When we hear and read discussions regarding the optical industry, it would be easy to believe there is not one, but two completely different styles of practice; multiple and independent.
Depending on which sector the proponent of the discussion works in, the ‘other side’ is portrayed in a negative light. This happens both ways, although my perception is that there is a stronger critical voice of their counterpart from the independent sector. However, these apocryphal tales are often based on one example someone has seen or heard about and has attributed this to the whole of that sector. There
is an echo of the term we now see frequently quoted; factoid. Meaning an item of unreliable information that is reported and repeated so often that it becomes accepted as fact.
As an example of this, I recently read a piece in an optical newsletter that attributed poor practice by one practitioner to ‘the time and financial pressures that exist in multiple practice’. I was left wondering whether there was any evidence to support this statement and I suspect it was written purely from a subjective, biased viewpoint and dare I say some degree of envy that the multiple sector has grown over the past 30 years at the expense of independent practice.
I wonder if there is any fact to suggest that inherently there is a flaw in multiple or independent practice and whether actually one has a distinct benefit over the other? I hear multiple practice is driven purely by the need to make money and that practitioners are rewarded not for their clinical skills, but for the number of spectacles they are able to sell. But surely all practices have to make a profit in order to continue to exist?
The individual optometrist in multiple practice is salaried and any bonus based on sales will be a small part of their overall remuneration and so will not significantly change behaviour. Within independent practice there is a closer link between the behaviour of an owner occupier optometrist, as what goes into the till, after the bills are paid, will ultimately go into their pocket. Does this give a greater incentive to change behaviour in a negative way?
Next some will claim that only independent practice will look after their reputation. While it is true that an independent will want to establish a strong local brand reputation, multiple practice chains are nationwide and some are now household names. Does this mean they have a greater awareness of any potential for adverse publicity, and will go to greater lengths to make sure they are doing the right things, so that one practice cannot damage the reputation of the chain? The multiple practice will have managers and clinicians who will uphold the clinical governance structures, which protect the patient, the practitioner and the brand.
Even if there is only one optometrist in the multiple practice there will be a managerial system that looks at their practice on a periodic basis. Compare this to the lone independent practitioner who has no oversight of their work, something that has been recognised as a risk in other professions such as dentistry and medicine.
I often hear the independent optometrist will be able to take more time for each appointment, which I suspect is true, as the mode of practice is built on establishing trust with the patient. Compare this with stories of 20-minute appointments or less in multiple practice, which is a tall order even allowing for pre-screening and delegated tasks. But, is there any evidence to say there is a better clinical outcome from one or the other mode of practice? We should also remember multiple practice led the way with introducing new technologies to the mainstream of optometric practice, something that has directly benefitted patients.
However, from a service perspective it seems a reasonable assumption that the independent will be able to offer a higher level of personalised service, since practices are smaller and there tends to be more continuity of staff with a greater focus on tailored solutions for the patient. This is a huge plus.
Where the truth lies is perhaps somewhere between the extremes that are painted. Remember that patients are not stupid and the rise of the multiple sector indicates they must be getting a lot right. Equally the good independent practice always continues to thrive and have a very loyal patient base.
Ultimately I believe whichever mode of practice an optometrist or dispensing optician works in it is their professional responsibility to do the best job they can for each and every patient. It goes without saying that this means keeping up to date, having governance in place to audit their work and giving advice irrespective of the financial reward.