Given a long time period for investment, most people would gladly choose investment number two. Even with short-term risk and variability, your long-term potential return is significantly higher. If this seems like an easy choice, then why do so many doctors choose the first option in healthcare and not invest in themselves? As you can surmise, choice number one is an employed position with safety, security (for a while), yet less control, influence, and statistically, much less compensation. Investment choice two is ownership of your own private practice.

A President of a College of Optometry recently told me when first year optometry students enter, 70% want a private practice opportunity. By the time they reach their 4th year though, only 10% are planning on private practice. * The drop in ownership aspiration is both astounding and disappointing. There are many personal reasons for the career change of plans, yet a few barriers I have observed are the following.

Large student debt: The investment costs for professional education are ever increasing. In Tennessee the average optometry student graduates with debt of $190,000.** That’s a big nut to overcome and one which prohibits additional borrowing for practice investment.

Lack of Knowledge: The purpose of professional training is to educate clinicians. Optometry education rightfully emphasizes preparing the student with the basic tools to identify, diagnose, treat and manage eye health and vision conditions. That is and should be the fundamental expectation of a professional degree in any healthcare training program. We know that real clinical training only begins after graduation. A real understanding of the fundamentals of leading and managing a healthcare business also develops post-graduation.

Lack of Confidence: Most business acumen, like clinical skills, is derived from a combination of education and experience. Professional students can only concentrate on a finite set of priorities and as such, the rightful focus on clinical care skills usurps the knowledge needed in business. Once clinical skills improve, most clinicians actively, or even passively begin to understand the business aspects of healthcare. Yet, that takes time, experience and a “want to learn attitude.” A lack of business confidence early in one’s career is an expected outcome of an educational system focused clinically.

Poor Accessibility: With fewer new starts and more doctors choosing employed positions, there are fewer opportunities for younger doctors to join a practice. Combine this with fewer new professionals choosing rural locations and many seasoned practicing optometrists (an Achilles heel not limited to OD’s) waiting too late to transition their practices and the result is a dearth of “good” opportunities for new optometrists in private practice.