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 By Neil B. Gailmard, OD, MBA, FAAO, Editor September 15, 2004 - Tip #139 
 Contact Dr. Gailmard | Subscribe | Archives | Print this issue Visit: optometricmanagement.com 
Want to take your practice to the next level?
Consider hiring an associate optometrist.

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Additional Information

This week's topic surely won't appeal to every reader - but before you pass on it, ask yourself this: Do you own or manage a busy practice right now - 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?

Let's 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 can't 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. That's great, of course, but the management demands have grown too - and it's 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 can't 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 be lost.

In addition to the loss of management leadership, there is a more practical financial factor. When I see a practice that's 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 - or even double! Ah, but it's not that easy, you're thinking? Well easy is what you make of it, but the truly hard part is getting the business, and that's already there! If we could see twice the number of patients every day, we'd make twice the income - it is that easy! Granted, the practice would no longer be booked two weeks in advance - in fact, hypothetically, we would have collapsed the backlog and we'd 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 can't! That's why we need another doctor. Of course, there are all kinds of logistical concerns if a practice is to have another doctor - 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 - 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 aren't ready for that. Actually, adding a doctor in your practice doesn't mean he or she has to be a partner at all - or even an associate leading to partnership. There are many OD graduates today who don't want the hassle and stress of running a practice. These doctors are interested in providing excellent clinical care only - and they would love to do so in a professional family practice environment. That would make a perfect match.

It's 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 can't 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 - and I don't mean that in a bad way. These doctors chose to place a high value on time away from the practice and don't 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. You'll be able to afford it because productivity will be much higher. Don't forget that many fixed expenses are already being met in your practice, so only variable expenses will go up - 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. Don't compete with the new doctor - 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,

Read Past Tips Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week

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Send questions and comments to neil@gailmard.com.

Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.
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