How well do you pay your staff? Studies have shown that job satisfaction is key to keeping staff in your optometry practice, but money is a close second. Successful optometrists who are also the CEOs of their practice know the importance of compensating staff fairly and equitably for their market while continuing to be a profitable practice.
The averages below are national averages of hourly rates that can assist you in analyzing how well you pay your staff and show you if increases are appropriate. It is also important to remember that smaller practices tend to pay 10 percent less. Based on MBA Key Metrics for 2015, these are the averages for each respective position:
Average hourly rate 2015
Contact Lens Technician
Of course, each practice may have its own variables. For instance, our practice is a large practice, so with the amount of production any mistakes in filing insurance can be exponentially costly to the bottom line. Therefore, we believe that an insurance administrator is extremely important for accurate billing and claims and feel that the above compensation guidelines are low in the area of insurance administrator. Each optometry practice will vary, but use this as guide to evaluate the competitiveness of your compensation.
Some people love change–it’s part of their DNA and makes them who they are. Some people easily tire of the stress and frustrations that come along with change. If you are the latter, you may be ready for retirement. If you are an optometrist and CEO of your practice, you must embrace change–whether you love it or not–and constantly try to improve if you want to be successful.
One area of change that makes many optometrists leery is online scheduling. Professions like cosmetology and massage have made this a norm for their clients, whereas healthcare professionals tend to be protective of their schedules and stick to the old “call the office” routine. Fortunately for those who are ready for change this will be the next evolution of patient convenience and practice success (and it isn’t as uncontrolled as you might think). For a business of any kind to grow and thrive it must change to meet the demands of consumers (or in our case, patients). Online scheduling is one of those conveniences that patients want. How do I know this? More and more patients are contacting our office electronically to schedule instead of calling the office.
Put yourself in your patients’ shoes:
Old way–Scheduling an appointment when it is convenient for the OFFICE.
Make sure the office is open.
Call a phone number.
Wait through the phone tree.
Be transferred to scheduling.
Answer a bunch of questions that you don’t have time for because you are late for your daughter’s soccer game.
Ask if you can go online to fill out the questions they are asking.
Phone call ends with you frustrated because you still have things to do to complete the appointment process.
New way–Scheduling an appointment when it is convenient for YOU.
The old “call the office” model revolves around you and your staff. When a company can design its processes and systems to revolve around the customer, the company wins and so does the customer/patient. Practicing optometry is difficult during this time when change occurs weekly and the office must constantly defer to consumers. However, if one ignores the changing patterns of society then one ends up wondering how some optometry offices have thrived while some have barely survived.
What do you do with an employee who has a post through two sections of her ear and a quarter-sized gauge in her earlobe?
The younger generation of staff members are more likely to have body piercings that may or may not be suitable for a healthcare facility, and, more specifically, your optometry practice. Unfortunately, many optometrists who own their practices are reactive instead of proactive. These individuals wait until a new hire shows up with a piercing before deciding it is time for a policy. At that point, the offending person will likely feel singled out and picked on.
That’s why all owners should be proactive and address piercings in their policy manual. Here is an example of a policy that you can copy and paste today. With a “body piercings” policy, you are setting an office-wide standard, and you may even avoid the unpleasant task of having to ask staff members to remove their piercings.
All visible body piercings should be filled with a clear post or stud. The exception is piercings that are in the ear. The preference of (Your Practice) would be for all staff to keep visible body piercings free of any type of post or stud, again excluding the ear.
If you believe body piercings are unrelated to the professional image you desire your practice to reflect, then most likely you can move on without such a policy. However, if you have not thought about this because someone has not asked or reported to work with one, it is time to be proactive and make a policy. It is always much easier to explain policies up front than to make them as you go along.
When a doctor needs to take an extended leave from work, the remaining doctors in the practice may try to take on the additional patients among themselves. However, the level of patient care may suffer as they work longer hours or add an extra day each week. Under the increased workload they can become stressed and on the path to burnout. To protect all of the optometrists’ quality of life, a better solution needs to be found.
Hire a locum tenen for an extended period of time. Locum tenens is a Latin phrase that means “to hold the place of,” or, “to substitute for.” Hiring a fill-in doctor takes planning, but if done correctly can be a win-win for all parties involved.
Finding a locum tenen – If you live within an hour or two from a big city, you can most likely ask an optometrist working at a commercial establishment to substitute in your practice a day or two. Online companies provide fill-in optometrists. Part-time optometrists across the city or in another town may want some extra hours.
Prepare patients – If the doctor leaving is already booked during the time he or she will be gone, use this as an opportunity to allow patients to keep their yearly appointments with a different doctor, and promise they can return to their original doctor for following visits. A month before, have staff notify patients that Dr. Extended Leave will be gone the day of their appointments, but another doctor will be filling in.
Malpractice coverage – It is important to visit with your malpractice carrier about terms of coverage. We were pleased to discover that our locum tenen is conveniently covered under Dr. Extended Leave’s policy for a 60-day period. Please check with your malpractice carrier.
Insurance – If the Locum Tenen practices in the same state, he or she is already on most of the insurance panels. If not, planning ahead will allow your insurance staff plenty of time to get them on the panel. Medical insurances make this extremely easy whereas the vision benefit companies (VSP, Eyemed, Superior, etc) make it more difficult.
Prepare staff – Staff appreciate being part of the decision-making process, and they and respond best when they know of changes in advance, so it’s important to communicate through this process and show them why this will be best for patient care. Explain they may not get many hours to work when Dr. Extended Leave is out, and they will warm up to the idea of a locum tenen quickly.
Doctors find it easier to take time away and actually let go of the office stress when patients are being cared for. The locum tenen solution allows for the new mother to enjoy a couple of months with her baby, or the compassionate doctor to serve for a term internationally giving of the gift of sight. It also may give a father extended time with his family before all the children are grown and gone. Whatever the need for an extended leave, a locum tenen for a replacement is a good option.
The results are obvious–the higher the number of cancellations, the lower your monthly production. Not only do cancellations hurt the bottom line, but they are especially frustrating in busy months like July when many other patients are trying to get in. A filled clinic schedule at the beginning of the month can be a misleading indicator of your office’s success, because cancellations can leave gaping holes. True results come from the number of completed exams at the end of the month.
Actively working to fill cancellations will improve your bottom line, and it can also improve your level of service to your patients. For example, your office is booked out four weeks, which might be longer than some patients prefer to wait. However, on this day you receive word of three cancellations. By filling those cancellations with previously scheduled patients, you will get three patients into your chair tomorrow, and now your schedule has three open spots in the near future.
So how do you ensure that 25 appointment slots equal 25 patients who show up and complete an exam or encounter in a given day?
Ensure all appointment slots in a given day represent a completed exam.
Train staff to put patients on the cancellation list. – All staff who schedule appointments by phone or online will need to be clear on how the office cancellation system works.
Use software that allows your staff to communicate a new opening quickly and efficiently. We have chosen SolutionReach, but others also allow for this capability.
Sync the cancellation list for all staff and locations, if applicable. – We use Ocuhub, which allows us to have synced folders (i.e., Dropbox). Unlike many folder-syncing software packages, Ocuhub is designed for optometry/ophthalmology and is 100 percent HIPAA compliant in protecting patient health information.
Offer patients the opportunity to be contacted should an earlier appointment become available.
Scheduling staff should listen for voice inflections or comments that indicate a patient is frustrated. Have them ask, “Would you like to be put on the cancellation list to get you in sooner?”
Twitter allows the staff to tweet available appointments for the afternoon. @WichitaOptom
Take advantage of the many opportunities to fill your schedule with patients instead of cancellations. Having a successful system in place will help fill in the non-producing gaps that every CEO faces in reflecting the end-of-month numbers.
The phrase “work smarter, not harder,” certainly applies to successful CEOs of optometry practices. Since many of us are doctors first, we may not be the number one draft pick for leading a business. Working smarter is knowing how to find resources that others have used in successful businesses. This is the primary reason that OptometryCEO makes downloads available.
Here are three resources that can be downloaded from OptometyCEO:
Employment Manual – This is not optional for an optometry owner. An employment manual is a working document that is available on your website for all staff to access. The employment manual can be used for defending a wrongful termination lawsuit, setting boundaries for cell phone and internet use, and explaining discounts for family members, among other things. The download can be edited to fit your needs. This helps the busy OD create a comprehensive employment manual without having to start from scratch.
Policy Manual – A policy manual assists your staff in addressing difficult situations that come up in an optometry office. For instance, how does the office handle patients who don’t want to pay even a portion of the cost of their new glasses until they pick them up? How about the patient that no-shows three times in the last three weeks? Does that patient get to reschedule? What is the office policy regarding sales reps scheduling appointments with your staff? Is any time of the day or week OK? Thinking through these situations and writing guidelines specific to your practice will help your staff make decisions that are consistent with the owners’ wishes.
Job Description/Expectation – An optometry office can operate without staff members having written job descriptions, just like a football team can advance the ball without having set plays. The problem is, it doesn’t work all the time. To be consistently successful, systems that can repeat themselves need to be in place. All of your staff members need to know what is expected of them to consistently be successful.
The three resources above can be customized for your practice and will provide you with a comprehensive guide to successfully lead your staff.
The hottest topic for optometrists in the past few years has been health insurance and the Obama administration’s impact on ODs as providers.
But what about the optometrist and staff as patients? Should you as the employer offer health insurance for all of your staff members?
In our parents’ generation many employees working in optometric offices were married and covered under their spouses’ insurance policies. Today, the majority of employees are single and don’t have another source of health insurance. Through the new state exchanges, health insurance can be an affordable option for your staff and potential employees. However, I believe you as an employer are at a competitive disadvantage if you do not build health insurance into your compensation model at your office.
Most applicants are looking for positions that offer health insurance. It has become imperative that you structure your compensation model to include health insurance.
If you do not currently offer health insurance to your employees, here are some ways to include it.
Controlled Benefit – As the CEO of your optometry practice, you choose how much money will be allotted for health insurance. For example, you may choose to put $250 per month for each employee who opts to have health insurance.
Better Applicants – By offering insurance, you will immediately improve the quality and sheer number of qualified applicants for any position in your office. Applicants are concerned about hourly compensation, but they also want peace of mind. If you offer health insurance, whether fully or partially paid, you are offering peace of mind.
Control Overhead Costs – Most of us are unwilling to include health insurance as a part of an employee’s compensation package because we are afraid of the increased overhead costs. Don’t worry. If you are adding health insurance, discuss the added benefit with your staff and explain the impact it will have on hourly wages. Most of your staff will be just fine with it because they are receiving the peace of mind of having health insurance. As the owner and operator of your practice, do the math backwards. If you usually pay 25 percent for staffing, include an amount towards insurance for each staff member and adjust other benefits so the re-allotment totals 25 percent of overhead. (Twenty-five percent is typically high for those of you wondering)
There are many good reasons to offer health insurance as a staff benefit. The most successful practices learn to adapt to what is important to employees and compensate accordingly. Remember, compensation alone is not the primary reason most employees leave their jobs. (Remarkable Leadership – Eikenberry)
As the owner of a multi-doctor clinic, you must define the standard of care for your practice.
When optometry owners bring in an associate OD to work as a long-term associate or future owner, they often assume the new OD is familiar with the standards of care the existing doctors are using. This is usually not the case. Communicating boundaries and guidelines to your new optometrists will help the transition to your practice.
As the leading optometrist, you must decide if the standard guidelines published by the American Optometric Association, the American Academy of Ophthalmology and Wills Eye Manual are appropriate for your patient care. For instance, a rural optometrist may manage a retinal pathology a little longer than an optometrist in a city that has a retinologist two miles away.
Giving specific guidelines to your associate optometrists is a great way to help them practice with confidence and a good way for the practice to guard against liability.
Questions to define your practice’s “standard of care”
How many times should a visual field be done in a year?
Is a 30–2 appropriate every time or should 24-2 be done at least once a year with one 10-2 once a year?
OCT – Should this be done every 3 years or once a year?
Gonioscopy – Did you know some optometrists managing glaucoma have not done this since optometry school? Are you OK with that?
Serial Tonometry – Did you know some optometrists never do this? Are you OK as the owner if an associate OD chooses to never do serial tonometry?
Is it OK to see the patient for the initial visit and not do a follow up?
Are you OK with a 3 month follow-up after an initial visit?
Is it OK if 3 doctors in the practice manage posterior vitreous detachment (PVD) in three different ways?
Is it OK if an optometrist in your practice does not require that the contact lens be evaluated on the eye yearly to renew the contact lens prescription?
Is it acceptable for your associate OD to fit teenagers into 30-day continuous-wear contact lenses?
Guidelines published by our national associations are meant to be the minimum standard of care for all optometrists. Some doctors who have been practicing for a decade or two have eased off their once-stringent guidelines, and any associate optometrists working with them are getting no real-world guidance.
Have you been thinking about retirement?
If you have graduated from optometry school and you currently own your practice, you should be. It’s never too early to begin the process of preparing your practice to sell. Many optometry practices do not sell for reasons that could have been prevented if the CEOs would have had the mindset that someday they would sell. If you plan to someday sell your optometry business, then avoid these four costly mistakes that have left many optometrists holding a business they cannot sell.
Aging Technology – Some optometry practices still use outdated technology like the GDx. You might have a chance of selling your GDx in the United Kingdom, but you won’t get anyone to buy it in the United States. The standard optometry practice should have some form of Optical Coherence Tomography (OCT) technology.
Paper Records – If you believe you will hold out on changing from paper to EMRs (Electronic Medical Records), then plan on holding out from selling your practice. Most of the optometrists who are in the market for buying a practice have not even performed an exam on paper. Also, as costs continue to mount for changing from paper to EMRs, the pool of investors who are interested in paper offices has shrunk. Investors do not want to spend thousands at the outset just to make the office current. If you remain on paper, the value of your practice is on the decline.
Single Owner Doctor – What would happen if you stepped out of the practice? Is the success of the practice dependent upon one individual? The optometry practices that can remain profitable independent of a sole doctor are practices that carry the most value for potential buyers. Hiring an associate OD can be a difficult decision due to the up-front costs, but not selling your practice can be much more costly.
Depending on vision benefit plans – If your practice cash flow is greater than 50 percent from vision benefit plans like VSP, Eyemed, & Superior, then selling your practice will be highly dependent upon the future of the segregation of vision and medical. As we move to an Accountable Care Organization (ACO) environment where fee for service becomes obsolete, practices must prepare for bundled payments and full capitation. To be profitable in this environment, the number of patients seen must increase as the reimbursements decrease. Optometry practices depending on “ramping up their schedules” can only ramp up so far until it starts costing the practice to see patients. Transitioning your practice to a medical model with complimentary vision benefits is a must for selling your practice.
Optometrists continue to make similar mistakes each generation. Building a practice that is salable is key to maximizing the potential profits of owning a practice. If doing this does not seem necessary nor desirable, it may be an indication that you are best fit for being an associate. If you currently own a practice, you will want to sell it someday. Making the above adjustments should be at the front of your list for working on the practice. An astute buyer will not pay much more than 55 percent of the last three years’ average gross collected, and many buyers will not even pay 55 percent. Take action now and build your optometry practice to sell.
The birth of a baby is one of the most exciting events a human can experience. When one of our associate ODs informed me she was pregnant, I was happy for her. As a CEO of our optometry practice, I also recognize scheduling her maternity leave will bring some challenges. Overcoming these hurdles and coming out stronger post-maternity leave is what all successful optometry practices do. The great management advantage of pregnancy and maternity leave is you most likely will be aware of it seven or eight months in advance, so you will have plenty of time for planning.
Here are a couple of tips for navigating a six-to-eight week span when an associate optometrist is out of the office.
Staff time off – When you find out an associate OD will need maternity leave, you can encourage non-OD staff to plan vacations and time off. Many times your staff can and will arrange for time off when you will be without a doctor for an extended period of time. Your role is to communicate and encourage them to use that time.
“Locum tenen” – The definition of locum tenens, roughly translated from Latin, means “to hold a place.” Locum tenens physicians fill in for other physicians on a temporary basis for a range of a few days to up to six months or more. When healthcare employers face temporary staffing shortages due to vacancies, illness, or other causes, they hire locum tenens physicians and other part-time clinicians to fill those vacancies and maintain patient care quality. (reference)
Extended “to do” list – Plan for the office to do jobs that usually do not get done during the busy week. This may mean going through patient records and calling ones who have not been in for two years to see if they still consider your practice their eye care provider and then schedule an appointment. This may mean doing a deep clean of the office and equipment. Whatever it is, time is maximized by planning ahead.
Adding appointment slots – This maybe the easiest way to address being short a doctor for an extended period of time. Depending on the size and how busy the practice is, an hour a day added to your schedule may be all that is needed.
The question still remains about how the practice is going to grow minus a doctor. The growth does not occur during the time the optometrist is out of the office. The growth is a product of what was done during the “off-season” With any sport, the success of the season is highly dependent upon what is done during the “off-season” Being intentional about making your “off-season” productive will grow the practice when it is back to running full speed. And whatever you do, don’t lose sight of the big picture. Family growth and prosperity far outweigh practice growth.