Optometric Management Tip # 139 - Wednesday, September 15, 2004
Want to take your practice to the next level?
Consider hiring an associate optometrist.
This weekís topic surely wonít appeal to every reader Ė but before you pass on it, ask yourself this: Do you
own or manage a busy practice right now Ė or do you hope to some day? If so, you should think about hiring
another doctor. Bringing in another doctor does not have to be difficult, and it can create a huge jump in
gross and net incomes, while providing many other benefits.
Why is an associate so important?
Letís take a hypothetical solo practice that is doing well and is booked solid with appointments about two
weeks in advance. The only thing holding this practice back is time, because the doctor/owner is so busy with
patients that he or she canít possibly attend to the growing business needs of a company that is so
successful. This practice now has many more patients and optical orders and staff, than it did a few years
ago. Thatís great, of course, but the management demands have grown too Ė and itís likely they are not being
met. A few years ago, the doctor could still oversee the whole operation, but now there is only time to put
out fires. Hopefully, an office manager was hired, but even that may not be enough. The doctor/owner has a
unique vision and leadership that is vital to business, but that vision canít flourish if he or she is too
busy seeing patients. The danger is that the high quality service that created the success in the first place
may be cut off by the lack of attention, and further growth will be stifled. A winning business formula will
In addition to the loss of management leadership, there is a more practical financial factor. When I see a
practice thatís booked solid for two weeks in advance, I see money sitting out there in the appointment
schedule. If those future earnings (think patients) could be brought forward to today, the practice revenue
could jump quickly. It could grow by 50% overnight Ė or even double! Ah, but itís not that easy, youíre
thinking? Well easy is what you make of it, but the truly hard part is getting the business, and thatís
already there! If we could see twice the number of patients every day, weíd make twice the income Ė it is
that easy! Granted, the practice would no longer be booked two weeks in advance Ė in fact, hypothetically,
we would have collapsed the backlog and weíd have openings tomorrow. But, so what? All that matters is today.
How can you see twice the number of patients? Well, if this is a fully booked practice, you canít! Thatís why
we need another doctor. Of course, there are all kinds of logistical concerns if a practice is to have
another doctor Ė such as the need for more exam rooms and equipment, but they truly can all be met easier
than you think. In many cases, office hours have evolved so that there are some times of the week that do
not currently have appointments Ė such as closed days, no-doctor half days, evening hours, or Saturdays.
This non-productive time allows a valuable resource (your equipment and space) to sit idle. Beyond those
times, an additional exam room or two could probably be managed if you get creative.
Not ready for a partner?
No problem. Many of us were trained to think that having a group practice meant bringing in a partner, but
that is a very big step and many docs arenít ready for that. Actually, adding a doctor in your practice
doesnít mean he or she has to be a partner at all Ė or even an associate leading to partnership. There are
many OD graduates today who donít want the hassle and stress of running a practice. These doctors are
interested in providing excellent clinical care only Ė and they would love to do so in a professional family
practice environment. That would make a perfect match.
Itís very important, however, that the senior doctor decide in advance if he or she is seeking an employed
clinician, or a future partner, and should discuss this openly with job candidates. Neither party will benefit
if expectations are not met. As long as both parties are up-front and honest about these career goals, there
is a strong chance of success. Note to senior docs: You canít have your cake and eat it too. If you are
seeking an employed doc, then you should be happy with an employee mentality to some extent Ė and I donít mean
that in a bad way. These doctors chose to place a high value on time away from the practice and donít want
administrative duties. If you want a doctor to share the responsibility of building and managing the practice,
then look for a partner.
How will you afford it?
Go back and re-read paragraph number three above. Youíll be able to afford it because productivity will be
much higher. Donít forget that many fixed expenses are already being met in your practice, so only variable
expenses will go up Ė like cost of goods sold. So the marginal net income percentage is much greater on these
additional patients then it was in the original group.
I believe in paying a very good straight salary and benefit package; no percentages or commissions are needed.
In my experience, it does not make any difference in productivity or prescribing rates anyway. Keep the new
doctor busy. Tell the receptionists that you want to get the new doctor booked. Refer some of your patients
to the new doctor, and allow those patients who want a sooner appointment time to move. Donít compete with the
new doctor Ė he or she is on your team.
A very smart move is for the senior doctor to take off one or two additional days per week in the patient
schedule. This makes the senior doc even more difficult to get an appointment with (although not impossible),
and it encourages patients to see the associate doctor for simple convenience. It also allows the senior doc
to pay attention to the business aspects on those new free days.
Hiring a new doctor is not difficult, but if you choose to pursue it, I recommend that you see a local attorney
for assistance in drawing up a simple employment agreement.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management