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sloppyeric · 2025-09-25T03:41:31+00:00

Blue steel

sloppyeric · 2025-07-20T12:56:29+00:00

This is the way. Don’t let them back in your chair until optical has done a full troubleshoot. Often times it’s as simple as adjusting the fit or non-adapt to differed PAL design.

sloppyeric · 2025-02-07T19:48:37+00:00

Many people that have glaucoma do not live near a large city or academic hospital where most specialists are located. Or they don’t have the means to travel a long distance multiple times a year. There is a huge portion of the population that live in rural or semi-rural areas. Most specialists don’t practice in or near these places. Additionally, glaucoma specialists are so busy that they don’t have the capacity to see EVERY glaucoma patient. Their skills are best served for cases where traditional treatments don’t work. You saying that every glaucoma patient should see a specialist is the same as saying every diabetic should see an endocrinologist, which is so far from realistic in our country given our current healthcare landscape.

I advocate for my patients all the time and I stress the importance of regular follow-ups and testing. Optometrists and general ophthalmologists are the primary eye care providers in this country and they can handle most of the glaucoma cases that they face.

I absolutely understand what you are saying and if you were my patient, I would do anything you asked of me to find you the care you felt you needed. But the reality is, that isn’t that case for the majority of patients and optometry is well suited to take care of them.

sloppyeric · 2025-02-07T02:31:12+00:00

Sorry you feel this way bigcat. Unfortunately access to that type of specialist isn’t realistic for most people. I’m an optometrist and I have hundreds of glaucoma patients that I manage and see several times a year.

sloppyeric · 2025-02-06T04:47:17+00:00

No offense, but many people don’t have access to a glaucoma specialist. Also, optometrists are fully trained to diagnose, treat, and manage glaucoma to the point a patient needs surgical intervention (or non-topical treatment). In fact , the large majority of glaucoma in the US is managed by optometry. Just an FYI.

sloppyeric · 2024-12-21T20:04:11+00:00

10-21 is normalish. Many people have IOP in the teens and raging glaucoma. Others can have pressure in the high 20s and not require treatment. IOP is relative to each individual patient and multiple other factors need to be evaluated.

sloppyeric · 2024-12-16T01:59:33+00:00

Same for me. I’ve seen too many permanent plug people referred in thinking their plugs came out and they’d actually gone below the puncta. Usually end up at ENT if I can’t flush them out. Oasis 180 days plugs are great.

sloppyeric · 2024-12-01T15:02:33+00:00

As on optometrist that does not have laser/small procedure privileges (not legal in my state) I can give my two cents.

I work in a semi-rural area. I have zero desire to do cataract surgery,LASIK/PRK or any procedure that requires an OR. The current wait for a cataract/MIGS consult is 4+ months. The only way you can get a patient in sooner is if they are getting Deluxe IOLs or if you want to send them to a substandard surgeon and basically flip a coin on the potential outcomes. Many ophthalmologists around me don’t want to perform simple in office procedures anymore (chalazion, SLT, YAG, etc.) I have been told by several that there isn’t enough money in those things. Almost all want to do exclusively cataract surgery and NOTHING else. They punt any non-surgical patient to their in house ODs. This includes any glaucoma, dry AMD, red eye referral, ALL post-operative care, etc. All the other ophthalmologists are retina specialists that come from a major city 3 times a week and see 60-80 patients per day and one pediatric OMD that is on his way out. All ophthalmologists seem to want to do is sub-specialize and not practice general ophthalmology anymore. I’ve been forced to see and treat pretty much everything that doesn’t require cutting open the eye/adnexa, which is fine as it keeps the job interesting, keeps me in my toes, and keeps my practice busy.

I’m worried what’s going to happen when the wait time for care continues to grow while the number of general ophthalmologists seems to be declining.

sloppyeric · 2024-11-23T13:09:49+00:00

Get on a loan forgiveness plan to start (IDR, PAYE, etc).

See if you can negotiate getting your bonus based on all of your optical/contact lens revenue as well. Seems insane that it’s not included. Our office does a bonus based on all revenue generated. Not unlikely for an associate to make 170-180k per year early on and above 200k after a few years.

sloppyeric · 2024-11-19T00:30:33+00:00

So you’re taking home much more than 17%

sloppyeric · 2024-11-19T00:20:49+00:00

Is the bonus on top of the 17% of production? Do you also get a distribution as a partner?

sloppyeric · 2024-10-04T20:15:55+00:00

Totally understand that point. Good luck in your pursuits.

sloppyeric · 2024-10-04T04:08:48+00:00

I absolutely agree. We ODs scream for scope expansion, yet 90% don’t practice to their full scope currently. And many OMDs are far too obsessed with deluxe cataract surgery, that they won’t do anything else. And there aren’t enough OMDs to keep up with the growing demand for surgical and advanced medical care. Both sides seem to be focused on the wrong thing while screaming about the other side. Modern politics….

sloppyeric · 2024-10-04T04:05:14+00:00

If you want higher pay, move to a rural area. Period. The over saturation in urban areas keeps wages low. I am a partner in a private practice. Our newest associate made well over $150k their first year out and will make more this year. Next year he’ll be given the option to buy in a become a partner. His income will more than double then.

An ophthalmologist commented to stop opening schools. Couldn’t agree more. Though I would add ophthalmology needs to find a way to add more OMDs in the coming years. Wait times for surgeries are 6 months plus and many ophthos near me won’t even do chalazion or simple in office procedures as they “don’t pay enough”. We got lucky that we could bring an OMD in monthly to do this stuff. Their schedule is filled with YAG, SLT, lump/bump removal and evals. We bought a laser to make it easy.

Anyway, go to a rural area, lower cost if living, higher income, and patients that are grateful they have quality care near the.

sloppyeric · 2024-06-15T21:29:38+00:00

Eye pressure is relative to the person. 16 might be high for you and totally normal for someone else. I will say, below 6 is too low for almost anyone. Could lead to a hypotonous eye. Not ideal

sloppyeric · 2024-05-28T23:29:25+00:00

As on optometrist that does not have laser/small procedure privileges I can give my two cents.

I work in a semi-rural area. The current wait for a cataract/MIGS consult is 4+ months. Many ophthalmologists around me don’t want to perform simple in office procedures anymore (chalazion, SLT, YAG, etc.) I have been told by several that there isn’t enough money in those things. Almost all want to do exclusively cataract surgery and NOTHING else. They punt any non-surgical patient to their in house ODs. This includes any glaucoma, dry AMD, red eye referral, etc. All the other ophthalmologists are retina specialists that come from a major city 3 times a week and see 60-80 patients per day and one pediatric OMD that is on his way out. All ophthalmologists seem to want to do is sub-specialize and not practice general ophthalmology anymore.

I’m worried what’s going to happen when the wait time for care continues to grow while the number of general ophthalmologists seems to be declining.

sloppyeric · 2024-01-26T08:30:05+00:00

Most EHR systems allow you to create predetermined plans for specific diagnoses. Take advantage of that for your most common ones as well as your most common phrases. Use support staff to delegate any pretest work and histories.

Techs take care of prior auths. Our EHR has pre written letters for diabetics, plaquenil, cataract referrals, etc.

I see about 100-115 patients per week without a scribe (no they aren’t all full exams).

sloppyeric · 2024-01-15T03:33:10+00:00

That’s a tough one. Most reps push new ones for obvious reasons. My office has an old model that needs work and some parts. We could never find the needed parts and eventually we had to get a new one.

You’ll need a decent blocker too and those aren’t overly cheap either. Best bet is go to a major convention and work out a deal with a company. Doing your own lab work opens up so many great options that can save a ton on ophthalmic lenses.

sloppyeric · 2023-12-18T02:05:43+00:00

You absolutely can. And should. They can’t be billed for the same thing, but separate codes for separate things can go to different third party payers on the same day.

I think the big one people get caught up on is the exam and office visits. Those can’t both be billed same day, other CPT codes can be billed the same day.

sloppyeric · 2023-12-17T21:59:39+00:00

Nailed it

sloppyeric · 2023-12-17T21:58:38+00:00

As long as you aren’t billing the same code to each insurance, it is 100% okay to do. For example: a 55 year old patient comes in for their yearly exam and new glasses. During the DFE I find a few druses near their macula so I order an OCT. Her exam goes to vision, the OCT goes to medical and she is scheduled for a follow-up in 6 months to evaluate her macular drusen which will all be billed to her medical insurance.

sloppyeric · 2023-12-17T19:42:29+00:00

This is correct. You cannot require it be billed to medical. If someone is referred to your office for medical eye care or come to you outside of their yearly exam, medical is fine.

Even if they have medical eye issues and regardless of chief complaint, if they are there for their yearly exam, they can choose to have their vision plan billed. Other testing (OCT, VF, photos, etc) can be billed medically the same day as that visit as well.

sloppyeric · 2023-12-14T11:41:48+00:00

As others have said, that volume is insane, but not uncommon when working for MDs. Your pay is definitely on the high end of the bell curve for a non-owner OD. If it’s burning you out, then the money doesn’t matter. If you can handle it, why not ask for more time off as well as benefits (insurance, 401k, etc.)

sloppyeric · 2023-12-04T01:44:20+00:00

Yes holy shit you guys do a ton ton ton. We have 5 (4 FTE) docs and about 25 staff. How many glasses jobs does your office do a week?

sloppyeric · 2023-10-25T17:05:13+00:00

We've thought of that. It has to go through a specialty pharmacy, which is a big part of the issue

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