To answer your question as thourough as possible without writing a book, optometry just does not give me the satisfaction at the end of the day that I feel I need out of my career. The part I love most about the job is the pathology, which I see a very limited amount of since I am in a metropolitan setting, and once I see most pathology I have to refer out to an ophthalmologist for most treatments anyway. Even for glaucoma, which am am licensed to treat, I have to refer out for diagnostic testing because I don’t have a large enough glaucoma practice to warrant spending $65,000 on an OCT which is quickly becoming the standard of care.
Which brings us to the retail side of the profession… As a poster has already aluded to, if you are a very good business person you can do OK, and really just OK in the current financial climate. Long gone are the days of what I would call “the golden age” of optometry when patients came in and purchased all their eye care and eye wear needs from their neighborhood OD. I feel I am constantly trying to think of new and creative ways to get patients to understand the value of our services and quality of our merchandise, but all too often it simply comes down to price. It just does not seem like people really care that much about quality and are just wanting the cheapest thing they can get. “Can I just get a copy of my prescription, I saw this pair of glasses at Costco that were really cute and much cheaper.” I started my own practice cold 3 1/2 years ago and trust me, you can’t even pay the overhead with just giving eye examinations, especially with some of the terrible vision plans out there that only reimburse $40 for an exam. So I have just really had it with the whole retail part of my practice because I constantly feel the stress of not making enough money to cover expenses let alone take home a salary that will provide the life for my family that I feel an 8 year degree should.
On your thought of working in an MD/OD setting. This was my original thought as well, until you get out there in the “real” world and realize that most MDs have very little respect for optometrists beyond just doing refractions and fitting contact lenses (which are almost just not even profitable with online ordering and Costco selling them for just barely over my cost). I say most because there are a few opthalmologists in my area that realize how well trained we are and co-manage patients without hesitation. Needless to say those are the busiest MDs in my area simply because most ODs refer to them. One of my close friends works with the corneal/cataract specialist I refer to and he loves the job, but really does not make as much as he should given the responsibility that he has, and when it comes down to it at the end of the day the MD has the final say in what happens in the practice and what direction he wants to take it in.
As far as the chain stores, I have done that as well and yes, they will suck the life right out of you. They just want more hours, for you to see more patients and then will still come to you with the attitude “what have you done for me lately?” Not a way I wish to spend the next 30 years of my life.
If you are really debating between the two, without hesitation I recommend you follow the MD path, unless you really want to live in rural Amereica, which I think is where optometry really thrives. You are booked solid, there is really no competition for you materials, and you treat alot of pathology because the closest OMD may be 2-3 hours away. Most ODs I know in rural settings do VERY well, all of my collegues, including myself, in the metropolitain setting struggle just to see enough patients to pay the bills. I know you think that your late 30s is old, but believe me, it is not. I just had my first child 9 months ago and am now HOPEFULLY headed back to med school. Take the plunge and become an OMD, you will not regret your decision, if you follow the OD route you may.