Anyone offering refractive surgery over the past year needs no headlines about the mortgage crisis, the moribund stock market and $4-a-gallon gas to know that the American consumer has developed a serious case of the yips over our collective financial state. That's certainly a cause for concern when elective surgeries, new cars or other major purchases are involved. But evidence now shows that basic health-care choices are also being negatively affected by our dreary economic state.

A study released in late June showed that more than 20 percent of the U.S. population in 2007 reported not getting or delaying needed medical care in the previous 12 months, up significantly from 14 percent in 2003.1 And this is not just the uninsured, though they're faring the worst. Between 2003 and 2007, the rate at which insured people cited a health plan-related reason for going without or delaying care increased 8.5 percentage points to 39 percent in 2007.

Now, entire wings of libraries are filled with what I don't know about running an ophthalmic practice, but I've edited enough practice management articles to know that the more tightly patients squeeze their dollars, the more critical it becomes to send them out of your practice with the feeling that they got value for that dollar.

The good news: Eye doctors are doing fairly well in this regard. According to a survey by Jobson Medical Information, publisher of Review, just 7 percent of respondents strongly felt the exam fee was too expensive, while nearly 40 percent strongly disagreed that the fee was too high.2 But the survey, which was roughly equally divided between ODs and MDs, also suggests some opportunities for improvement on the value proposition. Any survey based on perception and memory needs a fudge factor, though this included only patients who had en eye exam within six months. But even allowing for some drift, these numbers are too high: Some 40 percent of respondents say they weren't queried about allergies; only half of them were asked about occupational vision needs; just slightly more, 52 percent, were asked about avocational (sports, computer, etc.) needs. The last thing you need is another voice in the cacophony telling you to sell more product, but these numbers suggest not just practice management opportunities, but unmet patient needs. For the comprehensive ophthalmologist, filling those needs is more important than ever.


1. Falling Behind: Americans" Access to Medical Care Deteriorates, 2003-2007.  The Center for Studying Health System Change. Available at

2. 2008 Adult Consumer Eye Exam Experience. Jobson Optical Research. Call (212) 219-7825 for information.