Article Date: 6/1/2009

Boosting Practice Revenue With a Subspecialty

Boosting Practice Revenue With a Subspecialty

Introducing a subspecialty is a great way to get hired and generate additional revenue.

By Gina Wesley, OD, MS, FAAO, Medina, Minn.

DO YOU KNOW that adding a subspecialty can grow an optometric practice and boost revenues? In fact, it may even provide a key opportunity to jump-start your career. I secured my first job after graduation partly because of my proposal to add InfantSEE® exams to a practice. None of the doctors had any experience with babies, so I shared my background and my plan to bring in more patients. The partners liked my ideas, and the subspecialty was born — and it became a success.

There are many subspecialties you can consider, including postsurgical or medical glaucoma management, nutritional therapies for age-related macular degeneration, dry eye management, nutraceuticals or specialty contact lens fitting.

If you're a new graduate who's seeking a job, you may get your foot in the door if you can show how a subspecialty can benefit the practice. If you've already joined a practice, a subspecialty can boost the bottom line and enhance your professional viability. Either way, your first step will be selling the idea to practice owners. If successful, you'll be expected to lead the way in implementing the new focus area.

Getting Others On Board

Whether you're looking to land a job or you already have one, these steps can help you succeed in launching a subspecialty.

Review and research. One question you should ask yourself is, “Should the practice expand?” The answer depends on what type of care the doctors are currently providing and what the competition is offering. Research the competition by talking to patients, calling front desk staff, reviewing various practice Web sites and doctors online.

Don't be shy. Be up front with partners about the fact you'd like to introduce a subspecialty. Then educate them about the subspecialty area and what your role will entail. If you're applying for a position, discuss this desire and your area of interest in your cover letter, which is the first thing the partners will see.

Establish your experience. Partners already know their associates' experience, but job applicants need to spell it out in their cover letter and CV. Your training and experience should demonstrate your capability of delivering on your proposal.

To verify your credentials, encourage doctors to call people you've worked with in the subspecialty. My employer called the children's clinic at my optometry school to learn more about my background, experiences and job performance.

Crunch the numbers. Practice owners will respond to dollars and cents. Create and share a revenue-generating spreadsheet to show how much money you could potentially bring in with your subspecialty. Illustrating your profit potential demonstrates initiative, an understanding of their needs and the ability to think in terms of practice profitability.

Address the investment issue. The partners will want to evaluate the ROI (return on investment). Aside from the investment in your salary, they'll want to know what additional investment your subspecialty will require.

Sometimes, the investment can be relatively small if the practice already has the necessary devices and supplies. When I started my pediatric and specialty contact lens subspecialties in my first position following graduation, I brought most of the equipment I needed — such as specialty fitting sets — so the practice didn't need to invest in supplies.

Prepare for challenges. Sometimes, no matter how much you want to introduce a subspecialty, the practice partners may not jump at the chance. They may not even understand its potential. It's your job to educate them about the subspecialty and how it will contribute to the practice. Value their time and treat them with respect, even if they don't understand the need for it. Remember, they've adapted and survived through the years. If you deliver an excellent presentation, they'll see the value in what you're offering.

Getting the Inside Scoop From the Employer's Perspective

Interviewing for an associate position at an existing practice can be nerve-racking. Here are some insights into the employers' perspective and tips for delivering what they want.

Money employers need. Employers know all the financial factors that go into hiring a new associate. Costs are deducted from every dollar a practice generates. The cost of goods like frames and lenses averages 30 percent, while business costs like files, faxes and electricity consume 15 percent. That leaves about 45 percent for salaries.

When practice owners bring in a new OD, they need the associate to generate $2 in collected receipts for every dollar of the doctor's salary just to break even (for example, double a $75,000 to $80,000 full-time salary). This is called the contribution margin — and potential employers are looking for someone who will enhance that margin.

Compensation employers consider. Many practice owners expect that an associate one day will become a partner, which means going from collecting a salary to earning a cut of the profits generated by the practice.

In addition, some employers may want to start you with a base salary for 6 months. Then gradually reduce the salary so that by the end of your first year, you're making only a percentage of what you produce. They want someone who's prepared to get paid based on performance, not attendance, and your preparation to deliver sub-specialty services may help convince them that you're a valuable asset.

Opportunities employers might not see. If you've done your research, you'll know if you're interviewing at a practice that has room for the subspecialty you can offer. One good way to determine this is to ask your potential employers what patient care services they refer out. For example, they might refer dry eye or glaucoma management.

If you want to start a dry eye subspecialty and the partners tell you they refer punctal occlusion, you can explain that you're trained and comfortable doing the procedure. What's more, dry eye has the potential to yield $525 to $650 per patient if the treatment stays in the practice instead of getting referred outside. This shows you can pay for yourself.

Personality employers desire. Low-key doctors who simply do as they're told may handle the patient load, but they won't generate revenue, and they can't ramp up a new subspecialty. To build the practice, a new associate must be outgoing and willing to get involved in the community through faith-based organizations, civic clubs, health clubs and so on, so be sure to highlight not only what you've done in school, but also what you do outside of the office. In a nutshell, I counsel clients to look for marketing-oriented go-getters who have a risk-taking edge.

— By Bill Nolan, Lincoln, Neb.

Mr. Nolan is a vice president at the Williams Group, an international eyecare practice management consulting group based in Lincoln, Neb.

Use your position as an associate to your advantage. Partners may question if patients want or need the proposed subspecialty service. But associates have a clear advantage: existing patients. The best way to illustrate the value of a specific service is to survey patients, and you have the ability to do so. For example, you might ask patients, “If this practice offered glaucoma evaluations that measured your risk for the disease, would you and your family be interested?”

Also keep in mind that you can propose a trial period for the new services. If the partners are skeptical about the subspecialty, you could suggest giving it a test run for 6 months, and then evaluating its feasibility. You'll get an opportunity to show your worth, and the partners will feel better because they have an out if they want one.

You're Approved — Now What?

Let's say, the partners have “blessed” your subspecialty, and now it's time to implement your plan. Consider these tips for building your patient base.

Work with staff and other doctors. Building a subspecialty works best when everyone participates. One of your most important tasks will be to educate the staff about the subspecialty and the type of patients you're seeking. I've explained to staff what tests I'd be performing in the exam lane. I've discussed which patients needed particular exams and when to schedule them. Like the patients, the staff is encouraged to know the practice is growing, changing and improving. If the staff understands the basics about the subspecialty, they'll help book the appropriate patients.

Market internally. Most of my new pediatric patients came from moms talking to other moms. Existing patients are the best source of external referrals, but they generally don't refer people unless you mention it. I reminded doctors to ask patients if they or someone they know needed my subspecialty service. I always told patients that I was there to serve them. The staff also spoke to patients and asked for referrals.

Market externally. Newsletters, Web sites, local organizations and schools are great avenues to reach external customers. I sent letters to pediatricians after I saw one of their patients. In the letter, I introduced myself, explained the patient's test results and thanked them for the referral. This way, they were more likely to recognize my capabilities and keep me in mind for other patients.

Track the numbers. After the first year, I went back and counted how many additional patients and families my subspecialty brought into the clinic, and I reported the numbers to the practice owner. The InfantSEE® exams were free, but by offering it, we brought in new families and new revenue. This demonstrated that the subspecialty was a valuable addition to the practice.

Hard Work Pays Off

Building a subspecialty is a great deal of work, so you have to be prepared. Do as much homework as possible before you present your plan. Then, follow my tips to increase your chances of getting support from the practice. Once you get the nod, you can use my guidelines to implement your subspecialty, and that's when your hard work really begins to pay off. You'll be generating revenue and demonstrating your extraordinary value to the practice. nOD

Dr. Wesley is a 2006 graduate of The Ohio State University College of Optometry in Columbus. She practices primary care optometry with an added emphasis on contact lenses and children's eye exams at Complete Eye Care of Medina in Minnesota.


Optometric Management, Issue: June 2009