Capitalism is deeply ingrained into the American fabric.

Unlike some countries, the United States prides itself on its ‘opportunity for all’ premise, permitting its currently 327,092,927 citizens (Census, 2018) to chase after their dreams with no limit to their potential. This inarguably has its many pros and cons and, therefore, musters both supporters and opposers. Nonetheless, as the adage goes, ‘it is what it is’ and within no imminent time-frame do I foresee this changing. And for many reasons, that is not a bad thing.

As opposed to socialism, where theoretically all citizens are equally affected by both the benefits and the costs, capitalism fosters a ‘dog eat dog’ reality. To avoid being on the receiving end of this trend, one must do anything and everything possible to ensure they remain on top of the competition – regardless of the morality thereof. Only naturally, for some, greed and self-interest play a significant component in their decision making. History offers plenty of proof in the pudding.

Perhaps one of the most famous examples in history illustrating an attempt to gain an edge over the competition is Henry Ford’s creation of the assembly line amidst the Industrial Revolution. Henry Ford infamously coined the three principles of assembly, which were: (1) place the tools and the men in the sequence of the operation so that each component part shall travel the least possible distance while in the process of finishing, (2) use work slides or some other form of carrier so that when a workman completes his operation, he drops the part always in the same place—which place must always be the most convenient place to his hand—and if possible have gravity carry the part to the next workman for his own, and (3) use sliding assembling lines by which the parts to be assembled are delivered at convenient distances (Biography, 2018). The assembly line significantly decreased the assembly time per vehicle and, consequently, yielded one very important outcome – increased profit margin (Goss, 2018). Such modalities of achieving optimal efficiency increased profit margins, and a competitive edge has only become increasingly predominant over time.

What impact does the above reality have on healthcare? Everything.

Due to the natural pace of evolution, it was inevitable that arguably the two most wholesome industries – education and healthcare – would eventually fall victim to the effects of this trend. As much as I would like to delve into education as an additional soapbox of entertainment, I will humbly and graciously spare you the misery and will leave the focus of this article to solely healthcare and hone specifically on optometric eye care.

As a fourth generation Optometrist, I grew up with a healthy exposure to the rich history of optometric care, how it has evolved over time and the degree to which the aforementioned trend has impacted its vitality. I have books, photos, and a whole roomful of optometric history and equipment depicting this evolutionary journey.

As many of you may recall, optometrists were once called ‘Jewelers,’ known exclusively for their mastery of optics and opticianry. Ocular disease, vision therapy, and surgical co-management were non-existent. The Optometrist, or Jeweler, was the Receptionist, the Medical Assistant, the Specialist, the Master Biller and Coder, and the Head of Marketing. The Optometrist determined provider reimbursement, which at the time was received in various forms including but not limited to bartered trade-for-service, fresh commodities such as poultry, or money itself. In this era, the highest degree of ‘accommodation’ (no pun intended) optometrists faced was in the event of nearby competition.

Flash forward…

Flash forward in time to arguably one of the earliest signs of this trend impacting optometry – the revision from 20-foot exam lanes to 10-foot exam lanes, achieved by the simple use of optics. Optometrists could now either double their volume or minimize overhead, thereby achieving (surprise, surprise) optimization of the profit margin. Eventually, with the advent of health and vision insurance, optometrists could no longer dictate their reimbursement. Thus, unless their retirement exit strategy was to stare at four walls and sleep on a cot, they were forced to comply and devise alternative strategies for profit margin optimization.

With time and to date, all the above has been further compounded by additional hurdles such as congressional stronghold, greed, and technological innovation. Consequently, both patient care and provider reimbursement suffer. In order to appease the shareholders or, in some cases just keep the lights on, we must see approximately three to four times the volume of patients only to achieve approximately 60 to 70 percent of the reimbursement once received. Taking the extra time to establish and foster patient rapport, once echoed with recognition and praise, now lends to administrative reprimand. Arguably worst of all, the ability to provide the quality of care needed and rightfully deserved by our patients becomes a consistently daunting task.

As a proud optometrist, who lives and breathes for what we do and stand for, I can safely say that healthcare as a whole, but especially optometric eye care, has officially reached ‘assembly line’ status. We must continue to keep up the good fight for better reimbursement per encounter which, if achieved, would at least ‘loosen the slack’ and alleviate the coinciding burdens and stress exuded onto all involved.


Biography. (2018). Henry Ford. Retrieved from: https://www.biography.com/people/henry-ford-9298747

Census. (2018). U.S. and World Population Clock. Retrieved from: https://www.census.gov/popclock/

Goss, J. (2018). Henry Ford and the Auto Assembly Line. Retrieved from: https://www.thoughtco.com/henry-ford-and-the-assembly-line-1779201