Episode 113 – Career Choices, New Billing Codes, And Leveraging Optomap – Dr. Shiv Sharma

Share Your Story

TTTP 113 | Optomap


Optometry isn’t just about glasses; it’s about shaping the future of eye health. Join us with Dr. Shiv Sharma on this journey where new billing codes, Optomap technology, and career choices pave the way for comprehensive patient care and innovation. Being on the MSP Negotiations Committee that was responsible for the new agreement that BC Doctors of Optometry reached with the BC Government, Dr. Sharma sheds light on how these changes are revolutionizing patient care. He also explores the Optomap technology, a tool that allows for in-depth eye examinations that go beyond the basics. Finally, Dr. Sharma touches on the critical topic of career choices in optometry. As the profession evolves, how can optometrists ensure they’re offering the highest level of care and value to their patients? The answer may surprise you. Tune in now and learn what is shaping the future of optometry.

Watch the episode here


Listen to the podcast here


Career Choices, New Billing Codes, And Leveraging Optomap – Dr. Shiv Sharma

Thank you so much for taking the time to join me here. I’m very grateful that you would take the time out of your busy schedule to join me, to learn, and to grow. As always, I’m trying to bring on amazing guests who are going to help us do better as optometrists, as business owners, or even just in life in all the different things that we are doing. Our guest is no exception.

Dr. Shiv Sharma, who’s a good friend of mine, is an optometrist based in the Vancouver area. He’s the owner of two practices. He’s a former board member of the BC Doctors of Optometry and sits on the MSP Negotiations committee, which is a big role because our MSP Negotiations committee came up with a brand new agreement with the BC government for new billing for us as optometrists. To all of our BC colleagues who are reading, you are going to like a part of this conversation.

This conversation is going to be a lot about practice management. Again, Shiv is a practice owner. Both of us are owners of two practices. We are going to dive into a little bit about what we do in our practices, the ups and the downs. We are also going to be talking a lot about the Optomap. I want to say thank you to Optos for the support for this show. We are going to talk about how we have implemented this technology into our practices, how it’s benefited us, and maybe suggestions that we have for other doctors who may be looking to implement this in their practices. First off, Shiv, thanks for joining me. I appreciate it.

Thank you. It’s an honor to be on the show. I have been a long-time fan. I’m honestly humbled to have the opportunity to come on here. Thank you for inviting me.

It’s my pleasure. I’m very happy to have you here. I’m so giddy that I’m messing up my intro multiple times, but thank you. I want to say a collective, hopefully, thank you from all of us in BC as optometrists to you and everybody else who’s on the MSP committee for coming up with this new agreement. It’s a very hot topic right now for all of us excited to implement a lot of new billing and the new things that we can do.

I want to dive into that a little bit. I know there are people tuning in who are not based in BC. For those of you, stick with me and stick with us. I want to introduce you to a little bit of what we do in BC and how things work as far as billing goes. Maybe that will attract some of you, associates, to come and work for us.

One of the things is we can bill the BC provincial government for some aspects of the eye exam. We have the ability to do what we call balanced billing. For example, if a patient comes in and they have a medical condition, we can build a government proportion of that and we can have the patient pay a copay on top of that. There are some new billing codes that we have received. Thanks to the negotiations of Shiv and the team. Shiv, give me 2 or 3 of your exciting new developments on this new agreement.

I have been a part of the BCDO Negotiations Team for the past two billing cycles. The newest agreement is a three-year term, which is about to roll up. Our team did a great job in pushing for the ability of optometrists and the province to provide primary care eye services. John, Errin, Pria, and Evelyn as well, I’m super proud of the whole team. We put in a lot of work over the last several years of building into this agreement. We have reached a milestone in fortifying our role as primary eye care providers in the province.

There are two very important things. One, the fact that we are positioning ourselves as primary eye care providers is very important. We are going to go into what that means and why that’s important. It’s very important that we maybe give a shout-out to all the other members of that committee. I know you quickly mentioned them, but can we give a quick shout-out and a thank you to them as well?

Dr. Jonathan Lamb over in Nanaimo. Dr. Errin Bligh in Vancouver. Pria Sandhu, our CEO who’s been amazing in connecting us with the government and setting the framework for the deals. Dr. Evelyn Lo who’s our new committee member will be transitioning to in the next deal probably.

Thank you to everybody on the team there. All amazing. Let’s go into a couple of features of this new agreement that you are excited about.

The overall theme is primary care and also stepping into some specialized optometry services. On the imaging side, there are going to be some real improvements that will help us with diagnostic tests such as OCTs and fundus photography for a wide range of conditions. On the specialty side, things like myopia control and dry eye management, we have some pretty groundbreaking billing ability now, which is unforeseen in Canada.

We have new billing codes for all of those different specialties, including myopia management, dry eye, and imaging as well. Let’s touch a little bit on the dry eye and myopia thing because then we are going to dive more into the imaging and all of that stuff. What is it on the myopia management? That’s a hot topic right now. I talk a lot about myopia management. What is it that we want to share with colleagues about that? What’s relevant?

On the myopia management side of things, essentially, the ability to do axial length and build a government for myopic children. That was a big ask. There’s a big population of myopic kids out there. We were successful in explaining to the government, “That rate of myopia has been going up. This is essentially epidemic levels.” They did a good job of understanding that and allowing us to provide that surface for the kids in the province. We will expand on that in the future, hopefully, to get that information out there that the kids who are suffering from myopia at such a high rate, there are options out there now that maybe weren’t there many years ago.

That’s a big thing. I love having that part of the conversation with parents who are already myopic. If the parents are myopic, kids might be as well. When we were kids we didn’t have these options. Now, we do. It’s nice. Having the ability to bill for it encourages more optometrists and more of our colleagues to get into that. Let’s talk about the dry eye side. Dry eye has been a hot topic for years now. What’s changing in that capacity?

The main changes in the dry eye are around blepharitis treatment. Both on the expression side, so meibomian gland expression, and for anterior blepharitis, essentially lid margin, debridement, and cleaning. That was something that the government was cognizant of. There are a lot more complaints of dry eye, especially post-COVID with all the increased screen time. We have some great new technologies now, IPL radio frequency and things like that which we are able to provide to patients who are suffering from dry eye quite often. To have that recognition that this is a real condition that people suffer from and allow the public to know that there are options out there.

Let’s dive into the imaging side of things. We had a code that allowed us to build for some conditions, but that’s expanding.

On the fundus photography side, under the previous agreement, the fundus photos were pretty limited in terms of when you could bill them. That was essentially for the two diabetic retinopathy codes. They’d have to have active diabetic retinopathy for you to bill a fundus photo. We were successful in expanding that to essentially all posterior pulled retinal conditions. Any of those 362 codes in addition to choroid and for high-risk medication. For patients on the plaque, we can now bill fundus photography.

That broadens the scope of how many patients we can bill for. It will help us to track those patients. That imaging conversation, that’s something we want to talk a little bit more about. We want to dive in and talk a little bit about widefield and ultra-widefield imaging. I want to make a bit of a segue here. When we are talking about billing for something, if we are taking a standard retinal photograph, how many degrees is that usually, 45 degrees?

Depending on your camera. A good one would be 45.

If it’s something that happens to fall outside of that range, we don’t capture it on the camera, then we can’t bill for it technically.

If it’s not imaged, you can’t bill for that. That’s where widefield imaging, getting an 82% view of the retina, you are going to capture far more diagnoses, far more peripheral retinal hemorrhages, and things like that. Those would be billable under the new codes. The other main point that I wanted to get across is the OCT billing is also substantially changing in the new agreement. Not only on the reimbursement side, the reimbursement will be almost doubled for the OCT compared to where it was, but also when we can bill an OCT. That’s something that over the last few years, started with a visual acuity requirement. For those who could remember, it used to be 20, 30, or less. That was removed, so you could bill regardless of visual acuity and now, it’s further expanding.

OCTs aren’t cheap. It’s not a cheap technology to bring into our office. It’s not cheap to maintain either from a warranty point of view. We find that increasing the reimbursement was a key goal that to make it a little more in line with the cost of running the equipment. It’s a key piece of equipment now for primary care optometry. Whether it’s glaucoma conditions or retinal conditions. It’s essentially getting to the level of standard of care to have OCT. That’s a great benefit to the patients in the province for sure.

The standard of care thing is one of the key phrases I wanted to get to. OCT, who declares something to be the standard of care?

I don’t know.

Ultimately, I think we are in agreement. It’s pretty much a standard of care. We think it’s necessary or it’s very valuable to have it. The other thing is not a stretch to say something an ultra-widefield imaging Optomap. In the office, it can be considered standard of care too. I have had it for a few years now and I don’t even know what I was doing before I had it. I can’t remember. For me, it is my standard of care. I can’t open a practice and not have it. I don’t know if you would agree with that.

I 100% agree with that. I opened another practice a few years ago, I was looking at my list of shopping I had to do. It’s a slit lamp for Optos. Optomap was number three on the list. Later down are all the other equipment like radio frequency IPLs. I agree. It is standard of care. If you are an optometrist going into private practice now, you need an Optomap to be at the level of patient care that all the other competing clinics can provide.

I wanted to see what order we want to talk about this. You opened a new clinic. In this clinic, we are sitting at Clarity Eyecare, which is one of our practices. This is only a few years in. It’s not a very old clinic, but there are colleagues of ours that are opening up new. People are wondering, I have had this conversation with relatively new grads, and new business owners, and people opening their practice are like, “What should I get first?”

I know how I feel, I want to get all the toys. We all have a limited budget. Even if we have lots of money sitting around or we have a good loan that we can tap into, we still have limits on how much we can spend right away. With certain other specialties being hot topics like dry eye being a big one. It blew up in the last couple of years and the new technology that’s available and accessible now. Myopia is a growing specialty, but the cost to get into that is not nearly as high. You ranked it yourself. I will ask you the question that somebody asked me. “Should I set up my dry eye room first or should I get an Optomap?” We are looking at pretty much the same level of investment here.

In my opinion, Optomap is your foundation or your bread and butter, which you need to run on the vast majority of your patients. Retinal care is something that we have to do as part of your comprehensive eye exam. It’s a key component. The amount of pathology and the number of cases that you will be managing through your Optomap imaging and being able to present that Optomap to the patient every time is going to be very widespread. It’s going to be a very powerful tool, not only on the diagnosis and management side but on the education side as well.

TTTP 113 | Optomap
Optomap: The Optomap is a very powerful tool not only on the diagnosis and management side but on the education side as well.


The answer that I have given now to multiple people is, to full disclosure here, Shiv and I both have our radio frequency, IPL, do a lot of dry eye, and even aesthetic stuff, but we both have Optomap in both of our practices. If we had to do it from square one again, there’s no question we would need to get the Optomap first. That’s what I always tell colleagues.

If you are going to be spending that money, I would 100 times out of 100 spend it on that technology first, on the imaging, on the Optomap. Especially now because of the OCT and the Monaco that we just got. That way you are getting two technologies for imaging and now we can bill for all those things. You are creating instant value for yourself and are able to bill certain things. You are creating instant value for every single one. We don’t charge patients extra for our Optomap, do you?

I bill it into the price.

Same thing. We bill it into the price. When we got Monaco, the new Optomap, we bumped up our eye exam fee a little more to account for that extra test that we are going to do or the extra technology that we have. Our exam fees have gone up but our patient experience has improved because they are every time like, “That’s cool.” Some people are like, “That’s gross,” but still they are reacting. Every single adult patient is seeing that image, whereas what percentage is going to get exposure to the dry eye technology right out of the gate?

Especially for a new clinic, if you are a new optometrist out there and you have opened a practice, you are probably not going to have a ton of dry eye cases ready to go to the dry eye clinic right away. Your availability with Optomap is on every patient. You are getting every single case to essentially get to experience that technology and it’s much more usable, I would say, for a new practice.

As your practice builds, that Optomap will allow you to spend more time essentially talking about some specialty services and directing patients referring them over to myopia control, or referring them over to a dry eye clinic. Optomap is that corner piece, and then you could go from there and point them in different directions.

If you don’t mind, rephrase or expand on that thought. You have more time to talk to your patients. Why is that?

I feel like before I used Optomap, I spent a lot of time trying to data mine or making sure my charts were right, making sure I had seen all parts of the retina, and less time having one-on-one conversations about the patient’s care. The big change that I saw in my patient flow was most of my work is done essentially. If I have Optomap OCT done and have good pretesting, I can essentially get a glimpse of what this patient is about before I meet them. When it comes to that one-on-one time with a patient, I’m able to better address their concerns.

What was their chief complaint? That used to get missed sometimes because you are so busy making sure you have got all your information there. The practice metrics that I noticed after putting Optomap a few years ago, the per-patient-revenue went up about 30% in a year. That’s not even due to the price increase of Optomap. It’s due to the ability to capture more sales on glasses and refer them over to the dry eye clinic to talk about myopia control. Better address the patient’s concerns and offer a good solution.

I know that’s going to get some of our colleagues’ attention. You are seeing that increase in revenue per patient and it’s specifically since you implemented the Optomap. You figured out why is it happening. It’s because you have more time to talk to the patient and have that conversation that’s going to help convert them or capture them to make the sale. That’s cool. I didn’t even think about that and how that might make a difference out here in the optical gallery or other areas of the office.

There’s not only the per-patient revenue, there’s also the increased pathology you are catching. If you are catching more atrophic holes or lattice degeneration, you have to bring the patient back more often for follow-up, so your gross revenue of the practice is typically going to grow as well. That’s not even included in per full exam.

There’s that one side that I talk to doctors and they are like, “If I charge X amount of dollars for an Optomap, how much do I need to do to pay off that device?” Pardon the pun. It’s a little myopic way of thinking about it because you got to look at your practice as a whole and how your entire practice functions and I think that’s where the real difference maker is.

Not only financially, it’s on the patient care side. I don’t care how good you are at BIO, I have talked to ophthalmologists, and I have talked to several optometrists about this. You are almost guaranteed to capture far more peripheral retinal conditions when you are doing Optomap on every patient. You could always go ahead and investigate those after with BIO, but having that map telling you where to orient your BIO is super helpful.

TTTP 113 | Optomap
Optomap: You’re almost guaranteed to capture far more peripheral retinal conditions when you’re doing Optomap.


It’s almost priming you to look at certain areas. If you pick up something that looks a little odd, you can dive in a little deeper when you are doing your dilated exam to look for what might be happening in that area. “You see Shiv going off on talking about the numbers and the revenue and stuff. He was also the treasurer for the BC Doctors of Optometry. It’s good we have the right person in that position. BCDO has been doing pretty well lately. Thanks to Shiv.”

The financial side is key. A lot of times, we need to know how is this going to improve the bottom line and what’s the return on this investment. Very simple terms. You are right, a lot of times, we are like, “I got this. I have to do X number of treatments to make all my money back,” but it’s not that simple because it’s potentially increasing the capture rate. The other thing it’s doing is improving the patient experience, which is then likely going to lead to more word-of-mouth referrals and things like that. That’s something that we have seen. I assume it’s been your case as well.

There have been cases where patients have been going to another office year after year. I’m seeing them for the first time having an Optomap done on a pretest. The first thing I talk about is, “You do have a retinal hole out here. There’s some subretinal fluid, I’m going to have to refer you for a laser on this to a retina specialist.” They are like, “What do you mean? I have been getting my eyes checked diligently every year. No one’s ever told me this.” They go off with the referral, get the procedure done, and now, they are committed to your practice. They are referring all the family members to the practice because they don’t want that missed.

You hear a lot of debate amongst optometrists about, BIO versus Optomap, What’s the best way to go? I think you have to look at it two ways. One is on a case-by-case basis. If I have a peripheral lesion I want to take a look at, a dilated fundus exam with BIO is going to get you a view. You can use scleral depression and you have an availability to do that, which you can’t with Optomap. However, if you look at the point of view of an entire practice when you are doing 3,000 to 4,000 exams a year, your ability to capture more conditions is going to be higher from the whole practice point of view. That’s a shared experience with anyone who’s implemented that technology in there. Especially when they are running it on every patient.

If I was going to make a recommendation, I don’t want to overstep here but everybody runs their business the way they want to run it. We experimented a little bit with charging a little extra $30 to get your Optomap, but then everybody felt weird about trying to sell a service that we felt was necessary. It almost didn’t feel right to us and the patients felt a bit weird about it, so very quickly, we are like, “We have to do this for everybody for our sake and the patient’s sake.” It’s something that we have to include in every single eye exam. I never would change the way we approach that.

Stepping a little bit away from the clinical, there’s almost an emotional response I have seen. I don’t know if you get this. Patients will look at that picture and they will come up with a story about what it looks like to them. “It looks like the galaxy.” I had one patient tell me a story about it reminded him of when he was a kid in Africa and they would jump into the river. He would lay at the bottom of the shallow river, look up, and the optic nerve looked like the sun and his eyelashes looked like the grass. I was like, “That’s such a cool story.” I’m never going to forget that and I assume he’s going to remember this image reminding him of his childhood. It’s pretty cool how those kinds of things come up.

You often probably get people asking for their photos. “Can I take a screenshot or can you email it to me?” It’s a cool thing to have aside from the clinical relevance as well.

We both got the new Monaco which has the Optomap and the OCT integrated into one device. We have two practices though. One other practice is older and busier. There, we were finding a little bit of a backlog slowing down in the pretest thing because we have got patients lining up. Two exam rooms going since we brought the new Monaco and it’s been a lot faster. Not only is it faster to take pictures, but we have also got the OCT now on top of that. How have you found that having the two technologies integrated?

I love it. Having that OCT done beforehand, speeds up that patient flow much better, rather than having to send them back into the pre-testing room to go get an OCT after the fact, then bring them back in and do the counseling again. Having that all done in one is a huge time saver. It’s going to improve patient flow. I have the Monaco at my one office and I have the California at the other office. Sometimes I wish I had two of those Monacos. We will see if you can get us a deal on that.

I want to talk about the OCT side of things. We have got new billing codes that we talked about here in BC. We are able to bill for it, more than we were used to being able to. Also, there are fewer restrictions, as in visual acuity and so on. There are some entities that are using OCT simply to draw patients in to churn out more eye exams.

My question is, what’s the goal here? We are not trying to do an OCT on everybody and then, “See you later.” Even, do an OCT on everybody, and then refer them off. The goal here is we should be trying to manage. That’s the work that you guys have been doing on this committee. To get all these codes and to get the government to comply is to make us the primary eyecare provider and be able to manage these conditions. Not just pick them up and then send patients away.

As optometrists, we are primary eyecare providers. All of this patient care falls into the realm of primary eye care. Glaucoma managing ERMs, these types of things, we can do that. Dry eye is something we can do as well amongst others. Unfortunately, as you are saying, there may be some providers abusing the codes from that point of view that would not be in line with what we want for our profession. When I’m hiring associates and talking to new grads, I try to emphasize that. I’m like, “We are primary eye care providers. Our job is not to pump out glasses prescriptions. Essentially, an autorefractor can almost do that. You are selling yourself short if that’s what you think optometry is.”


As optometrists, we are primary eye care providers. All of this patient care falls under the realm of primary care.


Not just yourself but the whole profession. This is where I start to get warmed up a little bit. What are we doing to improve or do something that’s going to improve our practice or your career, but for the profession as a whole? When we have people who are working and fighting for us with the government to bring us these codes that we can use to help our patients better, and then we don’t use them the right way or we abuse them, it makes it difficult for everybody. Correct me if I’m wrong, but the government can look at it and say, “This code is not being used correctly or not being used the way you told us it was going to be used. Change it or take it away.”

There are mechanisms in place from the government to ensure that doesn’t happen. The amount of that going on is minimal. The vast majority of us are practicing to a very high level. It’s our job to encourage our peers to practice high-level primary care and take care of our patient’s healthcare at the end of the day. Some of the new grads are getting tempted a little bit by corporate optometry where they are getting tempted with big contracts early on. They might be recruited even out of school. Is that primary eye care that you are going to be providing? Probably not. It’s more in terms of pumping out prescriptions so that retail products can be sold typically at a high margin. That’s how those companies will take advantage of it.

This is going down a different path because I did want to talk to you a little bit about, what’s the current state of practice of optometry here in BC across Canada. One of the things that we are seeing for sure is that there seems to be a shortage of associates. It’s a challenging and interesting time to be a business owner, a practice owner, or multiple practice owner where you have to oversee multiple staff or multiple associate doctors.

There are so many different forces at play right now that are fairly new and somewhat a unique period of time that we are in. What are you seeing there? As far as you have mentioned, students are getting recruited at an early age. Getting money put in front of them saying, “Come work for us. We will pay your loans or we will give you this much money or a signing bonus.” What does that look like to you? What does that look like in the future as well?

We are at a bit of a crossroads in terms of which direction the profession heads. It’s very unfortunate that some of these entities out there can capitalize on that refraction side of optometry in order to build their retail business. At the end of the day, I would encourage new grads to consider the environment that they are going into.


It’s very unfortunate that some of these entities out there are able to capitalize on that refraction side of Optometry in order to build their retail business.


Look at it and be like, “Is this how I want to practice for the next 30 to 40 years of my career?” Most of the time, the answer is going to be no. They don’t want to do that, it’s just unfortunately, they may be drawn into that. In private practice, we probably have to do a better job of talking to the grads who are still in the school programs doing more internship sites. Having the ability for students to come into our offices and see how private practice is run.

This is the first time I’m telling anybody in public, but we signed on and got approved as a clinical site for NECO for the New England College of Optometry. That’s my alma mater, so I’m very excited about that. Also, a walk-the-walk type of situation. We are sitting here saying, “This is how we think optometry should be. This is how we envision it. You are working to get the codes and expand our scope.”

I’m sitting here saying we should not refraction from walking the walk. It’s like inviting students in to say, “Here’s how we should be practicing. Here’s a setting that I believe would help the profession improve and thrive in the future.” Opening the doors for students to see that, versus getting caught up in the more retail type of settings that happens. We have all been there. I don’t know if you have ever worked in that setting before. I have.

I haven’t myself, but I have a pretty good understanding of talking to my colleagues and speaking to ODs who have left that setting. The whole entities out there that are capitalizing on a portion of our practice, which is prescribing for glasses and manipulating that or trying to siphon out those patients into retail and building a business around that while the primary eyecare gets neglected. That is the real danger that we are in. At the end of the day, we are healthcare providers. We have to provide healthcare and eye care for our community. That’s our primary role as I see it.

There’s a topic that I have asked many of our colleagues about multiple times. That is about the value. How to create value as an eye care provider and how to have the patient see the value of having an eye exam. The question is from both perspectives. How do you create the perception of value? On the flip side, how would you deteriorate that perception of value? The question, “How do you create the perception of value?” It’s nuanced and complicated. There are multiple answers and multiple ways to bring that up. The answer to the question, “How do you erode the perception of value?” It’s very simple. When I have put the question out there multiple times, the answer is, “We will do it for free, do it for less, discount it, or put it on sale.”

It’s one thing if you are selling a pair of glasses. It’s another thing if you are providing a highly specialized service or a service that is an expert service that requires years of education and training. I’m going to be very frank in this conversation. I had this series of episodes that we did in the past, The Future of Canadian Optometry. Specsavers was the elephant in the room at the time and everybody’s talking about that.

Now, we have started to come to some equilibrium with the Specsavers being in the market and them charging that fixed rate of $99 for an eye exam. My qualm with them was like, “If you are just charging $99 across the board, then that’s going to start to set an expectation for, ‘This is what a complete eye exam with an OCT should be,’ when there’s so much more to it.”

We are looking at Specsavers across Canada. Locally, there are even worse things happening where we have entities offering free eye exams to draw people in to get the glasses. You know this because you brought it to my attention. We can’t. Legally speaking, the college should step in and say you can’t say if an eye exam is free. For an optometrist who’s working in a setting where they are discounting eye exams, doing them for cheap, or offering them for free. You should be wondering how much people value your services after you went to school for eight years in university, paid all this money for tuition, and all this headache for training.

Now, the company you are working for says, “I don’t care how specialized or how expert you think you are, this is how much we are going to charge for your eye exam.” That’s an issue. I have an issue with that and you should have an issue with that too. You should be talking about why that number is fixed at that level and why it shouldn’t be higher or where you think your services should be valued and what the dollar value is that’s commensurate with that. I’m going to step off my soapbox now for a second and let Shiv chime in if he has anything else to say about that.

Let’s get back to your question, “What is the value of an eye exam?” To me, we are healthcare providers. We are eye doctors. Our recommendation and our relationship with the patient are valuable because we are managing their eyecare and sometimes more than that, their healthcare in general. We are part of the healthcare system. That whole retail aspect out there trying to take advantage of that relationship that we have to direct it to sales is the danger.

TTTP 113 | Optomap
Optomap: We are healthcare providers. Our relationship with the patient is valuable because we’re managing their eye care and sometimes more than that, their health care.


When eye exams are discounted below market rate, it’s not going to be a full eye exam as we would see it at the center of care that you and I would want to practice at. It’s more going to be geared towards retail and it’s going to be more of a refraction essentially. That’s when you see the misuse of the healthcare billing system as well as you mentioned where maybe those are getting referred out to other clinics.

Some of us are going to have to take a good hard look in the mirror and think about how we want to practice. I could even foresee a two-tier system with an optometry developing potentially if that continues where some practices will provide primary eye care and others will essentially be more refraction style. I don’t think you want to be on that refraction side because it’s a race to the bottom.

That’s a slippery slope to me. The problem is that for years, for decades, or forever, the patient’s perception of what optometry is, is a refraction. When we talk about the health side of the conversation, it will a lot of times be like, “I didn’t know you guys did that.” We need to change that to like, that’s the expectation from our patients. We are going to check their eye health and we are going to offer specialty services. We cannot do those things, to your point, if the price is fixed at a low level. You won’t have the time or the capacity or you won’t want to. If we have a two-tier system, it’s going to continue to perpetuate that perception of optometry as just being a refraction.

I agree. I wouldn’t want it to go into that. I see that unfortunately happening to an extent. Whatever we could do to prevent that, I think we should. We should all be practicing at a high level. The majority of us do, but there are always a few troublemakers out there.

The majority of us do. The problem is, when you have entities that are growing large and continuing to create a bigger presence across the country, there’s going to be more associates who end up working there. There’s going to be a greater public presence for those companies that are going to sway the public perception of what optometry does. It’s incumbent upon us as a profession as a whole to make sure we keep that perception as high as we can and keep the value that we provide as high as we can.

If you are going to come to me and you are going to say, “I don’t know how much they charge, but I get paid so it’s all good.” That’s what’s going to drive the profession down. Just because you are getting a good paycheck doesn’t mean that we need to be settling for the company charging less for the eye exam. That is not going to work well for us in the long term. When we have people who are fighting for us and for our profession to increase the scope and increase the billing and coding that we have, it’s a bit of an insult. I encourage everybody to try to look at the long-term view and do what’s best for the profession. In the long term, It’s going to end up paying us all more if we make the right decisions now.

I couldn’t say it better myself. Look out for the profession. Also, look out for our community’s health. You are a healthcare provider, live up to that title.

I’m going to start getting too heated now if we keep going too much longer. I think we covered a bunch of great topics here. The new agreement with the billing that we have for MSP. We talked about Optomap, integrating that technology into our practice, and how we can elevate our practice on so many different levels. We also talked about the future of the profession and how we can make it all better. I don’t know if there’s anything more we could talk about. Any other final words you want to share?

The only other final word I would have is for optometrists out there, please volunteer for BCDO or whatever provincial association or state association you are part of. We can’t drive all those lists of wishes we have in the back of our minds unless we are active out there. Please take time out of your practice to do that.

It’s very important. I echo everything Shiv said there. Please get involved at whatever level you can get involved. Be part of a little committee or something and attend the meetings to network. It will help you personally, but it will help your profession, your province, your state, and across the country. Thanks so much, Shiv. I appreciate it.

Thank you.

This is a small window into the conversations that Shiv and I have often. If you enjoyed it, send me some messages. We will bring Shiv back for part two and we will see where that conversation goes. Thank you everybody for tuning in to the show. I will see you guys in the next episode.


Important Links

What I’ve Been up to Lately

Let’s Connect

instagram facebook facebook2 pinterest twitter google-plus google linkedin2 yelp youtube phone location calendar share2 link star-full star star-half chevron-right chevron-left chevron-down chevron-up envelope fax