Article Date: 11/1/2004

fix this practice
Work More, Earn More? Not Quite.
If your income needs a boost, seeing more patients may not be the answer.
By Richard S. Kattouf, O.D.

Q I'm employed by two different practices (an M.D. practice and an independent O.D. practice). The M.D. practice continues to pressure me to see more patients for the same compensation, but I actually make a better income from the O.D. practice and have fewer patient interactions. What should I do?

A. R. Diamond, O.D., via e-mail

A: It appears that your work relationship with the parties isn't laid out specifically in a contract. Many doctors enter into employment with no written contract or with a contract that's not specific. An employment contract must include (in detail) the following:

Note: Employee doctors don't necessarily get all of these perks, but he must insist that his contract addresses them.

Is it in writing?

Developing an employee contract and re-evaluating it on an annual basis prevents what has happened to Dr. Diamond. Tell the M.D. that you want to design an incentive program based on your number of patient interactions or on the revenue that you create.

This is also an opportunity for you to teach the M.D. that in evaluating any employee-doctor's production, he should be most interested in unit sale per patient, not simply in the number of patients. (I'm speaking of comprehensive exams, not post-op visits.) Note: Unit sale is defined as the amount of money spent by a patient per year.

Seizing an opportunity

Reviewing/creating an employee contract is a great opportunity for an O.D. employee to bring new services and profits into a practice. In the past eight years, almost all of my ophthalmologist clients have had me teach the O.D. employees specialties such as corneal refractive therapy, computer vision syndrome or low vision.

Defining an incentive program based on revenue collected is the best for the employee doctor. The specialties I listed are usually internally referred to one optometrist. The fees for these specialties are high and the net income is terrific because these are private-pay specialties.

A case from which to learn

R. C. Bond, O.D., has multiple independent locations. He called my consulting company with O.D. employee problems. He felt that three of the five optometrists who worked for him weren't financially productive. He insisted that the three O.D.s change their schedule from two patients each hour to three. The employee O.D.s balked at the increased patient load.

No one could produce any written agreements, which is unfortunately common. In studying the production numbers, it was obvious that this practice would solve its problem by simply increasing unit sale for each patient. The solution was in teaching the doctors how to increase unit sales per patient and to develop a financial compensation package that rewards the employee doctors for their efforts. Each O.D. earned at least an additional $15,000 and the owner's net income increased by 4% -- all from teaching the doctors specialties plus teaching techniques in the exam room for the doctor to sell multiple eyewear based on the patient's lifestyle.

Quantity = profits

In this ever-growing managed care marketplace, we achieve profitability by increasing unit sales. Many times when we simply increase volume, unit sales plateau or decline. 

Dr. Kattouf is president and founder of two management and consulting companies.  For information, call (800) 745-EYES or e-mail him at The information in this column is based on actual consulting files.


Optometric Management, Issue: November 2004