Photos: Todd A Rassmussen/Frepose Photography

I know Im in the minority when I tell other O.D.s that I like working at Wal-Mart.

Im not crazy. Hear me out.

Previous articles in Review of Optometry have focused on optometrists who were in corporate optometry but yearned for private practice (see How I Quit Corporate and Started Cold, February 2007.) I have nothing against private practice. Im merely suggesting that optometry students and practitioners should question whether solo private practice is the best and only option for them.

In other words, choose whats right for you. For me, for now, thats inside the largest retailer in the world.


My Story

I didnt start my career at Wal-Mart. I wanted a solo private practice, too. I left a comfortable career in the U.S. Public Health Service to pursue my dream of solo private practice optometry in Utah.

I firmly believe you should work where you want to live. I hired a practice consultant who told me that the place in which I wanted to live and work wasnt ideal, plus Utah has very low per capita health-care spending. He gave me a whole bunch of advice, and somehow I still came away thinking, If I build it, they will come.

Well, I built it, but they didnt come.

I ran out of money less than a year later. My bank wouldnt expand my line of credit, and my financing company wouldnt let me have anymore working capitol.

Thankfully, a Wal-Mart job opportunity came along. I figured I would work there until I could get my private practice in the black. Once I started, I worked six days a weektwo at my office and four at Wal-Mart. With the income at Wal-Mart, I could indefinitely bail out my losses at my private practice. My plan was that I could build up a patient base at Wal-Mart, and maybe those patients would later follow me to my private practice when I quit Wal-Mart.

So, while my private practice was able to keep its doors open thanks to my second job at Wal-Mart, I soon asked myself, Do I want to keep the doors open? Sooner or later I would have to make a choice. There was only one of me, but two practices to grow.

I calculated that I could close my practice, add another day at Wal-Mart (and now only have to work five days a week), and still pay off my debts, so I did.


My Face Registers with Customers

People actually like the experience at Wal-Mart. Thats why they go there.
I arranged with my store manager to put a business card with my photo and at every cash register. Immediately, I was recognized around town and in church as the Wal-Mart doctor. (True story: I was shopping at a different grocery store, and a little girl Ive never seen before pointed her finger at me and said, Thats the eye doctor at Wal-Mart!)

For my private practice, I did very expensive external advertising in the newspaper, on the radio and even in movie theatres. But, it was nothing compared to the effectiveness of half a countys population visiting the local Wal-Mart each week and seeing my face at the registers. The cost of that was next to free. If you want to help people maintain healthy vision, Wal-Mart could be a good fit for you.

The Advantages

So, why did I choose Wal-Mart?

Its still private practice. First of all, realize that Wal-Mart practice is not like all corporate practices. I really am just a doctor in private practicenot a Wal-Mart employeebut my location happens to be inside the biggest retail store in the world. Like any practice, I pay rent. A typical contract is for three years and 20% gross fee income, but that can be negotiated to 10% for certain locations when you do your own prescreening. Typically, youre required to accept a select set of vision plans and work at least two days of late hours, and the number of weekly hours is negotiable, depending on the location. I have a four-day lease, but I have heard of seven-day leases. Many complain that Wal-Mart doctors fees are too low. (See Lets Talk Numbers, above.) I set mine keeping in mind my local market and the rate that the set of vision plans reimburse. When my volume gets too high, I can raise my fees.

Low overhead. I dont collect any money from glasses sales, but I never liked dealing with optician work anyway. Besides, I dont miss it because I do collect cash from exams and my overhead is very cheap. In private practice, my overhead was over 100%; I was always in the red and never got to pay myself. Now its between 10% and 20%. In one-door states, they collect the money for you and write a check at the end of the day, so I dont even have to lose money on a credit card transaction. (Two-door states have laws that forbid patients from entering the doctors office from the optical, so they have to go around and outside to enter the doctors office front door. That means you have your own office area with your own telephone and credit card machine.)

Staff issues. I can hire my own staff or, in my one-door state, I can pay additional rent to have a vision center associate do work, like prescreening, for me. Ive had really good luck with the vision center staff in my location and in the three other locations where Ive filled in. But, if you want more control over the back office staff, negotiate the lower percentage lease and hire your own.

High foot traffic. My private practice struggled to get people in the door. Wal-Mart practice gave me patients from day one. I cant remember my private practice having walk-in patients. At Wal-Mart, it is an unusual day to not have walk-ins.

Pharmacy consultation. When I was in the Indian Health Service, I loved going to the pharmacy to chat, eat their food and listen to their music. It was a party. Unfortunately, Im too busy to do that with the Wal-Mart pharmacists, but still its been easy for me to keep up on the prices of eye drops. The answer is typically $4.00, by the way.

Good business in bad times. Another advantage about having a practice inside Wal-Mart is that you are almost recession-proof. When times get tough, more people end up in Wal-Mart because it helps people save money. When times get better, you still have people spending money inside the largest retail organization in the world. And guess what? Because I collect fees at the time of service and because I only deal with insurance plans that I understand and pay promptly, my accounts receivable is very low.

Fewer business headaches. Not having to run a business that I was never trained for, an optical, has been a big stress reliever. Im also not worried about the patient spending too much on eyewear. Wal-Marts lens coatings have come a long way since the old days. These babies dont flake, and their price point is almost half of the typical private practice. I dont feel guilty anymore because I know they are still getting the quality eyewear they need, but now it is at a price they can afford.

Organizational support. Wal-Mart has its own national doctor meetings, now called the Health and Wellness Meeting. Once a year, we get to meet in a convention with all the other Wal-Mart and Sams Club doctors in a nice place. Hotel and airfare are paid by Wal-Mart and optical industry sponsors. (You didnt think vision vendors only look out for private practice doctors, did you?) That meeting, combined with, helps doctors network to discuss best practices for clinical care and practice management. With the support of the national Wal-Mart leadership, your district manager and your vision center manager, you are never alone in growing your Wal-Mart practice.


Lets Talk Numbers

I wont reveal my personal numbers, but let me repeat what the Optometric Business Academys 2008 edition of Key Metrics of Optometric Practice at Wal-Mart and Sams Club says:

Profile of the Typical Wal-Mart-Affiliated Practice

Weekly hours of operation (median):           44

Annual eye exams (median):                      2,600

Annual medical office visits (median):          302

Annual gross fee income (median):             $167,473

Annual medical fee income (median):          $12,720

Fee income per exam (median):                 $60

Fee income per O.D. hour (median):           $72

Annual contact lens exams (median):         1,144

Walk-in % of total exams (average):            24%

Annual marketing investment (average):      $2,395

Annual marketing investment (median):       $1,100

The Caveats

Sure, there are things to look out for when considering joining Wal-Mart.

Location. If the proposed Wal-Mart location shares a parking lot with Sams Club and Costco, you might keep looking.

Management. Another thing to consider is your relationship with the stores vision center manager and store manager. If you sense that you could get along with them, then youll probably do great. If you cant, keep looking. Then again, even a good manager could leave tomorrow. Since you dont have any control over who the manager is, all you can control is your own people skills and positive attitude.

Contract. There have been reports of job insecurity in corporate practicedoctors not having their lease renewed for no apparent reason. From what Ive seen, there would never be a reason for Wal-Mart not to renew a lease if you dont violate the contract. Walmartod.coms forum chronicles the case of an optometrist who was going to lose his contract, but he appealed to the higher-ups and, luckily, they saw it his way. I think it helps to communicate with your vision center manager and district manager. You need to find out what their goals are. If they always make their goals, they should always be happy with you. But hey, thats another advantage. You dont have to be tied down if you dont want! Someday, if a good Wal-Mart location opens up in a nice tropical area, whos to stop me from applying for it?

Staff. Theoretically, you could be unhappy with the vision center staff. Our last Wal-Mart national meeting had a great class on having powerful presentations and interpersonal communication skills to achieve a better relationship with the staff. Be nice, and what goes around, comes around.

Clinical care.
If you did a residency in ocular disease, you should probably be working in a tertiary care facility. If you want to help people maintain healthy vision, then Wal-Mart is a good fit for you. In my Wal-Mart setting, I have done bifocal, keratoconus and ortho-K GP fits in addition to the countless spherical, toric and multifocal soft lens fits. I typically see one or two medical visits each day (red eyes, eye pain or foreign body). I only follow a couple glaucoma cases because I dont take a lot of medical plansso when I see it, I refer to a doctor in the area who is on the patients insurance panel. But, Im not slacking. I bought my own pachymeter, Heidelberg Retina Tomograph and Humphrey Matrix perimeter to facilitate early diagnosis. (Wal-Mart has deals with many vendors to get you a discount on special testing equipment.) Every Wal-Mart meeting has classes on how to jump on that medical eye-care bandwagon, so it is clearly something they encourage.

Clientele. Do you think Wal-Mart shoppers are undesirable? Sure, you could play Wal-Mart bingo to spot the guy with a mullet or the girl with the tattoo, but if youre a snob, then you probably dont belong here. These are my kind of people. I shop at Wal-Mart too, and almost every other day my wife calls to ask me to pick up various items before coming home.


Getting Started

To start hot in your Wal-Mart location, you need to let people know that youre there. Advertising inside your Wal-Mart store is very effectiveand very inexpensive. No need for radio ads, just accomplish it cheaply with in-store advertising and signage. If allowed by your store manager and state board, put a little card with your picture and information at every register in the store.

Your vision center manager will probably want to host an event celebrating your arrival with free cake and soda for store customers. You should also attend a few store meetings (optional for you) to get introduced to everybody in the Wal-Mart family. Consider enticing store associates to get an eye exam from you by giving them a 10% discount. Then, when someone asks them about the new doctor, they can tell them from personal experience what a wonderful, thorough exam they had with you.

These kinds of ideas also can be found at or to help you make the most of your private practice that, fortunately, is located inside the biggest retail location in the world.


In writing this article, I realize that Im opening myself up to have lemon juice squirted in my eye by some of you. Im not saying that working for Wal-Mart is right for every optometrist. But, by the same token, solo private practice is not meant for everyone either. Im merely suggesting that working at a location such as Wal-Mart is a good fit for some of us, and whats wrong with that?

Before starting his private practice and working at Wal-Mart in North Logan, Utah, Dr. Langford worked for two years with the Indian Health Service. 

Vol. No: 146:03Issue: 3/15/2009