Article Date: 5/1/2007

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Is it Time to Hire An Associate?

It’s never too soon to make plans to hire an associate. Here’s how to ensure a good fit.

By Gary Gerber, O.D., Franklin Lakes, N.J.

Like most new O.D.s, or soon-to-be O.D.s, you’re probably not thinking about hiring an associate. More likely, you’re facing hefty student loans and trying to figure out what career path to follow. Even if you’re running a practice, you’re probably so consumed with the day-to-day operations that hiring another doctor isn’t even on your radar. But it’s never too early to think about hiring an associate. In fact, the sooner you start planning for it the better. In certain instances, hiring another optometrist provides a wealth of benefits that will pay significant dividends for you down the road.
Read on to find out why you should consider hiring an associate to work in your practice, what attributes to look for and where to find the right person.

When’s the Right Time?
One of the biggest challenges any O.D. faces when it comes to running a practice is — well — running a practice. Whether it’s a brand new office or an established one you’ve purchased, you soon realize there are never enough hours in a day to get everything done. Even doctors who open cold find that squeezing in a few extra minutes each day for administrative tasks or strategic planning is almost impossible. Hiring an associate is a business decision, but it also can become a quality-of-life issue. If you’re missing too many family events and feeling burned out because of your workload, it’s definitely time to get some help.
However, getting help doesn’t always mean you need to hire an associate. In my experience, most busy practices hire an associate too soon before assessing if an additional administrative assistant or two would solve the problem. It’s less expensive to hire a staff member than it is another doctor, so consider your support staff first before hiring an associate. If you’ve already done this and you’re still too busy, hiring another optometrist is probably your answer.
What can a new associate do for you? By taking on patient care responsibilities, an associate frees up the time you need to plan and execute a marketing strategy, build and maintain your practice brand, train staff, get involved in the community and perform other nonclinical practice-building tasks. Clearly, devoting time to these activities will reap higher rewards than if you were to focus solely on patient care.
Some practices hire an additional optometrist so the practice owner can develop a subspecialty. The associate takes on a large share of the patient-care responsibilities while the owner pursues the specialty.
What’s more, hiring an associate allows you to develop a plan to inevitably leave the practice one day, otherwise known as your exit strategy. We ask all of our clients what their exit strategy is. I have to admit, we get some pretty interesting stares, particularly from young doctors. But what I’m suggesting is that career planning starts even before you open or buy a practice. For instance, if you plan to open several locations or practice part-time, you should consider hiring an associate in the earliest stages. The same holds true if you plan to eventually sell your practice. It will be easier to leave if you have an interested associate who wants to buy your practice upon your departure. If the associate has worked with you for many years, the transition will be easier for staff and patients than if the doctor were a new owner.

Getting Started
Once you’ve decided to hire another optometrist, you’ll need to develop a schedule specifying the number of hours and days you want him or her to work. Ideally, you should increase your core office hours to accommodate existing and prospective patients. You may be tempted to let your future associate choose the hours and days he or she would like to work, but you’re better off setting the schedule first and hiring to meet your needs.
When your schedule is set, you can begin your search. You could certainly place a help wanted ad in your local newspaper, but there are better, more effective ways to find an associate. Start with the Web sites of optometry schools and state and local optometric associations, as well as the American Academy of Optometry and the American Optometric Association. Spread the word about your search with industry sales representatives. They’re usually well informed about who may be looking for new opportunities.

Perfect Candidate
Any associate you hire must have integrity and possess certain attributes and clinical skills that will be a great asset to you and your practice. Here’s how to choose the right person:
1. Search for a specialist. Look for someone who specializes in a particular segment of optometry that your practice doesn’t offer. If you want to attract more pediatric patients, for example, it makes sense to look for someone who can bring that skill set to your practice. An associate who specializes in almost any segment of optometry will be an asset in most markets. So consider someone who specializes in vision therapy, geriatrics, rehabilitation-traumatic brain injury, low vision or specialty contact lenses.
During the interviewing process, check references and recommendations, particularly in the candidate’s area of expertise. A contact lens specialty should go beyond just knowing which solutions work best with which lenses. In addition to the clinical skills required by their specialty, prospective candidates should have passion and drive to help your practice flourish.
A word of caution: If you hire an associate to expand your practice’s services but you personally don’t want to practice in that area, make sure you’re aware of the added expenses that may be involved to support that particular subspecialty. For example, you’ll have to buy new technology to support vision therapy and spend extra marketing dollars to promote it to patients.
2. Ask about career plans. To determine if potential associates will be a good fit, ask them about their long-term goals. Anyone can change course in his career as time passes, but it’s best to have an idea of an associate’s goals before making a hiring decision. For example, if a candidate says, “All I want to do is be an employed doctor forever. I have no aspirations of ever owning my own practice because I don’t want the headaches that come with ownership,” you’ll know that person isn’t a good choice if you want to hire someone to whom you’ll sell the practice one day.
3. Focus on similar patient-care philosophies. Your associate’s clinical and practice-building philosophies should be in sync with your own belief system. You don’t necessarily have to agree on a first-line glaucoma therapy, but you should agree that you’ll treat glaucoma.
One way to find out if you’re on the same clinical page is to have the prospective associate observe you in practice for a few hours. Afterward, begin a chart review and have the candidate discuss the similarities and differences in how he or she would’ve cared for those same patients. This is critical. In many practices, patients will see both doctors on different days. For example, you might prescribe daily disposable contact lenses for a patient on Monday. The patient might return on Tuesday with comfort issues and see your associate. Will the associate abandon the modality entirely or try a different daily disposable lens? You’ll need to discuss these issues and agree on how to handle them. Otherwise, you’ll send mixed messages to patients who may conclude that the care they receive is less than optimal.
4. Discuss views on customer service. As with patient care, you and your associate need to agree on customer service policies so everyone in the practice communicates a consistent message to patients. For example, if it’s your policy to be generous with refunds and returns for eyeglasses, your staff will get stuck in the middle if you’re out of the office one day when a patient tries to return his eyeglasses and the associate refuses.
5. Get their take on billing and coding. You and your associate also should share the same views on billing and coding procedures. Consistency is important when dealing with insurance carriers. You and your associate may not intend to commit fraud, but inconsistent billing and coding practices between doctors may prompt insurance companies to question your procedures. Inconsistencies can cost you thousands of dollars in penalties. And if these consequences are a result of differences in opinion, you could find yourself in a heated debate over who’s responsible for the charges.
6. Protect your investment. To prevent an associate from soliciting your patients, employees or existing business relationships in the event he or she leaves the practice, mention during the interviewing process that you require associates to sign a noncompete, nonsolicitation agreement within the first few weeks on the job.
7. Consider a trial period. Hiring an associate for a predetermined trial period gives both of you a chance to see if the arrangement will work out. However, be careful how you define “trial period.” Usually, it’s best to hire your administrative staff, associates included, as “at will” employees. In most states, “at will” means you can fire employees, or they can quit, without a reason. If you have a defined trial period, some states view “at will” arrangements as contractual agreements once an associate makes it past the trial period.

Looking Ahead
Following these guidelines will help you hire the right associate that will benefit you and your practice — now and in the future. The key is to develop a plan — and to start early. You can begin in your first year of optometry school or even if you’ve started a practice already. An associate will share the workload so you’ll have more time to focus on the important nonclinical tasks that will attract new patients and expand the scope of your practice.

Optometric Management, Issue: May 2007