Insights From Our Editors

When Does an Independent Private Practice Stop Being an Independent Private Practice?

By Mark Wright, OD, FCOVD,
and Carole Burns, OD, FCOVD

July 28, 2021

“Independent private practice” is a term over-used in optometry. Not all practices that use that term to describe themselves live up to the true definition of what it means to be independent and private. Here are signs that your practice is not actually as independent and private as you think, and how to achieve a truly independent practice.

We are seeing practices purchased by private equity (PE), and those that have signed franchise agreements, still claiming to be independent private practices. It seems reasonable to ask the question: When does an independent private practice stop being an independent private practice?

Let’s start this discussion with the definition of independent. Merriam-Webster defines independent as: “not subject to control by others: SELF-GOVERNING; not affiliated with a larger controlling unit.”i

Since both parts of the definition hinge on the word control, the question becomes: is there any area of the practice that you no longer control? We had an issue come to our attention last week in which a PE group had purchased an independent private practice and was now dictating which spectacle lens-making laboratory the practice must use. The doctors and optical staff wanted to use a specific lab for a branded specialty lens, but were prevented by the PE group from doing so. That is clearly a loss of control. That is clearly a loss of independence. (By the way, the result was that there were many unnecessary patient remakes that occurred from using the PE-chosen lab.)

Another independent private practice sold to a different PE group and had a different situation occur. The doctor in the practice who was the previous owner, but now is functioning as an employee of the PE group, told his staff to book him out of the office on Friday afternoon so he could attend his son’s soccer game. He went into the exam room to see his next patient. Meanwhile, staff contacted the PE group management to inform them of the change. When the doctor came out of his exam room staff had to tell him that his request to take off Friday afternoon was not approved by the new owners of the practice. Because he is no longer the owner of the practice he must abide by the rules of the new owners.

Again, the loss of control results in the loss of independence.

But, wait a minute. What if an independent private practice doctor had purchased the two practices given above and the new owner had implemented the practice changes? Wouldn’t the practices still be considered independent private practices?

Let’s consider the second part of Merriam-Webster’s definition of independence: “not affiliated with a larger controlling unit.” The analogy that comes to mind is indie films. Indie films are “… a feature film or short film that is produced outside the major film studio system …”ii If we use this as our reference, then, an independent private practice is outside the major companies owning practices.

Vision Monday published a list of the top 10 largest retail players as:iii
1) Vision Source, LP
2) Luxottica Retail
3) National Vision Holdings, Inc.
4) Walmart, Inc.
5) Costco Optical
6) MyEyeDr./Capital Vision Services, LP
7) EyeCare Partners LLC
8) VisionWorks of America, Inc.
9) Warby Parker
10) Eyemart Express

So, are Vision Source practices or PE-owned practices still independent private practices since they are major companies controlling practices? What about practices owned by the PE-like subdivisions of EssilorLuxottica or VSP?

We think the true definition on an independent private practice is: you are what the general public thinks you are and what you yourselves think you are. If the general public thinks you are a retail chain, then you are a retail chain. If the employees of a practice that is owned by a major company feel they have changed from an independent private practice to something else, then you are no longer an independent private practice, but rather, something else.

At the end of the day, what does it matter? Your goal should always be to provide the highest possible care to the patients you see. Perhaps the real question is: has the care you deliver decreased or increased since the change in the practice? That is the most important question that needs to be answered.

One additional thought. Looking at what has happened to the profession of pharmacy, there is a slippery slope we need to acknowledge in the trend toward PE purchases and franchises – the movement of optometrists from owners to employees. Most pharmacists today are employees of large companies. Was that trend good or bad for the profession of pharmacy? Is the trend of optometrists moving toward employment versus ownership good or bad for the profession of optometry? Give that some thought over a cup of coffee this week.

References
i. Independent | Definition of Independent by Merriam-Webster
ii. Independent film – Wikipedia
iii. https://www.visionmonday.com/CMSDocuments/2021/06/top50retailers_chart_VM0621.pdf

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