The New Grad’s Guide to OD/MD Practice

The New Grad's Guide to OD/MD Practice

As recent graduates scan the horizon for their next professional move, there’s a good chance an opportunity to practice within an ophthalmology OD/MD group setting will arise. With the U.S. population expanding annually by over 2 million people1 and today’s baby boomer population exceeding 70 million,2 ophthalmologists (OMDs) are depending more on ODs to help keep pace with the increased demand for eye care. Based on these population statistics, it’s no surprise that the prevalence of macular degeneration3 and glaucoma4 have increased by 50% over the past twenty years. The prevalence of diabetes has also nearly tripled since the early 1990’s and is expected to further increase by 50% over the next decade.5

Practicing optometrists today outnumber OMD’s by almost two-fold,6,7 making it a worthwhile venture to combine forces under one roof to enhance patient care. Ophthalmologists continue to face new challenges in keeping pace with an increased prevalence of ocular and systemic disease. Some areas in our country simply do not have an adequate supply of eye care providers to meet patients’ needs. Ophthalmology practices can be a great fit for optometrists seeking to practice within the medical model, however clear expectations must be set from the beginning for the OD/MD team to thrive.

OD/MD practice: A day in the optometrist’s shoes

Depending on the office, you’ll likely be expected to see a mixture of patients of all ages with medical and vision plans. In some settings, you may exclusively see post-op cataract or lasik cases. Some ophthalmologists will have a surgical suite on-site while others perform surgery in various hospitals and then see post-op patients in a separate office.

Optometrists are typically paired with one or several technicians to better facilitate patient flow. In settings where optometrists are predominantly seeing patients with vision plans, they may be discouraged from dilating their patients. This scenario is further perpetuated by the decreasing reimbursements from vision plans and subsequent need to see more volume. Regardless of where you are practicing, you need to decide on how you’re going to provide patient care (and protect your license). Some optometrists acquire a false sense of security in OD/MD settings, and rarely dilate asymptomatic healthy patients (regardless of age, systemic health or refractive status). Unfortunately, we’ve all discovered the retinal lattice, tear, hemorrhage, or nevus in the seemingly asymptomatic patient.

There’s no denying that ophthalmologists can bring in more revenue by performing ocular surgery. You can market yourself by explaining the fact that when you as an optometrist dilate patients (typically billing medically) and perform a thorough ocular health assessment, you’ll be able to refer more patients who need surgical intervention.

In most settings, OMDs are typically not prescribing contact lenses or glasses. It is not uncommon for patients to be seen by the ophthalmologist for their medical exam (medical insurance) and then return to see optometry for their glasses or contact lens prescription (cash pay vs. vision plan). In these situations, remember that vision plans still require a complete ocular health assessment to be billed as a comprehensive exam, even if the patient was just seen last month for their annual diabetic eye exam under their medical insurance.

Tips for interviewing and negotiating salary

During the interview process, be cautious if you are told “we simply pay ALL of our optometrists a flat rate of X dollars.” The employing OMD potentially makes a big mistake in this approach, marginalizing optometry and making the assumption that the OD who primarily sees vision plans will generate the same amount of revenue as the OD who almost exclusively bills medical insurance and is comfortable with urgent walk-ins or post-op care. Sure it will take some time to adjust to the EHR and office flow, no matter where your new job is, however don’t let this deter you from negotiating adequate pay. In most OD/MD settings the optometrist will never exclusively see medical plans, however the ratio of vision vs. medical plans is important to agree upon.

There’s a good chance that if you’ve worked in a prior medical setting and/or have completed a residency, you could negotiate higher pay. The key is to offer value to the ophthalmology practice in ways that other ODs are not interested in doing.

Whether it’s offering low vision or specialty contact lens services, or simply being more comfortable performing medical eye exams and seeing urgent walk-ins/post-ops, value your skill set and convince others to do the same

Additional options for negotiating higher pay is to consider asking for health insurance coverage (full vs. partial), paid vacation time, or stipends for CE travel. Depending on the office location, speaking a foreign language may provide negotiating leverage. Some practices may also incentivize optical sales, paying the optometrist a portion of revenue they’re able to generate through the sale of glasses or contact lenses.

It is also important to be aware of the role that other optometrists have within the prospective OD/MD practice. If you have the desire to primarily see patients for medical exams, but other ODs are mainly doing 10-minute exams for vision plans, this practice may not be a good fit for you. Be upfront with your expectations regarding your role and what types of patients you’re expected to see. Will you mainly be seeing vision plans or will you mainly be doing medical optometry and billing medical insurance plans? Do you have a preference? Can you see patients every 15, 30, or 45 minutes? If you come from residency or other professional settings where you’re seeing and dilating a high volume of patients for medical reasons (diabetes, glaucoma, flashes/floaters, foreign body, etc), use this experience to your advantage. If you have no preference on what types of patients you see, or are not upfront with your expectations, you may be expected to exclusively see a high volume of vision plans (refractions and a quick undilated 90D), and possibly find yourself unfulfilled professionally.

In OD/MD settings where optometrists are reduced to refractionists, everyone loses including patients, doctors, and staff. In this outdated scenario, ODs are expected to see a high volume of vision plans, sometimes without adequate tech support. This scenario isn’t sustainable and should be avoided if at all possible.

Unfortunately, many ophthalmologists today are still unaware of the expanded skill set and scope of practice that the optometric profession has strived to develop over the past few decades. Gone are the days of optometrists exclusively doing refractions. Optometrists today have a significantly wider scope of practice than ever before. As our population continues to grow, we’re seeing an inevitable increase in prevalence of ocular and systemic disease. Optometrists are in an excellent position to provide full scope, medical-based care, bringing value to our patients, our profession, and our practices. Let these facts guide your decision in negotiating your role within the OD/MD practice setting.

References

References

  1. Bureau, US Census. “Library.” U.S. Population Up 5.90% Since the 2010 Census, United States Census Bureau, 1 Jan. 2018, www.census.gov/library/visualizations/interactive/population-increase.html
  2. Colby, Sandra L., and Jennifer M. Ortman. “The Baby Boom Cohort in the United States: 2012 to 2060.” Current Population Reports, May 2014, doi:https://www.census.gov/prod/2014pubs/p25-1141.pdf
  3. “Prevalence of Age-Related Macular Degeneration in the United States.” National Eye Institute, Archives of Ophthalmology, Apr. 2004, nei.nih.gov/eyedata/pbd4
  4. The Eye Diseases Prevalence Research Group. (2004). Prevalence of Open-Angle Glaucoma Among Adults in the United States. Archives of Ophthalmology, 122(4), 532–538. http://doi.org/10.1001/archopht.122.4.532
  5. Rowley, W. R., Bezold, C., Arikan, Y., Byrne, E., & Krohe, S. (2017). Diabetes 2030: Insights from Yesterday, Today, and Future Trends. Population Health Management, 20(1), 6–12. http://doi.org/10.1089/pop.2015.0181
  6. “Eye Health Statistics.” American Academy of Ophthalmology, www.aao.org/newsroom/eye-health-statistics#_edn25
  7. “Optometrists.” Bureau of Labor Statistics, 30 Jan. 2018, www.bls.gov/ooh/healthcare/optometrists.htm

About Kevin Cornwell

Kevin Cornwell
Dr. Kevin Cornwell graduated from The New England College of Optometry in 2015. He went on to complete a residency in ocular and systemic disease with Indian Health Services in Zuni, New Mexico. He now works with MACT Health Board, Inc in Northern California, a nonprofit organization that provides healthcare for Native Americans. He is enthusiastic about bringing eye care to populations in need, both domestically and abroad. He has been involved with several humanitarian outreach projects, in various parts of California, New Mexico, Nicaragua and Mexico. He is passionate about managing the ocular manifestations of systemic disease, and monitoring ocular pathology through retinal imaging with spectral domain optical coherence tomography. He’s also an avid health crusader and enjoys educating and encouraging patients to better manage metabolic disease. Dr. Cornwell enjoys hiking and kayaking in the Sierra Nevada Mountains as well as writing and recording music as a guitarist.

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