My recent articles about new optometry school grads prompted some excellent emails, including one from a doctor from the class of 2000 who admits he is no longer a new grad but is a successful practitioner who sympathizes with the grad's plight in finding a position with a good practice. In this doctor's experience, many established ODs don't have the patient demand to just add a full time doctor, so they look to the associate to bring a new specialty to the practice and hopefully increase demand for patients. Problems can arise however, and this doctor phrased it well: “With respect to adding specialties, it seems that it would require a major shift in the culture of most practices.”

Great idea

The concept of adding a new specialty to an existing practice to facilitate the addition of an associate doctor is an excellent business strategy. But to make the new venture successful it will require a culture shift along with financial support, special training and management effort.

Even though you may not be interested in providing a specialty yourself, it could open up a whole new market for your practice without relocating. And it is still eye care – it's not like you are entering a new field that you know nothing about. One of the best aspects of specialized care is that it is often a non-covered service by vision plans. Medical insurance may or not play a role, but coverage by medical insurance can help grow the segment faster. You already have an initial patient base and referral sources to draw from and some of the basic equipment is already in place in your office.

Let's start by considering some optometric specialties.

• Vision Therapy. This could include adjunct areas such as pediatric eye care, infant care, developmental vision and sports vision for kids and adults. Parents want the best for their kids as they progress through school.
• Low Vision. Demand for this field is increasing as a greater proportion of our population ages. Low vision practice can be built as mostly private pay and it can be lucrative.
• Glaucoma treatment. Many senior doctors treat some eye disease but have been reluctant to pursue glaucoma even though state law permits it. A new graduate arrives with the latest training in this field and generally enjoys working in this important field.
• Specialty contact lenses. Most senior optometrists already manage specialty contact lenses quite well, but for those who don't, this service could be huge. Specialty contact lenses include torics and multifocals, but also include corneal refractive therapy, hybrid materials, post-surgical problem cases and keratoconus.
• Other primary care. Dry eye treatments, emergency eye care and other services can provide a nice niche for a new associate.

To the senior doctor

Be prepared to not run the show in this new specialty, which will be a change from the usual practice culture. And be prepared to change some of the operations of the practice such as time slots for appointments and the adoption of new fees and billing procedures. Here are some other tips:

• Invest in new instruments. Discuss the budget and the plan with the new doctor and be willing to take some risk to build the new income stream. You may not be able to start with the latest and greatest of everything, but provide a good start and pledge to invest more as the service gets going and proves viability.
• Continuing education for the new doctor. This will not only fill out the training the associate received in optometry school, but it will put him or her in a setting with other doctors in this field. The sharing of ideas is invaluable.
• Try to set up observational visits with colleagues who practice the specialty. This real-world experience is extremely helpful. Be willing to finance a trip out of your market area if necessary.
• Membership in professional organizations that focus on the new specialty will be a great resource.
• Special efforts in marketing are needed and beneficial; marketing is at its best when you have something new to tell so take advantage of the opportunity. Consider a new logo for the new service; add new content to the practice website, brochures and other printed materials, newspaper ads, etc.
• Learn about the new service and adapt your exam routine to help foster referrals of patients to your associate. Talk up your new specialist to your patients.
• Meet with the associate regularly. Communication is vital to success and the new service will benefit from your experience.

To the new associate

• Be proactive and creative. You have more time and this is your new specialty so put your plans and ideas in writing and present them to the senior doctor. Propose exam templates, fees, patient handouts, polices and more, but don't be sensitive to criticism or suggestions. Try to accommodate the senior doctor when you can (pick your battles).
• Be practical about setup costs. Try to develop a budget for things like new equipment, special training, more staff and other expenses. Realize that the senior doc may not have thought of everything and may need time to figure out a way to finance the venture. A return on investment is needed for any investment.
• Use your free time to train the staff members to assist you and learn how the new service works.
• Suggest ideas for marketing the new specialty. Can you call on referral sources to introduce yourself? Host an open house?
• Prepare a brief seminar presentation for special groups such as the public, existing patients, parents, educators, or any other potential referral source.