Article Date: 3/1/2013

To Be Or Not to Be a Practice Owner

To Be or Not to Be a Practice Owner

In time, the wrong practice will lead to professional burnout.

NOT EVERY OPTOMETRIST is cut out for the role of practice owner. There are ODs who enjoy seeing patients, diagnosing and prescribing, but don’t want to concern themselves with the business aspects of practice. Some ODs are entrepreneurial, ambitious and willing to take the risks necessary to open a solo private practice or buy an existing practice. For others, working as an associate for an OD, MD, commercial firm or HMO/PPO are logical alternatives to ownership.

Hygiene vs. Motivation Factors

If you’re undecided about which career path to take, the answer lies in how you define job satisfaction. Psychologist Frederick Herzberg, who became one of the most influential names in business management, published a breakthrough article in the Harvard Business Review titled “One More Time, How Do You Motivate Employees,” focusing on this very issue.

Herzberg upended the common assumption that job satisfaction is one big continuous spectrum — starting with happy on one end and ending at absolutely miserable on the other. Instead, he said satisfaction and dissatisfaction are separate, independent measures, each having their own criteria.

Herzberg’s theory distinguishes between two types of factors that influence job satisfaction: hygiene factors and motivation factors.

Hygiene Factors

Herzberg said hygiene factors include status, compensation, job security, work conditions, management policies and supervisory practices. He claimed that unless these hygiene factors were addressed, they would be the source of job dissatisfaction. If effectively addressed (for example, a less-than-satisfactory salary is increased), the dissatisfaction would disappear, but job satisfaction wouldn’t automatically improve.

Let’s use the analogy of garbage collection. When garbage piles up, you’re unhappy. But when it’s finally collected, you’re not suddenly happy. You’re just not unhappy about the garbage.

By the same token, if you’re required by an employer to work long hours or not paid what you think you’re worth, you become unhappy and resentful. If these parameters change for the better, you won’t suddenly love your job. You’ll just be less unhappy or resentful. We’re back from a minus quantity to zero on the job satisfaction scale.


Motivation Factors

Motivation factors are an entirely different set of factors that, according to Herzberg, result in job satisfaction. They include challenging work, a sense of achievement, recognition, responsibility and personal growth.

An OD from Texas who spent 11 years with a commercial firm before going out on his own, asked rhetorically, “Would I do it again?” and without hesitation said, “Definitely. In fact, I wish I’d done it sooner. Others were making decisions about my day. It was all about numbers. I’m working harder than ever now, but I’ve never been happier.”

A Combination May Be Best

The best of both worlds may be the middle road — combining the best of hygiene and motivational factors.

“I’ve been at a commercial practice for 7 years and love it,” says Greg Ray, OD, from Clarksville, Tenn. “I spent 10 years in private practice and was burned out from working 6 days a week with basically no vacation or downtime. At my current practice, I make well into six figures with no quotas, and no one is trying to interfere in my practice. I have the latest in technology and EMR. I no longer work 6 days a week, so I get to spend time with my family, take vacations and have time off. Patient care is more fun and more rewarding.”

“I’m a working mom, practicing 2.5 days a week,” an Illinois OD told me. “That’s all the work I want. I’ve had my own practice and now I’m an associate in a colleague’s practice. I think I have the best of both worlds.”

Beware “The Golden Handcuff Syndrome”

Beware of this trap. I’ve met many optometrists who’ve used strictly hygiene factors, such as income and job security, as the criteria for deciding on a job as a salaried employee — in many cases with a commercial firm. Their reasoning is that a steady income, come rain or shine, is what they want.

“This will just be for a couple of years,” they say. “I’ll pay down my loans, get myself in a good financial position, then I’ll open my own practice.” But months pass, then years go by and many never get to that next step — trapped by what one OD calls “The Golden Handcuff Syndrome” — steady work and a decent salary (plus benefits) for what is essentially a 9 to 5 job — with no management responsibilities.

By taking such jobs, these ODs can pay down their college loans. They get their mortgages under control and their families settled and comfortable. But somehow, that early pledge to open their own practice is continually deferred. “Just one more year” or “Now isn’t the time to open a new practice,” they say.

It won’t be long, however, before some of these optometrists realize that they’re tired of it all. But they may feel stuck because they’ve expanded their lifestyles to fit their salaries and it’s very difficult to start over again.

In a Nutshell

“The best thing about private practice,” says Mike Burley, OD, Vermilion, Ohio, (who’s worked in both private and commercial practices) “is that, at least in my small town, I know patients as friends and get to see their children grow up, so my practice feels like an extended family.”

He says the best thing about commercial practice is that at the end of the day, you can leave the office and be done. “There’s no worrying about whether the lab will have Mrs. Jones’s glasses ready in time for her daughter’s wedding tomorrow and worrying about whether the check that was written for three pairs of PAL lenses on an out-of-state bank will bounce,” says Dr. Burley.

Never ‘Work’ Again?

Herzberg’s research underscores the importance of giving careful thought to which career path will lead to your greatest job satisfaction and work-life balance. As the saying goes, find a job you love and you’ll never work a day in your life. 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. He can be reached at

Optometric Management, Volume: , Issue: March 2013, page(s):