Optometry is one of the few remaining professions with a still-vibrant culture of single-doctor private practices, giving its practitioners a chance to live out the classic “hang a shingle” mode of making a living. Or at least it used to be a thriving part of optometry. More ODs are turning away from private practice ownership and opting instead to choose a paycheck over a P&L statement.

A recent study dissecting the profession’s workforce has much to say about the state of optometry now and in the near future. Age, gender and ethnicity characteristics, patient volume, hours worked, income levels and a host of other factors all get rigorous attention. There’s much about the study, undertaken by the AOA, worth digging into; you can read our full summary of it online in our news feed now and next month in the print edition.

One of the most interesting statistics was the report’s finding that the ranks of employed optometrists jumped 15% (from 29% to 44%) in five years, from 2012 to 2017. This period, mind you, is just before a wave of private equity acquisitions gobbled up optometry practices. Surely, the number of employed ODs today is even higher.

Is this a good or a bad thing? I doubt there’s a simple answer, as there are so many different stakeholders in the delivery of optometric care: ODs of course, their patients and employees, medical equipment and pharma companies, health insurers and lots more.

Some bemoan the decline of solo practice, out of a romantic attachment to the idea. But with a few exceptions, it’s hard to see overwhelming losses from the trend toward employment.

The AOA’s workforce study found that employed and self-employed optometrists worked about the same number of hours and were equally productive and satisfied in their roles. Interestingly, the employed ODs saw more patients per week than those who were self-employed (58 vs. 54) “This is despite the number of hours worked per week being similar,” the study points out, likely given the added hassles of practice administration that fall to a self-employed doctor.

One setback for employed ODs is income, as those who earned the most tended to be self-employed. Another seems to be fewer self-employment opportunities for women, as only 43% of female ODs in the study practiced that way, compared with 66% of their male counterparts. The report didn’t address underlying reasons for the distinction, but one popular explanation is that the added burden of childcare that women disproportionately shoulder makes self-employment a harder proposition for them. (Does that ring true? Please write to us at [email protected] with your thoughts!)

Who’s doing the employing? That’s not delineated either, but anecdotally I encounter more and more ODs who hail from within ophthalmology’s private practices and teaching institutions among the doctors who write for Review. This is obviously not a representative sample, but perhaps it is a bellwether. New grads enter the field with abundant clinical skill in medical eye care and eagerness to use it. If ophthalmologists are seeing the value of adding an OD or two to their offices, it validates the strength of optometry’s institutions—and its very calling.