This Just In (An Unscheduled Blink)
Who Really Owns the Practice?
One thing I very quickly learned about writing a newsletter ahead of schedule is that the news does not particularly care about my editorial calendar. I already have several editions written and scheduled, which is great until something happens that I actually want to talk about while it’s still relevant. Rather than playing musical chairs with everything I have planned for the next month, I decided to add a bonus section to today’s supplemental edition. This one felt worth squeezing in.
Earlier this week, Senator Elizabeth Warren and several other members of Congress introduced the Stop Corporate Takeovers of Physicians Act of 2026, a bill aimed at limiting corporate and private-equity control of medical practices. It would put restrictions on certain ownership and management arrangements that allow non-clinicians to control practices, while also addressing things like non-competes and other restrictive employment provisions. It was just introduced on September 16, so there is a long way to go before any of this potentially becomes law, but the conversation behind it caught my attention.
I graduated from optometry school in 2023, at a time when private equity and corporate ownership had already become a very normal part of our profession. A lot of my classmates and colleagues went that route after graduation, and I completely understand why. When you’re coming out of four years of optometry school, probably carrying a decent amount of student debt, and looking at your first real paycheck as a doctor, it can be hard to ignore the company offering substantially more than the small private practice down the street. Throw in benefits, a signing bonus, and the fact that someone else is responsible for running the business, and it becomes a pretty compelling offer.
I don’t think there’s anything inherently wrong with choosing that path. I also think it can be easy to focus on the number at the top of the offer letter without thinking enough about what the job will actually look like every Tuesday afternoon for the next few years. A higher salary may come with higher production expectations, more patients on the schedule, or less flexibility in how you want to practice. Obviously, that varies tremendously from one company and practice to another, but I’ve watched colleagues find themselves seeing more patients per day than they ever expected when they graduated. That pace can wear on you, especially when you don’t have much control over changing it.
The control part is probably what interests me most about this bill. There’s a difference between having a company take the administrative burden off your plate and having people who aren’t actually boots on the ground in your practice making decisions that affect your day. Staffing, scheduling, appointment times, production goals, equipment purchases, and how many patients you’re expected to see may look very different on a spreadsheet than they do when you’re the person trying to get through that schedule.
Owning my own practice has given me a much better appreciation for both sides of this. There are plenty of days when I would happily hand someone the insurance problems, payroll, bills, HR issues, and the hundred other things that have nothing to do with being an optometrist. There’s a reason employment is attractive. At the same time, I’ve become much more protective of the autonomy that comes with ownership. If I need more time with a complicated patient, I can take it. If I think we need another staff member, I can hire one. If I want to change how something is done because it isn’t working, I don’t need approval from someone who has never stepped foot inside my office. That autonomy has value, even if it doesn’t show up in your salary.
I’m not interested in turning this into a private practice versus private equity argument. I know doctors who are very happy in corporate settings, just as I know practice owners who would probably be happier if someone else were running the business. What interests me about this bill is the larger question it raises about how much control we’re willing to give up when healthcare practices become investments.
For those of us who graduated into a profession where selling to private equity, joining a corporate group, or working for an independent practice are all realistic options, salary is obviously going to be part of the decision. I just don’t think it should be the only part. How many patients are you expected to see? Who controls your schedule? Who decides how the practice is staffed? What happens when your clinical judgment and a production target don’t line up? And, maybe most importantly, who gets the final say about how you take care of the person sitting in your chair? Those are questions worth asking before you sign the offer letter, not after.
There is one part of this bill that gives me pause as an optometrist. The opening language refers broadly to protecting “physicians and other licensed health professionals,” which certainly sounds like it could include us. Once you get into the actual definitions, though, things become less clear. The bill defines a covered “licensee” as a physician under a specific section of the Social Security Act, or an advanced practice provider such as a physician assistant or nurse practitioner. Optometrists are recognized separately under the Social Security Act, and we aren't specifically named in this definition.
Maybe that gets clarified as the bill moves through Congress. Maybe the intent is broader than the current language suggests. But considering how much private equity and corporate ownership have become part of optometry, I think it's an important question for our profession to be asking now rather than after the legislation has already been written: If Congress wants to protect clinical independence from corporate control, are optometrists actually included?
Noh Filter (Fridays with Ada Noh, OD)
Incomplete lid seal ≠ Lagophthalmos
Incomplete lid seal and lagophthalmos are related, but they are not interchangeable terms. Lagophthalmos traditionally refers to an inability to completely close the eyelids, often due to neurologic, mechanical, or structural causes. An incomplete lid seal, on the other hand, describes a functional finding where the eyelids may appear to close but do not achieve complete apposition across the ocular surface. This is much more common, and relevant in more than half of our dry eye patients.
A patient can therefore have an incomplete lid seal without having true lagophthalmos. Subtle gaps, especially temporally, can allow increased evaporation and contribute to ocular surface symptoms—even when the patient appears to fully close their eyes. When evaluating the lids, it is important to look beyond simply asking, “Do they close?” and instead assess how completely and effectively the lid margins meet.
You can perform a korb-blackie test to look for a gap in lid closure, or you can ask the patient “How do your eyes feel first thing in the morning?”
Here’s how I explain this to patients (because they’re inevitably in denial that they can’t possibly sleep without their lids tightly sealed): “You know when you see a window and it looks closed? But then you stand next to it and you can feel air coming in, and then you know it’s not completely sealed?” If I still get resistance, I ask them to modify their night time routine (ointment, sleep mask, eyelid tape) for 1 week, and they can discontinue if they find no improvement. Shocker- 95% of them end up staying on the modification.
From A to Z (Fridays with Andrew Zagelbaum, OD)
One Star, Five Stages of Grief
Well, it finally happened. I got my first one-star Google review.
Up until this point, I had been fortunate enough to have all five-star reviews, many with some really nice comments from patients about their experiences with us. Then, 3 days ago, I checked Google and there it was. One star, no comment, no explanation, no feedback about what we did wrong. Just a single star.
Of course, my immediate reaction was to figure out what happened. I searched the name in our EHR and couldn't find anyone who matched it. I tried a few variations just in case, still nothing. Then I started wondering if maybe this was someone who had called the office but never actually became a patient. Our phone system transcribes our calls, so I went back through the previous few weeks searching for the name and trying to find any interaction that could explain it. Maybe we couldn't accommodate someone, maybe they didn't like something they were told on the phone, or maybe there was an interaction I simply didn't know about.
No luck there either, which meant I had now spent a considerable amount of time investigating a person who, as far as I could tell, had never interacted with my practice.
I did what most of us probably do when we don't know what to do next and started researching how other businesses handle this. The general consensus was to respond relatively quickly, but without getting defensive or letting any emotion make its way into something that was going to live publicly on the internet. I ended up responding with:
"We take all feedback seriously. However, we are unable to identify any interaction with our practice that corresponds with this review. We would appreciate the opportunity to better understand your experience. Please contact our office directly so that we can look into this further."
Google also has a process for reporting reviews that you believe may be fake or otherwise violate their policies, so I went through that process as well. From what I had read, it could take a few days before anything happened, which meant there wasn't much else I could do except wait while that one-star review sat there, menacingly, on my Google Business Profile. I'll admit I checked it more often than I should have.
Thankfully, less than 24 hours later, the review was gone and my five-star rating was back. I don't know exactly what happened behind the scenes or why it disappeared as quickly as it did, but I was obviously happy to see it go. Once the whole thing was over, though, I started thinking about how much stress I had allowed one completely unexplained star from someone I couldn't even identify to cause me.
I'm less than a year into owning my practice, and I care a lot about the reputation we're building. When someone takes the time to leave a nice review, it genuinely means something to me, and if someone has a bad experience, I want to know about that too. If there's something we can do better, I would rather hear it than not.
At the same time, if I plan on doing this for the next thirty years, I probably need to accept that eventually someone isn't going to be happy with me. I treat a chronic disease where improvement can take time, treatments can be expensive, and there isn't always a perfect answer. At some point, there will probably be a real patient who disagrees with my recommendations, doesn't get the result they hoped for, or simply doesn't like the way I do things. That's part of taking care of people, and it's probably unrealistic to think I'll make every single person happy forever.
The whole experience reminded me a little bit of social media and how easy it is to assign way too much importance to numbers on a screen. You can have a post that fifty people enjoy and somehow spend most of your time thinking about the one person who left a negative comment. You can watch likes, followers, views, or in this case stars, and slowly start treating them like a scoreboard for whether you're doing a good job.
I'm trying to remind myself that my reputation isn't one Google review. It's the patient who tells their friend to come see me, the doctor who keeps trusting me with referrals, the person who comes back months later and tells us they're finally feeling better, and all of the little interactions that will never end up online at all. If the same criticism starts coming up over and over again, that's something worth paying attention to. One person having a bad experience is worth listening to as well. But neither should erase everything else you know about the practice you're building.
I'm sure another one-star review will come eventually, and next time it might even be from someone who actually knows me. Hopefully by then I'll be a little better at not letting one star ruin my afternoon.
Have a great weekend.
Ada Noh, OD
Andrew Zagelbaum, OD