I was arrested once. Yes, I’m not to proud to say it. Although it was many years ago, I still remember the embarrassment of having the officer snap handcuffs on my wrists. Being handcuffed creates a real immediate problem and leaves a lasting impression. Handcuffs take away freedom, and freedom is the key to becoming who and what you want to be.
Debt is a lot like handcuffs that limit you from taking opportunities when they arise, opportunities that directly impact what your career in optometry will look like.
Debt handcuffs you in these three areas:
Buying an optometry practice – Many graduating optometrists want to buy a practice or be part of owning an optometry practice, but many are handcuffed to school loans that require a $3,000 or more monthly payment. With those large regular payments, many don’t feel they can put any extra towards the principal and pay off the loan early. Or, they would rather not live as poor college students while doing so. However, keeping your college loans around for 10 or more years gives you no margin to take advantage of great buying opportunities.
Investing to generate non-optometry related income – Most everyone dreams of someday being financially independent. If not having the money to retire, at least having the freedom to take time off to raise children or follow a personally fulfilling passion. Leveraging debt could allow this, but usually ends up handcuffing us much longer than we initially calculate. If you do not have debt 10 years out of optometry school, think about having the finances to purchase the building you practice optometry in.
Growing your optometry business – Whether you are in solo practice or part of a group, there will be a limit to how much you can realistically leverage for practice growth. Individual debt choices directly impact business decisions amongst partners. The partner (or partners) who are debt free may want to move ahead with practice acquisitions or bringing in an associate. Those partners may want to pay cash or acts as their own bankers, while the debt-handcuffed partner cannot get on board due to personal limitations.
Going back to my brush with the law: Fortunately, when we arrived at the police station, I was uncuffed and released. My two buddies, however, did get in trouble for underage drinking. I had been the designated driver so my record was cleared and my father did not kill me. The whole incident serves as a great reminder that during my life I want to keep my freedom.
Debt is unavoidable in getting an optometry degree, but the length of time that you choose to stay in debt is completely under your control. New grads are choosing to pay off loans of $220,000 and more in five to seven years and creating huge opportunities for themselves after debt. If you think this is unrealistic, start talking to those outside your social circle.
Saying you’ll do something tomorrow could mean you might never get around to it. Indecision over a long period of time creates an erosion of negative change.
Too often this is the case for those of us running optometry practices. You say that you will do it tomorrow, and tomorrow becomes a year from now. Ten years later, you are still practicing the same way. You wonder why you can’t keep good staff, and you feel trapped by your schedule.
Three things that can’t wait:
Planning your exit strategy – It is never too early to begin planning for your exit strategy. If you are planning to sell your practice at the time you want to retire, you will need to have a buyer.
Hiring an associate OD – There are many benefits to hiring an associate optometrist. One of those benefits is the freedom it creates for the owner to either work on the business or take some time away to avoid burnout. Hiring a new associate is investing in the future of your practice and your retirement. Most associates need to be groomed in order to successfully take over the practice. Start now so that you have a buyer or two in place when you are ready to begin selling shares of the company.
Practicing the medical model – If you are not billing 50 percent of your insurance to medical, then you are missing the evolution of optometry. Optometry practices that have not incorporated medicine are still finding buyers, but the purchasing ODs are having to spend thousands of dollars to make it compatible with the medical model. Optometry practices that mainly rely on vision benefits will be at a competitive disadvantage in the future.
The road of least resistance is always the easiest road to take, and it is the most traveled. Deciding to take action today can make a huge difference in when you retire, and how comfortably. It can help you keep your life in balance now, when your family needs you to be around the most. Don’t let your schedule or your practice run your life. Take action so you can live the life you were created for.
After a week of hanging out on the beach, my wife and I were in the rental car heading to the airport. We have been married long enough to remember the days when couples blamed each other when they got lost. Now, when the turn-by-turn instructions in our iPhone landed us in a neighborhood 15 minutes away from the airport, we were brought together as we both cursed Siri.
Taking the wrong exit for the airport is frustrating, but still can be corrected without too much trouble. Taking the wrong exit in your professional career requires a whole different level of redirection.
The best way to make sure you take the right exit in your career is to plan for it years in advance. Part of the preparation process is finding a potential new owner to mentor to be the next generation that takes your optometry practice to the next level. Many companies have successfully transitioned ownership, but not without the proper planning. The bigger the company, the longer the pre-ownership time required to successfully transition.
Here are 3 “leaving a legacy” tips to help the next generation succeed.
“Play house” – My boys like to pretend they are Daddy without the responsibilities of Daddy. This is the same for the owner-to-be. Before they boot up as the owner, they need to walk in the shoes of the owner with a full view of the responsibilities and the rewards. Neither you nor they want to just “start owning” only to find out six months later that ownership is not what they thought it would be. As an owner, plan meetings to include the owner-to-be and let them be a part of the process for a year. Let them process accounting statements and join a strategic growth planning meeting.
Be encouraging – The owner-to-be will most likely be overwhelmed with the responsibilities of ownership. They will most likely state, “I had no idea ownership required this.” As the owner optometrist, you will need to be by them to let them know that they can do it. Many young optometrists are scared to own because they have no idea how they can do it.
Discover their WHY – Ownership is usually driven by a passion for something. Those passions can be self serving, like having the title of “owner” for cocktail parties. Or, passions can be inspiring. I know individuals who seek to grow their business and create financial freedom to do good for others. Many individuals have used their success to make the world a better place. Does your owner-to-be have a bigger passion and purpose?
Whether you are just beginning to think about your exit strategy, or you are at the cusp of needing to retire, having a plan and initiating the dialogue with another prospective owner is huge. Begin thinking about how you are going to raise the next generation. It is a win-win for you and the next optometrist.
In 2015 technology has been changing faster than ever. It seems like just yesterday Facebook was the online place to be, now it’s being crowded by Pinterest and others. Which technologies are necessary for your optometry office, and which are only a passing fad?
The most important online technology is a website. Websites are where patients get information about your office and compare it to others. Many optometry practices have great websites that are growing their practices. As the CEO you can ignore many technology fads. However, a stellar, easy-to-use website is NOT one of them.
Three essential elements for your website:
Change – Regularly updating your website will keep it relevant while increasing your rankings in search engines. This also will give your visitors a fresh feel each time they visit. Rotate the home page pictures with the seasons and post updates on the latest eye health issues. For example, in October you could include warnings about decorative contact lenses and during the summer months discuss the dangers of swimming with contacts.
Current photos of doctors – Many patients are looking for doctors they feel they can relate to, and ones they think their children can relate to as well. You must have current photos and biographies of the doctors. Make sure to include the doctor’s interests for connecting points.
Make an appointment – Online appointment scheduling has become popular in many areas–healthcare, beauty, or even kitchen remodel consulting. Online allows people to schedule when they are available, not only during business hours. Many times it might be 10 p.m. If your website makes you easy to do business with and allows patients to schedule their appointments on their own time, you will be busy.
The single most important technology that your optometry office must have is a great functional website. The website must be easy to find in search engines and easy to navigate once found. You may be surprised at the number of new patients that are generated when this occurs. Successful optometry practices do not always understand the technology, they just understand they need the technology.
Imagine waking up every work day dreading going to the clinic. The practice is understaffed, and everyone avoids addressing ever-present problems. What a miserable way to spend a day, a week, a year–and a career.
Your career in optometry does not need to be like that. Many optometrists wake up looking forward to going to the office. They enjoy the camaraderie of fellow ODs, and they like laughing with staff who work well together.
This is not a dream, it can be your reality. It all starts by landing a position with the right optometry office and many times that begins with you. Yes, you. Opportunities will not come knocking. Most opportunities come from planting seeds early and often.
Three ways to plant the seeds of a successful career:
Assume all optometry practices are looking to hire an associate OD. The most successful practices and the dream career you are looking for will not be listed in the online classifieds. Practice owners throughout the country are planning three to five years in advance, and they know if they have an opportunity to bring in the right individual, they will make it work because they know the power of practice success is in the right people. Go to every optometry office that you would like to work for, wherever you want to live, and let them know that you are interested in working for them when a position opens up. Does it work every time? No. But it never works if you don’t try.
Overlook the initial salary. Look at a salary and incentives as a professional athlete does. Most of them are in multiple year contracts and have bonuses based on performance. If you are paid $105,000 for three years compared to $80,000 for the first year, $105,000 for the second, and $115,000 for the third, where would you rather be? I would pick the second option every time as you are most likely to continue to have the option of growing your salary.
Be available and willing to do whatever is needed. An OD asked me how I motivated associate ODs because he had an associate that would only see patients and then leave. I told him, “Start looking for your next associate.” For your team you want associates who are willing to go above and beyond. Pay them good and keep them. All optometrists should be willing to do the small things when needed, even if it means vacuuming the office on a day you are short staffed.
Many optometrists are looking for jobs every year. The best-paid jobs with the highest job satisfaction are grown. A dream job begins with the seed of imagination. Growing the dream requires perseverance, patience, and doing what others are unwilling to do. Go out and realize your optometry career dream today, it’s never too late.
Communication is the key to many successes in life. Any type of relationship will ultimately erode if communication breaks down, or even if it is just not consistent or clear. As optometrists, we often think we have communicated because we explained our issue. We simply assume the receiver of our communication understood. However, when attending to the medical eye care of our patients, it never hurts to overcommunicate.
Studies show that 68 percent of specialists received no communication from the referring Primary Care Physician (PCP) and 38 percent of those specialists stated that information on why the PCP was referring the patient to them would have been very helpful.1 Timely communication is also important so that the specialist can assess the case prior to seeing the patient.
To ensure your communication with specialists is clear and easy to interpret, include these three things:
Why you are referring the patient. Be specific, even if you do not know the diagnosis.
What you are doing. If you’re managing other eye diseases with this patient, note that the patient is under your care for “name the disease” and that you will be following them for a certain interval of time (i.e. – 6 months).
How you would like the specialist to proceed. State if you want the specialist to return the patient, or take over treatment of the diagnosis for which the patient was referred. For example, if you refer a patient to a glaucoma specialist, state if you want a surgical consultation only, or if you would like for the specialist to assume care of the patient. It seems simple, but due to medicolegal reasons, specialists have to assume care of the patient unless you state otherwise in the report.
The optometrist who is the best communicator usually ends up winning the most medical referrals. By communicating with the PCPs and specialty physicians, you include yourself in the healthcare network. Once primary care doctors become familiar with your name and your quality of care, do not be surprised if they start referring you new patients. Many busy optometrists take the path of least resistance and let days go by without typing notes in their patients’ electronic medical records (EMRs) and sending their reports. Clear and timely communication needs to be a priority for your patients, and you will reap the benefits in more referrals.
1. Gandhi, Tejal K., Dean F. Sittig, Michael Franklin, Andrew J. Sussman, David G. Fairchild, and David W. Bates. “Communication Breakdown in the Outpatient Referral Process.” J GEN INTERN MED 15.9 (2000): 626-31. Web. 17 Oct. 2015.
Having a family has taught me a lot about planning. As each new child is added, we as parents need to make adjustments. When my wife and I had our first child, we made plans to make sure we arrived at our destination on time and with all necessary items. As we added child number two and now child number three, it is apparent that poor planning–or lack of planning–leads to many undesired effects.
Owning an optometry practice is no different. Each day as the practice grows it comes closer to the day you will exit ownership. Those optometrists who do not properly plan and adapt their plan over time are the practice owners that never find a qualified buyer. Where are you in the process of selling your practice?
Sell when BUYER arrives – When opportunity knocks you should open the door. A friend of mine was considering selling his veterinary practice to an interested associate. However, my friend was only in his early 50s and not ready to retire, so he told his associate it was not time. To his dismay, the associate left the practice and started his own. My friend was surprised that he lost his best potential buyer because he, as the seller, was not ready when the buyer was ready. Always be ready.
Sell at end of career – This is a great option if you have associates in place to buy you out. In fact, if you let them start buying you out years in advance, when you are ready to retire they will make the last payment and you are FREE. This does not happen without careful planning. Planning your exit strategy now will afford you the opportunity to sell at the end of your career.
Never sell – Too frequently this is the case of those who own their own practices. Single optometrists work daily to meet the needs of their patients. Then the day arrives that they want to retire. They assume a “for sale” sign can be placed on the front door and someone will buy it, but 400 to 500 practices a year close their doors without a buyer.
Sell before a BUYER arrives – This is a theoretical approach about always being prepared to sell. Many optometrists do not think about selling their practices, which is unfortunate because they may end up in the “never sell” category above. Buyers are not always available, therefore it is important to keep your practice up to date and always assume that this year will be the year someone offers to purchase your practice. The future looks like it will be run by the BIG optometry groups that can manage all the healthcare and HIPAA changes that occur yearly. To remain small is to run the risk of never selling your practice.
Selling your practice does not have to be a negative milestone in your life. The most satisfied and successful optometrists are the ones who have strategically planned their exit. Exiting ownership does not necessarily mean exiting optometry. Consider the advantages of planning your exit strategy now, even if it’s 20 years before you actually exit ownership. It’s never too early to start.
Every optometry journal seems to be filled with articles and advertising about the importance of meeting patients online. Digital communication is regarded as the holy grail of marketing. This overemphasis on technology may be leaving many of your patients (and potential patients) empty-handed. Unless you live in Silicone Valley, it’s likely that a large segment of your population base hasn’t adapted to technology.
I personally love using new technology, and I do everything I can–read, bank, pay for coffee, etc. by digital or “paperless” means. As a CEO, I know running an optometry practice is about meeting the patients where they are and then slowly giving them opportunities to evolve to where you want them to be. Otherwise, those patients will find someone else who understands their needs.
The most effective optometry practices will meet patients where they are by using both digital and paper.
Newsletter – Paper newsletters are a great tool to inform patients on new technology available at the practice and who can benefit. They can also update patients on what is going on with their favorite doctors and staff. To reach the majority of your patients, this should be done both digitally and in print. Email it to all your patients and then send the paper copies to the ones on your “not so tech savvy” list. Our practice uses iMatrix which generates newsletters monthly.
The response rate for direct mail to an existing customer averages 3.4%, compared to 0.12% for email. June 2012*
EDDM – Every Door Direct Mailing is a service by the United States Postal Service that allows you to reach potential customers near your business. You supply postcards or mailing pieces and the USPS will deliver to homes on your selected postal routes. This is one of the most untapped but effective means of marketing in a digital world. Personally, I don’t look at paper mail but my wife goes through it daily. As a mom of three children, she is also highly involved in Facebook, Pinterest, and Instagram.
A study cited in the January 2012 Ballantine white paper uncovered promising trends in consumer behavior for direct mailers: 85% of consumers sort through and read selected mailpieces each day, 75% of consumers are examining mail more closely, 40% have tried a new business after receiving direct mail.*
According to a recent survey, Americans have declared their preference for paper-based media in a digital world with 70% stating they prefer to read print and paper communications rather than reading off a screen. January 2012*
Many optometry business owners may feel the experts in marketing are leading them to abandon older methods of communicating with patients. Depending on the area of the country you live in, you may have a good argument for using only digital marketing. However, if you live in an area of the country where people still read their paper mail and pick up the local newspaper, then don’t miss the opportunity to reach them by investing in good ol’ paper. Patients are not going to change their habits because you stop sending them a paper newsletter, they will just start reading the paper newsletter from your competitor.
Experts spend hours looking at past trends to anticipate the future and recommend ways to exploit the changes that are predicted to occur. In the profession of optometry many are speculating on the change in the health care model and the impact the Affordable Care Organizations (ACO) will have on the reimbursement model for medicine. As optometrists we must preserve our current reimbursement model while anticipating the future payment model. One way to approach the future is to remain independent but act as a group when it comes to discussing payer models. The main focus is who will you team up with to present ACOs with a model that they can commit all their covered lives to that will represent all aspects of eye care.
Large Eye Care Corporations – These are corporations that typically have 20-80 ODs that practice throughout the region and refer to the specialty ophthalmologists. They are under one name as they are a group that works to provide all levels and types of eye care to the general public. If a patient is referred into a practice like this they are typically referred internally. This model will have a competitive advantage when an ACO considers partnering with a group that can provide all the eye care needed for their covered lives.
OD-OMD network – This is a corporation (group) of multiple independent practices that come together under one umbrella. They benefit by being a large group but remain independent in individual office decisions. This group is typically made up of 20-150 optometrists of multiple small independent practices, referral centers that represent retinology, glaucoma specialty and cataract surgeons. This model allows an optometry practice to remain independent but still compete with larger groups.
Health Care Groups – This is a large regional multidisciplinary group that represents all and is positioned under one group name. It is different than the “large eye care corporations” since it is a multidisciplinary group. This type of group usually involves a hospital and has a competitive advantage with ACO alignment since it can offer all services to the ACO covered lives. Typically, the eye care is a carve out and the health care groups do not include all aspects of eye services.
If you are in a practice with one to five doctors that has always operated independently, please take notice that to not be a part of a larger body of providers may mean that in January 2016 when most health care plans change in industry, you may find you are no longer a provider for XYZ company. Assuming that you can continue to survive on only vision care plans is taking more risk than the average owner should be willing to take. Positioning yourself for the future includes being a part of an OD-OMD network. This will allow you to continue to remain independent but think and act as a group.
When patients have conditions that are difficult to diagnose or treat, an optometrist might want to send them to an ophthalmology referral center or to another optometrist at a different clinic. However, the fear of not receiving the patient back may keep the optometrist from making the referral. This becomes a lose-lose for all parties, most importantly the patient. So when is referring to another OD a good idea?
Refer patients when you need:
A second opinion – this seems counter-intuitive because we all view ourselves on equal diagnostic fields. In reality, we are not. If you are in your first years of practice, don’t be worried that you don’t know everything–you never will. Many of your referrals in the first couple of years will most likely be due to lack of experience rather than a true pathological active problem. Finding an OD that you can trust to refer these unknowns to will not only be best for patient care, but will guide the perception in ophthalmology that optometry should be THE primary eye care providers.
Access to technology – many optometry clinics do not have the tools to manage medical eye care. The optometrist does not lack the competency but only the equipment to properly manage medical eye conditions. There are optometry practices in your area that have all the equipment. Be proactive and see what optometrist would be open to allowing you to send patients for testing only. The facility would bill a per click fee to you and you would bill insurance.
Specialty contact lens fits – you may be guilty of telling patients “there are no other options” when there are many contact lenses that may work in the specialty lens area like scleral contact lenses. The most successful eye doctors give patients all the options even when an option results in referring the patient to another OD.
Controlling parents ultimately lose the relationship with their children that they are trying so hard to control. The same can happen with the doctor-patient relationship. However, if you are always doing what is best for the patient you will win in the end. Optometrists who regularly refer to other optometrists end up winning the trust and loyalty of their patients in the end and most ODs who receive a referral from an OD are more likely to refer their own patients to another OD.