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If This Team of Expo Slackers Worked for You, What Action Would You Take?

They spent most of the all-expenses-paid trip in the hotel bar.

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DR. BENNIGAN’S STAFF of 12 was buzzing. Liz, the office manager, was spreading the word that for the first time ever the practice would be sending some team members to a big optometry conference. The lucky staff members would fly from their home in Lexington, KY to Atlanta, GA for three days of continuing education, special events and expo exhibits.

ABOUT REAL DEAL

Real Deal scenarios are inspired by true stories but are changed to sharpen the dilemmas involved and should not be confused with real people or places. Responses are peer-sourced opinions and are not a substitute for professional legal advice. Please contact your attorney if you have any questions about an employee or customer situation in your own business.

ABOUT THE AUTHOR

NATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at info@meredithoptical.com

Liz asked everyone to email her a short “essay” describing why they wanted to attend and what they hoped to get out of the experience. Based on these essays Dr. Bennigan chose four staff—two opticians and two technicians—plus Liz to lead the trip. She immediately booked the flights so the group could sit together. Dr. Bennigan agreed to pay each staff person their regular wages for an 8-hour workday. Liz carefully scheduled each staff person with CE lectures as well as time to attend the expo. She printed the course handouts and made binders for each attendee.

The morning of the flight Liz met her four co-workers in the office parking lot and everyone loaded into an airport shuttle van. It was early, just after dawn. As they pulled out onto the highway Liz shushed the group to go over some of the details, beginning with her binders.

“I’d recommend reading through your handouts on the plane,” said Liz. “Dr. Bennigan has scheduled a 3-hour staff meeting for when we get back home, and each of us is going to need to present a 3- to 5-minute summary of what we learned at each lecture.”

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The group collectively rolled their eyes and shifted in their seats, but no one argued.

“Tomorrow night at 7:30pm we are going to meet up in the hotel bar and walk across the street to a restaurant so we can talk about the first day, okay?” The girls tiredly sipped cups of coffee and stared out the windows.

Liz was booked in a room by herself and spent the first night zoned out in front of the TV. The next morning, she saw one of the opticians on the shuttle bus.

“Where’s your partner in crime?” Liz asked amiably.

“Oh, we met up with a few of my old co-workers at a bar last night. She got pretty drunk,” the optician said, chuckling. “She’s still out cold; I left her in the room.”

“Oh boy,” Liz tried to hide her frustration.

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That evening, Liz waited for her team as planned but by 7:40pm she sent a group text asking for an ETA.

“I forgot!” wrote the technicians. “We’re at the big optometry party – come here!” “We have drink tickets!”

“We’re too tired,” texted one optician. No reply from the other.

Liz called the restaurant to cancel their reservation, and backed off the group for the remainder of the trip.

At Dr. Bennigan’s staff meeting the presentations were of varying quality: one of the technicians did an adequate job, but the other had clearly not taken any notes during her classes. The two opticians confessed to missing several classes and largely worked off the handout binders.

Dr. Bennigan held the four back for a recap. “Ladies,” he began, “Liz and I are not satisfied with your efforts—not today, and not while in Atlanta. I was OK paying you for the time you put in to your education, but you clearly have taken advantage of the situation.

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I think we need to revisit the terms of this trip.”

The Big Questions

  • Would it be fair of Dr. Bennigan to subtract from an employee’s daily rate for each missed course?
  • Should the team be held accountable for missing team-building events? How?
  • If Dr. Bennigan decides to send staff next year, what should he do differently?
Becky M.
Osawatomie, KS

We have to show proof that we attended our classes. If we don’t have our schedule stamped we don’t get paid for the time in that class. The staff should not be paid for the classes they did not attend. The staff was disrespectful for not attending the dinner they were aware of ahead of time. If the doctor sends staff next year he should spell out, in writing, what is expected of staff and none of the staff that attended this year aside from Liz should be allowed to attend again. We have never had to put the expectations in writing at our practice. We have a lot of fun at conferences but we also attend our classes and take notes because we’re being paid to be there and our doctor is paying for CE. Common courtesy and respect.

Thomas W.
Myrtle Beach, SC

The doctor paid the staff to attend the classes. They did not attend, so it would be fair for him to subtract for each missed course. The team should be held accountable for missing the team-building events, but as these were clearly after hours and not during their paid work hours, there should be no financial consequences for missing these events. If the doctor decides to send staff next year — and I think he should—he should personally explain his expectations to the staff. Additionally, it would be wise for him to attend the conference along with his staff. It would also be a good idea for him to take them out to dinner as a team-building event and not as a business meeting. I would encourage keeping the team together as much as possible. The office manager zoning out in front of the TV by herself is not acceptable.

Deanna A.
Fort Collins, CO

Express your concerns and document it in their employee file. I would consider sending less people the following year and certainly not the ones who didn’t follow through. There seemed to be a lot of hand holding and trying to make sure they follow through. There needs to be some point of responsibility of the employee. They go to learn and share. The partying and missing classes is abuse of the situation. Next year if they miss class, then they would be docked those hours and asked to reimburse for the cost of education.

Brian C.
Prescott Valley, AZ

We had a similar situation when I took my entire staff of five to Vegas Expo West about 20 years ago. Most of my staff did not attend the education I paid for, and were off drunk/gambling the entire time. Time dedicated to purchasing new frame lines and evaluating equipment was spent trying to find errant employees who were passed out/vomiting in their rooms after the “Marchon party.” It was a terrible experience. I was furious that I closed my clinic for three days (thousands in lost revenue), paid for the entire thing (a couple more thousand dollars), the staff’s hourly wage for three days, and I netted no positives at all. It was a complete waste of time and money. The staff noted my resentment for years afterward, and never brought up going to Expo again. I have never paid for any employee to go to Expo since. I attend it alone, sober, and only for one day.

Chris D.
Tampa, FL

I would not touch the employees’ pay for the trip. But not having filled the agreed requirements, I would suspend them for three days for gross negligence of their duties. This was not vacation; this was work and education. The expectations were set. They failed to deliver — three of them, at least. I would bar them for one year for any company paid events or education. I wouldn’t rub their noses in it, but set the tone to know it will never be tolerated again. And why.

Cherlyn F.
Decatur, IL

Speaking as an office manager, I would write up the employees who did not participate according to the agenda. I would also forbid them from any future trips for a period of time, say one to five years. Our policy on continuing education: Continuing education and the expenses involved will be left to the discretion of management. There may be times when you will be required to attend a seminar scheduled after office hours, or on a Saturday or Sunday. The doctors will pay your registration fee, and you will be reimbursed hourly pay for time spent in classes and for two hours for exhibit hall time. No reimbursement for travel expenses will be considered.

Pamela M.
Highland, CA

1. Would it be fair of Dr. Bennigan to subtract from an employee’s daily rate for each missed course? ABSOLUTELY.
2. Should the team be held accountable? YES.
3. No further out of area continuing education except for the staff person who adhered to the rules. No exceptions for staff members who took advantage of their employer and office manager. The staff, despite the rules, took this as a vacation at the employer’s expense. Shame on the employees. This breach of trust has now created an office problem and will remain as part of the employees’ records. Trust will have to be earned back, if that is possible, and it is up to the doctor and the office manager.

Taylor K.
Ellington, CT

1. Yes, it would be appropriate to subtract the daily rate for missed courses. The staff was being paid for the hours they were attending the conference/expo, so why would they be paid for not going? Especially considering typically you pay per credit hour, so not only would the staff be paid to not be working, they were wasting money for attendance fees.
2. While it is frustrating the team didn’t attend, if they weren’t being paid for that time, there isn’t much to do for this specific issue, unless staff was told it is mandatory.
3. I would call a meeting with the doctor and the attending staff and express disappointment with what transpired. I would then explain that I will not be considering any staff members who missed courses for the next education trip. In the future, having very clear expectations of the staff will be essential.

Judy C.
Wilkes-Barre, PA

Yes, the doctor should hold the staff members accountable. Rather than docking their pay, it should be considered during their annual review process and the costs reflected in any resultant pay increase. I also believe there should be a written agreement between the doctor and any staff members attending a conference stipulating what will be required during the event. I would hope that any staff members offered this opportunity would jump at the chance. I know I would have.

Pam P.
Downers Grove, IL

It’s disappointing when a staff member does not value an opportunity like this! However, without expectations set prior to the trip, I don’t know that it would be fair to not pay for something promised. Spelling out expectations and letting staff select classes that might interest them, or covering CE requirements if they are certified, would give staff the ability to decide if they could meet the doctor’s expectations. Additionally, it should have been noted that any missed classes/days/activities that are required (and most likely already paid for) would result in a reduction of any reimbursement or pay. Working together as a team to cover any aspects of the meeting the doctor needed information about would have benefited all. But the girls all missing the meeting Liz had asked them to attend at the end of the first day could have derailed plans for the following days and was blatantly disrespectful to Liz. Action might be considered in that respect. The staff acted irresponsibly.

Martha D.
Wheatfield, IN

I definitely think he should subtract some of the hours for the ones who didn’t attend their classes. They didn’t live up to their part of the bargain. If he does send anyone next time, I would draw up paperwork specifically letting them know what is expected of them and what is expected of the doctor and have everyone sign. That way, when they come back afterwards and the doctor goes over the conference with them, all parties will be held accountable. If I was the doctor, I would have been really upset with my staff; they were chosen to go and all they did was play around.

Dennis I.
Monroe, CT

The doctor should have laid out all expectations and consequences prior to the meeting. This way, if someone didn’t fulfill their duty, there would be no questions regarding consequences. The staff manager should not only have made sure the staff met for an appropriate meeting, but also allowed for free time. Because the doctor and manager did not lay out their expectations, the only consequence should be that the individuals do not qualify for another trip.

Rigo L.
Indio, CA

This is funny, and at the same time sad but true. The staff should be held accountable for this. There is no reason why the doctor has to pay/lose for their staff to party. The staff should be ashamed, but I understand how things got out of hand. I give props to the manager for not trying to babysit her staff. I would subtract their pay — they would understand why. They need to understand that this is not acceptable. If they get bonuses, I would consider skipping them or cutting them significantly. I would also consider a write-up as well. As for the following year, I would still send staff but not those same staff ever again. There is no room for immature staff.

What’s the Brain Squad?

If you’re the owner or top manager of a U.S. eyecare business serving the public, you’re invited to join the INVISION Brain Squad. By taking one five-minute quiz a month, you can get a free t-shirt, be featured prominently in this magazine, and make your voice heard on key issues affecting eyecare professionals. Good deal, right? Sign up here.

Natalie Taylor is an experienced optometry practice manager for Advanced Care Vision Network and a consultant with Taylor Vision. Learn more at tayloreye.com.

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Real Deal

This Myope’s Broke: How Would Your Office Handle Her?

Her illicit contact lenses trigger more problems than she bargained for.

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SATURDAYS WERE ALWAYS overbooked for Dr. Coakley, who owned a small private practice in a college town. His first patient of the day was ready in an exam chair when he walked in at 8:10 a.m.

ABOUT REAL DEAL

Real Deal scenarios are inspired by true stories but are changed to sharpen the dilemmas involved and should not be confused with real people or places. Responses are peer-sourced opinions and are not a substitute for professional legal advice. Please contact your attorney if you have any questions about an employee or customer situation in your own business.

ABOUT THE AUTHOR

NATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at info@meredithoptical.com

“Hi Stephanie, nice to meet you, I’m Dr. Coakley,” he said, perching on the stool. She was 20 years old and appeared to be in pain, cupping her left eye gingerly.

“Hi,” she said meekly. “I think I have pink eye or something.”

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Dr. Coakley gently pulled her hand away and saw a very swollen lid. “OK, let’s get started,” he said, pulling the slit lamp over her lap. During the exam he learned Stephanie’s last exam was 14 months ago in her home state. She had cracked a lens in her glasses six months ago, thought she was “about a minus 3” and ordered trendy contact lenses off a Facebook ad. Dr. Coakley noted corneal vascularization and pretty gnarly GPC.

“I am going to prescribe an eye drop. You can’t wear contact lenses until things clear up, and I would like you to come back in two weeks so we can do a complete exam,” Dr. Coakley explained. “I can do a proper contact lens fitting at that time.”

“Do you know what the price is for the drops?” Stephanie asked. “I’m a poor college kid,” she added, with an embarrassed chuckle.

“I don’t, but your insurance should cover a good portion,” he reassured. “I can’t imagine it being more than $20.”

Stephanie checked out at the front desk and called her mom for a credit card number for the $60 specialist co-pay.

Later that week Dr. Coakley’s staff obtained a faxed copy of Stephanie’s chart from her regular doctor. There was no indication of a contact lens fitting, nor mention of an online verification request, but the receptionist did mention a $340 outstanding balance.

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At her next appointment the technician pretested Stephanie and made note that she was still wearing a contact lens in her right eye.

The first thing Dr. Coakley did was evert her lids. “When was the last time you used the eye drops?” he asked.

“I didn’t end up going to the pharmacy,” she admitted sheepishly. “My roommate had some Visine — that’s definitely made my eyes feel better.”

“Unfortunately your eyes are still sick, so we need to reschedule again. I need you to go without contacts in both eyes for a while and use the drops. These contact lenses are not fitting you well and they frankly may not even be the right prescription, so I would recommend throwing them out as soon as you get home so we can start over.”

“I don’t get it,” she said, defensive. “I gave the contact lens company my other doctor’s info and they said they’d confirm everything. I got the contacts… so someone must have checked my records and approved it.”

“There was no indication the office was notified of your order,” he replied. “To be honest, that doesn’t surprise me. The internet is the Wild West.”

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She groaned. “My regular exam is covered by insurance but since we aren’t doing it today do I have to pay another $60?”  Dr. Coakley nodded. “Great. I shouldn’t have come back,” she muttered.

Dr. Coakley escorted Stephanie to check out, but at the front desk she had one more question.

“Now that you have my records from my old doctor, can you give me the glasses prescription she wrote?” she said, holding her broken glasses.

The Big Questions

  • Is there anything you would have done differently if you were Stephanie’s doctor in this case?
  • Have you ever dismissed a patient for not complying with a treatment plan? How about using contact lenses without a prescription?
  • Would you give a patient a faxed copy of an outside prescription? Why or why not?
Nancy C.
Cortland, NY

No, I would not provide a copy of another doctor’s Rx. I would instruct the patient that information needs to be provided by them. I would explain to the patient there was no CL Rx to verify or fill. The CL she is wearing was not prescribed and is equivalent to street drugs—a crapshoot. I would review proper procedures for exams, CL fitting and follow-ups, and have it in writing to have signed as understood. Then I would explain that I cannot provide services, nor will ever, as noncompliance and disregard has been the obvious choice of conduct. I would not be willing to accept responsibility for such a patient. I would provide a list of providers in the area, smile and wish her luck.

Angel M.
Cynthiana, KY

Stephanie’s previous office did nothing wrong; they faxed everything Dr. Coakley would need to start the fit. They definitely were in the right, alerting his office that she was a bad debt. Most noncompliant patients tend to dismiss themselves when they don’t like what the doctor tells them! Just make sure you document, document, document everything — and I mean everything. And giving a patient someone else’s faxed Rx, especially when they are a bad debt and have no history of contact lenses, etc., is beyond the pale of professional courtesy and could land Coakley’s office in hot water — considering she had never had a contact fit — if she re-orders sub-par contacts again and has permanent damage as a result. I’d tell noncompliant grifter Stephanie that she needs to call her doctor for a copy, and document, document, document. PS: Did I mention to document everything?

Nina C.
North Chesterfield, VA

I would not write a prescription from another doctor’s faxed record. I would charge her for a refraction so she has an updated glasses Rx, so she can discontinue contact lens wear and also for the specialist copayment.

Jenna S.
Fargo, ND

If she was a bunny hill skier who went down a black diamond slope and broke her leg, she wouldn’t think twice about paying for follow-ups and following the doctor’s instructions. The doctor needs to have a real serious talk and let her know what the long-term implications can be to her vision and her life. I would not release her Rx to her from another doctor — it wouldn’t be mine to release. She needs to talk to them about that. I would consider filling it in my office but she would need to pay for it before the order, since she has a history. I would have our opticians try to repair her frame, even if it is with superglue and tape, especially if it means she throws those contacts away before she ever leaves the office.

Martha D.
Wheatfield, IN

Unfortunately, we have run into this situation too often. When we do, the doctor will always try and advise the patient on the best course of action. If the patient is non-compliant then he’ll refer them to an ophthalmologist for further review. He will prescribe glasses to get them by until the eye is completely healed. The glasses would probably have to be changed a couple of times. The doctor would release a patient from his care if they were noncompliant. We did have a patient once who would sleep in his contacts all the time, get eye infections and end up in the emergency room. He quit coming to see us because we “nagged him” about his over-wear of contacts.

What’s the Brain Squad?

If you’re the owner or top manager of a U.S. eyecare business serving the public, you’re invited to join the INVISION Brain Squad. By taking one five-minute quiz a month, you can get a free t-shirt, be featured prominently in this magazine, and make your voice heard on key issues affecting eyecare professionals. Good deal, right? Sign up here.

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Real Deal

How Would You Handle This New OD’s Credentialing Crisis?

Her ethics are being tested on her first day on the job.

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LLOYD & ASSOCIATES was a successful private practice in North Dakota employing four optometrists and 20 staff. Earlier in the year, Dr. Lloyd had purchased a small two-lane practice in a rural town 45 minutes from his office; the previous owner was retiring but agreed to remain as an employee for six months. That deadline was quickly approaching, so Dr. Lloyd moved quickly to catch the wave of new optometry school grads.

ABOUT REAL DEAL

Real Deal scenarios are inspired by true stories but are changed to sharpen the dilemmas involved and should not be confused with real people or places. Responses are peer-sourced opinions and are not a substitute for professional legal advice. Please contact your attorney if you have any questions about an employee or customer situation in your own business.

ABOUT THE AUTHOR

NATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at info@meredithoptical.com

Three applicants visited for interviews, but student-doctor Dunne was the clear choice. After aggressively negotiating against competing offers, she signed a lucrative contract with Dr. Lloyd. Her final month of school was followed by a month backpacking in Europe; during this time the practice processed her state license and began booking her patients.

Dr. Dunne spent her first few days of work completing a mountain of paperwork, watching EHR webinars and observing the techs. That Thursday afternoon she sat down with Dr. Lloyd to discuss tomorrow’s protocol.

“Your first day seeing patients is going to be pretty busy!” said Dr. Lloyd enthusiastically, handing her a printout of the schedule. “This column over here indicates the insurance they have.”

Dr. Dunne scanned the page. “Okay, three Medicare, two cash-pay, a UnitedHealth, three VSP and one EyeMed,” she recited.

“Don’t click ‘sign-off’ on the chart in EHR,” instructed Dr. Lloyd. “The insurance team will do the rest of the work for you since we’re billing your charts under my name.”

“That’s legal?” asked Dr. Dunne.

“It’s what we’ve done for all the other associates,” he said. “Until you get credentialed, we’re forced to bill under my ID. I’ll try to look over some of your charts in the beginning, when I have time.”

“How long does credentialing take?” she asked.

“It can take several months, depending on the panel,” he replied.

Dr. Dunne rubbed her chin worriedly. “This doesn’t feel right. I mean… I could get in trouble!”

“What arrangement were you expecting?”

“Most of my friends are starting off as super-techs: the practice owner comes in at the end to confirm findings. Between patients, they learn about billing or work on projects,” she explained.

“I’d have to pay you a fraction of your base,” said Dr. Lloyd. “And I really don’t need a super-tech. I need a doctor who can work independently, as I said in your interview. I have too many patients of my own to check your work.”

“Can I see cash-pay patients for now, until I start getting approved?” suggested Dr. Dunne.

Dr. Lloyd shook his head. “Your schedule is built for the next three weeks, and I’d say only 5-10 percent are cash-pay. We need you to generate a certain amount each week to justify your pay.”

He started to clear the table, visibly frustrated. “I suggest you speak to the other associates for reassurance. I have a satellite location that will be without a doctor very soon.”

Instead of speaking to the other doctors, Dr. Dunne went home to call her best friend.

“He said the other docs did it, so that sounds reassuring,” her friend offered.

“If they want me to bend the rules on my first day, who’s to say there won’t be more sketchy compromises?” she replied.

The Big Questions

  • Obviously this discussion should have happened earlier; now both parties feel duped. Can you identify a compromise?
  • Is it fair for a practice owner to expect a new doctor to agree with pre-credentialing protocol without discussion/collaboration?
  • How should a new doctor identify and enforce her own ethical boundaries? Should it be a component of an employment contract?
Jonah H.
Sacramento, CA

Compromise is a state of life when dealing with third party payers. They should have told them that in optometry school.

Of course, this should have been part of the initial discussion so that the new associate could consider/investigate their comfort level with the arrangement. It also should have been written into the agreement that a “billing bridge” must be constructed towards full credentialing.

Here’s the compromise:

The new associate should get to work and kill it.

The owner should agree to block off one or two hours at the end of each week to sit with the new associate and review any cases he/she is uncertain about, and sign off on all charts—taking full responsibility for any errors.

Richard S.
Richmond, KY

In the case of a new graduate, the optometry school has missed something that they should counsel and help new graduates with. Since this is part of private practice, they should teach and help understand insurance companies and help them get credentialed.

Secondly, this is an insurance company issue. With so much technology available, why does it take so long to get credentialed? It is absurd!

Since no one seemed to care enough to deal with these issues, if I were the new doctor, I would not even consider balking at whatever was necessary to begin seeing patients immediately.

Although it should have been discussed earlier, because it is common practice at that particular office, I understand why the owner might have not thought about it.

John B.
Copperas Cove, TX

The super tech idea is the best until she is credentialed. Dr. Lloyd should find the time to look over each and every file and, better yet, he should participate in some concrete, hands-on way to justify the use of his ID for the insurance claims.

David E.
Little Rock, AR

I don’t know what is acceptable here, but am very interested in what other docs have to say. How likely is it that this arrangement would cause problems for either or both doctors? Is this a commonplace arrangement?

What’s the Brain Squad?

If you’re the owner or top manager of a U.S. eyecare business serving the public, you’re invited to join the INVISION Brain Squad. By taking one five-minute quiz a month, you can get a free t-shirt, be featured prominently in this magazine, and make your voice heard on key issues affecting eyecare professionals. Good deal, right? Sign up here.

Continue Reading

Real Deal

When This Doc Moved to a Concealed Carry State, She Didn’t Expect Staff to Be Packing

What would you say to an OD who balked at legal firearms in her office?

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DR. COLTAN, A recent NECO grad, was taking a risk. She and her husband, both avid hikers and snowboarders, had relocated from Rhode Island to Colorado to open a new solo practice. Over the last several months, between per diem shifts at local practices, she had worked to build her new office.

ABOUT REAL DEAL

Real Deal scenarios are inspired by true stories but are changed to sharpen the dilemmas involved and should not be confused with real people or places. Responses are peer-sourced opinions and are not a substitute for professional legal advice. Please contact your attorney if you have any questions about an employee or customer situation in your own business.

ABOUT THE AUTHOR

NATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at info@meredithoptical.com

Soon the time came to begin hiring employees, a task Dr. Coltan had been dreading. She had never even interviewed someone before, but within a few weeks she was able to secure employment contracts with Barbara, a receptionist/insurance biller, and Doug, an optometric assistant who had some optical knowledge.

Barbara and Doug helped Dr. Coltan a great deal with promoting the office leading up to the grand opening, as they had connections with many local businesses and community leaders.
On Dr. Coltan’s first day in business she was ecstatic about the seven exams her team had scheduled. The day flew by for everyone, and after locking the doors she invited Barbara and Doug to the break room for pizza and cake.

“Thank you so much for all your hard work today, and for pounding the pavement this last week!” she said, her eyes misting up.

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“You’re very welcome!” said Doug. Barbara, seeing Dr. Coltan’s emotional expression, reached out and gave her a big hug.

“Thanks Barbara,” she said, sniffling. As she dropped her arms she whacked her hand against something hard on Barbara’s hip. “Oh! Ouch,” she exclaimed. “Oops, are you okay?” asked Barbara.

“What was that?” Dr. Coltan wondered aloud.

Barbara swept her long cardigan back to show Dr. Coltan her sidearm. “I have a concealed carry license,” she said casually.

“Whoa!” Dr. Coltan’s heart skipped a few beats. She had never seen a handgun up close before, and instinctively backed out into the hallway. Doug and Barbara chuckled at her reaction, but Dr. Coltan felt her stomach turn in knots.

“It’s okay!” Barbara called out, “I’ve worn it for fifteen years. It’s an essential safety measure for the office.”

Dr. Coltan, still looking in from the hall, shook her head slowly. “It doesn’t make me feel safe,” she said quietly.

Doug and Barbara gave her a look of surprise. “There will be a lot of patients carrying,” Doug said. “This is Colorado. That’s just the way it is here.”

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The next day, Dr. Coltan found herself avoiding Barbara. She used the phone pager system rather than talking face-to-face and kept clear of the break room during the receptionist’s lunch break.

That evening, she brought up the issue with her husband.

“I don’t know if I can live like this,” Dr. Coltan sighed. “I feel hyper-focused on the hip or pocket of every person that walks in, wondering if they have a gun!”

“Can you put a sign in the window telling people they need to leave their guns in the car?” he asked.

“I mentioned this to Doug today, but he felt sure I’d lose patients,” she said. “I can’t believe I am on edge in my own office… I feel so blindsided by this.”

The Big Questions

  • Should this new business exclude a portion of the local population? How would you phrase signage at the front door?
  • Barbara is an asset to the practice, has done nothing illegal, and is not willing to stop carrying. How should Dr. Coltan proceed?
  • If you work in a state that allows it, how do you feel when interacting with patients who are carrying?
Darrell L.
Goodlettsville, TN

Interesting and thought-provoking Real Deal. The gun debate. A politically charged topic meets office management. I am a Tennessean, from the Nashville area, an optician/owner of a mom and pop optical shop and a believer in self-preservation. Through 40-plus years of dispensing, I have worked with numerous trainers and law enforcement, teaching them how to cope with presbyopia and the front sight. Yet, it is not just those who are paid to protect us, the general public has been coming to me for years who carry, some concealed and some open. At the age of 12, I was given the 12-gauge shotgun you would probably expect a Southern boy to get. I was also taught the proper use of the gun. If you don’t know how to use a tool, whether a lensometer, a hammer or a gun, then don’t pick it up. The doctor did a great job hiring. Barbara and Doug are working for the doctors’ best interest. “Avid hikers and snowboarders” and moving to Colorado implies they did visit before they moved. In Colorado it is legal to carry both concealed and open. Somewhere along the way they should have encountered locals who openly carried. Therefore she should not have been “blindsided” unless she had put on blinders. The first thing the doctor and her husband should do is take a handgun safety course to alleviate the fears they have. I’m not advocating that they buy a gun; they will be better educated after the course to make that decision themselves. They took a risk and moved to Colorado; I’d be more afraid of the bears. Partly, I feel sad that we live in a time that more of the populace feels the need to carry protection. Partly, knowing the person carries and has passed the course to own and carry making them one of the good guys, I feel relaxed. The gun is not the issue—that person needing my service is. But in the end, the doctor has every right to seek like-minded employees, have a pleasant office atmosphere and to decide who meets her criteria for patient base.

Joyce P.
Raleigh, NC

Usually those who have licenses to carry are doing it for protection, not to run out and start shooting the world up. We need to be more concerned about those who are carrying illegally, not legally.

Daniel M.
New York, NY

If you move to a state with open carry laws you have to accept that people will do just that.

Douglas C.
Beachwood, Ohio

Fear is derived, in this case, from ignorance. Dr. Colton needs to go to a range and take a class on gun safety and learn how to shoot. Doing so will allow her to gain an understanding of firearms and will make her more comfortable around them. When people conceal carry, you don’t know they have a gun … but are you safer around them or around someone who you know has one? There’s no difference. The doctor should have a gun policy for the office that states that people who are legally allowed to possess a firearm should be allowed to have it. Whether she likes it or not, it’s legal.

Brian C.
Prescott Valley, AZ

My office is in the Wild West of rural Arizona. Lots of people open and conceal carry weapons. I am not anti-gun. I grew up with weapons, so I was trained to properly care for and shoot pistols, rifles and shotguns. Took hunter’s safety classes as a teenager. I hunted elk, deer, duck, geese, doves for years. I own a shotgun currently. It is locked, unloaded, action open with a gun lock in the action, and the ammo is safely stored in a separate location. I put up a sign on my door that reads “No Firearms Allowed by Section 4-229” that AZ approved several years ago. I see them at the local VA I work in, at the local hospitals, and all the private practice MDs in my area. I am not an outlier on this issue. I did this because in the news at the time, somebody carried a concealed firearm into a business and dropped it causing a discharge (nobody got hurt). At the same time, I had a patient come in wearing TWO .45 ACP semiautomatic Colt pistols in holsters, open carry (Wyatt Earp style). He was wearing camouflage pants and black shirt with menacing writing on it. He revealed in his medical history that he had mental illness. This made my staff very nervous. In the lobby, I nicely asked him to leave his pistols in his car for the exam, showing him the 8×11 color sign on the door. I stated that in the 20 years my office was open that we never had a robbery or shooting or a need for a pistol. He huffed that I was “infringing on his second amendment rights.” I told him he could either leave the guns in the car for the exam or see another gun-friendly OD or MD down the street. He canceled, walked out the door and I haven’t seen him since. I frankly don’t care if I lose the business of people who feel (logically or illogically) that they need to carry a gun everywhere because they perceive a threat (real or unreal). My point is:

1. My office is my private property. I will do what makes me comfortable and safe. I will do what keeps my staff and patients comfortable and safe. I will control my office and what happens in it.
2. My office will be sued if a gun-toting person shoots or discharges a weapon that hurts anybody else. I need to limit my liability.
3. If you don’t feel your life is in immediate danger, then you don’t need a gun. If you feel your life is in immediate danger, and that you really need a gun, then you probably don’t need an eye examination right now.
4. Car accidents killed 11.9 people per 100,000 people in 2017. Guns killed 12.2 people per 100,000 people in 2017. I don’t let people drive cars in my office. I don’t let people have guns in my office either. Accidents killed 00.0 people per 100,000 in my office from 2002 to the present, and I intend to keep it that way.
5. This is not a political issue. It’s a common sense issue.

Sherri H.
Kansas City, MO

In states where conceal and carry are commonplace, to ask someone to leave their firearm in the car could indeed cause them to go someplace else. Dr. Colton feels very uncomfortable because she has not been around firearms. Maybe she should take a conceal carry class to get familiar with what conceal carry is all about. She might even feel empowered by the knowledge and know-how of handling a firearm. I personally feel more comfortable when I know someone is around with a conceal carry on them. She should also talk with other doctors in her area for their advice on this topic.

Angel M.
Cynthiana, KY

Pro- or anti-gun, that is an overly phobic reaction by Dr. Coltan to a trusted staff member. Maybe Coltan should seek counseling or move, because she can’t plant herself in a state that has a conceal carry culture, and demand that the patients and staff change for her. PS: Y’know, she has a gun right in her name…

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Tory M.
Dumas, TX

I would tell Dr. Coltan her fear is unreasonable and is because of unfamiliarity with firearms. Bad people conceal weapons all the time and you weren’t scared about that possibility? If not, you’re very naive. It was only after you were aware of it that it caused irrational fear. People are surprised if I mention I’m carrying concealed, because they can’t tell. Not the fact that I carry, but that they couldn’t tell. My advice is to ask the staff member to take you to the range and learn how to handle one safely and see what it’s like. It’s fun. And it’s freeing if you have a fear of firearms. Just like learning to drive a car, using a power tool, checking angles before dilating to prevent angle closure glaucoma, etc. If you are familiar, nothing to fear. You are going to have people ask you about prescriptions for using firearms; whether long rifles, shotguns or handguns. You might as well have a little knowledge about how they work to be a better expert too.

Brandy W.
Atlanta, GA

1.) You should absolutely NOT exclude concealed-carry patients from your practice.
2.) Dr. Coltan should expand her horizons, take a weapons safety course and learn. She clearly has zero experience whatsoever with weapons, and it seems she is making a judgment based on fear instead of education. I believe that she should respect her employees’ right to defend themselves, which is something she cannot do.
3.) I love to see patients carrying, or anyone for that matter — it makes me feel safer. I also conceal carry and rarely go anywhere without the means to defend myself. Many criminals carry weapons — we know this. I want to be able to level the playing field.

Julie U.
Jupiter, FL

I think the doctor should accept her employee with her weapon … she did before she found out. It is really great for the staff. Heaven forbid if someone came in with a weapon. At least they are protected. I carry in my business too and when customers find out we tend to talk about it in a positive way. The world is a different place, sadly, then it was years ago. I say CARRY on.

Dr. Craig F.
Rushville, IN

I have no problem with someone legally carrying a concealed weapon. This doctor should roll with the punches and learn to live with it. When she goes to the grocery store, or shopping at retail locations, she will be walking by other people that are carrying concealed weapons. Maybe she should take a gun safety class so she can understand the benefits and risks of carrying vs. not carrying a weapon.

Dennis M.
Cedar Park, TX

I’ve been a concealed carrier for over a decade and I suggest getting more educated on self-defense. Those of us with LTC are good people that have had EXTENSIVE background checks. Yes, it’s a way of life for a big portion of our country and is growing larger every day. I would suggest taking self-defense/beginner shooting classes and get to know the community. I’ve taken many first-time shooters to the range and seen their faces brighten dramatically. You don’t have to own a firearm, just be familiar with them. They’re not bad at all if you respect them and be responsible.

John L.
Nashville, IN

Ultimately, the decision of whether a staff member carries a firearm while at work lies solely with the practice owner. There may be serious legal or insurance issues that the doctor may want to discuss with her lawyer. Hoplophobia is a real problem with some people and the decision to relocate to a less conservative area may be necessary. Shooters, particularly presbyopic ones, have special visual needs, something that may help build a new practice.

Dennis I.
Monroe, CT

Dr. Coltan needs to grow up and be more tolerant. In fact, I think she needs to spend a little time at the gun range getting trained in the use of firearms. Who knows; maybe she’ll like it? Fear of guns is irrational. More people die at the hands of a drunk driver than the wrong end of a gun. She is not afraid of cars or beer, is she? Yes, this hit a nerve with me; as I have lost very young patients to gun violence (Sandy Hook). Guns don’t kill people. People kill people. Learn to handle the (whatever object causing fear) and fear goes away.

D Bailey
Huntsville, AL

We all have certain rights that we can choose to exert or not. I have a license to drive a car, but my boss won’t let me park in the spaces saved for our patients. I can buy alcohol, but the doc won’t let me drink at work. We have policies covering these issues. If I don’t agree with the polices, I can always find another job. The owners should set their policies to reflect the type of business/environment that makes them comfortable. As an employee or as a patient, all that is important is that the doctor is providing exemplary service. If so, they will have many people wanting to work and see them, regardless of whether they allow dogs, alcohol, legal marijuana, and yes, even guns on their property.

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