Practice Settings
What setting is the best fit for you?
In today’s optometric practice environment, there are many options available in how and where you practice. The following offer some considerations to help you explore the different modes of practice.
Solo/Private Practice
Typically primary care optometry, therefore a diverse range of care: refraction, contacts and treatment of ocular diseases.
Practitioner must manage entire practice which includes staff training, patient management and insurance billing.
Advantages
Income potential/financial incentives: After practice becomes established, high income potential
Job security: Excellent
Hiring/firing staff: Owner of practice has complete control of practice & employees
Challenges
Income potential/financial incentives: Lower starting income
Financial cushion/capital: Large initial capital investment
Professional liability: Purchased on an individual basis
Health benefits: Individuals have to purchase insurance
Retirement: Done on an individual basis
Group Practice
An increasingly popular mode of practice and consists of partners and/or associates.
May be able to focus on a different specialty allowing for a greater patient population.
Work schedules may be more flexible and overhead costs are shared.
Advantages
Income potential/financial incentives: Shared responsibility; higher income potential
Financial cushion/capital: Risk is spread over a larger number of people
Job security: Good
Professional liability: Larger group may allow access to a discount
Hiring/firing staff: Owner/doctors have final say
Challenges
Health benefits: Individuals may have to purchase insurance
Hiring/firing staff: Owner/doctors may disagree on staff issues
Retirement: Done on an individual basis
Health Maintenance Organizations (HMOs)
Various types of primary health care providers may be contracted by an HMO to manage the health care of its members. An example that most people think of is Kaiser.
Typically primary care optometry with an emphasis on ocular disease.
Advantages
Income potential/financial incentives: Guaranteed good salary with paid vacation, educational leave & holidays for employees who work >50%
Practice diversity: Practice with multiple health care providers of various disciplines
Full Scope: state of the art professional equipment, diagnostic scans, access to full medical records, ease of consult
Financial cushion/capital: Excellent — low or no capital outlay
Job security: Excellent with seniority
Professional liability: Covered
Health benefits: Extensive benefits covered by company
Retirement: Covered benefit
Challenges
Income potential/financial incentives: Cap on income growth yearly
Can be a very high volume
Job security: Dependent on HMO stability, seniority
Hiring/firing staff: No control due to corporate/organized labor structure
Hiring process: likely per diem/limited hours at first
Retail/Lease
Independent practitioner optometrists lease space from a large retail outlet.
The retail corporation owns and manages the dispensary.
Typically primary care optometry: refraction, contacts, some management of ocular diseases.
Subleasing doctor manages practice which includes staff training, patient management, insurance credentialing and billing.
Advantages
Income potential/financial incentives: Potential of median/high income quickly, mainly from examination fees. Sales of products not found in retail outlet may be allowed depending on lease terms
Job security: Good to excellent, dependent on lease term
Hiring/firing staff: Owner of practice has complete control of practice & management of employees, but not optical employees
Challenges
Financial cushion/capital: Low-mid initial capital investment with basic equipment potentially included in lease
Income potential/financial incentives: No optical sales income. May have mandatory office hour coverage depending on lease agreement
Professional liability: Doctors carry own insurance
Health benefits: Individuals have to purchase insurance
Retirement: Done on an individual basis
If you plan to practice in a retail setting, remember that there are specific laws governing an OD/Retail relationship.
Ophthalmologic Practice
Optometrist often works closely with ophthalmology and may provide co-management services.
See a larger share of refractive surgery and/or ocular disease patients than typical optometric solo or group private practice.
Scope of practice and standards of care may be defined by the ophthalmologic practice.
Advantages
Financial cushion/capital: No overhead cost; no business decisions
Income potential/financial incentives: Good, but may have to be negotiated
Professional liability: May be negotiated or may be available for full-time employees
Challenges
Job security: May be dependent on success and policy of owner MD
Health benefits: Purchased through larger groups
Hiring/firing staff: Doctor has little/no say
Retirement: Done on an individual basis
Military and Public Service
Optometrists in U.S. Armed Forces work in hospitals or clinics alongside other health care providers.
Common clinics include Veteran’s Affairs hospitals, Public or Indian Health Services.
Varying autonomy.
Advantages
Income potential/financial incentives: Good
Financial cushion/capital: None required
Job security: With seniority, excellent
Professional liability: Included as a benefit
Health benefits: Excellent
Retirement: Excellent
Challenges
Hiring/firing staff: Doctors have little/no say
FQHCs are community-based, non-profit health centers that provide healthcare services to underserved areas and populations. Find out more about FQHCs and optometric integration.
Academia
Teaching usually requires a minimum of post-OD residency certificate.
Research usually requires an M.S. or Ph.D. degree.
Advantages
Income potential/financial incentives: Opportunity to pick up additional assignments to supplement fixed income
Financial cushion/capital: No capital investment required
Job security: Good/excellent
Professional liability: No cost
Health benefits: Covered benefits; excellent rates available since a large group is insured
Retirement: Pension and/or other retirement savings plans may be available as an added benefit for faculty who work > 50%
Challenges
Income potential/financial incentives: Fixed salary based on standardized pay scales
Hiring/firing staff: Doctor has little/no say
Industry
Optometrists employed by corporations, e.g., pharmaceutical or contact lens companies, to carry out research, perform clinical trials and coordinate the marketing of products.
Optometrists may also act as consultants to corporations in the field of industry and education.
Advantages
Income potential/financial incentives: Excellent
Financial cushion/capital: None required; greater potential in start-up companies
Professional liability: None needed
Health benefits: Good
Retirement: Set by company policy
Challenges
Job security: Based upon productivity and company success
Hiring/firing staff: Doctors may have this responsibility in management positions
Additional Resource