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I view adding an associate optometrist as one of the best management strategies a practice owner can implement. If done properly, it can greatly increase the practice gross and net income and pave the way for the senior OD to spend less time seeing patients and more time as the practice CEO.
My experience in my own practice and in working with other practice owners shows me that the conventional wisdom prevalent in our profession about hiring associates is not always the best approach. Here are five points to consider as you plan to add a doctor to your practice, and I'll present five more points next week.
- The new doctor does not have to be a partner. The old school model in optometry was that if a doctor wanted to move from solo practice to group practice, a new doctor would buy in as partner or work on a track to earn partnership over time. The new doctor was expected to build his or her patient following and not take patients from the senior doctor, except for some overflow. The model I advocate is completely different: the senior doctor seeks an OD who will be an employee and does not want to be a practice owner. Owning and operating a business is not for everyone and many excellent ODs today just want to see patients, be well compensated for their work, and not worry about a business. I think private practice optometry should be a major source of employment for these ODs and they should not have to go to commercial chains or ophthalmology practices. Decide early in the planning process if you want a partner or an employed associate. It makes a big difference in the doctor you choose and how you structure the compensation. Of course, you can always decide later to sell all or part of your practice and the associate could end up being a buyer. It is much more difficult to become an employee.
- When to proceed. To make my model work, the associate OD must have a minimum base of patients to see. The practice needs some backlog of patients in the form of appointments booked in advance. The goal will be to convert as many patients as possible to see the new doctor, while always honoring the patient's preference of doctors. Ideally, I like to see two weeks of advance appointments if a practice wants to add a full time doctor. You may be able to get by with less than that if the senior doctor wants to decrease his or her clinical hours. You will also need a plan for the practice to be able to see more patients, such as multiple exam rooms so to doctors can work at the same time, or extended office hours so the total number of doctor hours per week is greatly increased.
- Find the right doctor. Plan to conduct a strong search program to find the best fit for your practice. Some areas of the country enjoy a larger pool of OD candidates than others, but there are many resources available to help you find those who are seeking work. Contact the AOA, your state association, all the optometry schools, ophthalmic publications, placement services and even online resources like Craig's List. Accept resumes and conduct interviews just as you would for any employment opportunity.
- Set compensation fairly but don't overpay. Most practice owners want to pay associate ODs on a percentage of their production, but I have not found that system to be necessary to obtain high production and it has some drawbacks. There really is no standard on what a fair percentage is and what metric to use in the calculation. It is certainly possible to set the percentage too high or too low and if that occurs, one of the two parties will be unhappy. Most percentages are figured out by trying to set what a reasonable salary will be and then working backwards by trying to guess what production will be and what percentage will work. Seems rather imprecise to me. A straight salary can actually work quite well and most ODs do not need a commission to practice good eye care and to prescribe appropriately. To find out what the going rate for an employed OD (not an owner), just ask some new optometry graduates what they expect to earn in their first year out of school. A good benefit package should also be included for full time doctors; this would include health insurance, paid vacations, holidays, etc.
- Set expectations clearly. Avoid discontent later by talking about everything in advance. Don't be too shy to bring up sensitive topics; talking about them early lets you get to know the candidate better and that is a good thing. It's important to set some standards for your practice that all doctors will follow. This will include fees, insurance plans, number of patients seen per day, some exam elements and more. There is also a need to let each doctor have his or her own professional judgment, so not everything should be dictated. The expectation of how many patients will be seen per day and who sets the doctor's schedule is very important. I make it clear those issues are determined by the senior doctor. It works out well that the associate will not be instantly fully booked with patients. This allows time for the doctor to adapt to the office process and to gain efficiency. But it should be clear that eventually the new doctor will see patients at a given pace. He can't decide that he needs longer exam slots or that he wants to see fewer patients.
I'll continue next week with five more tips that will help you prepare for an associate and successfully make the transition into group practice.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
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Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.
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