Balancing Vision and Life in an Insurance-Free Practice

I often reflect on how a simple part-time job opportunity changed the course of my life. As a sophomore in college, I answered an ad for an optician position, not knowing that this random chance would lead me to a fulfilling career in eye care. I ended up buying the business I worked for, and that serendipitous moment set the foundation for my journey in this profession to neuro-optometry.

The Accidental Path to Neuro-Optometry

My foray into neuro-optometry was equally unexpected. Initially, I focused on primary care, but I stumbled upon this specialty while working with patients who had been struggling with diplopia for years. I started prescribing prism glasses for them, and their success stories caught the attention of a physical therapist. She reached out to me, asking if I would collaborate on some of her challenging vision patients. I gladly accepted, and soon I began receiving referrals from Rusk Rehab at the University of Missouri in Columbia. My specialty practice snowballed from there, and I found myself deeply invested in helping patients navigate the complexities of vision issues related to brain injuries.

I purchased my practice in 2006, but it wasn’t until around 2012 that I began integrating neuro evaluations into my work. By that time, I felt comfortably established in primary care, allowing me to focus on this new specialty without losing sight of my core practice. By 2021, I sold my primary practice and focused solely on my specialty clinic.

Embracing a Cash-Pay Model

One of the most significant changes I made in my practice was transitioning to a cash-pay model. Initially, I billed insurance for neuro-optometry services, but I found that this often complicated the patient experience. Now, I accept only private pay, which has streamlined my practice and allowed me to focus on providing the best care possible.

When I began integrating neuro-optometry into my primary care practice, we established a special service agreement that outlined all fees before the patient’s initial evaluation. My staff was well-trained to answer questions about our neuro service agreement, which patients signed prior to their appointments. This agreement included information about potential prescription changes and associated fees, ensuring that patients were shielded from unexpected costs.

In my current specialty practice, initial evaluation fees are paid upfront, either by the patient or by an insurance company or attorney in work-injury cases. This transparency has fostered trust with my patients. They know exactly what they will owe, which alleviates any anxiety about hidden costs. After the initial evaluation, I provide patients with an overview of expected follow-up appointments and potential prescription changes, helping them weigh the monetary investment against the improvements I can offer.

Patient Reception and Building Trust

The reception to my cash-pay model has been largely positive. I attribute this success to the groundwork laid during my time working with insurance-based patients. By treating neuro patients in my primary care practice, I honed my clinical skills and built a reputation among referring medical professionals and patients alike. Now, patients have confidence in the treatment they will receive and are willing to invest in their care.

The most rewarding aspect of my work is helping patients understand how a brain injury can impact their daily lives. Many come to me feeling frustrated or confused, believing they are losing their minds. Once I validate their symptoms and explain the legitimate findings, they can shift their focus toward recovery. I take immense pride in helping patients regain their independence—whether that means returning to work, driving again or simply enjoying time outdoors with their families. I’m not just helping them see; I’m helping them function.

Achieving Work-Life Balance

Finding a work-life balance has been a journey in itself. After years of juggling the demands of being a wife, mother, daughter, doctor and business owner, I finally discovered a rhythm that works for me. I see patients one to two days a week and work from home as needed on other days. This flexibility allows me to attend school meetings for my special needs child and participate in my sons’ extracurricular activities. Knowing that I can be there for my family, especially as my mother ages, is priceless.

Achieving this balance required a shift in mindset. I realized that I needed to slow down and savor the moments around me. I learned that saying “no” is a complete sentence and that not every issue deserves my time and attention. My husband has been instrumental in this realization, often reminding me that my happiness should guide my decisions.

Advice for Fellow Practitioners

For other practitioners struggling with work-life balance, my advice is simple: don’t torture yourself with “shoulds.” Thoughts like “I should work more to help more people” or “I should volunteer for the school trip” can undermine your well-being. Instead, ask yourself, “Would I be as happy?” This question has become my guiding principle, helping me prioritize what truly matters.

I share my story in hopes of inspiring other accomplished female optometrists to find their work-life balance. You deserve it.

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