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| Author |
Message |
RM
medicine forum Guru
Joined: 25 Mar 2005
Posts: 326
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 Posted: Sun Jun 25, 2006 3:08 am Post subject:
Re: sick of astigmatism (soft torics)
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LB,
I am glad that you tried to clear this up. Frankly it needs a little
clearing up from some of the remarks that have been made.
Some clear pot-shots were taken at retail optical practices from doctors who
are also clearly biased against them. The following statements were
negative or contained misinformation at least regarding the optical chains I
am familiar with (which is admittedly limited).
quote:
| Quote: | Gas perms (sometimes) require more
time and to fit than soft and more experience. They are not available to
"take and run" as are soft lenses. They are often less profitable in the
short term than soft lenses. Hence you will not find them at
discounters.
(every retail optical chain in the area I live in fits gas perms) |
| Quote: | $70 is what I would expect for an oil change, not for fitting
a prescription like yours. Since you weren't charged a professional
fee, I doubt you can expect to get professional service.
(the price may be on the low side but that says nothing about the quality of |
the care. I guess the only car that you consider is any good is a Mercedes)
| Quote: | If you want quality, why are you going to the optician-equivalent of a
Wal-Mart?
(actually Wal-Mart has an optical division and in my opinion its one of the |
better retail outlets compared to others I know of in my area)
unquote:
I too work at both a private practice setting and an optical chain. So I
know what I am talking about like the other poster. I fit gas perms when
appropriate and have good access to suppliers at both locations. Where I
work, the optical chain management does not dictate any policies to the
doctor-- the doctors are totally independent. In fact they must be by state
law. I know of a few private docs in town who I personally think give
inferior care, and whose pricing is excessive. As you know, it is difficult
for a private practicioner to compete with the pricing that retain chains
can offer.
So I would agree with what a couple of people have already said. Find a
good doctor, and go to that doctor. Its not the location or the price you
pay that determines how good your care will be-- its the doctor doing the
exam.
And to the original poster, you indeed DO need to be more patient and quit
complaining. It is common for multiple doctors to practice at a location.
Retail or private. Thats whats happening at both locations I work at.
Simply ask for the working schedule of the doctor you prefer and make sure
your appointment is with that person.
RM
========
"LarryDoc" <larrybic@yahoo.remove.com> wrote in message
news:larrybic-D0BA92.15503224062006@news.verizon.net...
| Quote: | In article <1151169654.946715.129830@u72g2000cwu.googlegroups.com>,
retinula@hotmail.com wrote:
Two things, the first being FYI you posted a reply to this thread with
no new text. And next.......
Perhaps it's time to change the subject of this thread.
i think its irrelevant whether the eye doctor works out of his own
private practice or whether he works out of a retail chain. i cant
help but notice that the two doctors who spoke out in this thread have
a biased against retail doctors-- i'm sure its because both are private
docs.
My bias is against the retail opticals, not necessarily the doctors who
work for them. It is the opticals that commercialize eye health care
and that is my primary issue. It matters not if it's optical or
surgical or the fast-buck doc-in-the-box "urgent care" place. The
"insurance" payers have a part in this, too. It creates a mindset on the
part of the health care consumer that ultimately degrades the management
of their health. I have a problem with that.
whats important is that you have a doctor who will take the time to
properly fit you in the type of lenses you need. also-- whether you
paid a high price or not is clearly irrelevant.
That is most certainly true.
I'm certain there are bozo docs in private practice as there are in
retail, but there's a difference in the retail establishments. You could
have a fine, knowledgeable doc who simply does not have access to
product, due to corporate decision makers limiting him/her to certain
brands of lenses or lenses that exceed a certain cost/profit index. The
corporate "deciders" (for those of you outside of Bushville, a new
vocabulary word here in the USA, which is actually a old Middle English
word but I'm sure he didn't know that when he spoke.) may also limit the
amount of time that can be spent on any one service procedure.
I'm not saying that is the policy at all retail opticals, or that some
private practice docs don't do the same things to maximize the bottom
line. I just think that a private practice doctor with competence,
ethics and caring and depending upon good will and patient referrals is
more likely to go the extra mile to satisfy a patient's needs and
concerns. A corporate chain store is just a very different business
model.
personally, i have worked in both environments.
As did I, so I know. I tried to "to do the right thing" and was
promptly told to do otherwise. I lasted a couple of weeks. In private
practice, I try to profit from the time I spend making patients happy.
Sometimes, a contact lens fitting takes a longer time than I feel
comfortable billing the patient and I might make little or no real
"profit" (there's not a lot of $$ in the actual lenses, folks), except
from the many patients referred to me by the one who respects my work.
In the end game, it is, of course, getting what you need from someone
who is able to provide that in a timely and cost-effective, hopefully
pleasant manner. And wherever you can find that..............
LB, O.D. |
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Dr. Leukoma
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1283
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| Posted: Sun Jun 25, 2006 3:37 am Post subject:
Strawman argument from RM
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|
RM, the only point being made is that this patient is in need of
somebody somewhere who will spend the time and effort necessary to do
provide the level of service they desire. That kind of service takes
time, and time is money. It has nothing to do with commercial vs.
corporate practice, at least in my thinking. How much time does $70
buy in your practice?
I've been in private practice out of one location for more than 20
years in a state that gave birth to Royal Optical, Pearle Vision, Texas
State Optical, and Eye Masters. I am thriving, thank you, on patients
who are difficult to satisfy. But, I would have been out of business a
long time ago if I charged $70 to fit that kind of prescription. In
that kind of situation, neither the doctor nor the patient wins.
DrG
RM wrote:
| Quote: | LB,
I am glad that you tried to clear this up. Frankly it needs a little
clearing up from some of the remarks that have been made.
Some clear pot-shots were taken at retail optical practices from doctors who
are also clearly biased against them. The following statements were
negative or contained misinformation at least regarding the optical chains I
am familiar with (which is admittedly limited).
quote:
Gas perms (sometimes) require more
time and to fit than soft and more experience. They are not available to
"take and run" as are soft lenses. They are often less profitable in the
short term than soft lenses. Hence you will not find them at
discounters.
(every retail optical chain in the area I live in fits gas perms)
$70 is what I would expect for an oil change, not for fitting
a prescription like yours. Since you weren't charged a professional
fee, I doubt you can expect to get professional service.
(the price may be on the low side but that says nothing about the quality of
the care. I guess the only car that you consider is any good is a Mercedes)
If you want quality, why are you going to the optician-equivalent of a
Wal-Mart?
(actually Wal-Mart has an optical division and in my opinion its one of the
better retail outlets compared to others I know of in my area)
unquote:
I too work at both a private practice setting and an optical chain. So I
know what I am talking about like the other poster. I fit gas perms when
appropriate and have good access to suppliers at both locations. Where I
work, the optical chain management does not dictate any policies to the
doctor-- the doctors are totally independent. In fact they must be by state
law. I know of a few private docs in town who I personally think give
inferior care, and whose pricing is excessive. As you know, it is difficult
for a private practicioner to compete with the pricing that retain chains
can offer.
So I would agree with what a couple of people have already said. Find a
good doctor, and go to that doctor. Its not the location or the price you
pay that determines how good your care will be-- its the doctor doing the
exam.
And to the original poster, you indeed DO need to be more patient and quit
complaining. It is common for multiple doctors to practice at a location.
Retail or private. Thats whats happening at both locations I work at.
Simply ask for the working schedule of the doctor you prefer and make sure
your appointment is with that person.
RM
========
"LarryDoc" <larrybic@yahoo.remove.com> wrote in message
news:larrybic-D0BA92.15503224062006@news.verizon.net...
In article <1151169654.946715.129830@u72g2000cwu.googlegroups.com>,
retinula@hotmail.com wrote:
Two things, the first being FYI you posted a reply to this thread with
no new text. And next.......
Perhaps it's time to change the subject of this thread.
i think its irrelevant whether the eye doctor works out of his own
private practice or whether he works out of a retail chain. i cant
help but notice that the two doctors who spoke out in this thread have
a biased against retail doctors-- i'm sure its because both are private
docs.
My bias is against the retail opticals, not necessarily the doctors who
work for them. It is the opticals that commercialize eye health care
and that is my primary issue. It matters not if it's optical or
surgical or the fast-buck doc-in-the-box "urgent care" place. The
"insurance" payers have a part in this, too. It creates a mindset on the
part of the health care consumer that ultimately degrades the management
of their health. I have a problem with that.
whats important is that you have a doctor who will take the time to
properly fit you in the type of lenses you need. also-- whether you
paid a high price or not is clearly irrelevant.
That is most certainly true.
I'm certain there are bozo docs in private practice as there are in
retail, but there's a difference in the retail establishments. You could
have a fine, knowledgeable doc who simply does not have access to
product, due to corporate decision makers limiting him/her to certain
brands of lenses or lenses that exceed a certain cost/profit index. The
corporate "deciders" (for those of you outside of Bushville, a new
vocabulary word here in the USA, which is actually a old Middle English
word but I'm sure he didn't know that when he spoke.) may also limit the
amount of time that can be spent on any one service procedure.
I'm not saying that is the policy at all retail opticals, or that some
private practice docs don't do the same things to maximize the bottom
line. I just think that a private practice doctor with competence,
ethics and caring and depending upon good will and patient referrals is
more likely to go the extra mile to satisfy a patient's needs and
concerns. A corporate chain store is just a very different business
model.
personally, i have worked in both environments.
As did I, so I know. I tried to "to do the right thing" and was
promptly told to do otherwise. I lasted a couple of weeks. In private
practice, I try to profit from the time I spend making patients happy.
Sometimes, a contact lens fitting takes a longer time than I feel
comfortable billing the patient and I might make little or no real
"profit" (there's not a lot of $$ in the actual lenses, folks), except
from the many patients referred to me by the one who respects my work.
In the end game, it is, of course, getting what you need from someone
who is able to provide that in a timely and cost-effective, hopefully
pleasant manner. And wherever you can find that..............
LB, O.D. |
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p.clarkii@gmail.com
medicine forum Guru Wannabe
Joined: 11 Sep 2005
Posts: 247
|
| Posted: Sun Jun 25, 2006 4:45 am Post subject:
Re: Strawman argument from RM
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|
in my office I charge $75 for a toric contact fit, or an RGP fit. that
money buys enough chair time to be sure that the patient is properly
fit and satisfied. regardless of the number of follow-ups required.
even the patient with the high prescription that the original poster
who started this thread has.
it is you and others who keep suggesting that paying a higher price
will get you better service. I don't need to charge a higher price. I
don't have to pay overhead, business loans, utility bills, employee
salaries, etc. my patients get as good a quality of care as they do at
any private practice (and frankly I think better and so do many of my
patients who have been to various doctors) and I can charge less
because my costs are much less than private doctors. so to answer your
question, a $70 fee (or pretty close to that) buys you a lot where I
practice and I certainly wouldn't go out of business fitting high toric
patients at that price.
to get to the important point, i think that we are all violently in
agreement that its the quality of service that is the important factor
and not the practice location of the doctor. but exam prices DO NOT
reflect the quality of care that a patient is getting as you seem to
imply. A clinic down the street charges exam prices twice what I do
and then tries to entrap the patients into buying their contacts from
their office at a jacked-up price. the patient isn't getting any
better care; what they are getting is ripped off.
its the quality of the doctor that counts, not the location, OR the
exam price.
PS-- I practice in the US mid-west where pricing is overall quite low
compared to much of the rest of the country.
=================
Dr. Leukoma wrote:
| Quote: | RM, the only point being made is that this patient is in need of
somebody somewhere who will spend the time and effort necessary to do
provide the level of service they desire. That kind of service takes
time, and time is money. It has nothing to do with commercial vs.
corporate practice, at least in my thinking. How much time does $70
buy in your practice?
I've been in private practice out of one location for more than 20
years in a state that gave birth to Royal Optical, Pearle Vision, Texas
State Optical, and Eye Masters. I am thriving, thank you, on patients
who are difficult to satisfy. But, I would have been out of business a
long time ago if I charged $70 to fit that kind of prescription. In
that kind of situation, neither the doctor nor the patient wins.
DrG
RM wrote:
LB,
I am glad that you tried to clear this up. Frankly it needs a little
clearing up from some of the remarks that have been made.
Some clear pot-shots were taken at retail optical practices from doctors who
are also clearly biased against them. The following statements were
negative or contained misinformation at least regarding the optical chains I
am familiar with (which is admittedly limited).
quote:
Gas perms (sometimes) require more
time and to fit than soft and more experience. They are not available to
"take and run" as are soft lenses. They are often less profitable in the
short term than soft lenses. Hence you will not find them at
discounters.
(every retail optical chain in the area I live in fits gas perms)
$70 is what I would expect for an oil change, not for fitting
a prescription like yours. Since you weren't charged a professional
fee, I doubt you can expect to get professional service.
(the price may be on the low side but that says nothing about the quality of
the care. I guess the only car that you consider is any good is a Mercedes)
If you want quality, why are you going to the optician-equivalent of a
Wal-Mart?
(actually Wal-Mart has an optical division and in my opinion its one of the
better retail outlets compared to others I know of in my area)
unquote:
I too work at both a private practice setting and an optical chain. So I
know what I am talking about like the other poster. I fit gas perms when
appropriate and have good access to suppliers at both locations. Where I
work, the optical chain management does not dictate any policies to the
doctor-- the doctors are totally independent. In fact they must be by state
law. I know of a few private docs in town who I personally think give
inferior care, and whose pricing is excessive. As you know, it is difficult
for a private practicioner to compete with the pricing that retain chains
can offer.
So I would agree with what a couple of people have already said. Find a
good doctor, and go to that doctor. Its not the location or the price you
pay that determines how good your care will be-- its the doctor doing the
exam.
And to the original poster, you indeed DO need to be more patient and quit
complaining. It is common for multiple doctors to practice at a location.
Retail or private. Thats whats happening at both locations I work at.
Simply ask for the working schedule of the doctor you prefer and make sure
your appointment is with that person.
RM
========
"LarryDoc" <larrybic@yahoo.remove.com> wrote in message
news:larrybic-D0BA92.15503224062006@news.verizon.net...
In article <1151169654.946715.129830@u72g2000cwu.googlegroups.com>,
retinula@hotmail.com wrote:
Two things, the first being FYI you posted a reply to this thread with
no new text. And next.......
Perhaps it's time to change the subject of this thread.
i think its irrelevant whether the eye doctor works out of his own
private practice or whether he works out of a retail chain. i cant
help but notice that the two doctors who spoke out in this thread have
a biased against retail doctors-- i'm sure its because both are private
docs.
My bias is against the retail opticals, not necessarily the doctors who
work for them. It is the opticals that commercialize eye health care
and that is my primary issue. It matters not if it's optical or
surgical or the fast-buck doc-in-the-box "urgent care" place. The
"insurance" payers have a part in this, too. It creates a mindset on the
part of the health care consumer that ultimately degrades the management
of their health. I have a problem with that.
whats important is that you have a doctor who will take the time to
properly fit you in the type of lenses you need. also-- whether you
paid a high price or not is clearly irrelevant.
That is most certainly true.
I'm certain there are bozo docs in private practice as there are in
retail, but there's a difference in the retail establishments. You could
have a fine, knowledgeable doc who simply does not have access to
product, due to corporate decision makers limiting him/her to certain
brands of lenses or lenses that exceed a certain cost/profit index. The
corporate "deciders" (for those of you outside of Bushville, a new
vocabulary word here in the USA, which is actually a old Middle English
word but I'm sure he didn't know that when he spoke.) may also limit the
amount of time that can be spent on any one service procedure.
I'm not saying that is the policy at all retail opticals, or that some
private practice docs don't do the same things to maximize the bottom
line. I just think that a private practice doctor with competence,
ethics and caring and depending upon good will and patient referrals is
more likely to go the extra mile to satisfy a patient's needs and
concerns. A corporate chain store is just a very different business
model.
personally, i have worked in both environments.
As did I, so I know. I tried to "to do the right thing" and was
promptly told to do otherwise. I lasted a couple of weeks. In private
practice, I try to profit from the time I spend making patients happy.
Sometimes, a contact lens fitting takes a longer time than I feel
comfortable billing the patient and I might make little or no real
"profit" (there's not a lot of $$ in the actual lenses, folks), except
from the many patients referred to me by the one who respects my work.
In the end game, it is, of course, getting what you need from someone
who is able to provide that in a timely and cost-effective, hopefully
pleasant manner. And wherever you can find that..............
LB, O.D. |
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Anon E. Muss
medicine forum Guru Wannabe
Joined: 22 May 2006
Posts: 136
|
| Posted: Sun Jun 25, 2006 5:33 am Post subject:
Re: sick of astigmatism (soft torics)
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|
On Sun, 25 Jun 2006 03:08:14 GMT, "RM" <RM@nowayhose.net> wrote:
[snip]
| Quote: | And to the original poster, you indeed DO need to be more patient and
quit complaining. It is common for multiple doctors to practice at a
location. Retail or private. Thats whats happening at both locations
I work at.
|
It is NOT common for this to happen in a private practice.
Typical private practices may have multiple doctors, but follow-ups
are typically scheduled with the prescribing doctor so a patient has
continuity from eye exam to contact lens exam to completion of
fitting.
A "private practice" where a patient has one doctor perform the exam,
another perform the contact lens exam, another doctor perform the
contact lens dispense and another doctor perform the follow-up is a
wolf is sheep's clothing.
As far as the other comments by Dr. Leukoma regarding private practice
vs retail chains, I find them to be *generally* true. Sorry RM. |
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Anon E. Muss
medicine forum Guru Wannabe
Joined: 22 May 2006
Posts: 136
|
| Posted: Sun Jun 25, 2006 5:46 am Post subject:
Re: sick of astigmatism (soft torics)
|
|
|
On Sat, 24 Jun 2006 22:50:41 GMT, LarryDoc <larrybic@yahoo.remove.com>
wrote:
| Quote: | I'm certain there are bozo docs in private practice as there are in
retail, but there's a difference in the retail establishments. You could
have a fine, knowledgeable doc who simply does not have access to
product, due to corporate decision makers limiting him/her to certain
brands of lenses or lenses that exceed a certain cost/profit index. The
corporate "deciders" (for those of you outside of Bushville, a new
vocabulary word here in the USA, which is actually a old Middle English
word but I'm sure he didn't know that when he spoke.) may also limit the
amount of time that can be spent on any one service procedure.
|
These "corporate deciders" are a codeword for MBAs and other non
doctors making doctor decisions.
I was told by a nurse practitioner at a Kaiser (big HMO out here in
CA) that bean counters mandated that only OMDs were allowed to
prescribe ZYMAR there.
| Quote: | As did I, so I know. I tried to "to do the right thing" and was
promptly told to do otherwise.
|
<sarcasm>
What's wrong? Can't you do a 15 minute exam on every patient? And
what are you doing dilating patients on a routine basis?
</sarcasm> |
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LarryDoc
medicine forum Guru Wannabe
Joined: 29 Apr 2005
Posts: 262
|
| Posted: Sun Jun 25, 2006 7:33 am Post subject:
Re: Strawman argument from RM
|
|
|
In article <1151210724.518423.309910@i40g2000cwc.googlegroups.com>,
p.clarkii@gmail.com wrote:
| Quote: | in my office I charge $75 for a toric contact fit, or an RGP fit. that
money buys enough chair time to be sure that the patient is properly
fit and satisfied. regardless of the number of follow-ups required.
even the patient with the high prescription that the original poster
who started this thread has.
|
Let me see if I have this right. A reasonable fitting/follow up
appointment schedule for a somewhat difficult high toric or RGP fit is:
minimum two fittings and two follow up visits. IF all goes well. Add an
extra fitting and a follow up for it. So that's between 4 or 6 office
visits. How about 20 minutes for each---a stretch in my book, but for
the sake of discussion, not unreasonable.........
OK, that's 80 to 120 minutes. You're making $40 bucks an hour before
overhead? You're in the midwest but I bet after real life expenses it
still costs more than that for the gas to get to work!
| Quote: | but exam prices DO NOT
reflect the quality of care that a patient is getting as you seem to
imply. A clinic down the street charges exam prices twice what I do
and then tries to entrap the patients into buying their contacts from
their office at a jacked-up price. the patient isn't getting any
better care; what they are getting is ripped off.
|
No doubt sometimes people get ripped off and even taken advantage. But
are you going to tell me that the same money and time buys the same
examination services? Does that $35 10-15 minute exam include a dilated
fundus exam, screening visual fields, applanation tonometry (surely not
pachometry), a sitting behind a slit lamp----geez. It takes that much
time to write it all down!
Entrapment?
My patients, after successful contact lens fitting are entitled to buy
their contact lenses from me or whoever else they desire. I thought that
was a US FTC law, not to mention the right thing to do.
LB, O.D. |
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Dr. Leukoma
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1283
|
| Posted: Sun Jun 25, 2006 12:50 pm Post subject:
Re: Strawman argument from RM
|
|
|
p.clarkii@gmail.com wrote:
| Quote: | in my office I charge $75 for a toric contact fit, or an RGP fit. that
money buys enough chair time to be sure that the patient is properly
fit and satisfied. regardless of the number of follow-ups required.
even the patient with the high prescription that the original poster
who started this thread has.
|
Interesting math. $75 divided by a higher integer is still the same
hourly rate.
| Quote: | it is you and others who keep suggesting that paying a higher price
will get you better service. I don't need to charge a higher price. I
don't have to pay overhead, business loans, utility bills, employee
salaries, etc. my patients get as good a quality of care as they do at
any private practice (and frankly I think better and so do many of my
patients who have been to various doctors) and I can charge less
because my costs are much less than private doctors. so to answer your
question, a $70 fee (or pretty close to that) buys you a lot where I
practice and I certainly wouldn't go out of business fitting high toric
patients at that price.
|
My aren't we being defensive today! I said that a professional needs
to charge a professional fee in order to be able to provide
professional service. I didn't say that a higher fee automatically
gets you better service. However, that perception does exist quite
apart from me having to mention it.
But, I think you pretty much answered the question of how you can
charge so little, which is that the corporation (Cole Vision, etc.)
pays for everything, including the electricity, so that you are free to
dispense the highest level of care. Come to think of it, where are you
so I can send you my difficult cases?
| Quote: |
to get to the important point, i think that we are all violently in
agreement that its the quality of service that is the important factor
and not the practice location of the doctor. but exam prices DO NOT
reflect the quality of care that a patient is getting as you seem to
imply. A clinic down the street charges exam prices twice what I do
and then tries to entrap the patients into buying their contacts from
their office at a jacked-up price. the patient isn't getting any
better care; what they are getting is ripped off.
|
Let's quit flogging this dead horse, shall we? You've already made
your point, which is that commercial optometry really hasn't changed
that much in the more than 20 years since I got out of optometry
school. Frankly, you've convinced me that I must be insane for trying
to maintain a private practice surrounded by all of these high quality
chains within a 5 mile radius. At last count there were about 10 of
them: 2 Walmarts, 1 Costco, 1 Sams, 2 Pearl Visions, 2 Eyemasters, 1
Sears, and one other smaller chain. All of them accept most vision
plans.
| Quote: |
its the quality of the doctor that counts, not the location, OR the
exam price.
|
What convenient measure can the public use to determine that nebulous
quality?
| Quote: |
PS-- I practice in the US mid-west where pricing is overall quite low
compared to much of the rest of the country.
|
In other words, lots of competition, not so unlike my area. I think
there must be something wrong with at least one of your premises. I'm
not suggesting that you raise your fees considering the situation you
are in.
DrG |
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Dr. Leukoma
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1283
|
| Posted: Sun Jun 25, 2006 1:51 pm Post subject:
Re: Strawman argument from RM
|
|
|
LarryDoc wrote:
| Quote: | In article <1151210724.518423.309910@i40g2000cwc.googlegroups.com>,
p.clarkii@gmail.com wrote:
in my office I charge $75 for a toric contact fit, or an RGP fit. that
money buys enough chair time to be sure that the patient is properly
fit and satisfied. regardless of the number of follow-ups required.
even the patient with the high prescription that the original poster
who started this thread has.
Let me see if I have this right. A reasonable fitting/follow up
appointment schedule for a somewhat difficult high toric or RGP fit is:
minimum two fittings and two follow up visits. IF all goes well. Add an
extra fitting and a follow up for it. So that's between 4 or 6 office
visits. How about 20 minutes for each---a stretch in my book, but for
the sake of discussion, not unreasonable.........
OK, that's 80 to 120 minutes. You're making $40 bucks an hour before
overhead? You're in the midwest but I bet after real life expenses it
still costs more than that for the gas to get to work!
but exam prices DO NOT
reflect the quality of care that a patient is getting as you seem to
imply. A clinic down the street charges exam prices twice what I do
and then tries to entrap the patients into buying their contacts from
their office at a jacked-up price. the patient isn't getting any
better care; what they are getting is ripped off.
No doubt sometimes people get ripped off and even taken advantage. But
are you going to tell me that the same money and time buys the same
examination services? Does that $35 10-15 minute exam include a dilated
fundus exam, screening visual fields, applanation tonometry (surely not
pachometry), a sitting behind a slit lamp----geez. It takes that much
time to write it all down!
Entrapment?
My patients, after successful contact lens fitting are entitled to buy
their contact lenses from me or whoever else they desire. I thought that
was a US FTC law, not to mention the right thing to do.
LB, O.D.
|
I don't know about you, Larry, but I haven't made any comments about
commercial vs. private practice quality of care. On the other hand,
look at who IS. It's the commercial ODs, who are seemingly making the
boast that they do more work for less money.
Interesting business model. How can they ever learn about economics
without having any costs to manage or a payroll to meet?
DrG |
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p.clarkii@gmail.com
medicine forum Guru Wannabe
Joined: 11 Sep 2005
Posts: 247
|
| Posted: Sun Jun 25, 2006 5:06 pm Post subject:
Re: Strawman argument from RM
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|
this is my final remarks on this topic but I can't say anything for the
other doctors who reacted negatively to your remarks about retail
optometrists-- are you trying to say we are ALL being defensive? just
think.
Here are the derogatory remarks said about retail optometry. I won't
put the names by who said them because they can be easily looked up and
you'll recognize it yourself:
--------------------
| Quote: | But the right eye is always bad and blurry. Why would they prescribe me soft
torics when gas perm contacts are better?
|
Because you insist on going to discount optical stores for your eyecare
instead of private practice doctors.
--------------------
| Quote: | Seemed like a buffoon.
|
If you want quality, why are you going to the optician-equivalent of a
Wal-Mart?
Your expectations and your choice of providers are simply not a good
recipe for satisfaction.
--------------------
| Quote: | Can nobody help me?
|
I agree. $70 is what I would expect for an oil change, not for fitting
a prescription like yours. Since you weren't charged a professional
fee, I doubt you can expect to get professional service.
--------------------
I have nothing more to say beyond what I have said as well as the other
2 guys who spoke out. And Larry, noone ever said YOU try to entrap
patients into buying their contact lenses from you, it was just said
that another practice down the road does that. of course we are all
aware of the recent federal contact lens laws. its just that some heed
them more than others.
And DrG, I think its pretty obvious how a patient finds out who the
best practitioner is in their area. they go to them and then compare
their experiences, they talk amongst themselves, and they develop a
consensus about who is "good" and who isn't. thats how you try to
build your practice and thats how I do mine.
I'm done, but feel free to continue if you wish. I still believe that
the responses to the original poster tended to make it sound like he
would get better care at a private doctors office and paid a high price
rather than go to a commercial practice and pay a lower price. and the
horse has been beat to death, but that is simply a misconception. |
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RM
medicine forum Guru
Joined: 25 Mar 2005
Posts: 326
|
| Posted: Sun Jun 25, 2006 5:53 pm Post subject:
Re: sick of astigmatism (soft torics)
|
|
|
Man you guys just keep stepping in it don't you.
| Quote: | I just think that a private practice doctor with competence,
ethics and caring and depending upon good will and patient referrals is
more likely to go the extra mile to satisfy a patient's needs and
concerns.
|
Don't you think thats how retail chains do it too? Giving bad service and
rushing through exams will kill anyone's practice. At the retail chain I
work at, we are TOLD by the company to put the customer first. These
companies aren't stupid. The customer has to be taken care of and is "alway
right". As the doctor I not only want to personally do the best job I can
but the retail company I work for expects me to do so or might not be
working there next year. There is an incentive that you guys don't have to
deal with!
And in another post in this thread you wrote:
| Quote: | Let me see if I have this right. A reasonable fitting/follow up
appointment schedule for a somewhat difficult high toric or RGP fit is:
minimum two fittings and two follow up visits. IF all goes well. Add an
extra fitting and a follow up for it. So that's between 4 or 6 office
visits. How about 20 minutes for each---a stretch in my book, but for
the sake of discussion, not unreasonable.........
|
It doesn't take ME 4-6 office visits to fit a toric contact, or gas perm (at
least only RARELY). Its easy to look in a slit lamp and measure lens
rotation, and assess lens fit. I can see the patient, evaluate fit, and
take any notes faster than 20 minutes times 4-6 visits so I guess I can work
faster than you.
I charge a little more than $70 for a toric contact lens exam but not much
more. And it does include a visual field assessment, tonometry, and
dilation.
I too am going to let this thread die but I agree with DrPClark that the
remarks made earlier in this thread made it appear that a couple of people
were recommending that the solution to this patients problem was to go to a
private doctor and forget the retail chains. I disagree. Thats not the
issue at all. Its the doctor that you go to and how much he/she desires to
satisfy the patient thats the issue (as you say). And I don't think there
is any better chance of finding such a doctor in private practice versus
retail practice. I've seen lazy doctors in both locations. But in the
retail chain I work for, those kind of doctors are GONE after awhile. |
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Anon E. Muss
medicine forum Guru Wannabe
Joined: 22 May 2006
Posts: 136
|
| Posted: Sun Jun 25, 2006 6:12 pm Post subject:
Re: sick of astigmatism (soft torics)
|
|
|
On Sun, 25 Jun 2006 17:53:04 GMT, "RM" <RM@nowayhose.net> wrote:
| Quote: | Thats not the issue at all. Its the doctor that you go to and how
much he/she desires to satisfy the patient thats the issue (as you
say).
|
I agree.
| Quote: | And I don't think there is any better chance of finding such a doctor
in private practice versus retail practice.
|
I disagree, based on personal experience and anecdotal experience from
other patients.
I hear patients all the time compliment me on the thouroughness of my
exam or tell me the reason they came to me was because they were
disastified with a retail chain doctor.
It is a much rarer occurance for a patient to state they left a
private practice doctor for me because they were not satisfied with
them.
| Quote: | I've seen lazy doctors in both locations.
|
Same here.
| Quote: | But in the retail chain I work for, those kind of doctors are GONE
after awhile.
|
Is it because they were truly "lazy" or didn't work fast enough/did
"unnecessary tests"?
I know of a "retail doctor" who was given a lot of flak because he was
writing scripts recommending TRIVEX over polycarb because the lab
right next door which was run by the corporation who was leasing him
space had to special order it. He was basically reminded by a MBA
bean counter that his lease is reviewed every 30 days. Back to
polycarb it was. |
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Dr. Leukoma
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1283
|
| Posted: Sun Jun 25, 2006 9:01 pm Post subject:
Re: Strawman argument from RM
|
|
|
Yes, but I did not read the entire thread, and my comments have nothing
to do with those other comments, and they stand alone. Sorry if you
took offense, but none was intended vis-a-vis the
commercial/independent decades-old argument. My only observation was
that $70 did not seem to be enough of a fee to justify the amount of
time and effort necessary to satisfy this particular patient with that
particular prescription. I honestly thought that a $70 fee was an
anomaly. Instead, it appears to be the "going rate." And, if that is
so, then I am indeed sorry for the profession.
DrG
p.clarkii@gmail.com wrote:
| Quote: | this is my final remarks on this topic but I can't say anything for the
other doctors who reacted negatively to your remarks about retail
optometrists-- are you trying to say we are ALL being defensive? just
think.
Here are the derogatory remarks said about retail optometry. I won't
put the names by who said them because they can be easily looked up and
you'll recognize it yourself:
--------------------
But the right eye is always bad and blurry. Why would they prescribe me soft
torics when gas perm contacts are better?
Because you insist on going to discount optical stores for your eyecare
instead of private practice doctors.
--------------------
Seemed like a buffoon.
If you want quality, why are you going to the optician-equivalent of a
Wal-Mart?
Your expectations and your choice of providers are simply not a good
recipe for satisfaction.
--------------------
Can nobody help me?
I agree. $70 is what I would expect for an oil change, not for fitting
a prescription like yours. Since you weren't charged a professional
fee, I doubt you can expect to get professional service.
--------------------
I have nothing more to say beyond what I have said as well as the other
2 guys who spoke out. And Larry, noone ever said YOU try to entrap
patients into buying their contact lenses from you, it was just said
that another practice down the road does that. of course we are all
aware of the recent federal contact lens laws. its just that some heed
them more than others.
And DrG, I think its pretty obvious how a patient finds out who the
best practitioner is in their area. they go to them and then compare
their experiences, they talk amongst themselves, and they develop a
consensus about who is "good" and who isn't. thats how you try to
build your practice and thats how I do mine.
I'm done, but feel free to continue if you wish. I still believe that
the responses to the original poster tended to make it sound like he
would get better care at a private doctors office and paid a high price
rather than go to a commercial practice and pay a lower price. and the
horse has been beat to death, but that is simply a misconception. |
|
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|
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p.clarkii@gmail.com
medicine forum Guru Wannabe
Joined: 11 Sep 2005
Posts: 247
|
| Posted: Sun Jun 25, 2006 9:05 pm Post subject:
Re: sick of astigmatism (soft torics)
|
|
|
your experiences are clearly different from mine. i have heard other
docs talk about retail chains mandating certain behaviors from their
doctors, but where i work it isn't that way. they in fact are very
careful to stay at arms length, almost as if they are fearing some kind
of conflict of interest accusations. they trust me to do the thing
thats right for the patient, and they do that as well.
can't say whether your experience is more representative of retail
outlets overall, or whether mine is. i've only worked at one retailer.
but my view of many private doctors is not that they are doing a better
job. in fact it oftentimes seems to me that many patients who come to
me after having previously been to a private doctor have had their
wallets lightened to a significant extent unnecessarily (e.g. sold $400
progressives when simple OTC readers would have sufficed, etc.).
============
Anon E. Muss wrote:
| Quote: | On Sun, 25 Jun 2006 17:53:04 GMT, "RM" <RM@nowayhose.net> wrote:
Thats not the issue at all. Its the doctor that you go to and how
much he/she desires to satisfy the patient thats the issue (as you
say).
I agree.
And I don't think there is any better chance of finding such a doctor
in private practice versus retail practice.
I disagree, based on personal experience and anecdotal experience from
other patients.
I hear patients all the time compliment me on the thouroughness of my
exam or tell me the reason they came to me was because they were
disastified with a retail chain doctor.
It is a much rarer occurance for a patient to state they left a
private practice doctor for me because they were not satisfied with
them.
I've seen lazy doctors in both locations.
Same here.
But in the retail chain I work for, those kind of doctors are GONE
after awhile.
Is it because they were truly "lazy" or didn't work fast enough/did
"unnecessary tests"?
I know of a "retail doctor" who was given a lot of flak because he was
writing scripts recommending TRIVEX over polycarb because the lab
right next door which was run by the corporation who was leasing him
space had to special order it. He was basically reminded by a MBA
bean counter that his lease is reviewed every 30 days. Back to
polycarb it was. |
|
|
| Back to top |
|
|
Dr. Leukoma
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1283
|
| Posted: Sun Jun 25, 2006 9:11 pm Post subject:
Re: sick of astigmatism (soft torics)
|
|
|
p.clar...@gmail.com wrote:
| Quote: |
but my view of many private doctors is not that they are doing a better
job. in fact it oftentimes seems to me that many patients who come to
me after having previously been to a private doctor have had their
wallets lightened to a significant extent unnecessarily (e.g. sold $400
progressives when simple OTC readers would have sufficed, etc.).
|
Ummm, wait a minute. I CHOOSE to wear Hoya ECP progressive lenses with
AR coating OVER my contact lenses. Why do I do that? Because I once
used OTC readers and this is a heck of a lot better. If my patients
can afford to pay for it, why shouldn't I offer it?
Drg |
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|
Quick
medicine forum Guru
Joined: 19 Jun 2005
Posts: 343
|
| Posted: Sun Jun 25, 2006 9:14 pm Post subject:
Re: Strawman argument from RM
|
|
|
p.clarkii@gmail.com wrote:
| Quote: | this is my final remarks on this topic but I can't say
anything for the other doctors who reacted negatively to
your remarks about retail optometrists-- are you trying
to say we are ALL being defensive? just think.
Here are the derogatory remarks said about retail
optometry. I won't put the names by who said them
because they can be easily looked up and you'll recognize
it yourself:
--------------------
But the right eye is always bad and blurry. Why would
they prescribe me soft torics when gas perm contacts are
better?
Because you insist on going to discount optical stores
for your eyecare instead of private practice doctors.
--------------------
Seemed like a buffoon.
If you want quality, why are you going to the
optician-equivalent of a Wal-Mart?
Your expectations and your choice of providers are simply
not a good recipe for satisfaction.
--------------------
Can nobody help me?
I agree. $70 is what I would expect for an oil change,
not for fitting a prescription like yours. Since you
weren't charged a professional fee, I doubt you can
expect to get professional service.
--------------------
I have nothing more to say beyond what I have said as
well as the other 2 guys who spoke out. And Larry, noone
ever said YOU try to entrap patients into buying their
contact lenses from you, it was just said that another
practice down the road does that. of course we are all
aware of the recent federal contact lens laws. its just
that some heed them more than others.
And DrG, I think its pretty obvious how a patient finds
out who the best practitioner is in their area. they go
to them and then compare their experiences, they talk
amongst themselves, and they develop a consensus about
who is "good" and who isn't. thats how you try to build
your practice and thats how I do mine.
I'm done, but feel free to continue if you wish. I still
believe that the responses to the original poster tended
to make it sound like he would get better care at a
private doctors office and paid a high price rather than
go to a commercial practice and pay a lower price. and
the horse has been beat to death, but that is simply a
misconception.
|
Just my 2 cents (from an outsider) and I'm not sure I've
got my thoughts clarified yet.
You all seem to be focusing on the individual practicioners.
I thnk it's the context in which they practice that should be
the focus.
Well, OK, with an exception. On average, how much does
a doc/optom make working for a retail chain as opposed to
private practice? I realize there are a slew of advantages
and disadvantages to both and it depends on the individual's
goals, values, and priorities and there are a good number of
exceptions... but... I think it's a fact of our society that the
best move towards the money? Or is this strictly a business
end factor? I would guess there are significant barriers to
entry into private practice that don't exist in order to work
for a retail chain and so maybe the great majority enter into
practice there and move from there to private practice.
Defense laywers come to mind. I would expect a public
defender attorney to be competent. I would expect to be able
to find better in private practice. Any validity in this?
Back to my other thought,
Am I correct that the retail chains operate on economies of scale?
in order to provide services at the prices they do? I believe there
will be some conditions imposed by that. For example, in general
it seems that I buy goods at Costco for less but there may be
a limited selection or limited sizes. It's not so much that the goods
offered are any different quality than the same goods offered
elsewhere. So I would expect middle of the road good quality
products at a retail chain. Nothing at the bottom end and nothing
at the high end. Generally targeted at the large portion of the bell
curve. I would expect perfectly adequate care. I would not expect
the doc there to ask if I would like to experiment with something
that was new but looked very promising. Or be offered the very
latest materials, etc. I would not expect to be able to go to a retail
chain and say I want to try gas perms. I want to try translating
trifocal gas perms made by Fused Kontacts. I know they are not
recommended for my application (heavy computer user) but I
want to try them and I'm willing to pay even if it doesn't work out.
I went to one private practice and it was bad. I didn't know what
I really wanted and his intention was to give me the $300 package
exam plus soft contacts with a year's supply and out the door. At
the end of about 4 visits I did not have confidence in him and he
was frustrated. "Well, 90% of contact wearers would be happy
with your vision". So, sure, there is good and bad in both places.
No, I don't think I received "bad" care. I think it more that was what
he offered and I didn't fit the mold.
I looked around and found (turned out to be *excellent*) another
doc. He was willing to try fitting the rgps that I wanted even though
he had never done so before and had never dealt with Fused. He
first had me try a couple of different soft designs. In addition to
*many* visits with chair time we must have spent a total of 4 or 5
hours discussing parameters, options, products, etc. I was very
involved in the process and decision making. It cost more. (No
where near as much as I expected but it cost more going in).
I don't think I would have been able to get that sort of care or
options in a retail chain. I didn't get that sort of care or options
at the first private practice but I don't think I could have found it
in any retail chain.
*Personally* I perceive retail chains as a place to go if you know
what you want and you know they have it or if you're will to accept
what works or is best for the majority of cases.
....I'm still not sure if I have a point...
-Quick |
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