A number of trends are converging to put pressure on independent optometrists. If independent optometry is to survive, the practice of the future can’t look like the practice of today.
by Kirk Smick, OD, FAAO
In the last few years, many independent optometrists have adopted what is loosely referred to as the “medical model” of optometric practice, expanding their professional offerings beyond vision care to include the diagnosis and management of ocular disease. This has been part of a decades-long trend to enlarge optometry’s scope of practice and to maintain or grow revenues at a time when 3rd-party payers and competitive pressures from chains, big-box stores, and online retailers are squeezing reimbursement from vision care. In my estimation, independent optometrists have done a good job of adopting the medical model, but we have a long way to go before the public accepts us as the family eye doctor—and a lot is at stake.
Vision care, optometrists’ traditional economic mainstay, is clearly under pressure. While vision care plans are squeezing optometric fees, a significant number of patients who get their eyes examined by an optometrist now purchase their eyewear elsewhere—denying the practice a significant source of revenue. Younger patients in particular seem comfortable making purchases online and/or from eyewear chains and “big box” stores. In large metropolitan areas, such as Los Angeles and New York, eyewear companies like Warby Parker are becoming popular; people can visit them online or go to their brick-and-mortar store to complete the purchase—reducing the OD to a provider of low-cost exams only.
Not every independent optometrist is comfortable providing primary eyecare, and we may see a split between ODs who primarily refract and sell eyewear and doctors who provide comprehensive eyecare. Practices limited to eye exams and vision care already have significant competition, and that will only get worse if online refractions become a reality. While there may be room for a few vision care-only practices, for the majority of independent optometric practices, I believe that survival will require wholehearted adoption of the medical model.
Now let us consider two other demographic trends: a potential oversupply of optometrists and newly minted ODs graduating with massive student debt. How many of these young ODs will have the money or the courage to hang out a shingle in a market where success is hardly guaranteed?
Young ODs may still have opportunities to work as an associate, to work in corporate optometry, or to join an OD/MD practice. For generations, however, optometry has been a specialty of independent entrepreneurs; and these self-motivated, risk-accepting people worked together to reshape the profession and dramatically enlarge its scope of practice. Whether the next generation of optometrists (with more diverse economic incentives) will continue to have this drive and unity is an open question. Those traits will be essential if optometry is to consolidate its gains and survive the challenges of the coming decades.