Optometric Management Tip # 448   -   Wednesday, September 15, 2010
Work on your business; not in your business.

The title above is a brilliant statement often attributed to Michael Gerber, author of the ground-breaking book The E-Myth Revisited.  The advice is quite applicable to eye care professionals who own their practices and I believe it speaks to one of the major factors that holds most of us back from achieving greater success.  One of the best things you can do for your practice is to not spend all your time seeing patients!  Your practice is a business and it requires the leadership and vision that only the owner can provide.  Yet, a recent survey revealed that the median ratio of OD office hours spent on patient care is 85%!  How does your work week stack up against that?  With the doctor spending almost all of his or her time on patients, who is running the business?

Generating high income in optometry
Is it possible to generate high income levels in optometry, given our challenges of discount vision plans and increasing competition from internet-based vendors?  Of course it is.  All industries and professions have their challenges and eye care is as good as or better than other fields.  Think of practice net income as belonging to two sources: the business and the optometrist.  Optometrists earn very good incomes but the really great income potential comes from owning the business.  There is a going rate for work as an optometrist; it is a range with a high and low end.  There really isn't a limit on the income from business ownership.  Over an entire career, I advise practice-owning optometrists to gradually spend less time as a practicing OD and more time as a CEO.  This shift in work focus occurs as the practice is growing larger and there is a greater need for a higher level of management.  The higher volume of exams, increased optical sales, a larger staff, more office space, and associate ODs all require more management effort to make the practice run well.  Without increased management, the practice will stop growing and even decline.

Examples outside of eye care
Did you ever know of a carpenter who built beautiful custom homes mostly by himself, with the help of a few subcontractors?  This guy worked long hours out of the back of his pick-up truck, completing one house at a time and then selling it for a profit.  As demand for these custom homes grew, based on a reputation for quality, the carpenter gradually hired more employees and subcontractors.  Eventually, the carpenter becomes the owner of the premier home-building company in the region.  He is now a wealthy business person; the CEO of his firm.  It's extremely valuable that he is a master carpenter as he works with employees and other trades and as he evaluates his company's finished products, but he no longer swings a hammer.

We can find similar examples in any field: a hairdresser who builds a high-end salon, an auto mechanic who owns a chain of service centers, or an optometrist who leads a successful multi-location practice.  Many of these very successful business people stop doing their craft directly.

Hire an office manager
Conventional wisdom in optometry has long included a philosophy by the OD that his or her best use is to be a doctor.  The thinking is that the OD has the training and the license to provide eye care, so as the practice grows, the best strategy is to hire an office manager to take care of the business and the OD will see more eyeballs.  I certainly recognize the important role of office managers and agree with hiring them, but I also believe that the optometrist/owner is needed in day-to-day practice management as well.  In many cases, the practice owner would do better financially if he would hire an associate OD to see some of the eyeballs so he could spend more time managing the practice!

A management day (or two)
I recommend dedicating one or more days per week as a management day for the practice owner.  There would be no patients scheduled on those days (for the owner), but she would still come into the office and work on operations, staff issues, marketing, fee structures, the coding and billing process and any of the hundreds of issues facing optometric practice every day.  In many cases, the same number of patients that were seen per week can be compressed into fewer days with more delegation to staff and shorter time slots.  If the practice is already highly delegated and very busy, it makes sense to hire an associate OD.

Best wishes for continued success,

Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management