Ontario Optometrists' Restrictions - Time for positive change?

**eyemanflying** · 02-24-2008, 10:47 AM

A Coalition to free commercial restrictions on Ontario Optometrists
2008-02-14 16:45:00

Dr. Don MacQueen, an independent optometrist, and Dr. Patrick Quaid, one of the four optometrists associated with IRIS in Ontario, are using their skills to incite reform in the regulations of the Ontario College of Optometrists.

Created in February 2008, the « Coalition of Ontario Optometrists for Reform » (COOR) was initiated following recent measures taken by the College on Ontario optometrists – for more on this subject, see article published on the 6th Nov.

This coalition, which consists of optometrists from diverse practice backgrounds, aims to influence both the College of Optometrists and the Ministry of Health and Long Term Care to repeal the regulatory amendments submitted to Ministry of Health, which still contain restrictions on association. The coalition is invoking their right to free association which is guaranteed under the Canadian Charter and is requesting a complete revision of the current conflict of interest regulations with a view to eliminating any business restrictions.

The Ontario College of Optometrists state that in the interest of public protection, the provincial law (Ontario Drug and Pharmacies Regulation Act) was created to demonstrate independence and to avoid any potential conflict of interest. The Director of the Ontario College re-affirmed in the media that to practice optometry in association with anyone other than another optometrist or physician constitutes a conflict of interest.

To be followed…

**For-Life** · 02-24-2008, 11:10 AM

hopefully the government will wake up. This set up has been the biggest joke in the industry.

**eyemanflying** · 02-24-2008, 02:35 PM

Originally Posted by For-Life

hopefully the government will wake up. This set up has been the biggest joke in the industry.

An continues to be...the changes would be good for everyone.

**eyemanflying** · 02-27-2008, 05:57 AM

I received another letter from Iris yesterday providing an update. The Ontario College of Optometrists have a tough fight ahead of them and seem to be grasping at straws already.

**Golfnorth** · 02-29-2008, 07:13 AM

Originally Posted by eyemanflying

I received another letter from Iris yesterday providing an update. The Ontario College of Optometrists have a tough fight ahead of them and seem to be grasping at straws already.

I for one am intersted in hearing from other optometrists in this forum about how they feel about what is happening here. Come on don't be shy. Let us know how you feel!

Regards,
Golfnorth

**eyemanflying** · 02-29-2008, 06:29 PM

Originally Posted by Golfnorth

I for one am intersted in hearing from other optometrists in this forum about how they feel about what is happening here. Come on don't be shy. Let us know how you feel!

Regards,
Golfnorth

I agree. There are many out there, but nobody speaking up.

**Ory** · 02-29-2008, 07:19 PM

Originally Posted by eyemanflying

I agree. There are many out there, but nobody speaking up.

Why would we? I've already posted on a similar issue and you called me a liar. http://www.optiboard.com/forums/showthread.php?t=27203

**eyemanflying** · 03-01-2008, 04:26 PM

Originally Posted by Ory

Why would we? I've already posted on a similar issue and you called me a liar. http://www.optiboard.com/forums/showthread.php?t=27203

Why wouldn't you speak up if you support the change? That is exactly the purpose of this forum. If you back the fight, then take a stand and support your colleagues for positive change. Had you shared the information in the first place, there would have been no doubt to the authenticity and truthfulness of your post.;)

**Oedema** · 03-02-2008, 04:54 PM

I have to say that I support pretty much all of the changes (allow OD's to employ opticians, retail pricing, etc.) however the IRIS charter challenges concerns me b/c I'm hesitant about corporations directly employing OD's. I know that is not necessarily the aim of IRIS, however I'm sure their case would open the doors to it. In Illinois OD's are employed by a number of optical chains, and I have to say in some cases it can really lower the bar on the level of optometry practiced by some presumably b/c of their time constraints.

**eyemanflying** · 03-02-2008, 05:45 PM

I'm sure there are many OD's out there that don't want the hassles, frustrations and time/money investments of owning their own practice/business. A practice is merely a business. If their paycheck can come from a 9-5 job at a chain without the headaches, what's so wrong with that?? To each their own.

**Oedema** · 03-02-2008, 06:40 PM

Originally Posted by eyemanflying

I'm sure there are many OD's out there that don't want the hassles, frustrations and time/money investments of owning their own practice/business. A practice is merely a business. If their paycheck can come from a 9-5 job at a chain without the headaches, what's so wrong with that?? To each their own.

Nothing wrong with that, however when OD's can't be bothered to even dilate their own patients b/c of time constraints and instead refer them out for simple dilated fundus exams, I do think that is a problem. The prime example of what I've seen is of a patient seen at the college, referred by an OD in corporate setting, for a DFE b/c the pt. was hypertensive, had a history of hospitalization for severely increased blood pressure, but had absolutely no hypertensive retinal findings. Now why wasn't the referring OD able to manage this pt. himself???:(

My guess is that it has somthing to do with the practice setting. At this particular chain OD's sign a contract where they agree to see all patients that present during the work day. It is apparenty not ususual for an OD in these particular stores to see 50+ patients in a day with standard tech. work-up. I'm not saying that all OD's working there can't/don't handle their own dilations (I in fact personally know some that do), but it is a problem.

BTW what I'm talking about here is real employment of OD, not independent contractors.

**Golfnorth** · 03-03-2008, 12:00 AM

Originally Posted by Oedema

I have to say that I support pretty much all of the changes (allow OD's to employ opticians, retail pricing, etc.) however the IRIS charter challenges concerns me b/c I'm hesitant about corporations directly employing OD's. I know that is not necessarily the aim of IRIS, however I'm sure their case would open the doors to it. In Illinois OD's are employed by a number of optical chains, and I have to say in some cases it can really lower the bar on the level of optometry practiced by some presumably b/c of their time constraints.

Odema;

I see that you are in favour of optometrists employing opticans. Are you also in foavour of opticians employing optometrists?

Regards,
Golfnorth

**Oedema** · 03-03-2008, 01:28 AM

Originally Posted by Golfnorth

Odema;

I see that you are in favour of optometrists employing opticans. Are you also in foavour of opticians employing optometrists?

Regards,
Golfnorth

That's a difficult one. I understand if opticians were to employ OD's they would most likely be much more benevolent than the chains I've mentioned above. However, I'm not sure a legislative/regulatory distinction could be made. Eitherway, I think it's a moot point since this IRIS challenge could very well open the doors to everything.

**eyemanflying** · 03-03-2008, 05:40 AM

Originally Posted by Oedema

That's a difficult one. I understand if opticians were to employ OD's they would most likely be much more benevolent than the chains I've mentioned above. However, I'm not sure a legislative/regulatory distinction could be made. Eitherway, I think it's a moot point since this IRIS challenge could very well open the doors to everything.

Legislation and rules aside, OD's are quite arrogrant in the sense that only some would admit employing opticians is a good idea. And reverse scenario, I have yet to see one OD swallow their pride and admit that they would be willing to be employed by the optician. One word, ego.

**Oedema** · 03-03-2008, 12:19 PM

What benefits are there for an optician to employ an optometrist vs. independent lease holder? what does it accomplish that you can't already get with such an arrangement?

**Golfnorth** · 03-03-2008, 03:05 PM

Originally Posted by Oedema

What benefits are there for an optician to employ an optometrist vs. independent lease holder? what does it accomplish that you can't already get with such an arrangement?

I haven't really thought through the above scenario in order to answer your question properly. I was just wondering if you were in favour of full reciprocal freedom of association both ways not just one way. I gather from your response that you are not in favour of full freedom of association.

Regards,
Golfnorth

**eyemanflying** · 03-03-2008, 03:40 PM

Originally Posted by Oedema

What benefits are there for an optician to employ an optometrist vs. independent lease holder? what does it accomplish that you can't already get with such an arrangement?

Exactly my point.

**Oedema** · 03-03-2008, 05:08 PM

Originally Posted by Golfnorth

I haven't really thought through the above scenario in order to answer your question properly. I was just wondering if you were in favour of full reciprocal freedom of association both ways not just one way. I gather from your response that you are not in favour of full freedom of association.

Regards,
Golfnorth

I'm not necessarily against it, but my feelings are very tentative.

**optical maven** · 03-04-2008, 01:54 PM

Employing someone means you pay them a salary for their services. Optometrists, like physicians, are paid by OHIP for services which are still insured. If an optometrist is employed by someone, they are not allowed to share or split these fees. Cost sharing arrangements can be done. So does the optician hire an optometrist, pay him/her a salary, and forego any OHIP collection? I'm an optometrist and I employ an optician. I pay her a salary. As an optician, what is your business model?

**For-Life** · 03-04-2008, 02:25 PM

Originally Posted by optical maven

So does the optician hire an optometrist, pay him/her a salary, and forego any OHIP collection?

Yes

That is how the other Provinces do it

**Golfnorth** · 03-04-2008, 09:08 PM

Originally Posted by optical maven

Employing someone means you pay them a salary for their services. Optometrists, like physicians, are paid by OHIP for services which are still insured. If an optometrist is employed by someone, they are not allowed to share or split these fees. Cost sharing arrangements can be done. So does the optician hire an optometrist, pay him/her a salary, and forego any OHIP collection? I'm an optometrist and I employ an optician. I pay her a salary. As an optician, what is your business model?

What I am saying is that what is good for the goose is good for the gander. Yes OD's are paid by OHIP for some exams. Forgetting my business model and the benefits, if any, under current market conditions.....are you in favour of complete freedom of association both ways? Are you in favour of having legislation that will allow an OD to employ and optician and an optician to employ an OD regardless if it fits or not with the current optical climate and government paid for exams? Yes or no.

**AdmiralKnight** · 03-05-2008, 12:04 AM

Speaking as an Optician who has just recently started working for an OD in Ontario, I can tell you that I think there are quite a few Docs out there who want to be a little more free when it comes to their hireing as well as their prices. From the month I've been here, I can tell you right now, cost plus is horrible. Not only from a business aspect, but also from a quality aspect. Charging cost for your product, then adding on a fee might sound good, but where's the incentive to try new things? Where's the incentive to help your patient find a great looking frame? Where's the incentive to see if they actually need more than what they have? In the end, you'll make the exact same ammount off the job if you go with a VIP with a discontinued, marked down to $25.00 frame, then you do with the the newest in progressive technology with the most expensive frame available. You still get the same dispensing fee. And that's it. So, to me, it just doesn't make any sense. Get rid of it. In the end, it's a business. The dispensary is there to bring in extra money. As a business, the government should keep it's nose out of it in saying how much you're 'allowed' to charge.

**Oedema** · 03-05-2008, 01:46 AM

Originally Posted by For-Life

So does the optician hire an optometrist, pay him/her a salary, and forego any OHIP collection?

Yes

That is how the other Provinces do it

What?? Don't you have to give away the exam for free if the patient is actually covered by the provincial plan since it is illegal to charge for services that are covered? For example, OD employed by optician, examines a senior covered by provincial health care plan. Can't bill said plan, and can't bill the patient, so you give the service away for free??:drop:

What provinces allow opticians / lay corporations to employ OD's anyways?

**eyemanflying** · 03-05-2008, 05:39 AM

Originally Posted by AdmiralKnight

Speaking as an Optician who has just recently started working for an OD in Ontario, I can tell you that I think there are quite a few Docs out there who want to be a little more free when it comes to their hireing as well as their prices. From the month I've been here, I can tell you right now, cost plus is horrible. Not only from a business aspect, but also from a quality aspect. Charging cost for your product, then adding on a fee might sound good, but where's the incentive to try new things? Where's the incentive to help your patient find a great looking frame? Where's the incentive to see if they actually need more than what they have? In the end, you'll make the exact same ammount off the job if you go with a VIP with a discontinued, marked down to $25.00 frame, then you do with the the newest in progressive technology with the most expensive frame available. You still get the same dispensing fee. And that's it. So, to me, it just doesn't make any sense. Get rid of it. In the end, it's a business. The dispensary is there to bring in extra money. As a business, the government should keep it's nose out of it in saying how much you're 'allowed' to charge.

Glad to see you've made it to Ontario. Don't get homesick. I agree with your comments. But I'm puzzled...you actually found an OD that's charging cost, not inflating or accepting vendor rebates? I have to sit down...
:drop:

**optical maven** · 03-05-2008, 01:44 PM

First on employment. As an optometrist, you want to hire me, go for it. (is there a pension plan). I am curious though why opticians don't make a stink about hiring MD's and reciprocity. Refracting MDs work inside opticals, but are not hired by a store and paid a salary.
Second, the dispensing fee model works exactly opposite to what was said. It is in my best interests to provide people with the best products since I am most competitive at the high end and not the low end of the price scale. Frame $1.00 + lens $30 + fee $100 doesn't work. Frame $100 + lens $120 + fee $100 is competitive in the market. In an optical the mark ups are usually 2.4 X cost (or more). That is why optometrists (in Ontario) are always less expensive for glasses when comparing the same products. I only use trivex in rimless (the optician at Hakim told me trivex and poly were the same) and freeform in progressives (Hoya ID, Essilor Physio). We don't have 2 for 1 (the Adaptar specialist). It also is better in the long run to give people the best, since their adaptation and long term satisfaction is what is important.