Working at a Costco Independent Practice as a New Grad Optometrist

Have you been considering working as an associate optometrist inside your local Costco? Practicing in a Costco retail setting can facilitate the career path of a new graduate who is exploring various practice settings, especially if you are unsure which setting would be the best fit for you.

If you are interested in eventually subleasing a Costco space, associating first can provide you with hands-on experience and help you establish a network of local doctors in the retail space. Filling in per diem for supplemental income can also be a great option depending on how much flexibility your location offers.

I would highly recommend consideration of the Costco setting for new graduates as this is a prime setting to understand the potential of retail optometry. It is typically a fast-paced environment, which will afford you opportunities to hone in on your ability to think critically in a timely manner, perform efficient eye examinations, and solidify your problem-solving skills. A Costco practice that is highly focused on contact lenses will allow you to very quickly build your skills in fitting a large range of patients, from simple myopes to modified multifocals in highly hyperopic astigmats.

There are opportunities to build relationships with other optometrists in your local area as you may find yourself referring patients with disease states, such as glaucoma, that require ancillary testing. Co-management with ophthalmology for refractive surgical cases and other healthcare providers is also likely. It is also a great opportunity to work per diem, filling in a couple of times a month for supplementary income. Be prepared to practice full-scope optometry and build successful relationships with your patients!

Costco Optical operates separately from the independent optometrist who subleases a space inside Costco for their private practice. The independent OD subleases space from Costco, but the patients do not have to be Costco members to be seen by the optometrist. Therefore, as an associate, you will have to approach the subleasing optometrist when in search of a position, rather than the retail center of Costco.

To search for openings:

If your location of choice is not hiring, ask the optometrist to reach out to the Costco network of subleasing optometrists on your behalf, or ask for a contact email. This way, other hiring doctors are aware of your availability.

The scope of the practice is typically determined by the subleasing optometrist and is likely to be discussed during your onboarding. If you are uncomfortable with a certain population (such as pediatric exams) or certain skills (such as RGP fittings), be honest and candid about your experience so the schedule can be adjusted accordingly.

Once hired, you will be asked whether you are credentialed with any major vision insurance carriers your location accepts. You may be asked to apply as a provider, or the office manager or hiring doctor may complete this process on your behalf. Be prepared with proof of your optometric license, NPI, DEA if you have one, and malpractice insurance information. You can expect to be asked to come in for “training,” which may entail EMR, flow and observation with your hiring doctor. Now you are ready to see patients independently!

Depending on how large the office is, there may be up to 2 exam rooms that accommodate double-doctor days. This is an indication that the office is busy and fast-paced. Typically, you can expect patients scheduled every 15-20 minutes. Needless to say, you will be very busy. A technician/front desk check-in may perform ancillary testing for you such as auto-refraction, auto-keratometry, Optos or fundus photos and PDT visual fields before the patient enters your exam room. Then the patient will see you for an exam, presenting with a range of complaints, such as flashes requiring dilation to RGP fittings. Contact lens insertion and removal training is usually performed by a technician as you prepare to see the next patient. Patients will be given their eyeglass/contact lens prescription and move on to make their purchases from Costco Optical. Be prepared to accept walk-ins, which can vary from comprehensive eye exams to complex multifocal soft contact lens fittings.

Consider the fast-paced environment when negotiating your compensation. Expect a schedule filled with walk-ins, comprehensive exams, and complex contact lens fittings every 15-20 minutes. Ask the hiring optometrist how many patients are seen on average on the days you will be working (weekdays will differ from weekends) and whether there are opportunities for bonuses based on productivity. Keep in mind that since the independent optometrist is not associated with the Costco Optical, that bonus productivity will typically be based on the number of patients seen or ancillary testing performed, i.e., Optos, rather than optical sales.

Scope of practice is similar to any other retail setting and is determined by the independent, subleasing optometrist. Optometrists may choose which ancillary testing to perform and charge for in the office, ranging from auto-refraction to Optos. Patients may present with medical complaints such as red eye, contact lens-related keratitis, retinal detachment, and RGP fittings. The weekends may draw in more medical complaints when urgent care centers and traditional ophthalmic private practices are closed. Refractive co-management for LASIK and premium cataract surgery is absolutely possible in this setting as well as co-management with primary care physicians and other healthcare providers for diabetic eye examinations. Optometrists may choose to implement primary care pediatric management such as the treatment of amblyopia and myopia management. A common misconception is that primary care and medical management might not be possible in such a fast-paced environment inside a large retail center. In reality, the subleasing optometrist can choose the scope of practice based on demand and insurance and each practice will vary in scope.

The Costco retail setting has much to offer in terms of developing your optometric skills and building a strong network of colleagues. It affords flexibility in your schedule, and even if you are unsure of which setting you’d like to practice in, it’s an opportunity to “get your feet wet.” I would encourage any new graduate to consider the possibilities of practicing inside Costco.