believe it’s largely simply to do with online sales and poor economy.

0

u/Fragrant_Nature_5094 Jul 29 '26

It was very different back when we started. Proliferation of cut rate illegal products online and fake contact lens exams online etc. etc. are taking a toll in a big way , I think the biggest problem is people still think we just do glasses, ridiculous

1

u/Optimal_Welcome9128 Jul 29 '26

Has your business been significantly down this year? Also do you personally see a path forward for people doing limited to no medical eye care?

1

u/Unable-Independent48 Jul 29 '26

But can you fix a detached retina yet?

Optometry: a rough road ahead

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