Article Date: 3/1/2005

Hot Tips for Opening Cold
Here are three must-learn aspects of real-world practice.
BY TOM MILLER, O.D., F.A.A.O., Fayetteville, N.C.

After completing my military service and graduating optometry school, I took what many would say is the road less traveled and opened a practice cold the day I got my license. My knowledge of optometry as a business was limited, but with unwavering enthusiasm, I opened in a small office complex, working hard for referrals and seeing anyone I could get in my chair.

Fortunately, in the past 5 years, I've learned a great deal from my setbacks. Who knows how much more I could have learned from others, if only I'd asked?


Where do you go for inside information on private practice? My expectations would have been more realistic if I'd visited more optometrists' and ophthalmologists' offices before opening my own.

Most everything you're doing has been done many times in many places. Ask to observe a practice and pay attention to everything that goes on, not only clinically but also on the practice management side. Often, doctors will be more open to advising you as a student before you become a competitor.

Observe what happens from the time a patient enters the office until the time he leaves. Pay particular attention to how these practices collect fees and file insurance claims. Observe how frequently patients are scheduled for follow-up.

Visit ophthalmology offices as well as optometry practices. Compare and contrast patient flow, level of delegation and instrumentation used in each type of practice.


The world of third party insurance is like no other, with very few hard-and-fast rules and little logic. It's easy to lose a great deal of money by not paying careful attention to insurance. If I were starting out today, I'd work harder at becoming an insurance expert very quickly. How can you do this?

Make a special effort to visit the insurance departments of several large eyecare practices to learn how they bill. Take courses on coding and reimbursement and read the latest coding books. It's a trial-and-error game, and the rules vary greatly from region to region, so you'll only learn by doing it.


No amount of clinical training can prepare you to manage employees. Keeping staff trained, motivated and happy requires special people skills, logistics and hard work.

A senior doctor can be a valuable advisor on staffing issues. Seek a practitioner with a thriving, up-to-date office and ask how he finds top employees. Ask about working with employment agencies vs. newspaper advertising. Consult the experts on tricky issues like wages, taxes, benefits and employee law.

Professional journals routinely publish practice benchmark data you can use to compare salaries and benefits. Business advisors from local colleges usually are eager to give advice. Use this information to stay competitive.


The scope of optometry has changed over the years, but the basics of practice management remain much the same. Seek help from those who are happy to give it. You may avoid some early mistakes and grow your practice faster than you ever expected.

Dr. Miller is in solo practice in Fayetteville, N.C. He graduated Southern College of Optometry in 2000 after serving in the U.S. Marine Corps. He was North Carolina's Young O.D. of the Year in 2002. E-mail him at

Optometric Management, Issue: March 2005