Eye care professional trade publications and social media are awash with posts from ‘young and old, ‘employed and owner, and ‘private and corporate’ ODs with disparate opinions. They battle each other over salaries, work-life balance, self-worth, practice value, private equity buyouts, corporate jobs vs. MD practices vs. solo, and the beat goes on. Everyone has valid points and reasonable points of view. What I gather from all of these discussions is that there is a slow and insidious unrest percolating beneath the surface of our profession.

Where can we come together as ODs?

The common denominator in all of this is economic pressure squeezing ODs from every angle: debt, inflation, economic, and political uncertainty. As a profession we have been resilient through many tough times, and although we are an independent sort, it is prudent to remember that there is great power and strength in numbers. I'd like to address just one issue here. We are not each other's enemies. Quite the opposite. We all agree on many things. For instance:

• Most important is that we provide a necessary service to the populations we serve and play an integral role in the health-care team needed to care for those growing and aging populations.
• We are well trained thanks to our extensive and expensive education.
• Our time has value.

What is the value of an eye exam from an OD?

So let's talk about that value. A patient comes into my office for an eye examination. By the nature of the beast, the patient is naive and I am sophisticated. Meaning that I have knowledge that the patient does not have but needs to resolve whatever problem they knowingly or unknowingly have. I gather information, make my educated judgment, and formulate an appropriate treatment plan. I educate the patient, prescribe, and execute the plan. The issue is resolved or not and so on. Simple, clean.

This transaction requires tools and ancillaries in order to flow efficiently. I might need sophisticated diagnostic and therapeutic equipment, a trained technician to help operate it and gather data, and/or a licensed or trained optician to execute my plan. I need a space in which to operate and staff to keep it clean. I need assistants to facilitate communications with my patients and partner vendors. Offering that one patient good, efficient care for one hour will incur the following minimum costs:

• One tech at $17.
• One optician at $25.
• Equipment leases at $15.
• Office space at $17.
• Doctor's salary at $65.

And that’s the bare minimum! $139.00 for that one hour spent in my office.

Note I have not even begun to include any other overhead at all. Of course, there is electricity, phones, internet, EHR, health insurance and other benefits for staff.

Great! Now I can charge for that time plus a little more, let's say $160, and for a reasonable price my patient is cared for and I can feed my family, pay my health insurance, put a roof over my head, and hopefully take a vacation once in a while.

How our services become devalued

But in walks a third party. The third party says, I will send four patients to your office per hour and you will therefore make a better living. Oh, but I'll only pay you $40 for each one of those four patients.

Let's see. Now I have to examine four patients per hour instead of one to make that fictional break even sum of $139. Ok, I guess I'll do that since I'm scared that if I don't I might not have even one patient per hour to see. But wait: Now I need more room and now I don't have time to talk to my patients, gather enough data to make really good medical decisions and educate patients sufficiently enough to achieve good compliance.

I'll likely need another staff member to check their benefits. Then another one to take the excess calls, bill the third party, check that reimbursements are coming in correctly, and balance bill the unpaid claims and send them to collections when they don't pay, as well as deal with angry and confused patients who really just want adequate time and access to my very expensive education and experience.

Ok so I'll hire two more people to help with all this at a bare minimum of another $40 per hour for the two. But wait, now my hour costs me $180. And by the way my staff is overworked and overwhelmed. At these prices and in this economy, they’re probably also underpaid and therefore unhappy and snippy. So that one lonely patient that used to love having access to my time and expertise and was willing to pay even $350 for a full half hour of my attention is now dissatisfied and gone to greener pastures.

So I guess I'm paying the third party $40 an hour to send me the four patients I didn't have when I was happily seeing only one and taking my time?

Can I make this any clearer?

What to do about this moving forward

Eye care professionals can we all agree that the time for fighting with each other about our self worth is over and that there is really only one enormous enemy elephant in this room? You can negotiate and either have them pay you what it costs to deliver care properly or tell them to take a long walk off a short pier. However, for goodness sakes people, I know your fancy education taught you to do simple math.

I'm speaking to legal counsel about this to determine the best approach and what the implications are for antitrust laws. But, in the meantime, there is nothing stopping each and every one of you from writing a letter to the admin of your VCPs stating that reimbursement has not increased since 1980 and that the RVUs, according to the federal government for your region, for a 92004 is $150 (insert your regional value by searching in this lookup tool) while the VCP reimbursement for that same code is $40.

State that you cannot pay your overhead at fees from the ‘80s and cannot in good conscience provide the inferior and substandard care that necessarily occurs when trying to squeeze in four times the number of patients per hour in order to pay your staff. Therefore you cannot continue to see their patients unless they reconsider their reimbursement fees.

A few thousand letters may cause a hiccup.