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Many doctors believe they are doing a good job in practice management by keeping expenses down.
To a point, we all should watch expenses and reduce financial waste, but we also must be mindful
of creating a cycle-down effect. You cannot cut your way to prosperity! You must spend money to
A cycle-down effect occurs when cost-saving measures reduce services, and they almost always do.
A hypothetical optometrist looking to increase her net income decides to not hire more staff and to
not spend money on equipment or inventory. In turn, service is not quite as good as the competitive
eye care practices in the area, but the doctor rationalizes that no one will notice. Actually,
patients don’t complain but they aren’t overly impressed either. They are gradually pulled to
other providers who they hear about from enthusiastic friends. Net income for our doctor remains
flat or declines a bit, so she cuts expenses a little more. Service drops off further and the
downward cycle continues. Eventually, the only patients remaining are the ones on the very worst
Deciding to not invest in the practice is virtually the same thing as cutting expenses. Practices
that are stagnant will lose ground to other practices which are improving. On the other hand,
practice owners who invest every year create a cycle-up effect. Patients and staff can see that the
practice is on the cutting edge of technology and that customer service is a priority. There is
something exciting to talk about in the office and outside in the real world.
Jump-start #3: Buy or lease a new instrument now
A new high-tech clinical instrument can jump-start your practice. I believe in investing in at least
one major item every year, even if you have to borrow the money or lease it. New equipment can do
The quality of your eye exam is often judged by the instruments used. Patients have no way of
evaluating a doctor’s skill at ophthalmoscopy or refraction, but if he uses a phoroptor from the 1940s
and an old pump chair, that becomes a clue. It may not be correct, but it’s all patients have to go
We know the biggest practice building factor is word-of-mouth referral of one patient to another.
Our goal is to make patients talk about your office to others. Since almost all adults have had an
eye exam before, we must do something significantly different and better than their expectations.
Maybe we can do several things better. A big part of that difference can be in the testing
You need competitive advantages to attract patients. Having a reputation as a high-tech
practice that cares about people is a big one.
An instrument can actually increase gross and net revenue. Not all instruments have a direct
financial payoff, but when they do, it’s great. Indirect financial payoffs are good also, and most
new instruments provide that if it saves doctor time, improves accuracy or just creates a wow factor.
Don’t underestimate the value of saving doctor time. Even five minutes per patient creates an
hour per day in the average practice! And don’t make the mistake of thinking it doesn’t matter
because you’re not busy enough anyway. Act as you mean to go.
Instrument priority list
Deciding on what instrument to invest in next is a very individual decision. It depends on what your
practice already has, your practice specialty and your goals. Here are few ideas to get you started.
Digital retinal camera. This one is huge. When networked with desktop computers in the exam
rooms for viewing images and when included as part of all exams, patients are very impressed. A fee
can be charged to the patient or to insurance when appropriate. It saves doctor time and it is a
great patient education tool.
Computerized refraction systems. Finally, a breakthrough from the age-old refractor. Whether
performed by the doctor or by a technician, patients are ready for a change in the subjective
Digital acuity charts. Consider the one thing that a patient looks at the entire time they are
in your exam room: the Snellen chart. How does yours look? Compared to most items on this list,
the cost is minor.
Nerve fiber analyzer. A great adjunct to diagnosing and monitoring glaucoma. This instrument
pays for itself in many practices because the procedure is billed to insurance or Medicare. If it
costs nothing, why not have one?
Corneal topography. Contact lenses are a big part of optometric practice and this is the premier
way to evaluate corneal shape. This test alone justifies the contact lens evaluation fee because
patients see that something extra is being done at the annual exam. Have it networked to your exam
room PC so you can view the images and talk about them.
Corneal pachymetry. You really can’t evaluate intraocular pressure without it and they are not
Autolensmeter. If you had to perform lensometry as often as your staff does you would have
bought one of these a long time ago. The newest designs are amazingly easy for anyone to do; just
place the glasses in a tray and push a button and 10 seconds later both lenses are accurately analyzed
and the Rx is printed.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
Dr. Gailmard's new book, Practice Management in Optometry: A Blueprint for Success Based on the Optometric Management Tip of the Week, is now available on Amazon.