A Reply: Is the Solo, Independent Practice OD a Dying Breed?

Please read the article by Dr. Diane Palombi, “Is the Solo, Independent Practice OD a Dying Breed?”. I do not have the right to reprint it here so I am simply providing the link.

I applaud Dr. Palombi for taking on this sensitive subject.  It is the proverbial elephant in the room.  No one wants to acknowledge never mind address. I enjoyed her format as well. Instead of just saying,”This is what I think”, Dr. Palombi recognized the need for different points of view. She included two additional doctors in her article.

What is missing from the article is the answer.  Straight. Unequivocal. Unmistakable.  If you are in the eye care industry and speak to practices on a daily basis, the answer to the question, “Is the solo, independent practice OD a dying breed?” is YES.

Reasons for Dying

Of course there are those who will read that and say, “I know a solo practitioner who is thriving” and the answer is “of course”. There are always exceptions. However, the rule is that you cannot make it as a solo practitioner today given the following reasons:

  1. First, what successful company do you know that operates on one person’s vision, knowledge and expertise in all areas of business? None that I know.  Business is a team sport. It is sad that the industry (schools of optometry, State Associations, etc.) have led so many doctors to believe that INDEPENDENCE is the the value to pursue. Sure, you want to provide good patient care at an affordable rate, but being independent, that’s what it’s all about.  It’s not.
  2. The vision benefits programs have all but stripped any hope of profitability and doctor control. Solo practitioners almost always have to rely on the plans for patient volume, but unfortunately, this is a not-for-profit activity.
  3. Economics. The same cost structure that is required for one doctor can also support two and three and sometimes as many as four.  That means the solo practitioner has to dedicate a significantly higher percentage of his or her revenue to over head, where multi-doctor practices dedicate significantly less. The cost economics for a solo practitioner don’t work.
  4. Lack of purchasing power is also soon to bury the solo practitioner. No power to negotiate better rates or prices on goods. You need to rely on buying groups for paltry 3% to 5% discounts and this is never enough to make up for poor economics
  5. Solo practitioners may enjoy (I don’t think this is true) being their own boss, but they risk the collaboration and conflict that generates better ideas. In problem solving, singular is not better.

Where Do We Go From Here

If I were advising doctors coming into practice now, I would recommend any number of successful venues  where an optometrist can provide great care and earn an excellent living. Multi-location, multi-doctor practices make that list.  MD/OD practices that have surmounted the split in eye care to provide coordinated care would also be high on my list. Forming a consortium of practices to increase accessibility for patients, coverage for doctors and a shared overhead to name just a few benefits is another option, albeit one that requires some re-education.  You can find out more here.

I hope no graduating OD is opening their own practice in today’s market and I would also caution against any doctor taking over for a solo practitioner (buying their practice) just to continue that futile effort.  You won’t make it.

Let’s take a step back from this model and understand our healthcare and business climate.  Understanding where you are (no, this is not 1970), is a key first step in making the right decisions for your career. Follow the examples of corner pharmacists (there are less than 1,000 in the US today) and then look at family practitioners and dentists. Granted all of these are metaphors, powerful metaphors that hold more truth than we care to admit. But that lack of acceptance will simply lead more and more qualified, hopeful optometrists to make a key error that may not be able to be overcome. Say ‘no’ to starting or acquiring a solo practice.  If you are in solo practice start making plans to grow, merge or exit.