Article Date: 5/1/2003

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Which Is Better: More Patients or Less?
The answer may surprise you.
By Gary Gerber, O.D.

Imagine that each of your patients paid you $1,500 each year just to be a "member" of your practice. Then, each time one of them visited you, you'd bill their insurance company as you normally do. In exchange for this arrangement, you agree to only see a fixed number of patients and to provide concierge-type services to these patients who really want to see you -- and who are obviously willing to pay. Once again you are your patients' "doctor" -- not just their "eyecare provider."

Seeing less, making more

Sound too good to be true? For a small but growing number of M.D.s, this is their new practice reality. These doctors say that their new brand of "Boutique Medicine" allows them to spend quality time with a smaller number of patients and to provide more comprehensive care.

Seeing fewer patients and making more money -- might it work for optometry? Might there be a market for Ritz-Carlton-like service and fees that exists outside this small group of M.D.s that also fits into our ophthalmic universe? I contend that it's already here and does work -- albeit not nearly to the same degree (at least not yet).

Can optometrists participate in "boutique medicine" successfully?

There's no question that the M.D.s participating in these programs chose to do so rather than face the same day-to-day frustrations we deal with in our own practices. Beyond managed care's low reimbursements, the many obstacles that managed care places between us and patients are largely removed with this VIP service business model.

Improve your bottom line

In optometry's case, we could benefit from more carefully analyzing which managed care plans make sense for us. Approached analytically and non-emotionally, we would discover with a spreadsheet what we already surmise as true. Namely, we're seeing significantly more patients and not being paid for it. Looked at over time, we'd see that this is a trend that continues to spiral toward lesser profits per patient.

Stepping back from the spreadsheet and re-examining what our M.D. brethren have done, we'd see that they've rediscovered a fundamental law of economics: If we lower our fees and see more patients, we can raise our fees and see fewer patients. They have certainly chosen to raise their fees in a unique way, but have raised them nonetheless.

So where does all this leave rank-and-file O.D.s struggling with HIPAA headaches and staffing woes? It points to strong evidence that there is another way to be profitable and that feeling like we're powerless against the evil managed care Goliath isn't a reality for all doctors. And if these doctors demonstrate no other lesson, it shows us that careful analysis of your bottom-line business and strategies to improve it will win out over emotional non-factual knee-jerk business decisions.

Examine the example

The intent of this article isn't to stir you to do what these doctors have done. For indeed, significant and real objections to what they're doing exist. Not all patients can afford their higher fees and those who have been patients for a long time may now be forced to seek care elsewhere.

The intent, rather, is to prod you to examine it more globally and realize that increasing numbers of O.D. practices in the United States are growing and succeeding by gradually seeing fewer patients. 

Dr. Gerber is the president of the Power Practice, a company specializing in making optometrists more profitable.  Learn more at or call Dr. Gerber at (800) 867-9303.


Optometric Management, Issue: May 2003