COT's refracting and charging???

[chip anderson]

An OMD generally has at least 7 years of education after finishing college(pre-med). And even those at the bottom of the class can start out at over $100K if they go to work in an established practice. It may take a little more time if they start out with a new single shingle. But even it they have a great many "bad habits" they don't start out at less than $50K. In fact I wouldnt be supprised if a resident's salary isn't near that now.
I think most O.D.'s can start at around $100K now. I am not knocking this as long as it is made honorably. I do admit to a bit of envy.
Now if the earnings are less than honorable, i.e. forcing un-needed tests, and tests and equipment that are there to "impress the patient", Sticking it to the insurance company just because "the code is there." Then I have problems with this. Doing a refraction but not presenting the result and not stating it was done because "it isn't covered by insureance" then I have a problem with this. But another man's honor or lack of same is not my problem personally.

Chip

[HarryChiling]

I have received many private messages about this lurker.

Unfortunately the individual is not listed on ODwire.org under the name he uses on Optiboard.com.

There no way to trace this individual. If someone can supply me with his e mail address, perhaps our Web master can find a way to ban him .

He he he, I'm a lurker. :D:cheers::p:p:p

[jediron1]

Ok,

This post is not beneficial for anyone, but I would like to pose a reality check.

In the midwest a high school graduate has pretty limited options. Many choose a factory job. These jobs don't pay nearly as much as before and there is no job security. Many make around $15 an hour with little to no benefits. This is uncomfortable and mind numbing work. You get 30 mins for lunch non paid and maybe 2 10 minute breaks. Others may get $8 in a service industry.

Lets say one of our newer techs makes $10 an hour with full medical. This makes it equivalent to $13-14 an hour. The environment is clean and pleasant. The work is varied and non stressful. They get respect and get to help the patients.

Considering this comparison, how are techs / opticians getting such a bad deal? Most are 2nd wage earners in the family. The training is done while being paid at the office.

A buddy is part of a large office that pays their head optician around $45k with benefits. On par or better with teachers.

What is the problem?

Ok reality check. 1. At least around NY where I m at I know of no one that is 2nd wage earners as you put it. Do you mean they don't need the money it's just for spending. Come on get real have you seen the price of gas? Most need the second income to survive. In your little economic scenario you quote: " Lets say one of our newer techs makes $10 an hour with full medical. This makes it equivalent to $13-14 an hour" So the tech earns gross roughly $560 minus $160 benefits and $80 in taxes and your down to take home at $320 per week. I don't know of anybody that could live on that. As for your buddy, if you break it down using your above numbers they earn $45,000 minus roughly $8000 benefits minus $7381 taxes grand total take home $29,619. Very hard to have a family living on that. 2: My daughter is a teacher and when she started out she started at $37,000 and now 3 years later she is at $45,000. If she stays she will top out in 10 to 15 years at $65,000 to $75,000, far cry from what an optician makes after 20 years which is about $45,000. Now in Indiana maybe $45,000 is big money but in NY I need my wife to work to make ends meet. Gas is at $4.00 per gallon my gas and electric just shot up another $60.00 to 379.00 per month and we just went to the grocery store and everything we picked up had risen in price from 10 to 20% so your premise that your help is well paid is unfounded in NY in Indiana maybe. Plez :bbg:

[jediron1]

He he he, I'm a lurker. :D:cheers::p:p:p

Harry keep it up I love it! :cheers: :D

[npdr]

HarryChilling,

I'm inquiring mainly to clarify your position on optician refracting. I accept your vast experience in the technical aspects of ophthalmic appliances but I'm having a hard time seeing how that knowledge equates familiarity with the issues surrounding a quasi medical procedure called refraction.

What is lost on this thread is that refraction is considered by ophthalmology as part of a medical eye evaluation and although it can be separated out by the insurance company or delegated out, its importance as an independent procedure without any medical evaluation or original complaint is what bothers me the most.

I also don't believe a traditionally trained optician has the educational background to evaluate the relevance of a particular visual acuity level. On each patient, optometrists and ophthalmologists relate the visual acuity to the presenting complaint or lack thereof. That judgment is likely to be glossed over by an optician.

In my opinion, the optician desiring refraction is simply wanting to sell glasses, while the optometrist refracting is trying to determine if there is eye disease.

Eye disease is evaluated by both structural (physical examination of the eye, imaging) and functional changes (visual acuity, visual fields, etc) and both paradigms serve to check and balance the other. Not doing either means that there are likely things to be missed whether they are performed by any particular kind of ECP.

[HarryChiling]

HarryChilling,

I'm inquiring mainly to clarify your position on optician refracting. I accept your vast experience in the technical aspects of ophthalmic appliances but I'm having a hard time seeing how that knowledge equates familiarity with the issues surrounding a quasi medical procedure called refraction.

What is lost on this thread is that refraction is considered by ophthalmology as part of a medical eye evaluation and although it can be separated out by the insurance company or delegated out, its importance as an independent procedure without any medical evaluation or original complaint is what bothers me the most.

I also don't believe a traditionally trained optician has the educational background to evaluate the relevance of a particular visual acuity level. On each patient, optometrists and ophthalmologists relate the visual acuity to the presenting complaint or lack thereof. That judgment is likely to be glossed over by an optician.

In my opinion, the optician desiring refraction is simply wanting to sell glasses, while the optometrist refracting is trying to determine if there is eye disease.

Eye disease is evaluated by both structural (physical examination of the eye, imaging) and functional changes (visual acuity, visual fields, etc) and both paradigms serve to check and balance the other. Not doing either means that there are likely things to be missed whether they are performed by any particular kind of ECP.

That's great and I am all for all of that, but lets say the patient leaves your office and then 6 months later they decide they want to have glasses made. The need for refraction amoung opticians as I see it is solely to sell the patient glasses, but it's more than that it's a means of satisfying a patients needs.

Currently what I have to do is call the doctors office and have them fax me a script, which sometimes meets resistance although there are laws in place to prevent the prescriber from giving me any resistance, but their is a significant percentage that will ask me to fax a release to their office, because of HIPAA. This is a misconception and even if I manage to explaint his to them and convince them that this is not the case and I can fax them the documentation of the law, then they resort to the fact that the doctor has to sign it or a technician needs to pull the file, this can often takes hours. Then their are the occasional doctor that has sloppy hand writting and gettign confirmation from their office on the correct script will often start this whole HIPAA process and argument over again. Then their are the few prescribers that will not release the Rx acording to a study done that was referencedd in the federal register it's somewhere in the 10% range that flat out refuse.

I have lost good patients that have always been very happy with my service to doctors offices that play hanky panky with prescriptions. It's a real issue, now your in a unique position where you don't dispense in your office. For you there is no financial motivation for tom foolery with the scripts and from what you have expressed in past posts your goal is to provide patients with the best visual outcome. My original suggestions was and still is,

"What's wrong with a refraction only within the one year period between exams?"

I am not suggesting that opticiasn become the gate keepers of the exams, just that opticians have the ability to tweak or update the measure after a thorough exam has been performed within a specified period of time. The customer can be better served in all aspects of the eyecare delivery system not just the exam if this were allowed.

You mentioned that a traditionally trained optician doesn't have the educational background. I actually agree with that and this is the kind of inpt I have been trying to coax. As the primary care providers for the health of the visual system WHO ELSE COULD I ASK A MORE RELEVENT QUESTION TO. All my questions here have to be directed at an optometrist, you are the ones that woud have the most relevent answers and be able to provide the proper input into how something like this could work.

Others have mentioned and I have as well that OMD's could be an alternate source of solutions, but if the OD's on this board truly believe that they are more suited for the solution that is a great opportunity to put in valid input of how to make it work instead of being left out of the loop.

I look forward to your responses.

[IndianaOD]

Ok reality check. 1. At least around NY where I m at I know of no one that is 2nd wage earners as you put it. Do you mean they don't need the money it's just for spending. Come on get real have you seen the price of gas? Most need the second income to survive. In your little economic scenario you quote: " Lets say one of our newer techs makes $10 an hour with full medical. This makes it equivalent to $13-14 an hour" So the tech earns gross roughly $560 minus $160 benefits and $80 in taxes and your down to take home at $320 per week. I don't know of anybody that could live on that. As for your buddy, if you break it down using your above numbers they earn $45,000 minus roughly $8000 benefits minus $7381 taxes grand total take home $29,619. Very hard to have a family living on that. 2: My daughter is a teacher and when she started out she started at $37,000 and now 3 years later she is at $45,000. If she stays she will top out in 10 to 15 years at $65,000 to $75,000, far cry from what an optician makes after 20 years which is about $45,000. Now in Indiana maybe $45,000 is big money but in NY I need my wife to work to make ends meet. Gas is at $4.00 per gallon my gas and electric just shot up another $60.00 to 379.00 per month and we just went to the grocery store and everything we picked up had risen in price from 10 to 20% so your premise that your help is well paid is unfounded in NY in Indiana maybe. Plez :bbg:

That was $45k plus medical/vision/dental so the equivalent of around $55k.

By 2nd I mean that their spouse is the primary wage earner. Automotive manuf jobs are very hard to come by these days and very unstable. New hires at Subaru Indiana get around $16.22 an hour, this goes up to around $22 or so after a couple of years. I think working in our office is much better than doing the same repetitve motion over and over again all day with no personal freedom.

The median income for a household in the county was $43,840 (This is for our county HOUSEHOLD income)

As our office grows everyone makes more, not just the docs.

[jediron1]

That was $45k plus medical/vision/dental so the equivalent of around $55k.

By 2nd I mean that their spouse is the primary wage earner. Automotive manuf jobs are very hard to come by these days and very unstable. New hires at Subaru Indiana get around $16.22 an hour, this goes up to around $22 or so after a couple of years. I think working in our office is much better than doing the same repetitve motion over and over again all day with no personal freedom.

The median income for a household in the county was $43,840 (This is for our county HOUSEHOLD income)

As our office grows everyone makes more, not just the docs.

My fault I thought the way you originally put it down it was the total compensation. If he or she is getting what you say then yes that is a good compensation package for that individual. Again I agree working in an office environment is much better, but to get the compensation you quoted at least around most of NY state you have to go retail. In NY most OD's and OMD's top out their opticians at $15 to $17 per hour. I know I have worked for many OD's and OMD's and as soon as I had topped out ($16.50 at one place ) they let me go, had nothing to do with ability or selling glasses had everything to do with how much I was making. As I have said else ware on this site most OD's and OMD's in NY don't pay.

[HarryChiling]

My fault I thought the way you originally put it down it was the total compensation. If he or she is getting what you say then yes that is a good compensation package for that individual. Again I agree working in an office environment is much better, but to get the compensation you quoted at least around most of NY state you have to go retail. In NY most OD's and OMD's top out their opticians at $15 to $17 per hour. I know I have worked for many OD's and OMD's and as soon as I had topped out ($16.50 at one place ) they let me go, had nothing to do with ability or selling glasses had everything to do with how much I was making. As I have said else ware on this site most OD's and OMD's in NY don't pay.

That's not always the doctors fault, many don't have very much business aumen so they end up relying on consultants or industry figures to gauges their business. If you look at labor it is one of the largest expenses in any practice. As a consultant the easiest way to make an imediate impact would be to cut an optician that makes 16.50 and replave with an opticians at 9.00 or round abouts, now the consultant can brag about reduceing the practices labor costs. The long term effects will not be evident immediately and if they are it's usually a steady decline. I have seen 2 models of running a successful business, treat your employees like assets, pay them well and expec t them to earn that pay and often they will exceed expectations if the correct staff is hired. What usually ends up happening is the staff makes higher wages, but the cost of goods and operational expenses come down because the staff is vested in making the employer money and making sure their best job is always there. Another method is the cheap labor method, where the cogs and operational expenses are ridiculous and the labor is short changed. Oftne the consultants have a field day with these practices, they make a few minor changes just enought o justuify their salaries and then coast untill next time. I find that the offices with educated staff seem to do well and it's easy, the other business model works well also but it always seems like the office is in a state of turmoil.

I think this is where OD's should get more educated, in teh runnign and manageing of a businesss, most are like sheep and follow the latest magazines or consultants advice blindly. This unfotunately harms the educated and skilled optician, they almost educate themselves out of a job. One of the greatest suggestions I have to highly qualified opticians that I myslef use is to leave stuff off your resume and cherry poick what you think that particular practice may want to hear from your resume. Too much info and you end up with no offers, or being told your too qualified, too little experience and your pay is reduced. I have found that my ABO, and my NCLE with two management positions and two dispensing powsitions tends to do well in the market. Add in writing and advanced certification and I'm often told when I follow up that they're looking for someone with a little less experience.

[jediron1]

That's not always the doctors fault, many don't have very much business aumen so they end up relying on consultants or industry figures to gauges their business. If you look at labor it is one of the largest expenses in any practice. As a consultant the easiest way to make an imediate impact would be to cut an optician that makes 16.50 and replave with an opticians at 9.00 or round abouts, now the consultant can brag about reduceing the practices labor costs. The long term effects will not be evident immediately and if they are it's usually a steady decline. I have seen 2 models of running a successful business, treat your employees like assets, pay them well and expec t them to earn that pay and often they will exceed expectations if the correct staff is hired. What usually ends up happening is the staff makes higher wages, but the cost of goods and operational expenses come down because the staff is vested in making the employer money and making sure their best job is always there. Another method is the cheap labor method, where the cogs and operational expenses are ridiculous and the labor is short changed. Oftne the consultants have a field day with these practices, they make a few minor changes just enought o justuify their salaries and then coast untill next time. I find that the offices with educated staff seem to do well and it's easy, the other business model works well also but it always seems like the office is in a state of turmoil.

I think this is where OD's should get more educated, in teh runnign and manageing of a businesss, most are like sheep and follow the latest magazines or consultants advice blindly. This unfotunately harms the educated and skilled optician, they almost educate themselves out of a job. One of the greatest suggestions I have to highly qualified opticians that I myslef use is to leave stuff off your resume and cherry poick what you think that particular practice may want to hear from your resume. Too much info and you end up with no offers, or being told your too qualified, too little experience and your pay is reduced. I have found that my ABO, and my NCLE with two management positions and two dispensing powsitions tends to do well in the market. Add in writing and advanced certification and I'm often told when I follow up that they're looking for someone with a little less experience.

Good points. I have gone on many job outings only to have them say your qualifications are impressive, which is to say your too expensive and I won't pay it.Your point of putting less and getting more caught my attention and I think I will try it the next time. Your other point about business sense is very true. Most Doc's maybe great at what they do but when it comes to business and common sense it goes right out the door. Good chat!

[tmorse]

In my opinion, the optician desiring refraction is simply wanting to sell glasses, while the optometrist refracting is trying to determine if there is eye disease.

"... the optometrist refracting is trying to determine if there is eye
disease"

How VERY noble, but you forgot to add... ;)
AND IS ALSO SIMPLY WANTING TO SELL GLASSES.

[LandLord]

Maybe it's different in the U.S.A. where OD's are known for their gentle, caring approach, but here in Canada, the optometrists are very, very, very, very, very business, hours, compensation and eyeglass sales-minded!

[bob_f_aboc]

By 2nd I mean that their spouse is the primary wage earner. Automotive manuf jobs are very hard to come by these days and very unstable. New hires at Subaru Indiana get around $16.22 an hour, this goes up to around $22 or so after a couple of years. I think working in our office is much better than doing the same repetitve motion over and over again all day with no personal freedom.

The median income for a household in the county was $43,840 (This is for our county HOUSEHOLD income)

As our office grows everyone makes more, not just the docs.

I am the primary wage earner in my family. My wife makes significantly less than I do and also has insurance with her job. I am not even close to what your Subaru people make and I have been doing this for nearly 10 years. The benefits offered at my office are so poor and overpriced that it would be stupid for me to take them. Since I am the optician, lab tech, back up optometric tech, back up receptionist, back up insurance filer, and maintenance man at my office, repetitive motion is not a problem.

As our office grows, the staff grows more disheartened. Since I have been with this office (2 years), total revenue is up nearly 40%, optical sales are up over 50%. The only raise I have received as well as everyone else in the office was 3% last fall.

[jediron1]

I am the primary wage earner in my family. My wife makes significantly less than I do and also has insurance with her job. I am not even close to what your Subaru people make and I have been doing this for nearly 10 years. The benefits offered at my office are so poor and overpriced that it would be stupid for me to take them. Since I am the optician, lab tech, back up optometric tech, back up receptionist, back up insurance filer, and maintenance man at my office, repetitive motion is not a problem.

As our office grows, the staff grows more disheartened. Since I have been with this office (2 years), total revenue is up nearly 40%, optical sales are up over 50%. The only raise I have received as well as everyone else in the office was 3% last fall.

As I have said about a hundred times OD's and OMD's are cheap they don't pay never have never will. I once worked for an OMD about 15 years ago who was making a seven figure income. We went to him one day ( one OD, myself and office manager ) to bring to him a proposal to increase business in the Optical shop by having his front end people refer people to us. By doing this we would offering them a bonus for every person they sent us. He said I already pay them an hourly rate ( minimum wage ) and I won't pay them more for something they should be doing anyways. We told him it was just an incentive to get more business, he said no and would not talk any further about incentives for the help because they were already get a pay check. Once worked for an OD who called me on a Friday to let me go. On Monday I get a call from the front end person telling me the OD just pulled up in brand new Cadillac. She said I asked him where he got that. He said since we let the optician go I could afford to buy the Cadillac. Almost all the time it's not that they can't afford you but it's about what toy they next. All true stories. Most of the time I had the business going up a nice healthy 10% every year at every place I had been. OD's are cheap and OMD's are cheaper yet!

just my take

[npdr]

''... OD's are cheap and OMD's are cheaper yet!

just my take

I concur that 90% of ophthlamologists and optometrists are quite thrifty with salaries or bonuses.

I have been employed by both and in all cases, the salary or "day rate" was quite modest.

The question is whether an employee would be willing to go 100% commission. Would an optometrist do that? In many cases, optometrists hired by ophthalmologists are given that option of a minimum base salary with a incentive or productive element that increases the income.

I'm not saying that one way is better, but that is the landscape now. With the deluge of graduates, it isn't likely to change soon.

[jediron1]

I concur that 90% of ophthlamologists and optometrists are quite thrifty with salaries or bonuses.

I have been employed by both and in all cases, the salary or "day rate" was quite modest.

The question is whether an employee would be willing to go 100% commission. Would an optometrist do that? In many cases, optometrists hired by ophthalmologists are given that option of a minimum base salary with a incentive or productive element that increases the income.

I'm not saying that one way is better, but that is the landscape now. With the deluge of graduates, it isn't likely to change soon.

I think you missed the point. OD's at least in NY where I am who worked with the last OMD I worked for averaged $110,000.00 per year with the head OD at each of four sites receiving a bonus if his location exceeded expectations. Now for the three and half years I was there all four locations exceeded expectations with the one OD getting a bonus of $35,000.00 and the second location OD got $30,000.00. The reason I know is I was told by the OD at my location because he was upset because his bonus was smaller, but we also had the smallest location in relation to volume. But he felt he worked his tail off and should have gotten a larger compensation.

[npdr]

I think not,

Most optometrists want to do better than that.

[jediron1]

I think not,

Most optometrists want to do better than that.

PLEZZZZZZZZZZZZZZ
Maybe you are ok with more because you live in California where the cost of living is much higher and you need more. I have a cousin who lives in San Diego and they said my home in California would run between $300,000 and $400,000, here in NY it's $100,000. So what their making is good money no matter what you say.

[npdr]

I think you missed the point. I think it matters if the OD is from West, South, Central or wherever.

110k +30k is not a lot of change if the business is pulling in $1MM. It just means that the 110K outside of CA goes a lot farther. The funny thing is that the OD pay is about the same whether in CA or anywhere else.

I've been recruited for the Southeast with a generous salary and would have only moved if that salary wasn't at that level.

[jediron1]

I think you missed the point. I think it matters if the OD is from West, South, Central or wherever.

110k +30k is not a lot of change if the business is pulling in $1MM. It just means that the 110K outside of CA goes a lot farther. The funny thing is that the OD pay is about the same whether in CA or anywhere else.

I've been recruited for the Southeast with a generous salary and would have only moved if that salary wasn't at that level.

Actually if I remember right the average for each location was 1 mil a year for a total of roughly 4 mil. They employed 4 OMD's, 12 OD's, and 12 opticians with additional support staff.

[OHPNTZ]

I think you missed the point. OD's at least in NY where I am who worked with the last OMD I worked for averaged $110,000.00 per year with the head OD at each of four sites receiving a bonus if his location exceeded expectations. Now for the three and half years I was there all four locations exceeded expectations with the one OD getting a bonus of $35,000.00 and the second location OD got $30,000.00. The reason I know is I was told by the OD at my location because he was upset because his bonus was smaller, but we also had the smallest location in relation to volume. But he felt he worked his tail off and should have gotten a larger compensation.

I work in NY state, and earn no where near that amount...as I work for an optician based company...

What is the true motivation for optician refractions??? Is it not to get more patients (customers) within your boutiques??? What is the motivation for Harry who works for Pearle???? I don't quite get it...

For example...the optician(s) I work along side do contact lens fittings. Before I arrived, 20/20 was 20/20...no need to overrefract from their thinking. Many were overminused. Some had underlying conditions...ie. Fuch's Endothelial dystrophy, EXTENSIVE corneal neovasculariztion, etc...etc. Thank God I arrived. The opticians had no idea of the difference between corneal neo and pannus. Mucin balls...what are those? SPK...dont' stain...so cannot tell... The list goes on...

So what is the REAL motivation for refraction? Do you analyze conditions? What about anomolous retinal correspondance? Where do you draw the line????

And...there are OD's who have no idea what I'm talking about...believe me...I've seen their charts...

[jediron1]

I work in NY state, and earn no where near that amount...as I work for an optician based company...

What is the true motivation for optician refractions??? Is it not to get more patients (customers) within your boutiques??? What is the motivation for Harry who works for Pearle???? I don't quite get it...

For example...the optician(s) I work along side do contact lens fittings. Before I arrived, 20/20 was 20/20...no need to overrefract from their thinking. Many were overminused. Some had underlying conditions...ie. Fuch's Endothelial dystrophy, EXTENSIVE corneal neovasculariztion, etc...etc. Thank God I arrived. The opticians had no idea of the difference between corneal neo and pannus. Mucin balls...what are those? SPK...dont' stain...so cannot tell... The list goes on...

So what is the REAL motivation for refraction? Do you analyze conditions? What about anomolous retinal correspondance? Where do you draw the line????

And...there are OD's who have no idea what I'm talking about...believe me...I've seen their charts...

If you would have taken the time to analyze the whole picture you would have noticed that I was speaking from the opticians perspective as I am an optician. I was speaking about the Docs I had worked with. Next time please read all the posts instead of just picking and choosing certain ones for your entertainment.

[Dannyboy]

I work in NY state, and earn no where near that amount...as I work for an optician based company...

What is the true motivation for optician refractions??? Is it not to get more patients (customers) within your boutiques??? What is the motivation for Harry who works for Pearle???? I don't quite get it...

For example...the optician(s) I work along side do contact lens fittings. Before I arrived, 20/20 was 20/20...no need to overrefract from their thinking. Many were overminused. Some had underlying conditions...ie. Fuch's Endothelial dystrophy, EXTENSIVE corneal neovasculariztion, etc...etc. Thank God I arrived. The opticians had no idea of the difference between corneal neo and pannus. Mucin balls...what are those? SPK...dont' stain...so cannot tell... The list goes on...

So what is the REAL motivation for refraction? Do you analyze conditions? What about anomolous retinal correspondance? Where do you draw the line????

And...there are OD's who have no idea what I'm talking about...believe me...I've seen their charts...

Thank god you came...I would have fired them opticians that dont know **** and get some real opticians that do know their stuff. The world is a better place with you there.

I believe is your duty to contact the New York Department of Education/Board of Opticianry and complain about the negligence of them Opticians... not knowing mucin ball from donut balls...what where they thinking?..Overminused..not knowing how to transpose.. You should also complain about the the ODs that do poorly in charting to the board of Optometry...lets see if you have cojones to do that an protect the public from these scums. Keep your good work.Thank you lord for having him there.

Dannyboy

[tmorse]

The opticians had no idea of the difference between corneal neo and pannus.

Sorry I didn't know there was a difference either.. my understanding is that OMD's refer to neovascularization as 'pannus', that same way OMD's choose to refer to hyperopia in their lexicon as hypermetropia.

Kindly provide differential diagnosis.

[HarryChiling]

What is the motivation for Harry who works for Pearle????

This is the second reference to where I work in this thread alone, care to explain your intentions for bringing me into your rederick?