Article Date: 3/1/2006

I Learned to Think Outside the Box ...en Español
Here's a creative idea to build your practice. Go where the patients are ... and learn their language.
By Allan S. Tocker, O.D., Wilmington, Del.

DO YOU "think outside the box"? We often use this phrase to describe today's successful eyecare professionals. These are the docs who take creative or unusual approaches to meet an important need or excel against the competition. Their innovation drives us all forward as it advances not only their positions, but also our profession as a whole.

We can learn from their examples or get inspired to think outside the box in our own practices. When I examined my practice, I discovered an idea that could have an enormous positive impact was staring me right in the face.

Dr. Tocker measures "presión de ojo" (eye pressure) with a tonometer.

Find a Whole New Population

In 1991, my 3-year-old private practice was suffering some growing pains. I wanted to expand my business, and I was searching for ways to reach potential patients. I realized that because of language or cultural barriers, not everyone in my area had easy access to eye care — particularly the fast-growing
Hispanic population.

Then I had an epiphany: Learn Spanish. By learning the language, I felt I could gain a foothold in the Spanish-speaking population and provide much-needed services.

Of course, thinking outside the box is one thing, but actually implementing a great idea can be a bit trickier. In fact, it can present a roadblock that stops a creative idea in its tracks.

If I'd had even the most rudimentary high school or college Spanish courses, learning to talk eye care with Spanish-speaking patients would have been easier, but I wasn't blessed with that foresight in school. So, to reach our vibrant, growing Hispanic population, I needed to start from scratch.

Learning a new language seemed daunting at first, but I soon realized picking up conversational Spanish wasn't difficult.
I learned the language from my bilingual patients. As I examined their eyes, I asked them to tell me the correct words and phrases to use, which I practiced and memorized. I wrote them down and kept them near my exam chair.

The first, and most important phrase I learned was "Es mejor aquí o aquí?" (Is it better here or here?) Then I built my vocabulary from there. Once you master basic phrases, performing a comprehensive eye examination while communicating in another language becomes routine.

Reach Out to the Community

Dr. Tocker measures "agudeza visual" (visual acuity) with a phoropter.

Once I'd learned the language skills I needed, how would I use them? I needed to reach out to the community, but how? I found the answer in, of all places, a farmer's market. 

The New Castle Farmer's Market is a compact, diverse, mixed-use collection of owner-operated businesses. Not only can people buy fruit, vegetables, meats and baked goods at the market, but they also can visit restaurants, hairstylists and repair shops, and buy clothing, jewelry and hardware. Visitors represent diverse ethnic and socioeconomic groups. It was the perfect venue to expand my practice.

I opened a satellite office at the market in 1991, and I still divide my time among three offices today. About 40% percent of my patients at the market are Hispanic and speak no English, so my Spanish language skills are essential. We have bilingual signage and patient information forms, and a bilingual staff member joined the practice last year. 

Opening an office in the farmer's market is paying dividends. My Spanish-speaking patients are relieved when they realize language won't be a barrier in their exam. Imagine you're seeing a doctor in a country where you do not speak the language. It can lead to some anxiety. We offer comfort.

Go Beyond your "Comfort Zone"

Learning a new language pushed me outside my comfort zone, as did opening an office in a farmer's market. Another "out of the box" change I made to my normal routine was working weekends.

Many of us aren't accustomed to working weekends, and certainly not Sunday, but most people prefer to shop on the weekends. And the market is open only Friday through Sunday, so weekend hours were a given at my new office. In fact, many patients make appointments on the same day for the weekend, and we even accept walk-ins as well.

We're all learning that we may need to follow the example of other service industries to gain a competitive foothold. You may have noticed most banks have switched from "banker's hours" to full weekend access. Sure, the schedule may put a crimp in your golf game or limit partying on a Friday night, but it has its rewards.

By going beyond typical extended hours — occasional evenings and every other Saturday — my practice is much more accessible than those of my competitors. And to capture the population I've targeted in a retail setting, a weekend schedule is pretty much non-negotiable.

Dr. Tocker makes sure frames aren't "demasiado apretado" (too tight) or "afloje también" (too loose).

Count On More Growth

If you already speak a second language, you have an advantage. If not, don't rule out learning a new one. The language you choose depends on your community's population, but Spanish is useful in many areas.

According to the U.S. Census Bureau (, the Hispanic population in the United States grew from 9% to 12.5% between 1990 and 2000. That's an increase of about 35 million people, which makes this the fastest-growing ethnic group. Today, the trend continues. Hispanic people account for about 14% of the U.S. population.

Experts say the strong demand for Hispanic-focused retail and professional services is underserved. According to Prudential Real Estate Investors, Hispanic people will have $736 billion of disposable income in 2006.

This growing economic strength is influencing everyone from realtors to retailers in the largest markets, and optometrists can tap into this growing market as well.

The opportunity to gain access to a young, large, fast-growing ethnic group with a strong demand for services left a great impression on my approach to optometry. By learning Spanish and opening a satellite office in the Spanish-speaking community, I have made a strong commitment to my community and my patients. I've become comfortable thinking outside the box. After all, the most productive changes often start with a simple, unique idea.

Experience the Rewards

My 15 years in the New Castle Farmer's Market have been rewarding on several levels. Most important to my budding practice, I gained new patients and income. One of the main reasons for this growth is my accessibility. Fifteen years ago, my Farmer's Market location accounted for about 25% of my business. Today, it still accounts for about 10% as my other locations grow.

My Hispanic patients have been a very loyal segment of my patient base, returning year after year. These patients are more likely to refer family and friends, too. I have seen an increase in Hispanic patients in my other offices as well. My greatest long-term reward has been service to the community. The anxiety melts away when patients realize we have no language barrier. My staff and I deliver this confidence and peace of mind to our patients. nOD

A 1983 graduate of Pennsylvania College of Optometry, Dr. Tocker practices in Delaware at his offices in Wilmington, Newark and the New Castle Farmer's Market.

Optometric Management, Issue: March 2006