OT? Cataract surgery assembly line

Investment Analysis Clubs Macro Economic Trends and Risks
1

My cataract surgery yesterday went smoothly. Although my left eye vision is blurry I can see the color BLUE more brightly now while the right eye sees blue as a duller color since the yellowed cataract veils it like old varnish.

The Northwest Eye Surgeons business is owned by Sight Partners Physicians, P.C., a Washington State professional service corporation. It operates 7 facilities in the Seattle area.

The practice is an assembly line. Each specific job is done by a separate person - receptionist, check-in, payment for eye drops, walk to the blood pressure chair, take blood pressure, place I.V. line for anesthesia, help onto a gurney, wheel the gurney into the operating room, place tape on head, operate, recover, wheel to waiting room to meet ride home.

Each person does her own job and nothing else. It’s incredibly efficient. The only male I met was the surgeon (for under 5 minutes when I asked him if I can do yoga during recovery – nope!).

Today I will return to have a post-op inspection of the eye. This doctor will not be the surgeon. The surgeon only operates, again and again, all day every day.

At the pre-op meeting a month ago, there was a woman whose entire job was to convince me to request modern multi-focal lenses which aren’t covered by Medicare but cost $6,000 per set. I have “prism” (eye muscles don’t match) so I would need glasses anyway so I ordered plain vanilla lenses which are covered by Medicare.

Studies have shown that surgeons who perform the same procedure repeatedly have better results than surgeons who perform many types of procedure. That’s why I went to the cardiac center in Swedish Hospital. I find the assembly line reassuring.

They tried to pressure me into having the second eye done today at the same appointment as my first-eye followup. That would make sense from the standpoint of efficiency if I had to travel a long distance. But I live only 5 minutes from the NW Eye Surgeons practice in Sequim. I want a good eye so I chose to have the second eye done next Wednesday right after the 1-week followup for my first eye.

Medical practices have come a long way since a doctor or surgeon would open their own office and provide every business and medical service from soup to nuts. The current assembly line business model is less stressful for the surgeon and is a way to mint money.

This may be on-topic for METAR because this business model is often taken over by private equity which borrows from the shadow banking system. These medium-size businesses could be vulnerable to a debt crisis in the shadow banking system as we discussed a few days ago.

Wendy

13 Likes
2

We have the same thing for the larger practice where my parents were going, and I go for eye care, but it is NOT every day for the surgeons. The 12 ophthalmologists switch off on which days they perform surgery and see patients for routine care in the office on other days.

The failure of the doctors’ offices would be welcome. The doctors would set up within days elsewhere as their own bosses. As employees they would not owe a dime to the bloodsuckers. The doctors pennies on the dollar might buy out the bloodletters.

My Dad as a younger man played hardball early on without a glove, cricket.

There is a common misnomer on this board. Doctors do not assume themselves faithful obedient employees. With their skills they go anywhere and do what they want. Good luck telling them anything. Yes in your job experience you did what you were told. Find a doctor like that, you can’t. Only the state standards of care decides anything.

2 Likes
3

The follow-up probably does not require an MD. They are watching to see that implant is in correct position and no signs of infection. A nurse practitioner can do that. MD needed if there is a problem. Division of labor like this helps keep medical treatments affordable.

1 Like
4

Nurse Practitioners won’t like this, but to hell with that. See the Ophthalmologist.

I am not sure an Ophthalmologist’s office has an NP.

5

Actually, the follow-up was done by an M.D. A “woman of a certain age” who told me that she had volunteered in Ukraine over her Christmas vacation and used tampons to seal the bullet holes in wounded soldiers.

The surgeon is a retired Army colonel who graduated from West Point and worked in Walter Reed Hospital.

I wonder how these folks ended up in quiet Sequim?

Anyway, I feel confident in their ability. My eye is recovering well. I was able to drive and read today.

Wendy

8 Likes
6

That would be a difficult task, I thought.

But then I realized that the alternative is leaving the bullet holes unsealed.

7

My wife had double cataract surgery last year, each eye separated by something like 2-3 weeks for balance & recovery. This particular technology is nothing short of astounding to me. Slice the side of the eye open, pull out the old lens, swap in a brand new model, a few light disappearing stitches and 48 hours later voila, 20-20 or better vision. UN real.

7 Likes
9

Dr. Glaucomfleckens has his loyal scribe do everything but the surgery.

intercst

10

My ophthalmologist is like that too. He does give me his personal attention but after his assistant has done the preliminaries. Seems efficient and works for me.

11

I’ve noticed that the magic words on an ophthalmology chart are “performed by an assistant trained by me”. That allows you to bill the assistant at the doctor’s hourly rate.

Before I was on Obamacare, I had my eye exams done by the Optometrist at Walmart where she did a full exam and visual field test to check for glaucoma for $100. I had her full attention for 45 minutes or so.

Once I got on Obamacare, I figured I’d go to an ophthalmologist, just to make that sure the optometrist didn’t miss anything. The first 45 minutes of the exam was a repeat of testing done by the optometrist, except it all was performed by a young lady who appeared to be a high school intern. Once all the testing was done, the doctor came in and looked at me for 3 or 4 minutes and said I was fine. They billed about $1,000 for the exam and my Obamacare insurer reimbursed him about $650.

US Heaith Care is a scam.

intercst

3 Likes
12

The medical field has many trained specialists. Often they are certified after training. Your “intern” might be one of these. They are highly skilled professionals. Your optometrist might be one of those too. Sometimes licensed by the state. Often they cannot be hired unless certified. And some are trained for certification on the job.

People seeking careers should be aware of these opportunities. Some are trained in junior colleges or other specialty schools. Often less than a 4 yr college degree. Sometimes an associate degree.

1 Like
13

That’s right. And there’s not much that the surgeon has to do. The machine is doing most of it.

If you had cataract surgery done 50 years ago, there was probably only one surgeon in town you’d trust to do it. And the operation typically required a week in the hospital with your head between two sandbags to keep you still enough to heal properly. Cataract surgery was a big deal – and the Medicare reimbursements for the procedure reflected that.

The fact that doctor’s are advertising the procedure on TV and sending “free buses” to nursing homes to pickup the patients tells me that Medicare hasn’t changed the reimbursements to reflect the much smaller time required with today’s technology.

intercst

4 Likes
14

{{ No, an ophthalmology assistant is generally not required to be licensed or certified by state or federal regulations to work in the United States. However, employers strongly prefer or require professional certification—most commonly the Certified Ophthalmic Assistant (COA) designation—through the International Joint Commission on Allied Health Personnel in Ophthalmology (IJCAHPO) is generally not required to be licensed or certified by state or federal regulations to work in the United States. However, employers strongly prefer or require professional certification—most commonly the Certified Ophthalmic Assistant (COA) designation—through the International Joint Commission on Allied Health Personnel in Ophthalmology (IJCAHPO) }}

Without a law to require certification and a training regime that limits the number of graduates, an ophthalmology assistant doesn’t have much leverage on compensation.

Anesthesiology assistants are licensed in about 25 states and can make $250,000/yr. I believe JLC has complained that they are allowed to do about 80% of a real doctor’s scope of work..

{{ As of late 2025/early 2026, Certified Anesthesiologist Assistants (CAAs) are authorized to practice in 24 jurisdictions (22 states, D.C., and Guam), with significant growth in the Southeast, Midwest, and Mountain regions. While the profession did start with a heavy concentration in the South (Georgia, Florida, Alabama), it has expanded to include states across the country.

intercst

3 Likes