Article Date: 11/1/2004

Are you ready for what awaits you on your first day of practice? Learn from this new O.D.'s mistakes
By Robert Szypczak, O.D., Hilton Head, S.C.

Many of us would like to open our own practice right after graduation, but lack of funds or inadequate business experience often prevent us from realizing our dream immediately. But don't despair! I'm living proof that it's possible to learn about business and earn a good salary practicing optometry at the same time. Keep reading and I'll let you in on the secret.


Before graduation, I contemplated working as an employee for an established private practitioner or a commercial optical shop. Although the sizeable salary and the prospect of a guaranteed 40-hour work week was appealing, I knew this kind of job wouldn't teach me what I needed to know to run my own business.

I definitely didn't have enough money to start my own practice. Luckily, I knew about another option, one that would let me be my own boss and pick up business skills at my own pace. I decided to become an independent doctor of optometry.


Independent O.D.s rent office space from commercial retail establishments, such as LensCrafters, Pearle, Sears or, in my case, Wal-Mart. Each practitioner runs his own business within the main store, but he must comply with state laws that restrict the practice of optometry in a commercial setting.

In "one-door" states, independent O.D.s share an entrance with and are considered part of the host store. Legally, the O.D. is affiliated with the host store, which usually provides examination equipment and office staff, pays general liability insurance and files insurance claims. The good news is that you still get to set your own fees and schedule, so you have more flexibility than you would as an employee.

My office is in a "two-door" state, which has different regulations and requirements. I still control my fees and appointment schedule, but I must maintain an entrance separate from the main commercial store. I'm also considered a separate legal entity, so I had to obtain my own business license, general liability insurance, telephone service and, as I found out on my first day, I'm responsible for collecting my own fees and billing insurance. If these are the kinds of details you're trying to avoid by becoming an independent O.D., you may want to think twice before signing a contract in a two-door state. (For more tips about contracts, see "Contract Common Sense.")

Knowing whether you'll be working in a one-door or a two-door state is probably the most important piece of information you can have before opening your practice. If I'd known the difference, I could have avoided quite a few of the mistakes that made my first day so "interesting."


My first mistake was arriving in town only 2 days before my grand opening. Everything seemed in order: My name was on the door, the fees were set and the patients were scheduled. Assuming I had everything I needed to operate my eye clinic, I showed up on the first day ready to go, briefcase and BIO in hand and the stray butterfly or two in my stomach.

The first indication that I was in for a bumpy ride was my schedule. One look at the appointment book made me shriek -- 11 patients all in a row and no lunch break! Worse yet, my schedule was wide open for the rest of the week. Which brings me to Tip #1.

TIP 1 Make sure your scheduler spaces appointments over the week, blocks out some time so you can eat lunch and schedules two examinations and one follow-up per hour.

Next, I realized I didn't have any diagnostic drops in the office. Where was my fluorescein and rose bengal? How would I remove a foreign object from a patient's eye without topical anesthesia?

TIP 2 Inventory exam room supplies in advance so you can order missing essentials and have them on hand before you open your doors.

But most important, where were my mydriatic drops? Suddenly realizing I couldn't do a dilated examination and wondering what I'd do if a patient showed up with a detached retina, I fervently hoped my malpractice insurance was in effect.

TIP 3 Make sure you have malpractice insurance before seeing your first patient.

Just as I was thinking to myself, "How much worse can this get?" my first patient arrived. While passing him off to my "rented" technician for pretesting, I noticed she looked a little nervous. I soon found out why when she admitted she'd never pretested a patient before.

TIP 4 Make sure your staff is properly trained.

After working-up and examining my patient, I was eager to collect my first dollar. What? This is a two-door state? The store can't collect my fee? Reduced to accepting cash, free rounds of golf and the occasional IOU as payment. I made a mental note to contact a business banker and arrange for a credit card machine as soon as possible.

TIP 5 Make sure you have a functioning payment infrastructure.

The next two patients were the easiest of the day. Of course, that's because they left as soon as they learned I wouldn't be able to accept their insurance until I'd received approval from my carrier, which would take about a month.

TIP 6 Submit all necessary insurance applications as early as possible so you don't have to turn anyone away.

I realized I'd overlooked another important detail when I discovered my next patient had a rare macular dystrophy and a macular hole. I knew I had to refer him to a specialist, but to whom? I was new in town and didn't know any ophthalmologists.

TIP 7 Establish a referral network.

My supply problem reared its ugly head again when I didn't have sample eye drops for a patient with elevated IOPs. No problem. I sent her to the pharmacy with a prescription.

TIP 8 Contact the major drug firms to arrange a visit from their local reps.

About a half-hour later, the pharmacist called to ask for my DEA number. I need a DEA number? Yes, I do, and the application fee is $390. Adding this task to my mental list, I gave the pharmacist my state license number, which will work in the interim.

TIP 9 Complete all necessary paperwork before writing your first prescription.

And it didn't end there. One patient asked me for a business card, which, of course, I didn't have. I couldn't help a patient who'd lost her GP lens because I didn't have a fitting set on hand or the phone numbers for local contact lens labs.


Finally, my first day was over. I was hungry, tired and had a to-do list two pages long, but it was worth it in the end. My situation gradually improved over the next few weeks as I settled into a routine. Sure, I was stressed and sleep-deprived, but I accepted these inconveniences as part of my crash course in business.

I definitely haven't given up my dream of owning my own practice. In addition to seeing patients at my Wal-Mart office, I work for a private practitioner who's nearing retirement. By the time he's ready to sell his practice, I'm confident I'll have accumulated all the capital and business experience I need to run my own private practice.

Dr. Szypczak graduated from the Illinois College of Optometry in 2004. He works as an independent optometrist and a private practitioner in Hilton Head, S.C.



Contract Common Sense

Most optical businesses, private or commercial, will want you to sign a contract. I strongly advise you review this document with a lawyer who can translate all the small-print before you sign on the dotted line.

Pay particular attention to the competition clause, contract length and your starting salary and benefits. Some easygoing companies will let you break your contract with 60-days' notice. Other contracts penalize you for leaving early. Do you really want to promise not to practice within five miles of your former employer for 5 years after leaving your job? In extreme cases, employers can bar you from dispensing a particular brand of contact lenses if you set up a new practice within the same county.

Contracts can work to your benefit, too. Always remember that you have bargaining power, especially if you're hired to take over a practice that's been vacant for some time. Your employer or host store needs you to help them make money, so they're often willing to compromise on certain terms of your contract. Independent doctors of optometry typically pay 10% to 20% of their gross income in rent. Don't be afraid to negotiate for lower rent or even ask them to waive the first 6 months' rent. If you ask, you also may be eligible for reimbursement of moving costs, a minimum guaranteed salary or tuition reimbursement. 


Are You Ready for Your First Patient?

Before hanging out that "Open" sign, you should take at least 2 weeks to make sure your office is fully stocked and your staff is completely trained. When you think you're ready, test yourself by asking these questions.

  • Do you have malpractice insurance?
  • Did you submit the paperwork you need to write prescriptions?
  • Do you have all the office furniture, examination equipment and diagnostic drops you need to do a complete work-up?
  • Do you have access to sample drugs?
  • Have you sent a referral letter to local specialists and established a referral network?
  • Do you have information and phone numbers for contact lens labs?
  • Is your office HIPAA compliant?
  • Can you accept credit card payments? Do you have a cash box and receipts?
  • Do you have a tax I.D. number, business manager or business checking account?


Optometric Management, Issue: November 2004