Pro Tips on Specializing Your Practice

With a growing number of optometrists entering the workforce, it’s important to find a way to set yourself apart. In many cases this means going beyond simply refracting patients and offering prescriptions. In order to differentiate yourself and stand out as a health care leader in your community, you must embrace the medical model and practice at the top of your optometric license. This issue of Modern Optometry focuses on business strategies for the medical model. For this article, we spoke with four established clinicians who are known for their work in dry eye and glaucoma to gather some words of wisdom for those interested in specializing in these areas.

THE DRY EYE EXPERTS

Whitney Hauser, OD, and Leslie O’Dell, OD, FAAO, are recognized dry eye experts.

Dr. O’Dell is a member of the Dry Eye Divas and a certified Dry Eye Coach in Pennsylvania. Before her dry eye center was open, she said, Dr. O’Dell spent time educating patients so that they would feel confident in her skills and knowledge. “Now [my patients] look to me as the dry eye specialist in their area,” she said. About half of her time in clinic is spent with patients with dry eye, while the other 50% is divided between medical eye care and routine eye care.

According to Dr. O’Dell, what makes a dry eye practice different from a general optometry practice is time. “At the initial dry eye visit we spend a lot of time gathering data and talking with patients,” she explained. Intake appointments are typically scheduled for 45 minutes, whereas at her previous practice she saw a patient about every 10 minutes, “so it was hard to fit in a dry eye evaluation,” she said.

Dr. Hauser, founder of DryEyeCoach, said she feels the same way: “When you work in a dry eye center, you have the luxury of teasing [the disease] apart. It can take more focus than some other conditions, in my opinion.” Like Dr. O’Dell, Dr. Hauser said that in primary care it’s hard to devote sufficient time and resources to dry eye until you have a patient base to support it. She added, “almost everyone should have a patient base to support a dry eye clinic—it’s so pervasive and the prevalence is so high.”

On Standing Out

Dr. O’Dell said that what sets her clinic apart is having all the diagnostic equipment in place and having extensive experience in the field.

Dr. Hauser commented that delving into dry eye requires not so much a financial investment as a time investment—although, of course, time is money. It’s not necessarily time-consuming to evaluate a patient, she said: “A lot can be accomplished with a standard slit-lamp exam. Doctors who are pressed for time, however, may not go in and really make sure a patient doesn’t have additional problems that may exacerbate their main complaint.”

Dr. O’Dell said the next step for her dry eye practice will be to participate in more research opportunities such as clinical trials and contact lens studies. “Now that we’ve built the patient base, we are going to work on being a center where we can conduct research with companies, because we definitely have patients who would be interested in participating,” she said.

Keeping It Simple

Dr. O’Dell’s top tip for anyone interested in becoming a dry eye expert is to keep it simple. “Look actively at all your patients, whether they’re complaining or not. Many patients are symptomless, but if we actively screen everyone we’ll find patients. They’re already in your practices, but if you’re not looking, you’re not going to see them.” She also notes that, to start, you don’t have to have any more equipment than you already have.

Dr. Hauser said a common misconception is that buying equipment makes you a dry eye center. “Anyone can write a check,” she explained, “but what differentiates you from other dry eye practices is the accuracy of your diagnosis. Proper diagnosis is essential, and it’s downhill from there.”

THE GLAUCOMA GURUS

According to Michael J. Cymbor, OD, FAAO, “We need more individuals who are passionate about glaucoma care to rise up and give patients the care they deserve.” In almost any area of the country there is a need for better, more thorough glaucoma management, he said. Dr. Cymbor had managed glaucoma in a group practice setting for 18 years before co-founding the Glaucoma Institute of State College 3 years ago.

Murray Fingeret, OD, FAAO, has worked for the Department of Veterans Affairs (VA) since 1980, and has been at St. Albans VA Medical Center in Queens, New York, since 1983. “My facility in Queens is in an African-American community,” he said, “and, like many hospitals and clinics in minority neighborhoods, the amount of glaucoma is huge.” This is especially true in the VA system, which has a large elderly population. About 50% of his patients have glaucoma.

Professional Observations

“In my experience,” Dr. Cymbor said, “optometrists do a great job with medical care but may be somewhat reluctant to recommend surgical care out of fear of losing the patient.” Conversely, some ophthalmologists recommend surgical care at the exclusion of medical care. “By teaming up,” he said, “we bring the best in both medical and surgical care.”

Dr. Cymbor works with an ophthalmologist who is a fellowship-trained glaucoma specialist in what he called a true optometric-ophthalmologic collaborative setting. Dr. Cymbor handles most of the diagnostic work and initial intake of patients. “When a patient needs surgery, the care and the billing are transferred to the ophthalmologist,” he explained. Once the surgery has been performed, the care of the patient is transferred back to him. In many cases he and his partner see new patients together, and he is often involved when his partner evaluates patients for surgery.

Dr. Fingeret’s career-long stint with the VA has offered him great latitude, he said, and he has developed long-term relationships with many patients. “The VA provides optometry with a level of responsibility that, while now relatively common, was not so common 30 years ago,” he said. “The VA was the first organization that allowed optometrists to practice to the fullest extent of our licensure and training. Back in the 1980s, it was a site for our profession to practice so-called full-scope care, which is commonplace nowadays.” According to Dr. Fingeret, the VA was also the first organization to provide residencies for individuals who graduated from optometry school.

STRICTLY BUSINESS

Some of the following pearls from these opinion leaders may apply no matter what subject matter you’re looking to become expert in.

Dr. Cymbor said that partnering with an ophthalmologist allowed him to see more patients with advanced glaucoma and secondary glaucoma. The relationship “has expanded my knowledge base, and my comfort level with advanced disease and secondary glaucoma is much greater now,” he noted. Dr. Cymbor said that combining optometric and ophthalmologic care can benefit patients tremendously.

Your practice name can be key. Dr. O’Dell said the name of her clinic, Dry Eye Center of PA, helps attract patients. “Patients will self-refer because they’re searching for better answers. They find us by searching on Google for dry eye treatment in their area,” she explained.

“Practice what you know,” Dr. Hauser advised. In dry eye disease, “you can start modestly, but if you want to establish yourself as a practitioner of excellence in dry eye, then you’re going to have to step up your game,” she added.

Dr. Cymbor recommended that any eye care professional interested in opening a specialty practice should start with the needs of patients. “When the patient feels respected and cared for, regardless of the focus of your practice, you’re going to be successful,” he said.

Dr. Fingeret said working at the VA allowed him to be involved in research. At the VA, he said, optometrists provide primary eye care, which constitutes the majority of the care. “Glaucoma specialists are available for more advanced care,” he noted.

The VA also offers educational opportunities for optometric students. There are few technicians in the VA system, Dr. Fingeret said, so residents and students often perform the tasks typically done by techs in private practice settings. “Although this is a limitation of the VA that reduces efficiency, these students and residents learn a lot about their patients when they have to run the test themselves,” he said. Dr. Fingeret oversees two residents and two students at his facility. “The students and residents have an opportunity to see it hands-on and be involved in the care of patients” he said.