The End Of The Status Quo, A New Beginning, And Telemedicine???

I hope everyone is staying safe and hanging in there as best as possible given the uncertain circumstances we all have been presented. It’s been a while since my last post, but wanted to share my thoughts with you regarding what I see happening to Ophthalmology.


New Beginning

To beat a dead horse over and over: I didn’t think I could be any happier having gone into solo practice, but this crisis has brought my appreciation to a whole new level.  I’m sorry to all my colleagues who have experienced furloughs, lay-offs, cancellation of partnership offers, and any other form of pay cuts. Like everyone else, my practice has  also taken a significant hit, having 95% of my clinic schedule postponed for a little over a month now. I still have business expenses, and am still paying both my employees their full pay, while they answer maybe 2 hours worth of phone calls a day. Nevertheless, I’ve actually been having the time of my life. This lock down has actually felt more like a forced vacation for me.

Don’t get me wrong. I’m still concerned about the future of my practice and career, but just not as much as the rest of ophthalmology. I feel like I’ve inadvertently positioned myself for a quick recovery, if not even more success, in the post-COVID world. Having lived relatively beneath my means, I won’t be encountering a personal financial crisis any time soon. In addition, because my monthly business expenses are so low, I don’t expect to be facing an existential crisis for my practice in the near future either. Of course, if this lock down lasts 12 to 18 months, I’ll definitely be in a world of pain. However, I expect most other practices will have already closed down by then. We’re in the middle of a “who lasts longer” game, and I will most likely last the longest.

Because my patient volume is 30-50% of the typical ophthalmology practice, and my wait times have been minimal, patients have always walked into an empty waiting area. They also don’t encounter 5 different middle men before seeing me. In my practice, you pretty much walk in, give your name to the front desk, I walk you in, examine you, and you go home. That’s as minimal contact and minimal time spent in the office for a visit as possible. There’s going to be a lot of demand for a practice like that.

I also have built a lot of patient loyalty with my care and service, and patients will unlikely be going anywhere else. My practice relies on zero premium or ancillary services to thrive, and my cash rates tend to be the lowest in the area.


End of the Status Quo

The days of patients being ok with going to a doctor that sees 60 patients a day, while spending 2 hours in a crowded waiting area and being taken on the Disneyland runaround by 6 different techs and scribes, only to spend 3 minutes with the doctor is long gone. Practices will need to learn to retrofit themselves so that they run more efficiently without sacrificing profitability. Easier said than done when there usually is a large disconnect between the doctor and the practice management side of things.  High volume, high overhead practices will not be tolerated anymore.

On top of that, with more than 20 million people likely to be unemployed, and the economy taking a massive hit, it’s going to be more difficult to keep your practice afloat by up-selling premium IOLs, FLACs, Lipiflow, etc. Eventually, demand for these services will perk back up, but practices will need to stay afloat until that happens.

Unfortunately, any financial difficulties that existing practices experience will hit young ophthalmologists the worst. I imagine more predatory practices will arise. All the bad stuff that was happening before will even be worse: false promises for partnership, unattainable bonuses, bloated partnership buy-ins, partners stealing your surgeries, and more Medicaid/postop dumps. This is assuming that the job market doesn’t dry up and practices will still be hiring. Especially if the stock market collapses, you’re going to find more older doctors being forced to delay their retirement in order to make up for their losses.

Speaking of market losses, I anticipate the days of private equity are numbered as well. People who have sold their practices are just starting to feel the unexpected pain of their actions. Former owners, who are now employees, are having their pay reduced or even furloughed. If things get really bad and PE practices fold, these guys will be left holding the bag: no job, worthless shares, and no ownership. The government will most likely bail out dying PE firms, but I don’t expect them to share the spoils. At that juncture, doctors will be viewed as expendable “employees” and not “partners.”  Although they probably called them such when they were wining and dining them pre-sale. I guess it all will depend on good the contract negotiations were.



There’s all this talk about how telemedicine will revolutionalize the way medicine is practiced, but I’m a little more skeptical about its utility. I think we are still 10 years away before telemedicine is efficient and user friendly, all the while the majority of users become tech savvy. Telemedicine, at this point, seems more like an act of desperation amongst ophthalmologists starving for revenue.

I see too many challenges currently for telemedicine to replace the office visit.

  1. Older patients, who tend to be our bread and butter population, will struggle to adopt the technology.
  2. The current limitations of  the virtual visit increases risks of liability.
  3. The pre and post visit process will be rather time consuming.
  4. Reimbursement rates will be rather paltry for the time required to conduct the telehealth visit.
  5. Expect hurdles for insurance reimbursement, given the rules are rather new. Some insurances will just flat out deny the claim.
  6. All platforms are currently in its nascent stages. Expect more upgrades and changes to your system, which can cost $$.


I personally don’t think it’s worth the time or effort to implement telemedicine at this point because you just don’t know how useful it will be after everything is said and done. Thankfully, I’m not starving for revenue at this point and I don’t feel the need to hang onto telemedicine as a lifeline. Although, it is nice to be allowed to bill phone encounters now (9944x). I’m definitely doing that because it’s super easy.


If you are interested in starting a solo ophthalmology practice, Independent Practice Partners can help you accomplish this goal.


5 thoughts on “The End Of The Status Quo, A New Beginning, And Telemedicine???

  1. Well said-you are lean and mean, can retain your few employees (because there is always more work than the day is long!) & can apply for the SBA loan hoping for some forgiveness. Our patients in ophthalmology are elderly & on fixed incomes. By & large, they don’t have smart phones, computers with cameras & wouldn’t understand how to use them anyway. Telephone calls are the best bet for us since video cannot add a pressure check or retina exam. It also avoids the audits that will come with use of unnecessary technology for no gain over a less expensive phone call.
    For new patients or those who don’t have telemedicine benefits in their plan, credit cards work just fine. Patients will get care, we can maintain some subsistence income to the practice. Besides, I’m hopeful this epidemic will be controlled and we will resume some form of office visits.
    I encourage those of you who have relied on a bevy of technicians & front office staff (who don’t perform or even show up for work!) to look toward automating, outsourcing, seeing fewer patients & cutting the inexorable payroll costs. Don’t sell yourself short-you can do all these tests better anyway because you care!!!

  2. please go to AAO Survey ,love to hear comments please
    Ralph Lanciano DO Councilor Emeritus

  3. Why do you think that this will decrease PE’s market presence? They have deeper pockets and will be looking to buy low from desperate practice owners. Any owner who has recently sold is probably feeling like they lucked out.

    This is not what I’m hoping for, of course, just my concern.

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