OD-MD Practice: Make it a Career Pathway

 By Suzanne LaKamp, OD, FAAO

February 25, 2015


An OD-MD practice provides a steady stream of patients—and interesting challenges. Consider this model when starting out or at various career stages.


ESTABLISH PAY STRUCTURE. A base salary, with at least a 20 percent draw of net collections for the doctor, is a good framework.

PLAN STAFFING & SCHEDULE. Doctors can have individual clinic schedules, but the technicians and scribes help all of the doctors and clinics.

GROW & SHARE KNOWLEDGE. Inquire about difficult cases to learn as much as possible. And share. MDs learn from ODs, as well!

Following a residency in ocular disease, I joined a medically based ophthalmology clinic, and it has been a natural transition with complex and challenging cases. As it happens, the practice, which has five MDs and three ODs, is located close to my family in Kansas. In fact, while still in school, I read about the practice and thought, “I want to work there.”

There are numerous benefits to being an OD employed in a ophthalmology clinic. The work is structured, so the OD’s role in a refractive surgery clinic, for instance, is to provide pre- and post-operative care, as well as to decide if the patient’s visual needs are being met. Multiple visits, refractions, testing, contact lens simulations and eye health evaluations are necessary to ensure the patient is on target. The OD will recommend changes as necessary to the treatment plan. The OD can refer the patient back to the ophthalmologist for surgery, or for additional consult. OD input to the ophthalmologist is critical in guiding successful refractive patient care.

Opportunity for Employed ODs in OD-MD Practice

For employed ODs in a high-volume surgical practice, base salary and production-based bonus systems yield great income potential. Post-operative patients, whom you wouldn’t see in a OD-only practice, except by referrals, are also a great source of income. Most post-operative patients are relatively straight-forward, quick visits. It’s a great way for an OD just starting out to achieve even more volume.

Key Advantages of Employment By OD/MD Practice

Working in a combination OD/MD practice certainly has many advantages in patient care. Optometrists and surgeons working alongside one another is an absolutely synergistic relationship. It is easier to triage and to manage patients, and keeps most medical referrals in house. There is more exposure to difficult cases, which is great for optometrists looking beyond the routine examination. The OD can also learn quite a lot from the MD or specialist. I also ask a lot of questions, and try to learn as much as possible. MDs learn from ODs, as well!  As long as people are willing to learn, and are communicating well, everyone benefits.

Build Your Own Patient Base

Traditionally, refractive surgery practices rely on co-management with outside doctors to drive referrals. This business-to-business model is profitable to both parties.  My current practice, however, discontinued this particular practice in order to provide what we perceived as even better care for the patient. The surgeon is heavily invested in excellent patient care and results. No catch and release. The current model is business-to-consumer, which works great for the patient and for the health of the practice. Advertising is even more important for this particular business model to continue to thrive, and word of mouth referrals keep things self-sustaining. Due to the success of advertising, there is no pressure on the employed doctors to obtain their own patients. We also provide consults, perform comprehensive examinations and see acute care patients regardless of surgery candidacy. Patients become loyal from the quality service.

Establish Pay Structure

I recommend a base salary with at least a 20 percent draw of net collections, or the allowable reimbursement based on contracts minus expenses. The employee contract regarding net collections is often negotiable, but must include the specifics of net collections, and whether or not collections apply to examination fees, contact lens fitting fees, imaging, tests, materials, or other billable items. The base keeps you safe, but the production bonus keeps you and the practice profitable. With high volume, I highly recommend you and a potential employer find a number of patients per day that is comfortable. Also, it is worth determining if technicians and scribes will be available at all, part-time or full-time. State your demands. If those are not met, then move on.

More than simply salary, it is worth negotiating a good contract for paid time off, or personal time, vacation, and sick leave, professional licensing fees, non-competes and continuing education allowance, among other stipulations for retirement plans, benefits and on-call coverage.

Share Staff, Establish Schedule

The doctors in my practice share the same staff. The staff is managed by the chief operating officer, who oversees clinic operations. The doctors have individual clinic schedules, but the technicians and scribes help all of the doctors and clinics.
On average, there are three surgeons and three optometrists in the office during normal business hours. Staffing and patient flow is carefully monitored and analyzed. While each doctor has his or her own schedule, it isn’t uncommon for the doctors to help each other when necessary by seeing an extra patient or two. The patient comes first, and never has to wait. Our doctors aren’t rushing. Patient and doctors alike enjoy time at the office.
The ODs and MDs on our staff share on-call privileges for after-hour emergencies. Should the patient require a procedure or surgery, a surgeon is always available.

Suzanne LaKamp, OD, FAAO, is an associate at Durrie Vision in Overland Park, Kan. To contact:

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