As one of two owners in a large optometry practice, I have to face difficult employment issues each week. Like many optometry graduates, I had trained for the clinical aspect of optometry and had what I now see was a naive interest in being a business owner and employer. As job descriptions get more specialized traveling up the practice hierarchy, staff management risk increases. The associate OD position is near the top. I define risk as making employment changes or systems changes that may result in unhappy associate ODs. The only thing worse is having a full schedule of patients and learning an OD just quit. So how do we navigate difficult employment conversations with associate ODs, even conversations that may result in their compensation being reduced?
Warning lights before the danger – When you drive on a major highway and come upon backed-up traffic and a perpendicular state trooper vehicle, you know that there is most likely danger ahead. A well-structured employment manual will provide warning lights to an associate OD. Follow the guidelines outlined in your employment manual and the warning lights will be obvious.
Associate agreement – When an associate agreement is designed with the end in mind, difficult situations like a pay decrease are no surprise to the optometrist. The reason great practices spend a large amount of time putting together a very clear and well-structured associate agreement is so there will be no surprises.
Performance-based compensation – Designing a compensation package that rewards an employed OD for his or her passion, initiative and hard work will not only benefit the optometrist, but will also benefit the practice. When an employed OD is compensated based on performance, there is no need to adjust compensation according to the ebb and flow of the practice financials. Instead, it will adjust itself. If a practice is a successful growing practice the employer may also want to adjust compensation to a percentage of the gross based on performance of the practice. For example, if the compensation is 15 percent less of practice net, then when the practice nets 35 percent for the month the associate OD receives 20 percent of their gross collected production. This motivates the associate to be aware of expenses and work to keep them low.
Managing other doctors is never easy. Many times the threat of an uncomfortable confrontation is enough to make you avoid the situation, which only makes things worse. Vision in staff management is the ability to see potential outcomes and position yourself for the smoothest ride through those outcomes. No one wants to decrease an associate OD’s pay, because that most likely means that the OD is struggling. By envisioning the potential outcomes you have a role as the CEO to assist in helping the associate be successful so that pay decrease may never need to happen after all.
Optometry offices typically do not have the most convenient hours for patients to pick up their glasses and contact lenses. Private practices are usually open 8 a.m. to 5 p.m., Monday through Friday. These hours are convenient only for retirees. In today’s dual-income culture and 5 a.m. to 5 p.m. schedules, patients not being able to find time to do business with your practice may be why you are losing patients. Based on this, you as the CEO have two choices: open up longer hours or weekend hours, or communicate so skillfully that patients can fit you into their long hours and busy schedules. Text messaging is the fastest and most convenient means of communication today. Email is second, and the phone is a distant third because most people under the age of 50 do not listen to their voice mail.
Since you are most likely not interested in expanding your hours, you must use technology to be easy to do business with. Our communication partner, SolutionReach, has positively impacted our “not so convenient hours” by alerting patients through text and email when their glasses and contact lenses are ready to be picked up. What’s more, each patient within SolutionReach can be contacted directly by text during specific times when the office is slow to let them know you currently have no waiting time, similar to when the DMV texts people to notify them when they are next in line. Best technology ever!
Based on the 500+ survey results that Wichita Optometry SolutionReach post-surveys have generated, we know 98 percent of our patients are enthusiastic about our communication and overall technology experience. If your practice is easy to do business with, patients are more likely to stay with you and tell their friends.
Many optometrists believe today’s optometry business requires more and more effort to achieve the same financial rewards. If you agree, you may have fallen into one of these three traps:
Refusing to Change – With decreasing vision care benefit reimbursements, optometrists can operate their offices the way they always have, or they can adapt to the changing environment. Surprisingly, even many optometrists who say they are operating in the new medical model still bill the old vision benefit plans for more than 60 percent of their total billing. Change begins from the top down and requires the optometrist leading their practice to think and act differently.
Poor Communication – The production per patient in the dispensary is a direct reflection of what the doctor is prescribing. Doctors are to remain ethical in prescribing only what will benefit the patients and meet their needs. However, many doctors will not talk about ophthalmic product in the exam room because they say it is not their job. If a patient is suffering from poor vision, it is the doctor’s job to prescribe the best prescription and products to best correct that defect. If the patient wants to compromise visual quality because of price, let that be the patient’s decision, not the doctor’s.
Working IN the Business, Instead of ON the Business – “I see patients five days a week and our practice net is only 28 percent.” I hear statements like this from optometrists who work harder and not smarter. As the CEO, you must get out of the exam room from time to time so you can run the business. This may require hiring an associate sooner than later. Even though it’s a big initial financial investment, I’ve seen many cases where only a year after hiring an associate, the optometrist CEO is seeing fewer patients and profits are up.
Don’t get frustrated in today’s optometry business because you are working harder and making less. Do something about it. My best friend in optometry school and I always said there are two kinds of individuals–those who make things happen and those who let things happen. Individuals who make things happen end up in the destinations of their choosing. Go make things happen.
Marketing can be internal, like when a patient recommends her optometrist to a friend, or external, which includes advertising like billboards, radio ads, and mailed flyers.
Many optometry practice owners put little emphasis on external marketing. Owners tend to believe they are not impacted by marketing, so they see spending money on marketing a waste of time. However, studies show four out of five Americans are influenced by external marketing and make decisions accordingly. Considering this, forgoing external marketing seems like a grievous error.
An often-overlooked form of external advertising is promotional products. Spending money on apparel and gadgets may may feel like a black hole, but when done right over time it can have an exponential impact.
Here are three great resources for promotional products that every optometrist should be aware of when looking for creative external marketing:
4imprint – 4imprint has a good variety of products that can be imprinted with your office logo for competitive prices. We have been impressed by the quality of their regular fare, and 4imprint offers high-end options also. We were pleased with the response we received from our most recent marketing promo item, infuser sports bottles. OptometryCEO does not receive any proceeds or benefits from recommending this company.
GotPrint – They offer the best prices with the “rounded corner” business cards. We had used Vistaprint for years and found their pricing to be a moving target. They would advertise low prices but charge extras that drove up the per-card price. After frustration with them, I landed on GotPrint and haven’t used anyone else since. OptometryCEO does not receive any proceeds or benefits from recommending this company.
CustomInk – If you want a T-shirt that everyone is sure to love, use these guys. They have available the American Apparel brand, which are some of the softest, most comfortable shirts to wear. When you spend the money for great shirts you find that your staff, doctors, and patients love to wear them, and they talk about them to their friends. OptometryCEO does not receive any proceeds or benefits from recommending this company.
Marketing your optometry practice requires you to be resourceful and creative. Most optometrists do not have a large marketing budget, so all dollars must be spent wisely and have the greatest impact. Finding resources that you can use to save money is one of many ways to keep expenses down and profits up.
Patient care is more than vision correction and eye disease management. Patient care involves just that–caring. The best optometrists take a holistic approach and advocate for their patients’ needs.
Many optometrists offer refractions and slit lamp exams for approximately the same cost.
Differentiating yourself from the rest of the field requires you to tap your inner resources of compassion and care. If you don’t believe you are compassionate and caring, think about something you would never give up. Everyone cares about something.
The elite optometrist is not the one speaking at national meetings or running a 10-associate OD practice. The elite optometrist is the one giving patients more–more compassion, more time, and more practical resources.
Here are 3 resources every optometrist should bookmark.
Rx Hope – Many glaucoma patients are not compliant with their expensive medications, and they are embarrassed to admit to their doctor they can’t afford them. Rx Hope is a great resource that allows you, the optometrist, to suggest alternative ways to obtain the necessary medication. There is more to prescribing than just clicking through your EMR.
GoodRx – As an optometrist you want to be sensitive to the cost of the antibiotics you prescribe patients for eye infections. This resource compares local prices and allows you or your staff to assist patients in keeping their costs to a minimum.
Clinical Trials – Many optometrists do not think their patients would be interested in being involved in a clinical trial. However, if a patient is willing to take a risk, or is open to traveling a bit, being part of a clinical trial might be a great option. It is important to use your expertise and knowledge to present all possible options.
Patient care is the essence of practice success. An optometrist can have the nicest office and all the latest technologies and still find his or her practice struggling. Patients want more than clinical answers, they want a person who cares and will advocate for them. Be a patient advocate and give them your best.
Growth occurs when you invest in what you want to grow. Investing in your practice requires a strategic approach to internal and external marketing.
The best way to grow your practice is to connect with existing patients. Many patients get lost in follow-up and go one or two years without a comprehensive eye evaluation.
The best way to grow your practice is to invest in your database of patients. This is simple and requires no time if you are using software that can do it for you. The top three software programs with these capabilities are DemandForce, SolutionReach, and Websystems3.
SolutionReach is the software we continue to use because of its many benefits, but the most important is the “recall” function. The recall function searches our database in RevolutionEHR and finds all of the patients who have not been in within the last two years and either sends these patients an email, a text, or an automated call.
In January and February alone, our office had 96 patients schedule appointments through this system. These are patients who were lost in general care follow-up. We did not spend marketing dollars to find these people. All optometry offices that have an electronic practice management system compatible with SolutionReach can do this.
As an employer you hired an optometrist to clinically evaluate patients and work as described in an Associate Agreement. So what happens when your associate OD uses patient clinical data generated when working with your company?
For example, the associate examines patients four days a week and uses down time during those hours to write papers that are then published in both peer-reviewed journals and professional journals alike. Depending on the length and depth of the topic, the associate may be compensated for the work. Should this time and use of clinical data and records that are owned by the employing optometrist’s practice be property of the associate, or the owner?
Should employee be a recipient of any research grant, books, publications or other revenue-generating materials involving retrospective, current, or prospective studies on patients of “Your Practice Name” who have been examined and/or treated primarily by the Employee during the ordinary course of business, all revenue received from such efforts shall be the property of Employer and shall be added to and considered to be a part of the gross revenues generated by Employee.
Associates may feel they would have their hands tied with the above stipulation. That’s why it is so important to read associate agreements thoroughly and to not sign anything with which you are not comfortable. If you plan on researching or writing during the time of your employment, then negotiate for the privilege of doing just that. I would recommend consulting your attorney prior to signing the associate agreement to make sure you have the freedom to work at the optometry practice and do research and writing.
Prior to placing a name on birth certificate, many parents spend countless nights and Google searches looking for a name that resonates with them and will ultimately define their next child. The importance of a name should not be underestimated, especially when naming an optometry practice.
Two types of people will read the above and come to different conclusions. An individual with a fixed mindset will say a name really doesn’t make much difference, so changing the practice name isn’t worth the effort. The individual with the fixed mindset will also continue to blame the economy and insurance companies for lack of growth.
In contrast, an individual with a growth mindset will see changing the optometry practice’s name as an opportunity to be relevant today while preparing for tomorrow. Growth mindset optometry CEOs know change is inevitable and change is occurring at a faster pace than ever. For more on fixed mindset versus growth mindset read Carol S. Dweck, Ph.D’s book, Mindset: The New Psychology of Success.
The best advice for growing a practice is starting with a new name. A good name defines location and relevance to what you do.
Donald Trump’s reality show is known for two words dreaded words: “You’re fired!” As an aspiring entrepreneur, I remember watching The Apprentice every week trying to glean wisdom. I was hoping I could get all the right words and actions down so firing staff would be easy. After 12 years, I have come to the conclusion that hiring and firing is never easy. Letting staff members go is difficult, especially after investing in them for years. It’s also painful to realize it was a mistake to keep them so long.
Even though firing is not easy, here are three ways to make the process as fair and painless as possible.
Document – Start documenting at the very beginning of hiring your staff. I use a digital notebook, Evernote, to create a “Staff Profile” on every staff member and document any problems that arise during the year. It allows me to review the concerns over the past year, and it helps me and my partner discern if we are simply frustrated with current situations, or if this has this been a long-term pattern. Document, document, document.
Communicate – Visit with your staff members regularly to communicate how they are meeting and exceeding expectations, as well as where they are under-performing. Too many optometrists wait to communicate to their staff after they have become so frustrated that they have to do something. This is too late. Begin early by communicating behaviors that are good and those that need improvement. This will create an environment with no surprises. It is much easier to fire someone if they have a good idea it is coming.
Just do it – NIKE’s long-time slogan is easy to say but hard to do. It finally comes down to scheduling the meeting and walking through letting them go. This part should be as short as the slogan. To keep yourself from getting in trouble, experts say schedule the meeting and keep it short and sweet.
Being the CEO of your company requires you to have big shoulders, and sometimes the weighty job of firing a staff member is required. Do not back down, or your patients will suffer. When a staff member needs to go, take it from Donald Trump and get comfortable with “You’re fired!”
Are optometrists who work at commercial establishments real doctors?
I take offense when patients walk into my exam room and tell me they have been getting their eyes checked at a commercial establishment, but now that they think they have problems they have come to see a “real” doctor.
This patient assumes that my being in a free-standing practice makes me, an optometrist, a real doctor while my colleague at a commercial establishment is not. I take offense to this because the doctor they had been seeing went through the same trials and tribulations that I went through to get the same degree I have. In my opinion, that doctor is as real as I am.
So why does this patient perceive the doctor at the commercial establishment as not a “real” doctor?
Here are 3 ways you control the patient’s perception:
Look like one – First appearances are extremely important and can make or break a patient’s perception of you. Do you look professional in the way that you dress? It may be more comfortable to have a “jeans Friday,” but does it communicate professionalism? It may be more comfortable to wear those Tom shoes, but do they look like you’re headed to the cabin for the weekend?
Talk like one – This may seem trivial, but I have witnessed doctors who are unprofessional and speak like they are with three of their best friends hanging out. Also, use medical terminology that differentiates you from a refractionist who is only concerned about the prescription for glasses or contact lenses. You should be educating your patients, telling them that the exam is part of keeping their eyes healthy for life. As you look behind the slit lamp, describe what you are looking at and what problems you are looking for (i.e. – “I’m looking at the surface of your cornea to determine if you have signs of dry eye.”) Also consider your staff–do they talk to the patient as though the patient is receiving medical eye care along with the prescription for glasses?
Diagnose and treat like one – Many optometrists believe the only reason patients go to commercial establishments is for glasses. Don’t assume this. Instead, diagnose and manage their eye diseases so they perceive you as managing their medical eye problems. If you have them return for a dry eye check, use terms that would indicate they are returning for a “medical eye encounter.”
Patients will always believe what they want to believe and make their own choices. Like many marketing agencies will tell you, the choice of your words and actions make a huge impact on the way a person will perceive another person or service. If you feel you are a doctor by name but a refractionist by perception, then choose to change the impression you are giving your next patient.