Article Date: 6/1/2012

Excellence Comes From Experience

Excellence Comes From Experience

Don't follow in the footsteps of others. Learn from their mistakes.

By Bob Levoy, OD

STARTING YOUR own practice can seem like a daunting feat,” says Russell Beach, OD, and Rahim Kanji, OD, of Virginia Beach, Va. “While there's no handbook that guarantees success, it's important to recognize and learn from the mistakes of optometrists who've been down this path. Avoiding pitfalls in your practice's early stages will allow you to build a solid foundation for success while serving your patients' best interests.”

As part of the market research I conduct for my articles and books, I've asked countless practitioners what mistakes they made when first starting out. Here are the top three:

1 Hiring Inexperienced Staff

Hiring inexperienced staff often leads to a trial-and-error approach to tasks as well as introducing costly mistakes when setting up business systems, organizing the clinical and dispensing aspects of the practice and achieving office efficiency.

“If you have to borrow your first employee's salary as part of your office loan, do it,” is the consensus of those practitioners who initially skimped on this critical aspect of practice management, and later regretted it. These practitioners included those who hired an inexperienced person or family member who meant well, but didn't have the necessary skills for the job.

This first employee very well may determine where you will be 1 year, 3 years or 5 years down the line. Not developing a well organized base for scheduling, recalls and collections — not to mention billing, coding and claims processing, can prevent your practice from succeeding.

Another consideration: an experienced staff member will have the know-how to deal with everyday issues such as comparison shoppers, overdue payments, complaints about insurance coverage, cost objections to disposable contact lenses, missed appointments and a 101 other situations that arise every day and require tact and skill to resolve — all tasks in which you don't want to be involved.

“Most practices start with a single employee,” says Susan A. Resnick, OD, New York City. “The first person you hire has to be almost like a partner — an extension of you. While you'll be seeing patients in the exam room, your first employee will do everything else.”

“You could hire someone cheap,” Dr. Resnick says, “but I'd want the first and even the second person I hire to be my ‘expensive’ people. Start high and work your way down. You'll get much more out of one highly capable person who commands a higher salary than you will from two inexpensive people who take 3 or 4 times the energy to train.”

If you serve communities with limited English proficiency, consider hiring someone who speaks their language. For example, Michael Johnson, OD, Sacramento, Calif., hired a staff member fluent in Russian to better serve the large Russian and Ukrainian populations in his area. It's an easy way to give your practice a competitive advantage.

Reality check: If a higher salary isn't in your budget right now, hire an experienced person part time.

2 Ignoring Appearances

A second mistake that's often made when starting a practice is failing to pay enough attention to appearances. I once saw a sign in an interior decorator's office that offers wisdom for new ODs. It read, “The longer your office says 'struggling lawyer,’ the longer the struggle.”

Many new ODs start by purchasing a practice from a recently retired optometrist. The price may be right, but if the office has faded wallpaper, tattered furniture and old equipment, it will delay the growth of the practice.

“Some say it's wise to start with only the basics and buy used equipment if possible,” says Tom Miller OD, Fayetteville, NC. “I disagree with that advice because, like it or not, people judge by looks. I didn't want shabby equipment or furnishings when I started out. I wanted to give the impression of being a state-of-the-art facility, so I bought a new chair and stand, phoropter, slit lamp, autorefractor/autokeratometer, autolensometer, an automated perimeter and an autopupillometer.”

Dr. Miller had other equipment from school such as his handheld instruments, a binocular indirect ophthalmoscope and a lens kit. “But instead of stopping there, I purchased a digital imaging system for my slit lamp that has been worth every penny. I know it was a good purchase every time I see patients who are excited by seeing images of their eyes for the first time,” Dr. Miller says. “The system generates referrals and, of course, is billable for appropriate diagnoses.” Since then, he's added numerous other diagnostic instruments.

Reality check: If you can't afford your wish list on day one, leasing may be a viable alternative.

3 Not Hiring an Optometric Assistant Sooner

A third mistake new ODs often make is not hiring an experienced optometric assistant soon enough. The most common reasons: “I'm not busy enough,” and/or “I can't afford it.”

“Even if you don't have enough patients to fill the schedule, you're better off seeing those patients with the help of a technician,” advises Neil B. Gailmard, OD, MBA, FAAO. “This way, you create open days during the week that can be used to work on the practice. And if your schedule isn't full enough, that's exactly what you need most.”

Reality check: If you don't get the right people on board to start, you may sink your practice.

Get it Right — Right from the Start

You'll note that two of the three penny-wise, pound-foolish mistakes I've listed have to do with staffing. Getting the right people on board for your new practice is one of the most important management decisions you'll make.

“Staffing costs are one of the biggest expenses in a practice,” says Rebecca St. Jean, OD, South Charleston, WV, “and the only area I would NOT recommend trying to stretch a buck.” When starting your practice, remember that cutting corners on staffing and practice appearances could have a detrimental effect on the success of your practice. nOD

Dr. Levoy is an editorial board member and monthly columnist for Optometric Management. He is the author of seven books including 201 Secrets of a High Performance Optometric Practice available at and 222 Secrets of Hiring, Managing and Retaining Great Employees in Healthcare Practices.

Optometric Management, Volume: , Issue: June 2012, page(s): 68 69