Maintaining Mental Health as a Private Optometry Practice Owner

The World Health Organization defines mental health as a “basic human right.” Rather than an absence of disorders, mental health is defined on a complex continuum, shaping one’s ability to process and cope with distress, make decisions, and contribute to community.¹

Concerns surrounding public mental health are growing, and there has been a growing focus on mental health since the COVID-19 pandemic. The United States Surgeon General released an Advisory to raise awareness around public mental health to reduce the risks of depression, anxiety, social isolation, and loneliness.²

Even before the COVID-19 pandemic, 1 in 2 Americans reported measurable rates of loneliness and social disconnection.²

Declining mental health amongst physicians

Mental health affects everyone on a social, personal, structural, and professional level, including physicians in a variety of healthcare settings. Declining mental health and physician burnout are intimately related. Physician burnout is defined as “a state of emotional, physical, and mental exhaustion caused by prolonged stress in the workplace.”

Physicians who report burnout are more likely to have higher absenteeism, make more medical errors, and result in lower patient satisfaction scores, resulting in an overall lower quality of patient care, higher emotional exhaustion, and depersonalization of care.³

It is worth noting that 63% of physicians reported at least one manifestation of physician burnout in 2021, specifically emotional exhaustion and depersonalization, and ~50% of those physicians were in a private practice setting.⁴

Some of the causes of physician burnout include:³

Poor work-life balance
Increased workload
Lack of autonomy
Insurance company authorizations and regulations

The challenges of private practice

Most of the literature published on physician burnout focuses on large, hospital-based settings. But is opening a private practice the answer to resolving physician and/or optometrist burnout?

Not necessarily.

What do studies say about mental health for private practice optometrists?

Given the additional entrepreneurial and administrative responsibilities required to manage a practice, there is no doubt that managing a private practice as a medical professional and entrepreneur can also lead to a decline in mental well-being.

A small study reported that most entrepreneurs and small business owners are actually not stressed about the long hours required to maintain their business; rather, they are concerned about doing it alone and isolating themselves from their family members.⁵

It is then not surprising that struggles with mental health can lead to a reduced ability to solve problems and create and make decisions related to managing a business, especially as a business and private practice owner.

After a careful literature search of the mental health and well-being of entrepreneurial optometrists in private practice, the results are slim, highlighting the need for more private practice owners to come forward with their stories of mental health struggles and how they are addressing them.

One poll on social media showed that out of 700 optometrists in various settings, 77% reported physician burnout. The AOA’s Ethics Forum features recommendations from 2000 on how to recognize optometric physician burnout and the ethical obligation to address mental health concerns to deliver the best care to our patients.^6,7

We, as a profession, need to continue this conversation and publish updated data.

Improving organizational issues with cognitive reframing

Given that 80% of stress in the workplace is organizational,⁶ how do we address adjusting our mindset in the given work environments? One technique involves cognitive re-framing—turning problems into opportunities for growth and change.⁸ This technique teaches one to ask the question, “How can I look at this a different way?”

For private practice owners, reframing negative thoughts by seeing the opportunity in the struggle to create a solution can look like the following:

Struggle: I have too many patients today.
Solution: Set your own patient care schedule and manage patient workflow.

Struggle: Vision plan reimbursements are too low.
Solution: Choose which insurance plans to accept.

Struggle: I don’t have enough time to see patients and manage the practice on the same day.
Solution: Dedicate time for administrative tasks that are separate from patient care. Or delegate time for your staff to perform these administrative tasks. Use task lists and calendars to help organize these items.

Struggle: I cannot practice medical optometry because I am stuck with time-consuming, low-reimbursing comprehensive eye exams.
Solution: Freedom to make financial decisions that ultimately improve the profit of the practice, i.e., drop a VCP plan and schedule “medical only” time slots in the schedule.

Struggle: I don’t have time for insurance prior authorizations (PAs).
Solution: Delegate tasks to staff or enlist the help of your industry rep to train your staff on your behalf.

Battle social isolation and join a buying/alliance group

The US Chamber of Commerce reported that being an entrepreneur can be socially isolating and perpetuate heightened stress, feelings of burnout, and loss of motivation.⁹

Having a group of like-minded private practice owners can help a private practice owner identify and navigate resources in practice management, encourage open discussions about finances for new and seasoned practice owners, and advise in decision-making. In addition, having a support group may also assist in alleviating feelings of social isolation.

Social media: Use it purposefully

Social media can be helpful in so many ways: networking, industry opportunities, connecting with like-minded practitioners, or simply gaining education from colleagues. However, it is no secret that social media can be toxic and lead to a decline in mental health.

Oftentimes, selective content creates the notion of toxic positivity, meaning that only positive aspects of one’s life and/or practice are displayed. Put another way, we like to only advertise and celebrate our successes, creating a cognitive distortion—or the impression that our lives are only successful and happy. Few accounts really highlight the negatives of their lives/private practice.

My advice as a private practice owner who uses social media for marketing is to stick to marketing and/or medical education. Try to avoid the personal validation one tends to chase with “likes” and “shares;” rather, focus on your own goals of gaining patients from your posts. Social media is not a competition, although it can feel that way at times.

Consider a direct care model

Alternatively, we can challenge and change the workplace environment rather than simply adapting. Many private practices have been successful in implementing a direct care, insurance-free, cash-pay-only model. Medicare reimbursements have been reduced by 18% for some procedures in 2024, and these numbers are only trending downward every year.

As a result, practice owners are forced to see more patients to maintain similar margins as previous years, leading to less time spent with patients, less quality patient care, lower patient satisfaction, and overall higher rates of burnout. Direct, cash-pay models have been successful as optometrists are leaning more on cash-pay procedures for specialized services such as myopia control and aesthetics.

Final thoughts

The overarching themes in facilitating mental health as a private practice owner lie in re-framing and taking control over factors that contribute to declining mental health and increasing feelings of isolation.

Private practice ownership should provide agency and freedom to make decisions that lead to a healthier and more successful mental well-being.