As I See It

After the Gold Rush

Despite economic instability, ophthalmologists can still thrive by rediscovering the basics.

By Paul S. Koch, M.D. Editor Emeritus

The 80s were a great decade. Intraocular lenses exploded onto the scene, driving people to have cataract surgery in ever-increasing hordes. Patients who already had surgery came back to have implants retrofitted to their eyes. Reimbursements approached two grand per operation (imagine what would that be in today's dollars!) and it would be fair to say that everyone was rolling in the stuff. Even the smaller practices had trouble spending all their loot.

The 90s were a great decade, too. Sure, the insurance companies tightened their belts and chopped what they would pay for covered services, and admittedly that wasn't great at all, but surgeons moved on to the new frontier of uncovered services. The dot.com bubble was ever expanding, as companies with no tangible products demanded P/E ratios that were out of sight. Even conservative investors earned 20% returns and cash was overflowing the drawers. Stampedes of people waving the green stuff jammed our laser centers, shoving the bills into our pockets while diving onto the table.

Unfortunately, the 00s haven't been so hot. National tragedy, natural disasters and a popped bubble tempered the laser market, and the cataract business had tighter margins. Opportunities arose with premium lens implants and things seemed good for a while, but crashing banks, brokerage buy-outs and roller-coaster markets finally brought home the need to be cautious. While some patients remained high spenders, others were stuffing their mattresses for a rainy day.

We have had a nice few decades, and perhaps this one will shape up nicely, too. But the financial markets are putting a damper on the economy, and so we may have to react just like any other working stiff would.

The bank has to be paid, the staff has to eat, and you need a little bit for yourself. How are you going to pay the bills if patients stop spending money?

We can fall back on the basics, what a loyal Patriots fan would call blocking and tackling, the all-important four yards and a cloud of dust. It means nothing flashy, just hard work. It means watching the budget. It means drinking tap water instead of bottled spring water and eating at home more often.

For us it means filling the schedule, and ordering the annual visual fields and optic nerve images. It means being sure the recall notices go out. It means calculating returns on investments before deciding to buy, and performing price comparisons before you sign.

Your strapped patient might get a part-time job. You can, too! You can hire yourself to put in a few more minutes a day on the floor. If you normally see patients 7 hours a day, adding an extra 45 minutes of examination time increases your billing opportunities by 10%. That's all net, because presumably your overhead was covered earlier in the day.

Don't Worry, Be Happy

All businesses have their ups and downs, and whether we are in a short-term hiccup or a long-term slowdown, we should keep in mind that we are fortunate enough to have a trade, and one that will always be in demand. If our patients come under hard times, we probably won't because the government guarantees most of our fees. We get to work inside during the winter and in air-conditioned comfort during the summer. We put in regular hours, and almost never work at night. Sometimes we work with our hands, but we never get calluses. Mostly, we ponder and chat. What's better than that? True, things could get tight for a few years, but compared to a lot of people, we're very fortunate. We're going to do just fine. OM