Finances

Optometric Guilt: Move Past It to Profitability

By Arthur B. Epstein, OD, FAAO

Over a long and multi-faceted career, I’ve worked with all kinds of health care providers. As a general rule, no group has been more patient-centric than optometrists. In fact, ODs are so focused on patient advocacy that they often forget to advocate for themselves.

During lectures, I sometimes ask colleagues if they ever walk out of the exam room, see their last patient standing at the front desk about to sign a check or a credit card slip, and almost reflexively, call out – “STOP, THERE WAS NO CHARGE FOR THAT!” They were actually stopping the patient from paying the practice for a service they had just received. You would be shocked at how many nods, uncomfortable smiles or aversions of eyes I get. Or maybe you wouldn’t be. Most of us have done the exact same thing, myself included!

We always have a good explanation for this generosity. The patient is a personal friend (amazing how many friends we have). She might be the sister of your cousin’s mother’s hairdresser. Perhaps a local doctor referred them and they told you how they play golf with the referring doc. Or maybe the procedure was too minor or your time too little to charge for. It was just one lash. There always seems to be an excuse for reducing charges or not charging at all.

Contrast this with other health care providers. When was the last time you went to a dentist who filled a cavity for free? Imagine the GI specialist running up saying, “No charge for that colonoscopy… it was on the house!” Silliness aside, most health care providers have no difficulty charging for their services. So why are we ODs so willing to give our services away?

I’ve pondered this question for years and have come to the conclusion that the reason we forgo payment is guilt. We actually feel guilty about charging. I call it optometric guilt.

Most of you, especially those who grew up with close Catholic friends as I did, are familiar with Catholic guilt. It is a chronic condition that many Catholics seem born with and can’t escape no matter how hard they try–and try they do. I can tell you from personal experience that Jewish guilt can be overwhelming and can fundamentally suck the joy out of living. Jewish mothers are particularly adept at applying Jewish guilt to their advantage. My mother was so skilled at it; I still have urges to call her even though she passed away more than a decade ago.

With all of this experience with guilt, I can tell you that no guilt is greater or more impactful than optometric guilt. So what is optometric guilt? Well, it’s hard to describe exactly. I can tell you that it is likely transmitted in the schools and colleges of optometry, probably from teacher to student. I believe it is what drives us to give our services away or offer discounts even when patients don’t ask. And for some, it is that nagging feeling of inferiority that prompts us to describe ourselves as an “eye doctor” rather than as an optometrist.

Although I have attempted to keep this blog light, if not a little humorous, optometric guilt is both real and damaging. Moreover there is no reason for it–just as there is no reason not to charge a patient for a service that you invested a good part of your lifetime learning to do.

As someone who has recovered from a severe case of optometric guilt, allow me to share that charging for services is a healthy thing. Wearing a suit or a white coat and dressing like the doctor you are is a good thing. Finally, excommunicating the patient who doesn’t show you the respect you deserve can be a blessing in disguise.

My advice–and I mean this sincerely–go look in the mirror and see the good you do, the value you have, and accept what you have earned. Leave the guilt for the Jews and the Catholics. We’re probably better at it anyway….

How do you balance an admirable patient-centric attitude with an interest in profitably expanding your practice?

Arthur B. Epstein, OD, FAAO, is a contributing editor of Review of Optometry, executive editor of Review of Cornea & Contact Lenses, and chief medical editor of Optometric Physician. To contact him: arteptstein@artepstein.com.

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