My First Private Practice Visit
It’s awesome visiting a private practice, because while I’m certain that ICO will train me to eventually become a competent optometrist, the business side of running a successful optometry practice is something that I don’t believe can fully be taught in any institution. In speaking to different optometrists who own a practice, almost all of them tell me, “Optometry is easy, but business management isn’t.” Before I came to ICO, I worked at an optometry office, and I thought I learned all I needed to know about how to run one. But then I found out there are different kinds of practices that focus on different things, with varying reasons for their success. I’m very interested in vision therapy, so I was fortunate to be able to visit a practice that specializes in that.
Tip: If you dream of opening a practice one day, you’ll want to visit some existing ones before you open your own. You’ll learn a lot at ICO, but there are things that you can only learn outside the classroom. Plus, you’ll be sitting in the same room all year, so field trips are a nice change of learning environment. It’s worth your while, I promise.
Dr. Margolis’ office is inside this huge medical building, where the office gets so busy, sometimes the parking lot isn’t big enough to fit all the cars of patients.
Dr. Neil Margolis, an ICO alum, was kind enough to host members of ICO’s College of Optometrists in Vision Development club and Neuro-Optometric Rehabilitation Association student group at his suburban practice. He blocked off an entire afternoon to teach us things we might never learn in our normal optometric academic curriculum. His practice specializes in working with patients that have visual-spatial processing, tracking, or other binocular vision issues that may negatively affect academic learning and visual attention. Children compose the biggest portion of his practice, and from this visit, I could really sense that he cares about them.
After giving us an office tour, Dr. Margolis discussed how he came to build such a successful practice, imparted clinical pearls of wisdom and printed out lots of reading material for us.
What I observed (extremely abridged):
1. Humility I took notes as Dr. Margolis spoke, as much as I could, but I don’t think I was a fast enough writer to fully recall everything that he explained. He came across as an extremely humble man. “I have no ego,” he said while addressing how he treats his staff. I believe him. There are optometrists with egos–I’ve worked with one before, so I know what they’re like–and this isn’t the story with him at all. This is the story of an optometrist who sits on the floor to interact with his young patients, so he’s not intimidating. That’s what I have always imagined the perfect doctor to be like–one who doesn’t demand respect just from owning the title of a doctor, but actually deserves it for what they do for their patients.
2. Dedication and hard work He said that he was only allowed to purchase the part of the practice that he built. He started out doing everything, optometrically speaking, because that was what was needed to pay the bills. He’s even done a little bit of low vision work, but didn’t enjoy it. What he really enjoyed was working with the kids with learning disabilities attributable to visual problems. One of the things that he said really stuck with me that day: “I spend my free time writing customized reports, and that makes me different. I write one for the teachers, a different one for the insurance, or for the doctor that referred the patient to me. Sometimes I go home with two backpacks of files.”
That’s pretty much at least three times the work that I saw done in the old office I worked at, but it also meant for him that he’ll gain more referrals for the patient population that he is interested in focusing on. Outside of all that work, he also reads books and journal articles for enjoyment. He said that he didn’t learn all that he knew in one day, that he learned about one subject that he was interested in, and dove into text, internet, journals, etc., and attended all the conferences and seminars he could. He became an expert in one area before he moved onto something new. He also insisted we should devote time to ourselves and wake up early to make use of day time, so he wakes up extra early in the morning to read or kayak for fun.
I distinctly remember that it made me feel extremely lazy in comparison. I thought working four jobs, being a co-president of a student organization and managing school work made me busy, but Dr. Margolis inspired me to do donate more of my free time to learning, in order to better treat my future patients. I resolve to read something about vision therapy every weekend (still have yet to start, but I will!).
Dr. Margolis spoke to us without the aid of any PowerPoint slides (even though he prepared one in advance).
Students listened attentively and took notes, some even got their spouses to come along.
Dr. Margolis also spoke of the importance of keeping time. Since his special needs patients have very limited attention spans, he tries to make sure that he doesn’t keep them waiting. He told us a story of a patient who was referred to him for seeing double vision, and how the patient left seeing single again on the very same day with the use of Fresnel prisms (press-on prisms). It was interesting to see something we learn in first year optics class with Dr. Goodfellow used in a real clinic setting. I can imagine how satisfied both the patient and the referrer would be if an optometrist could provide relief of double vision within such a short amount of time. Fun fact: Hilary Clinton was treated with Fresnel prisms at one point.
Dr. Margolis rarely take more than three days off at a time. He says it’s really important to be present for his staff and his patients, and the stack of files that piles up on his desk in his absence makes it not worth it.
3. Accountability and credibility Some patients have asked Dr. Margolis if he could instruct their occupational therapist or someone else to perform the vision therapy the patients need, and his response surprised me: “Yes, I can, if the person you go to can be personally responsible to ensure that you succeed. I can be personally responsible for your success in treatment.”
He makes realistic promises he can keep, spends his time to go through each skill the patient can improve on, and informs their parents what can be changed, and what can’t. He said that people who don’t have his expertise would not likely promise the patient that they’d be personally accountable for the outcome of treatment, and that it’s important for us as doctors to hold ourselves personally accountable.
He also stressed the importance of being credible–that if a patient doesn’t need vision therapy, we should be honest about it. “You get more referrals by being credible. If the patient was referred to you for vision therapy, and they don’t need it, send them back out.”
He said it would be tempting to just do vision therapy on everybody, especially when we’re in debt and have bills to pay. However, we lose more patients in the end because you’ll be less credible as a doctor.
4. Interesting clinical tidbits Dr. Margolis gave us a lot of information on visual spatial processing, autism, binocular vision disorders, etc., but there were two clinical stories that stuck with me. He talked about a child with autism who squinted and constantly shut his eyes. He diagnosed the child with strabismus and double vision, so he gave the child glasses. Once the problem was addressed and treated, the child was able to see single and opened up his eyes. Dr. Margolis also spoke about neglect, when patients neglect the existence of half of the world, and perceive the world differently from the rest of us. These patients only eat from half the plate of food, shave half their faces, or draw a clock with 1-12 scrunched up on one side.
Google image of what kind of clock a patient with neglect on their left side might draw
5. Lots of interesting gadgets I took as many photos as I could, so hopefully you all can get an idea of how awesome it was.
The decorations made it seem more welcoming than in most doctors offices I’ve been in, I mean check out his front door:
Just past the reception desk is a hallway to rooms that contain different testing equipment. You can see the colorful decorations and paintings on the walls no matter where you walk.
Fun activities in one of the waiting rooms
Dr. Margolis said that everything he does is very physical, since he needs to constantly catch the attention of the kids he works with. Toys were even on the ceiling in some of the rooms.
This is how you get a child to pay attention to a target far away:
They’re just ordinary stuffed toys: They can be remote controlled to move and light up.
Even the OKN drums have adorable Snoopy stickers on them. What a great idea!
As we visited some of the rooms he tests patients in, and he showed us some more of his gadgets.
A phoropter: No optometry office is complete without one!
Every room comes with an explanation of the purpose of the gadgets inside.
The pre-testing area
Visual field machine
Next, we move onto some vision therapy rooms.
The cabinet is full of toys, and the chairs and tables are tiny. Perfect for the children.
An adorable chair in one of the test rooms. I can see why kids would love to come here– exams and vision therapy can actually be fun!
I asked him what these were for, they looked really fun.
They can be used as balance beams!
Dr. Margolis said that he’s worked with some famous individuals. TV announcers, a child of one the Chicago Bulls players, the Bears, and probably some others that shouldn’t be mentioned.
I suppose this was from one of the people he has helped.
A closer look at what it says: “Optometric Vision Therapy made a big difference in my life and my career. I was fortunate that my vision problems were caught early in life. Learning-related vision problems can have a serious impact on a child’s education. Don’t wait, take action today.”–Larry Fitzgerald, Arizona Cardinals, 2008 NFC West Champions’ wide-receiver
6. Inspiration I can’t help but imagine how rewarding it must feel to make such a difference in a child’s life. On our way out, after all that was said and done, he said that the purpose of this for him is the hope that we can catch his passion and make a difference in the kids– that we can give kids a greater proportionality between effort and outcome, which builds self-esteem. If that was his goal, I believe he accomplished it that day. I learned a lot from Dr. Margolis, and I can’t wait to work hard help my future patients in a similar way.