An Introduction to the Medical Contact Lens Micropractice

I never thought of myself as an entrepreneur. If you had approached almost any past version of me—from my first day of optometry school to my tenth year in practice—and told me I’d be a business owner someday, my reaction would be one of disbelief. At present, however, I find it difficult to imagine practicing any other way.

MY BACKSTORY

Getting into optometry was a no-brainer for me. My vision was poor as a child, and I’ll always remember how much my world changed when I received my first pair of eyeglasses. I knew I wanted to have the same effect on others.

In optometry school, I focused on posterior segment disease, thinking it was my top area of interest. After graduating, I spent 2 years working for various private and corporate practices, surgical centers, and even as a traveling optometrist in Alaska. I realized that, although posterior segment disease is interesting to study, there was not much I could do clinically to reverse the conditions I saw.

During that time, I also saw some unique prescriptions and a handful of patients who wore hard lenses, and absolutely loved them. I decided to try my hand at fitting some of my high prescription patients in hard lenses and fell in love with the process. The feedback from these patients and the relief they expressed once I fit them was immediate and rewarding. Designing the lenses was a challenge I found very fulfilling. I decided that I wanted to learn more about fitting these lenses and understand the conditions that necessitated them.

I was concerned that being out of school for a few years would be a barrier to applying to residency. Instead, it was a huge benefit for me, as I was already confident in my primary care skills and had no question that this was a specialty I was truly interested in. I was accepted into the medical contact lens fellowship at the Casey Eye Institute of Oregon Health and Sciences University in Portland, Oregon, where I took my skills to the next level. I honed in on the management of patients with severe corneal conditions, corneal transplants, high prescriptions, light sensitivities, and traumatic eye injuries.

After my fellowship, I joined a multidisciplinary clinic that needed a specialty lens service. I had to build this service from scratch, but I still had no interest in opening my own practice. I was content on providing clinical care and did not want to deal with the business or administrative side of optometric care. However, starting a new specialty within an established clinic would prove to be very helpful in setting up my own practice down the line. I became the go-to person for all tasks related to specialty contact lenses. I trained staff, managed lens fittings, determined scheduling for specialty lenses, and learned billing and coding for medically necessary lenses.

THE BIRTH OF MY MICROPRACTICE

When the multidisciplinary clinic I joined was bought out by an insurance company, things immediately changed. Specialty lenses were no longer a priority, and my patient base was feeling the effects. This is when I realized I actually do like to be in charge and want to have an active part in determining how a service is provided. However, I still had little interest in dealing with insurance, the administrative side of running a practice, or hiring and managing.

A few other primary care doctors from my clinic left and went on to open their own practices. Theirs were low-volume, high-service concierge practices that offered a membership plan. This was my first time learning about an alternative way of running a practice from what I was traditionally used to. I then came across the concept of a micropractice, a type of solo doctor practice with minimal to no staff, which reduces overhead costs in order to increase chair time. Micropractices also limit the size of their patient population to build a stronger patient-doctor relationship.

This style of practice is perfect for me and my patients; I am a clinician at heart and want to spend the majority of my time providing clinical care for patients who need extra time and want to better understand their condition and treatment options (Figures 1-3). Many such micropractices, including mine, are self-pay only.

Opening my practice didn’t come without its own trials or tribulations, but by keeping the focus on my mission of providing dedicated specialty services with plenty of one-on-one time with patients, things fell into place. I did not have to overthink the business side because patient care came first. To me, what makes sense for the patient makes sense for the business, and I have been able to thrive because of this mantra.

THE NOW

I fit many brands and lenses; I could list dozens of designs that I am familiar with and how each reacts to different adjustments and conditions. Staying updated on what new designs are coming out and comparing notes with my colleagues allows me to stay current and informed. I enjoy specialty lenses so much that I no longer perform routine exams or manage dry eye.

If I could start over again, I would have chosen this path sooner. Having control over the cases and patients I take on has been monumental for me. I encourage anyone considering how they want to practice to be honest about the type of care they enjoy offering. This will go a long way in providing both you and your patients with fulfillment.