A NICHE can breathe new life into your practice as you, the practitioner, differentiate your practice in the marketplace and help create patient loyalty. In my practice in Edmond, Okla., we decided to add three specialties in the past year: a dry eye disease (DED) center, scleral contact lens fittings and aesthetics, such as neurotoxins, fillers, eyelash enhancements, etc. (In Oklahoma, optometrists can become licensed to give injections.) While we have found these additions both personally rewarding and profitable, the question remains, should you add new services in your practice? And if you answer “yes,” what steps must you take to ensure success?

Read more on practice expansion:

Here are a list of questions you should ask yourself and the steps to take before adding a niche.


You should answer these six questions before deciding on adding a niche:

  1. Are you passionate about one aspect of eye care? Developing a niche takes a great deal of energy, so if you aren’t stoked about it, you may run out of steam before you hit the finish line. Therefore, pursue it only if you genuinely love and are enthusiastic about sharing the niche with your patients. (See “Two Ways to Clarify Your Professional Passions” to help you identify your fervor: .)
  2. Does a need exist for it? Utilizing your practice management software, run a report, and take a close look at your current demographics. If you see mostly children and parents younger than age 40, for example, a glaucoma practice may not be the right niche for you, at least not yet.
    But, by performing a case study on the patients you do have, you may identify a niche you haven’t considered, but would enjoy providing. For example, if you identify three out of 10 patients who have DED, then you might begin to further investigate DED as a niche.
  3. Are you referring out services that you or an associate could do? Run a report via your practice management software to review patients you refer out and for what. If a substantial amount of your patients are referred for sports vision, for example, and your associate is a huge sports fan and is well-versed in this niche, he or she may have the enthusiasm and skills to make sports vision a niche you offer, enabling you to create an additional source of revenue.
  4. Do you have the required equipment? This question does not require a “yes,” as you may be able to afford the needed equipment, based on patient need and, therefore, ROI. (ROI = Net Profit / Total Investment x 100.) To really drill into ROI, I utilize the resources from Lean Six Sigma management techniques. The items I identify include:
    • Necessary Equipment Owned:
    • Necessary Equipment Needed:
    • Cost:
    • Timeline to obtain: (Equipment goals have to be time specific to plan, measure and achieve.)
  5. Do you have enough staff to help with the niche? This question also does not require a “yes,” answer, but you do need to determine whether hiring more new staff members will be worth it. Calculate the ROI on a team member just like we did in question four for equipment. Leadership skills are also essential here. You will need to be able to influence and inspire your current team to embrace this, and possibly hire new team members to take it on. Simon Sinek is one of my favorite resources to help you increase leadership skills. (See Mr. Sinek’s talk at .)
  6. Does the breakeven point of revenue minus expenses make sense? Be realistic. This may take a little work, but better to do your financial homework in a realistic fashion than to start the process and be disappointed. (See April OM’s Interdisciplinary column, “Equipment Acquisition,” for more information.)
    To determine whether a DED clinic would be a good idea, for example, calculate your average patient collection by what you collect when treating your DED patient. Make sure to include the exam fees through the course of a year and any additional testing you bill to the patients’ insurance or that the patient pays out of pocket. (See “Estimated Niche Revenue Worksheet,” above.)
1 Total number of general patient encounters
2 Estimated capture rate (% of patients)
3 (#2 x #1)= Estimated total number of niche patients
4 Average revenue per encounter (include services and diagnostic testing reimbursement)
5 Average encounters per patient per year
6 (#4 x #5) = Average revenue per patient per year
7 (#3 x #6) Total estimated revenue for activity


Successful implementation of a niche requires a strategic plan of preparation that corresponds with definitive timelines. (That which gets measured, gets done!) The three steps needed to prepare:

  1. Get yourself up to speed on the niche. Attend a workshop or a meeting. Similarly, visit an expert who has already established himself or herself as a specialist in your chosen area, and pick his or her brain about successes and pitfalls, so you can avoid them.
  2. Communicate your vision with staff. Invite honest feedback of where potential roadblocks will be and how to change the business to accommodate the new niche. Carefully explain “why” you want to add this niche to your practice. Develop a protocol so that the whole team is on the same page. Ensure adequate training is provided for you and your staff. Give staff the tools needed to help you succeed.
  3. Design your marketing plan. Divide marketing into four categories: Internal marketing, external marketing, digital marketing and professional referral marketing. (Favorite sources: Seth Godin, Tim Ferris and Jonah Berger.)

Internal marketing could include point-of-purchase materials, signage, handouts, rack card and reception television videos. (Gather patient testimonials as you go to add across multiple marketing platforms). External marketing can include: newspapers, news channel interviews, billboards, community events, public talks, radio and television ads. Digital marketing is your website, blog, eblasts and social media outlets. Professional referral strategies can include contacting other optometrists, ophthalmologists, primary care physicians, allied healthcare professionals and other thought leaders in the community, who don’t offer the service, via letter.


Now, make sure to measure what success looks like for your niche. Set Specific Measurable Achievable Relevant Time-Specific (SMART) goals. Revisit each month, and fine tune or overhaul as needed. Have a staff meeting at which you define what’s working and what’s not working. Re-aim and fire again! OM