HOT TOPIC A new look at old problems

Challenges and.. Opportunities

A roundtable of leading ODs addresses the future of their profession

by Stephanie K. De Long

Optometrist Paul Karpecki discusses the industry's burning questions

What does the future hold for eyecare? How will private practice stay competitive? How has technology changed optometry? These are some of the questions addressed in a two-hour roundtable, sponsored by Eyefinity and Altair Eyewear in New York City and moderated by Eyecare Business editor-in-chief Stephanie De Long.

In this first of two parts, we will look at some of the challenges, as well as opportunities, that face today's optometrist.

INCREASING DEMAND

EB: What's seen as a challenge can also be an opportunity. How will a changing and aging population impact optometry?

Dr. Whitman: You have the geriatric population on one end being educated about how a lot can be seen and diagnosed through the eyes and then you have the new parents who want the best for their child. That gives us an increased scope, and we have to get that message out.

LEADERS IN OPTOMETRY

As seen above, participants in the panel on business trends included: Front row (l. to r.): Steve Baker, Eyefinity; Ryan Wineinger, OD, Kansas City, Mo.; Denise Whitman, OD, New York City; Laurie Lippiatt, OD, Salem, Ohio; John Rumpakis, OD, Portland, Ore.; Paul Karpecki, OD, Cincinnati. Back row (l. to r.): Richard Edlow, OD, Baltimore; Ian Lane, OD, OfficeMate; Ken Suesse, Altair; Greg Ossip, OD, Indianapolis; F. Mason Smith, OD, Mount Pleasant, S.C.; Joe Boorady, OD, Eyemaginations

Dr. Edlow: I disagree with the general consensus that there are too many ODs in the U.S. As the population continues to age, and the changes in ethnicity in the U.S.—Asian and Latin American patients who have higher prevalence of eye disease—the demand for services is going to become dramatic. The biggest challenge is going to be providing care for this increased demand and keeping the patient in the office for the long term.

Dr. Lane: If we look at the patient as a totality, we can really provide total care. That's something we weren't able to do before. Because of the aging population, we are going to be seeing 33 percent more patient encounters.

Dr. Rumpakis: I call optometry the sleeping giant. We need to wake up and realize how we affect the marketplace. The AOA says that in terms of first-time encounters, we take care of 71 percent of patients, and on an ongoing basis, 74 percent. I'm not sure we're taking advantage of that.

Dr. Ossip: We've gone from not being able to prescribe even an antibiotic for a corneal abrasion to full scope. With the aging of America, if we as optometrists don't embrace and take care of those patients, and let them know we can treat all these things, and fill their optical needs, they will look for someone else.

TECHNOLOGY'S INCREASING ROLE

EB: Technology is playing a growing role in optometry. How and why is it changing the profession?

Dr. Boorady: Keeping up with technology is going to be the key to succeeding in practice and thriving in the future.

Dr. Wineinger: I work with a lot of smaller practices and a challenge is first getting a baseline so that you can build on that with technology, which helps eliminate costs and then builds upon itself as you move from one initial piece of instrumentation to more and more technology.

Dr. Lippiatt: Practitioners are starting to understand they need to be more electronically driven. The problem I hear them having is implementation—the incorporation of the technologies into their workflow. In private practice, a lot of optometrists were not brought up in the business arena of organizing and conducting their practices.

Dr. Edlow: Eight years ago, none of the technologies talked to each other. They were all standalone. Now, there is so much interfacing, and the percentage of gross revenue that you need to devote to purchasing technology becomes less and less. It also becomes a little easier as we get away from solo to group practices. That helps to spread the cost around.

Dr. Rumpakis: You're talking about synergy—about systems that collect all the data into one place. When you have that, the information is at your fingertips, so you can then use your intellectual property to interpret and make a decision on what course of action is best for that particular patient's care. Efficiency is great, but if it's not effective, it means nothing.

STAFF TRAINING AND DELEGATION

EB: The OD can't do everything. How will new technologies help with staff in terms of training and retaining, as well as delegating to them?

Dr. Smith: You can't put technology into place until you delegate to your staff. One problem is obtaining office staff that is trained and capable of doing this. There is not a ready supply of ophthalmic ancillary personnel to come into a practice.

Dr. Ossip: There are not trained people out there, but there are people who want to create a career path rather than just have a job. Even if you're a solo practice, you need to set up some sort of training program. If everyone used technology and practiced delegation, you'd find you could probably see 40 percent more patients in your practice and not work harder. It's a matter of employing the technology and the personnel together.

Dr. Whitman: Here in New York state, it is against the law to delegate authority to non-licensed professionals. The new technology allows us to have our technician run tests and not have a hands-on, touch experience with a patient.

Dr. Lippiatt: The increased use of technology has grown my practice by at least 40 percent, but the average practitioner is still stuck in that "I want to do my own contact lens insertion" mindset.

Dr. Edlow: Simply having a patient view a video on contact lens insertion rather than someone explaining it to them saves your time or hopefully the technician's time with an I and R by about 50 or 60 percent. There are lots of things out there that allow us to get more productive, and then more profitable.

BALANCING MEDICAL AND OPTICAL

EB: Young ODs are trained in the medical, not optical, side of optometry. In your practices, how do you balance and serve both the ocular/eye health and optical/refracting needs of your patients?

Dr. Smith: Optometry has moved so far into the medical mode of practice that we've forgotten about the optical needs of our patients. We need to make sure we carry forward what has been the strength of optometry, despite the scope of practice and all these new technologies. We have to look at the patient as a whole.

Dr. Edlow: You get out of school, and you're interested in pathology. But, in the latest stats, 47 percent of revenue comes from frames and lenses in an optometric practice, and 24 percent comes from contact lenses. So we don't want to forget about optical.

Dr. Ossip: If you don't treat the 150 million people that need eyeglasses, then you're not going to get the pathology. If you interview young doctors out of school for a couple of years, they'll tell you their training of eye pathology and ocular disease was thorough. However, the implementation of that is a whole different story. They may be familiar with it, but there's a fear of treating it, coding it, etc.

Dr. Rumpakis: This question of income from optical versus services covers up a basic problem. If I brought in an MBA, he'd say, "You're using your exams as a loss leader to sell them product." We really can provide cradle-to-grave services for our patients, but we need to learn how to price those services and get the value for what we are providing. The problem is that most people don't analyze their business in two different areas.

Dr. Wineinger: I'm a second generation practice, so I've seen where optometry came from. You have to cover both sides. Five years ago we were probably 70 percent refractive. Now we're probably 60 percent medical.

Dr. Lippiatt: We started out, and it was 35 percent professional fees and 65 percent optical. We tried hard and worked with John [Rumpakis] to change that. It took me five years, but now we're at 51 percent optical and 49 percent professional. Both sides have grown together.

Dr. Lane: What you're really talking about is introducing a process into the system. Let's say you have three employees. You lose your best one, and now you've lost 30 percent of your workforce. That person did a broad range of jobs. That's a big loss, but if you have a process in place, which is what technology will bring, you still have that process.

Dr. Karpecki: We're not taking away from what we do in optical, but the medical allows us to keep our patient base. I don't see them as one advancing and our losing our roots. I just see them as allowing us to grow.

THE PATIENT EXPERIENCE

EB: How do technology and other advances impact patient loyalty and the patient experience?

Dr. Lippiatt: To gain loyalty, we have embraced the new technologies as part of our marketing. We also use the Starbucks experience in our practice. I required my staff to read that book because when you go into Starbucks, you do have an experience. And, that's what we try to create.

Dr. Karpecki: Since I started 15 years ago, we've strived to have patients leave saying, "Wow. I don't think I've ever experienced this kind of care." Practices have changed a lot, plus now you have the sophistication of patients. They want speed and efficiency, but they want to be educated. So that hallmark to success—the total quality experience—is still there, but the way we deliver it is completely different and will continue to evolve.

Dr. Boorady: Restaurants are the best benchmark. You walk in, and based on the location, the name, the décor, whether there's a maitre d' or not, you come to expect a certain experience. As a profession, we confuse that. We all have to work at creating that total patient experience through the use of technology and technicians, and listening to patients. Start by listening for 10 or 15 seconds to find what they want, not what you want. EB