This is an abridged version of the author’s paper distributed after an invited talk to the study body of the Illinois College of Optometry in Chicago, Illinois in 1998. Notes were added August 2018.
Introduction and Purpose
There are few accurate studies of how optometrists practice. And no studies cited in the literature have been made by physically visiting practice sites to gather practice data first-hand.
The only comprehensive study, the 2012 Lewin National Eye Care Workforce Survey of Optometrists, did collect detailed data on types of practices using a mail survey in which optometrists were asked, among many other questions, which of 17 specific practice types listed on the survey response sheets best described how they practiced.
For undisclosed reasons, Lewin collected this data but did not publish it. Instead of reporting the percentages of optometrists in each of the 17 practice types, Lewin reported only whether responding optometrists were self-employed [70%] or employed-by-others [30%].
By reducing the survey’s 17 possible practice types to only two types, whether the optometrist was, or was not, employed by others, severely limited information about how the surveyed optometrists actually practiced as it left out the other 15 different types of practice.
In 1998 the Author spent two weeks visiting all the optometry practices he could locate in the Akron, Ohio metropolitan area via the Akron Ameritech Yellow Pages, the membership list of the Ohio Optometric Association and membership list of the American Academy of Optometry. He visited these 72 optometry practices on site and identified 91 licensed optometrists who practiced at one or more of 72 practices. These 91 optometrists included several not listed in any membership list or the phone book who resided outside the Akron metropolitan area.
While at the practice site the author took pictures showing the location and surroundings of the practice for later determination as to whether the practice appeared to market itself as an office–based or store-based practice. While such determination is somewhat subjective, those who assisted the author in picking which marketing method was used by each of the 72 practices were seldom in disagreement but, when reasonable doubt existed the practice was classed as office-based rather than store-based.
Summary of Results
Sample Size
- 72 practice sites and 91 optometrists distributed among them with 28 practicing at more than one site.
- On average, 72% of optometrists based at offices were AOA members compared to 33% at stores with AOA membership for all 91 optometrists averaging at 55%.
- Two of the 91 optometrists were Fellows of the American Academy of Optometry (2%) and they were both office-based.
Ownership of Practice Sites
- 35 commercial-owned optical stores
- 27 optometrist-owned offices
- 7 optometrist-owned stores
- 3 ophthalmology offices
Optometrist’s Primary Practice Site
- 52 practiced only, or mainly, at optometrist-owned stores
- 34 practiced only, or mainly, at optometrist-owned offices
- 5 practiced only at ophthalmology offices
Examination Fees
- $25-$43 at store sites
- $50-$72 at office sites
Optometrist dilated asymptomatic new patients?
- Routinely; 31% usually O.D.s at offices
- Sometimes; 31% a mix of offices and stores
- Never; 39% usually O.D.s at stores
Of the 91 optometrists, 26 (29%) were not listed in the Akron Ameritech Yellow Pages and did not have home addresses in the metropolitan area. Of these 26, 16 practiced at commercial stores.
In summary, in 1998, about half of practices were optometrist owned; the majority of optometrists practiced at stores, and about one-half of optometrists did not dilate eyes performing general eye examinations.
Optometrists practicing in office-type settings were more likely to dilate their patients, be AOA or AAO members, charge higher fees, schedule by appointments vs. walk-ins, and be located in the suburbs of Akron.
One striking fact however stood out to the author (licensed in 1974) when the practice model held out to our generation was the “professional practice” located within an office building containing other professionals and located above street level.
Only two practices among the 72 visited met those 1974 requirements. And while one of these two was vibrant with patients in its waiting room, the other practice had a hand written sign at its door indicating the phone number to call for an appointment and was located in an old two-story building up a creaky, musty staircase.
Survey Methods
The survey was designed to visit all 72 locations in the Akron metropolitan area found to have practicing optometrists and to determine ownership of each location, names of optometrists working full or part time at that location, costs of eye examinations, whether dilated exams of new patients were made and the overall style of the practice as to its orientation towards a private office or a store atmosphere. AOA and AAO membership or fellowship was determined by waiting room observation, asking questions and/or consulting membership lists of the Ohio Optometric Association and the AAO listings of Fellows. Desk personnel were asked about available appointments and whether a new patient would be dilated. Photographs were taken for later use to determine whether the site appeared as an office or store. Sample photos are in the appendix.
Examinations were not obtained so quality of examinations and materials were not determined. The chief purpose of the survey therefore was to determine types of practices in which optometrists practiced and the ownership of those practices to differentiate between what are commonly called “private practices” and “store practices”; terms that do not have precise meanings and can be misleading so a classification system was used that spanned 18 distinctively different types of practices.
Initial locations of practice sites were determined by using the 1998 Akron Ameritech Yellow Pages but, during the survey, 26 additional, unlisted optometrists and 3 additional locations were identified.
Types of Practice and % of Each Practice Type
Locations Owned by Optometrist(s)
Office-Based Practice
- Solo office in professional office building 5.6%
- Office, 2 or more optometrists in professional building 2.8%
- Solo office in professional mall or plaza 6.9%
- Office, 2 or more optometrists in professional mall 5.6%
- Solo office in dedicated free-standing building 5.6%
- Office, 2 or more optometrists in free-standing building 1.4%
- Solo office in commercial mall or commercial setting 6.9%
- Office, 2 or more optometrists, commercial mall 2.8%
Store-Based Practice
- Solo store in dedicated free-standing building 1.4%
- Solo store in commercial mall or zone 2.8%
- 2 or more optometrists in free-standing store building 1.4%
- 2 or more optometrists in mall or commercial setting 4.2%
Locations Not Owned by Optometrist(s)
Store-Based Practice
- Co-op optical stores, a local cooperative 5.4%
- Union Eye Care stores, local optical cooperative 4.3%
- Mall Optical stores (Lenscrafters, EyeMasters, Pearle, etc.) 16.7%
- Department Store optical stores (Sears, Penny, Ward, etc.) 8.3%
- Local optical/optician stores 13.9%
Office-Based Practice
- Free-standing ophthalmology group practice 4.2%
With these 18 types of practice settings it was possible to enumerate all practice types at the 72 locations in the Akron metropolitan area at which optometrists practiced.
While perhaps appearing overly detailed, this complexity came from the widely diverse types of settings at which the 91 optometrists practiced. Only this level of detail can avoid ambiguity as to optometrists’ practice types and show the wide variety and compartmentalized ways in which optometrists practice.
Which is why studies using less precise typing of sites can offer little substantive data. For example, studies using only two or three vague terms such as “self-employed”, “employed”, “private practice”, to represent the 18 types of practices are misleading and imprecise.
The 91 optometrists distributed across these 18 types of practices resulted in:
- 47.2% of optometrists practiced in an optometry owned location of which 37.5% were offices and 9.7% stores.
- 48.6% of optometrists practiced in a commercial optical store.
- 4.2% of optometrists practiced in an ophthalmology office.
The most frequently encounter location types were:
- Mall chain optical store 12
- Local optician/optical store 10
- Office in office mall 9
- Office in commercial area 7
- Co-op/Union optical store 7
- Dept. store optical 6
- Office in office building 6
- Office in dedicated building 5
- Store in commercial area 5
- Ophthalmology office building 3
- Dedicated store building 2
Office or Store Optometrist?
While it was relatively simple to determine whether a location was an optometry office or optometry store, it was more difficult to decide if an optometrist was office or store based since a good number of optometrists practiced at 2 or more locations.
For while most optometrists located at offices did not practice at stores, a few spent 1 day/week at a commercial store location and it was common for store optometrists to practice at several stores and even different corporate stores. As one example, the optometrist who practiced at a Wards Optical Department, a Wal*Mart Vision Center, an optician’s store and an optometrist’s office.
- Including ophthalmology offices, 42.9% of optometrists practiced primarily at offices.
- The majority of optometrists, 57% practiced in a store location owned by an optometrist or non-optometrist.
- Locations at which optometrists practiced were almost equally divided between offices and stores owned by optometrists (47%) and stores owned by non-optometrists (48.6%) with the remaining 4.2% at ophthalmology offices.
- Of the 91 optometrists 26 (29%) were not listed within the Yellow Page listings and 16 of these were based at commercial mall optical stores.
Yellow Pages Marketing
Optometrists marketed in Yellow Pages under:
- “Optometrists-Doctor of Optometry (OD)” 62%
- Within ad in “Optical Goods” 26%
- Under “Optical Goods” 8%
- Somewhere within Yellow Pages 71%
- No listing* 29%
*16% of these were at stores rather than offices.
Author’s Notes
In 1998 the author stated there were about 31,000 U. S. licensed optometrists and about 22,717 dues paying AOA members for a national 73% AOA membership rate.
In 2018 there are about 43,000 licensed optometrists and about 20,600 dues paying AOA members for a national 48% AOA membership rate.
To the degree these numbers are accurate, it seems quite possible that since this survey (and others) found a lower (37%) AOA membership among commercial optical store O.D.s compared to a 69% rate among optometry-owned offices-stores, that the decline in national AOA membership from about 73% to 48% may be due to the relative increase in commercial-store-based optometrists, the rapid increase in optometry schools and graduation rates and the shift of optometrists from privately owned practices and stores to essentially “piece rate” or “hourly” corporate employees.
Such a major shift has now taken place among pharmacists who, historically, owned their own pharmacies but today 80% are employed by the five largest national pharmacy store chains.
Sensing this change in how optometrists practice led the author to title this survey, in 1998. “The Mitosis of Optometry” for, as the data from 1998 show, by that time, the way optometrists practiced had already become highly fragmented.