Article Date: 6/1/2012

How to Build a Robust Patient Base

How to Build a Robust Patient Base

Panelists share five proven tactics to gain and retain patients for long-term success.

Thomas M. Bobst, OD, FAAO • Joshua Lahiff, OD

Dr Castleberry: Keeping current patients while attracting new patients is the ideal combination for enduring practice success. Here are steps you can take to gain and retain patients.

1. Build long-term relationships with patients.

Dr LaHiff: I strive to build long-term relationships, particularly among families. Fifty-five percent of my patient base comprises children, mostly because I engage patients in conversations about their families, which creates opportunities for me to educate parents about their children's vision needs.

Dr Brujic: Some of our office routines are designed to help nurture relationships. For example, the technician who teaches a new contact lens wearer how to apply and remove his lenses calls the patient the next day to make sure everything is going well. When we personalize our service, the patient's perception of his experience with our practice — not just his eye examination but his overall care — is better than he expected.

Dr Castleberry: For me, it's all about gaining a patient's trust at all costs. That means evaluating his wants and needs, using my professional judgment to decide what's best for him and then doing it. Sometimes, that means not selling him something, which may go against a short-term goal in the practice, but it's a win for me in the long-term. If I have a patient's trust, I have everything.

Dr Pearson: I agree. No matter how much marketing or advertising we do, at the end of the day, most of the time, people go where they feel cared for and comfortable. Creating that experience and building that relationship is paramount.

2. Use the best available technology.

Dr LaHiff: To be the best, you have to use the best. When you use products you know will work time and time again, one, it decreases your chair time, and two, you create a better experience for patients.

Dr Bobst: When patients love the products and services you provide, they gain confidence in you, and they tell their neighbors, friends and family. You don't want to be penny-wise and pound-foolish by prescribing something based on cost or profit margin. I guarantee, no patient will tell his friends, “Dr. Bobst is a genius. He saved me $6 a box on my contacts,” but plenty of patients will say, “Dr. Bobst is a genius. He prescribed this contact lens I can wear all day. It's the most comfortable lens I've ever had in my life. You should go see him!”

Dr Brujic: If we start worrying too much about costs, our mindset gradually changes, and that's a dangerous place to be. If you're prescribing a lens based on perceived cost concerns, patients may not have the best lens-wearing experience. Consequently, they may stop wearing their lenses, stop seeing you for care and start looking for a practice that can meet their needs. Certainly, we need to be aware of costs, but they shouldn't drive our clinical decision-making.

Dr LaHiff: When patients know you use the latest, greatest, best technology, they feel confident they're receiving cutting-edge medical care, and their perception of your value rises.

Dr Pearson: We want patients to experience the best examination possible. We want them to have the most information, and we need to communicate that to them. Just knowing you have the most up-to-date technology, whether or not they choose to use it, is important to patients. They feel reassured that you're on top of things.

3. Protect your reputation.

Dr Castleberry: According to the latest Caring for the Eyes of America survey by the American Optometric Association (AOA), 36% of patients ask their friends or family about their experience with their optometrist before they decide where to go.1 So, even though patients have been seeing you for years, they want reassurance you're providing the best care.

Dr Pearson: Remember, too, those people aren't necessarily asking the person sitting beside them at a soccer game. They're just as likely to look for answers on Yelp, Facebook and Google Plus. It's the new word of mouth.

Dr LaHiff: It's also important to consider everyone with whom you interact at your practice — the delivery man, the mail carrier, and so on — as potential patients or referrers, who can help grow your practice.

Dr Castleberry: Reputation management is important. I try to handle every case as if it will wind up online. I only want happy patients in my practice.

4. Focus on what you can control.

Dr Castleberry: A 2009 study found that, on average, 52% of a practice's gross revenues come from professional fees. This is something we can control. We can't control whether or not patients buy a product that day, how much they'll buy or if they'll return during the year to buy more, but we definitely control our professional fees.

I can attest to the importance of professional fees. As some of you know, we don't sell contact lenses in my practice. I'm not advocating that everyone follow this model, but it has worked well for me. I stopped selling contact lenses, raised my professional fees and started scripting everything. While my revenue plummeted 33% that first year, my earnings went up 3%. A decade later, I'm still happy with that decision.

Speaking for myself, of all the things I do, my most profitable patient is the one who comes in for an eye examination and a contact lens examination. He is the most profitable patient I have per visit by a factor of about two. What are your thoughts?

Dr Pearson: Our practice is also somewhat different from many because our offices don't have optical shops. So, we, too, are more driven by our professional fees.

Dr Castleberry: The Practice Profile Report of the Management and Business Academy reveals some interesting data related to volume and professional fees.2

As you see in Figure 1, whether you practice in a small town or a large city, the difference in gross revenue per exam is just $45, leading to the conclusion that it requires more patients to grow your practice.

Figure 1: The Practice Profile Report
Management & Business Academy™
Population Gross Revenue/Exam
Under 10,000 $312
10,000 – 24,999 $300
25,000 – 49,999 $311
50,000 – 99,999 $309
100,000 – 249,999 $295
250,000 – 999,999 $299
1 Million+ $340

Figure 2 gives us another perspective. When you compare a solo practitioner with a multiple-doctor, multiple-location practice, the practices with the most revenue are conducting the most exams. What's also interesting is that, regardless of the type of practice, if you have more patients, your revenue is higher. To put it another way, the primary reason for practice growth is related to the number of patients you see, not dollars per patient.

Figure 2: The Practice Profile Report
Management & Business Academy™
Solo ODs 1 Location 2+ ODs, 2+ Locations
Revenue <$500M $500-749M $750M+ <$750M $750-1,499M $1,500M+ <$1,000M $1,000-1,499M $1,500M+
Complete Exams 1,296 2,049 2,828 2,172 3,536 5,548 2,500 4,002 7,446
Exams Per OD Hour 0.76 1.04 1.48 0.78 1.05 1.15 1.09 1.13 1.28
Exams Per Active Patient 0.44 0.32 0.42 0.45 0.46 0.45 0.39 0.39 0.40

Dr Pearson: In our practice, contact lens patients are more likely to stay with us than eyeglass-only patients.

Dr LaHiff: And in our practice, the more frequently patients replace their contact lenses, the more frequently they come back for routine care.

Dr Castleberry: To add to what you've observed in your practices, the CWatch Referral and Return Study of 1,086 consumers also found the more frequently people replace their contact lenses, the more likely they are to recommend their current eye doctors.

5. “Wow!” your patients. Then ask for referrals.

Dr LaHiff: I think the statistics we've just heard support the need for us to “Wow!” our patients from the time they walk in the door until they leave. Providing an amazing experience and then asking for a referral is the fastest way to grow your practice.

Dr Castleberry: Intuitively, we know that referrals drive growth, but research also supports the value of referrals for any business. In an American Express Open Forum post, Mike Periu of EcoFin Media notes that the most effective marketing programs are those that cost nothing or next to nothing and are proven to work.3 Although most marketing techniques don't meet these criteria, referrals do. He goes on to define referrals (which consumers don't really consider marketing) as “when existing, satisfied customers voluntarily recommend your business to people within their circle of trust.”

Next, let's discuss some of the metrics that can be used to measure success and ensure practice growth. ■


1. American Optometric Association. Caring for the Eyes of America; US Chart Audit; 2010; Available at
2. The Practice Profile Report (MBA). Available at:
3. Periu M. Use customer referrals to grow sales. Posted July 26, 2011. American Express Open Forum.

Dr LaHiff: Given the complexities of eye care, it's sometimes difficult to keep staff members up to date with advances in best practices and products. One way we do this is to invite manufacturers' sales representatives to speak at our staff meetings. These men and women, whether they're pharmaceutical reps or contact lens reps, know more about their products than most people do, and they're pumped up about them. When they educate the staff to their level of knowledge, our patients also benefit.

Dr Brujic: Sales reps are underutilized resources. We give them a specific amount of time to present their products at our office meetings, so that we can decide where they fit into our practice. I like that everyone in our office hears the same information and has an opportunity to ask questions.

Dr Bobst: We think of the reps as our business partners. By taking advantage of what they can bring to us — not just products but also knowledge — our entire practice benefits.

Optometric Management, Issue: June 2012, page(s): 6 - 8