Practice Expansion: Why I Hired an Optometrist

About 3 years ago, I decided to build a new practice from the ground up. I have been fortunate in my success so far. Now, I am embarking on the next phase of my business development: growing the practice so that I can be more efficient with my current patient base and see more patients.

There are essentially three options for expanding capacity: hire technicians, bring on an optometrist, or seek out an ophthalmologist with whom to share clinical and/or surgical responsibilities. Each of these approaches has its merits. I decided to hire an optometrist, and it has made a tremendous difference in my clinical efficiency while significantly increasing my ability to see new patients. I have been surprised to discover a few unexpected benefits along the way, too.

EXPECTATIONS AND OUTCOMES

My practice is primarily surgery based, but I found I was losing a lot of potential surgical time to pre- and postoperative management. I had a healthy and robust patient roster, but as new patients called, we were scheduling them so far out that we risked losing them. That left me without the ability to add new patients or to properly manage add-on and emergency cases.

These factors led me to focus on hiring an optometrist comfortable in the medical model who could help to manage postoperative care while also seeing patients on his or her own. I expected at least three benefits. First, I could continue to see patients on postoperative day 1, but the optometrist would ably monitor the 1-week and 1-month visits. Second, to the optometrist could provide regular screenings and perhaps identify surgical candidates. Third, a medically oriented optometrist could handle the unexpected office visits that typically slow down a clinic’s operation.

I have had an optometrist working in my practice for about 4 months now, and so far, the results are better than I expected. For example, because I could offload the postoperative care of the 20 or so surgical cases I dealt with in a given week, I was suddenly able to add about 40 to 50 patients to my schedule. I perform surgery on Mondays, and I have another commitment that takes me out of the office on Fridays. In the past, patients needing clinical services during those days were referred to another practice or had to wait until I was back in the office. Now, my practice offers a full cadre of clinical services, Monday to Friday.

Previously, I lost money when I was away from the office. Now, I have coverage while I am on vacation. I may be paying for resources (front desk and back office, power, and electricity), but I am also able to attend to patients’ needs while I am away. I will accept that tradeoff in the interest of better care.

Hiring an optometrist has also positively affected my patient flow. I am able to see more patients and perform more surgeries. In addition, my practice is able to provide basically 24-hour service.

WHAT DO YOU WANT TO ACCOMPLISH?

Hiring an optometrist is certainly not an immediate promise of success. All staffing and human resources concerns come down to the people who are hired and how people work with each other.

There is extraordinary variety in the field of optometry. Not all optometrists want to focus on refractions or optical services. This can be a real boon to expanding clinical capabilities. I hired a medically oriented optometrist who completed a fellowship in anterior segment disease. I was not interested in someone who could run an optical shop, which did not fit with my needs.

I could have entered into a partnership with an ophthalmologist or hired a junior medical provider. However, I was and continue to be satisfied with my surgical volume, so adding to that capacity was not a priority. There may be other reasons not to want to bring on an ophthalmologist. For example, ancillary expenses can be vastly different between providers. Above and beyond the salary differences, malpractice insurance for an ophthalmologist can be about $20,000 a year. For an optometrist, that figure is about $700 a year. It would take a whole lot of additional surgery to realize a break-even proposition, much less a profit.

A medical provider may also want greater autonomy in the practice and input on operations, especially as they relate to patients’ care. I wanted to maintain my vision of the practice, so I decided to keep myself at the helm of the ship.

CONCLUSION

A practice may have several reasons for wanting to bring on new staff. Hiring an optometrist may serve any of a number of different objectives; easing postoperative care, adding optical services, and attracting pediatric patients are just a few.

In my opinion, expansion should start with a simple question: What are you trying to accomplish? If you want to increase surgical volume or add a different kind of surgery (such as retina or pediatric services), then hiring an ophthalmologist is the obvious choice. If the desire is to ease stopgaps in patient flow, maybe a technician would make sense. It is crucial to think about what kind of provider will suit your individual growth needs.

On a pay scale, a technician is going to be cheapest and an ophthalmologist the most expensive. If the latter is added, will the volume increase justify his or her salary? Hiring an optometrist would be middle ground in terms of salary, and he or she could bill for patient services.

If the decision is made to onboard an optometrist, the next thing is to decide what kind is right for your setting. There is a lot of subspecialization in modern optometry, with providers focusing on dry eye disease, contact lenses, medical optometry, prism refractions, etc. Moreover, do you want someone right out of training who is perhaps more malleable, or do you want someone with a wealth of experience who might have different expectations about the work environment?

Of course, there are the human resource questions about salary, incentives, and other compensation, all of which will affect whom you attract and your ability to retain staff. My staff is happy and gets along well with patients, which is really important to me. I wanted to make sure a new hire would be a harmonious addition, so I made finding someone with sound clinical skills and a welcoming bedside manner a top priority.

I would not suggest that everybody hire an optometrist, but there are certainly a lot of benefits, expected and not, that can come from that decision.

David A. Goldman, MD
• private practice at Goldman Eye, Palm Beach Gardens, Florida
• (561) 630-7120;david@goldmaneye.com