Optometrists spend a lot of time defining the mode of practice for themselves and their colleagues. In most instances, the definition has to do with the employment status of the optometrist, which has always struck me as odd. From my first day of optometry school, I was told that private practice should be my goal. The implication was that I should work for myself because working for someone else would somehow cause me to be a lesser optometrist.
Most other health professionals talk about the location of their practice or their specialty ignoring the place that they practice: hospitalist, primary care physician, cardiologist, physician assistant, nurse anesthetist. There seems to be no implication that the practice of that professional’s area of expertise would be more or less professional based upon where the professional practices. The field of medicine has evolved over the last three decades so private practice is not a significant differentiator anymore.
For optometrists, self-employment is still the majority status. So it makes sense that we still stratify ourselves based upon the class-system that has been so common: private practice (solo or group), corporate, employed by OMD, employed by HMO, military, academic. As I see it these are not modes of practice, they are modes of payment for practice.
It can be argued that an OD in an academic institution practices differently than an OD at a WalMart, but in the end they are both following the SOAPE format while negotiating the patient care experience. Same with the typical comparison between private practice ODs and corporately employed ODs — really, how are their practices different? There are optometrists in Lenscrafters who have invested in more equipment than ODs who are self-employed, so what really differentiates their practices?
I recently heard from a doctor who has practiced nearly twenty years at a WalMart location where he essentially pays rent for a practice site. Aside from being in the building, he is an independent optometrist who is free to see patients as he wishes, buy equipment he wants, and bill insurances that he desires. There is no one dictating his practice, number of patients seen, or paying him. He gets no revenue from lens prescriptions that he creates. He feels that he runs a “private” practice and it’s hard to disagree with that.
Of course, optometrists have historically had the view that doctors who are located in retail sale-oriented locations cannot avoid the potential distractions of selling products for the owner of the location. That further engrained the belief that corporately employed ODs were practicing less fully than ODs who wrote their own paychecks. The reality is that most private practice ODs work very hard on the retail part of their practices and can get distracted from deeper delivery of patient care by focusing on optical retail sales. There’s nothing wrong with that.
This is not a commentary against private practice optometrists. I think that optometry is delivered in a very conscientious way when an optometrist signs one’s own paycheck. The doctor decides the age of patients seen, number of patients per hour, and the fees that are charged based upon an introspective review of skills and business ideals. Optometry has been a player in the health care arena in large part because so many ODs still make business decisions in the world of patient care for themselves. That’s a very important point.
I don’t have a solution to fix the nomenclature of classifications of optometric practice. We simply spend too much time trying to differentiate ourselves. The public doesn’t understand optometry because the delivery of service from various optometrists is so different. We should be loyal to our oath of practice taken at graduation, and to our professional license, moreso to any employer.
Anything you can do to make your commitment to patient care deeper should be your priority today. If that means moving to a new practice location, buying a new computer program, hiring a staff person, or taking unique education — do it, regardless of your mode of practice.
