Optometrist Daryan Angle's Waterloo, Ont., vision care centre, Iris, had just opened for business in 2007 when it hit a major roadblock.
The College of Optometrists of Ontario, with whom Dr. Angel believed he had established a good rapport, suddenly challenged Iris's Ontario expansion on the grounds that optometrists and opticians were required to operate independently, not under the same roof, as they did at Iris's vision centres.
With his professional licence and Iris's growth plans on the line, Dr. Angle turned to the lawyers who had worked through similar objections posed by B.C. regulators during Iris's 2000 expansion into that province. To overcome those objections, the company had prepared a challenge in B.C.'s highest court arguing that optometrists' rights of association were being hampered by regulators. The province sided with Iris and the regulations were amended.
“We were pretty confident, based on … the precedent from British Columbia, but it was something we had to overcome,” Dr. Angle said.
In May, 2008, with Iris's threat of a constitutional challenge again on the table, the Ontario college suggested a compromise: Iris could operate in the province so long as the Charter of Rights challenge was dropped and Iris's executives agreed to work on new regulations with the college.
Four more Ontario stores opened in the past year and there are plans for another 20 by the end of 2010. Within five years, Iris aims to open as many as 150 in Ontario.
Dr. Daryan Angle joined us to discuss his company's breakthrough. Your questions and Dr. Angle's responses appear below.
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Dianne Nice: Hi Daryan, thank you for joining us today to talk about Iris and its expansion into Ontario. You are both an optometrist and a small business owner. Did you have a business background before opening your store? If not, has it been difficult to make that leap?
Dr. Daryan Angle: Hi Dianne. It's my pleasure to be here to answer any questions.
I come from a purely science background, but my desire to learn about the business side of eye care led me to work in a number of diverse practice modalities following my graduation from Optometry school in 2001.
In 2002, I met Dr. Francis Jean in Vancouver and began practising in the Iris environment. I found that the IRIS model not only allowed me to provide a high standard of care for my patients but also supported my growth in knowledge regarding business.
I partnered in two Iris locations in Burnaby, B.C., in 2003 and the experience I gained in these successful partnerships helped me contribute to the company as a whole. In 2006, I relocated to Waterloo with the intention of practising in the model in which I felt the most comfortable. As an optometrist, I believe the Iris model provides the highest standard of care and as a business owner it has the security of proven success.
Perry Brodkin from Toronto writes: Would you not agree that you are contravening the currently existing law in Ontario and that the only reason why the College of Optometrists of Ontario allows you to contravene the law is that the College does not have the resources to litigate in the courts? And would you not agree that you have not re-invented the wheel in Ontario in that your scheme has been used for several years by hearing aid dispensaries in Ontario?
Dr. Daryan Angle: When a regulation violates the Canadian Charter of Rights and Freedoms (such as Freedom of Association) it is 'ultra vires,' meaning that it cannot be valid as it is superceded by the overarching Charter law. This has been proven by a 1998 B.C. Supreme Court ruling, Costco v. The British Columbia Board of Examiners in Optometry, which ruled that any restriction on association between an optometrist and an optician violates the Charter.
The college would be in the best position to elaborate on why it chose to settle the court action it initiated against Iris.
Indeed, open collaboration between optometrists and opticians has occurred in Quebec for the past 20 years, and in Western Canada for the past 10-15 in various models, including that of Iris. In fact, in the United Kingdom, Australia, New Zealand and in most U.S. states, optometrists and opticians have worked together in various organizational structures for more than 20 years. Where Iris is unique is that we focus our efforts on providing the highest quality products and professional services, evidenced by the technology of the equipment in each Iris location, the type of ophthalmic lenses dispensed, the frames we carry and our laser surgery centres.
M Godden from Canada writes: Choice is one thing and market diversification is always good for the consumer, but this is about people's health records, too. Doctors need to control the patient record and if they are employees of an Iris store, the store would control the patient record, not the doctor. There is also a privacy issue. I don't want just anyone looking at my files. If the optometrist wants to leave the Iris store, who would control the patients' files in Dr. Angle's store? If the doctor is independent, they will determine what solutions I need. If they are an employee of the business, who will be in control?
Dr. Daryan Angle: Every optometrist practicing at Iris an independent contractor who is responsible for the custodianship of the patient files. Iris employees are contractually obliged to follow the direction of the optometrist as custodian and maintain confidentiality as per the standards of the optometric profession as well as follow federal privacy legislation. If an optometrist were to leave an Iris location, the patient files are then transferred to another licensed optometrist who will take responsibility for the files and patients. There are advantages for patients at Iris centres as, if they are moving to another city or province, their records can be more easily transferred from one Iris doctor to another without cost to the patient.
Any optometrist practicing at an Iris centre must uphold the clinical standards of the profession and thus recommend options that best suit that individual's needs. The act of practicing in an Iris centre does not change the ethical responsibility of a doctor to do what is in the best interest of his or her patients.
Paul McCreery from Canada writes: 1. Are you presently using opticians in your locations in Ontario? If so, how are you getting around the present regulations? 2. Are you also using certified optometric assistants at your locations? 3. Are you targeting the high end of the optical market? 4. Is your company solely independently funded or is there additional financial assistance from optical or contact lens companies?
Dr. Daryan Angle: 1) All Ontario Iris centres employ at least one licensed optician, and in other parts of the country, opticians can also act as store managers and work in partnership with Iris optometrists. The Ontario Ministry of Health and Long Term Care has a mandate to encourage open collaboration between health care professions in order to enhance the delivery of care in the province. Iris follows this concept in order to deliver high-quality eye care. As for regulations, please see my response to Perry Brodkin, above.
2) We do employ certified optometric assistants in some of our locations.
3) Our target market is mid to high end, as we focus on providing only the highest quality products and professional services.
4) As with any independent optometric practice or optical store, it is common for suppliers to provide support through co-operative marketing, and in this regard, Iris is no different.
Dianne Nice: It seems from some of the questions and comments we've received about this story that consumers are still skeptical about opticians and optometrists working together under one roof. Why do you think that is and what can Iris do to overcome this suspicion?
Dr. Daryan Angle: I don't believe the majority of consumers are skeptical, based on our company's success across the country and on the poll results on the Globe website. It's important to note that the Ontario Ministry of Health an Long Term care supports open collaboration between health care professionals in order to provide a higher standard of care. This is true for optometrists and opticians, a collaboration that has been commonplace in the U.K., U.S., the province of Quebec and in Western Canada for the past 20 years. However, from what we've seen in the online comments, there seems to be room for further education in Ontario regarding the roles of optometrists, opticians and ophthalmologists who are all important members of the eye care team. At Iris, we believe our collaborative environment helps clarify these issues for our patients and customers.
Iris focuses on providing only the best eye care possible and our professionals work together as a team to provide a high standard of care, using the expertise of each professional to the benefit of the consumer. For instance, in the case where a consumer might have a problem with their eyewear, it means that they are not ever stuck in the middle between the optometrist who performed the eye exam and the optician from whom they purchased the eyewear. If these professionals are not working together, there is the potential for either professional to attribute the problem the person is having to the other (as they are not affiliated). At Iris, our optometrists and opticians work as a team to ensure that any problems are dealt with in an efficient and timely manner.
K Maloney from Toronto asks: It seems like your business plan was fully based on the idea that the Ontario optometrists' college wouldn't have any objections to the 'hybrid' store you wanted to operate. If the college had completely rejected the idea, what options would you have had? Would your professional licence have been in any danger, for example? With hindsight, do you think that was a good way to approach the business, or would it have been better to nail down the regulations first and then go about opening the store?
Dr. Daryan Angle: Before coming to a settlement, the College of Optometry of Ontario did reject the Iris concept. Technically yes, my professional licence was at risk, but I strongly believe that the Iris model of open collaboration is in the best interest of my patients and was prepared to work as hard as we needed to allow our expansion into Ontario. In Quebec and B.C., where the Iris model and other similar models have existed for 20 and 10 years respectively, the regulations have just formally been modernized in 2008 and 2009 to reflect the open collaboration between optometrists and opticians. Knowing how long the regulatory process could take, we felt that moving ahead with our vision in Ontario was the best way for Iris.
John Omand from Newmarket, Ont., writes: My question is, when a customer is entering your establishment, is it one open room and entrance when dealing with both the optometrists office and optical or is it divided?
Dr. Daryan Angle: At Iris, the optometrist's examination rooms are integrated into the same location without any separation. A patient can receive a complete eye health and vision examination with the optometrist then walk with their doctor to the eyewear area to sit down and discuss solutions to their visual needs with a licensed optician. This allows for the optometrist and optician to work as a team by having a collective discussion with the patient about their range of options including glasses, contact lenses or even laser eye surgery in order to deliver the best care.
Dianne Nice: What's next for Iris? Do you have plans to enter other jurisdictions and, if so, how do you think the company will be received?
Dr. Daryan Angle: Right now Iris is focusing on expanding our presence in Ontario. Long term, the goal is to reach 500 locations across Canada. At Iris, we truly want to provide our customers with great professional service, the highest quality products and allow them to enjoy the best vision and eye health possible. Based on the success we are currently having, we feel that the company will be well received as we expand.
Dianne Nice: Is there any advice you can offer to readers who may be thinking of starting or expanding a small business of their own?
Dr. Daryan Angle: Find a business vision that you truly believe in, and be passionate, honest and respectful to those you deal with. If you love what you do, be persistent, it will never feel like work and you will be able to overcome any obstacle thrown in your way.
Dianne Nice: Daryan, I'd like to thank you once again on behalf of our readers for joining us today to discuss Iris. Is there anything you would like to add?
Dr. Daryan Angle: Thank you for all of your great questions and interest in getting to know Iris better. I also want to thank all of the Iris doctors, partners, opticians, associates and staff who are the lifeblood of our dynamic organization and without their support and passion we would not be here today.