Economics, rising demand may herald era of détente between eye care specialties

Ophthalmologists and optometrists working as equal practice partners consult with one another, share expenses and receive same rates for all services.

In recent years, ophthalmologists and optometrists have increasingly developed equitable partnerships that are beneficial to practices and patients, according to some observers.

Financial pressures, burgeoning demand for care and an ongoing trend toward larger group practices may spur a thawing of relations between the two eye care specialties, experts said in interviews with Ocular Surgery News.

“Certain elements of both optometry and ophthalmology are both wedded to the idea that their lives will be perfect once they get rid of the other guys, either legislatively or procedurally,” Blake Myers, MD, said. “That is an absolute wrong impression. … We will work together or we will be forced to work together after we have finished fighting over the small crumb that we think of as our entire world.”

Thomas Smith, OD, an optometrist and partner of Dr. Myers, echoed his colleague’s assessment.

“The two sides should consider the other an asset,” Dr. Smith said. “Daily, I consult and am consulted for different situations. … It is a very reassuring way to practice.”

Practice management consultant and OSN Practice Management Section Editor John B. Pinto characterized integrated practices as a durable state of affairs. For integrated practices, there is no turning back to an “MD-monoculture” business plan, he said.

“As long as you have crossed the Rubicon and decided that you are going to add optometrists to the practice, it really falls into line,” he said. “I am not sure that I have ever seen a client practice that went forward and added optometrists, then reversed that decision. It usually is a one-way street.”

Robert S. Gold, MD, OSN Pediatrics/Strabismus Section Editor, also attested to the permanence of an integrated practice model.

“This is here to stay. Ophthalmologists need to work together with optometrists,” Dr. Gold said. “We are all here for the same purpose — to make people see better — and there is no reason to have in-fighting.”

Opportunities and challenges

Currently, optometrists outnumber ophthalmologists two to one, according to Mr. Pinto. In coming years, the typical practice will likely have one surgeon for every two or three optometrists, he said.

“I think we are going to continue to see — because of a surfeit, an excess, of optometrists and optometric training slots — that the majority of optometrists remain in a durable associate position,” Mr. Pinto said. “Which, when seen through the lens of an ophthalmologist owner, is great because it provides an opportunity for passive income for the surgeon-owner of the practice, although mixed MD-OD ownership is also on the rise.”

The integration of ophthalmology and optometry gives practices the opportunity to maximize efficiency by making full use of personnel and equipment, Mr. Pinto said.

“In a world where we are getting paid less per unit service, we have to be able to put out more units of service to stay even,” he said. “That feeds in directly to the efficiencies that flow from adding optometry to an all-surgeon practice.”

Potential pitfalls of integrated practices include “channel conflicts,” wherein an optometrist who refers patients to an ophthalmologist fears losing business if the ophthalmologist employs another optometrist. In addition, some patients may be reluctant to accept a new primary eye care provider, Mr. Pinto said.

Optometrists should charge fees at the same rate as ophthalmologists for a given service, and care pathways should be established to enhance the efficiency and accuracy of patient care and flow, he said.

“There are some practices that go the way of charging a lesser amount for a given service if the OD provides the service,” he said. “That is really not best practice. You should have the same fees for the same services, regardless of the professional designation in most settings.”

Large integrated practice

Drs. Myers and Smith are partners in an integrated group practice that has existed for 16 years and now includes 15 ophthalmologists and three optometrists.

The partners’ willingness to consult with one another builds durable professional relationships and enhances patient care, Dr. Myers said.

“We’re not dating; we’re married,” he said. “One of the nice things is that we don’t actually have to worry about who is individually more productive. The people who are productive are the people who are here every day working.”

Dr. Myers said he is free to ask Dr. Smith for a second opinion on a particularly challenging case.

“[We] maintain that if we all take care of the patients, then the issues of productivity, compensation and dollars will take care of themselves,” he said.

Only one charge is generated in a case where one partner asks another for a second opinion, and that charge is for the doctor who has the patient on the schedule, Dr. Smith said. “That is an efficiency from a patient care standpoint,” he said. “We certainly provide that.”

In addition, partners are compensated at the same rate based on a complex equation based on expenses and productivity, Dr. Smith said.

“Expenses that are based on how much you use the resources in the practice are tied to your productivity,” he said. “The more you produce, the more you are presumed to have used the resources of the practice in such areas as personnel. Those who produce less are also less liable for the variable practice expenses.”

Medium-sized practice

Dr. Gold is a partner in a practice that includes six ophthalmologists and one optometrist. Three of the ophthalmologists specialize in pediatrics. The optometrist sees both children and adults.

It is particularly challenging to get parents to bring their children in to see the optometrist rather than one of the pediatric ophthalmologists, Dr. Gold said.

“We tell them that when they go to their pediatrician’s office, many times they are going to see a nurse practitioner or a physician’s assistant,” he said. “This is someone who has more training than that. If we have a several-month wait in our practice, patients usually get in within a week with the optometrist, then we can transition them to the pediatric ophthalmologist if we need to.”

An optometrist who will see adults and children is a boon to productivity, Dr. Gold said.

“It works for our practice, but you have to have the right optometrist with the right mindset,” he said. “I think you are seeing [this arrangement] more and more around the country.” – by Matt Hasson

• Robert S. Gold, MD, can be reached at 225 W. State Road 434, Suite 111, Longwood, FL 32750; 407-767-6411; fax: 407- 767-8160; e-mail: rsgeye@aol.com.
• Blake Myers, MD, and Thomas Smith, OD, can be reached at 601 Halton Road, Greenville, SC 29607; 864-458-7956; fax: 864-458-3833; e-mail: cbm@jervey.com; tws@jervey.com.
• John B. Pinto can be reached at 619-223-2233; e-mail: pintoinc@aol.com; website: www.pintoinc.com.