Optometry is an ever-changing and evolving discipline. Shouldn’t it naturally follow that the profession’s approach to patient flow changes along with it? Some enterprising doctors see that question as a challenge—one they’re eager to rise to. 

The American Optometric Association’s 2014 Eye Care Workforce study, commonly known as the “manpower study,” noted that optometrists, collectively, have excess capacity and can see on average about 20 more patients per week.1 But figuring out how to begin building a practice’s volume may leave some feeling confused. An important first step in undertaking any project is knowing the right questions to ask. 

Here, several experts give their take on how to build patient volume, and what questions doctors ought to ask.

Photo: iStock.

What’s the Best Practice Model For Me?
“First of all, you need to define ‘high-volume,’” says Jack Shaeffer, OD, president and CEO of the 16-location Shaeffer Eye Center of Alabama. Many people, he says, just use it to mean “a well-run practice that makes money.” Define your terms, and your goals, right up front. To him, the most important part is making sure you don’t sacrifice patient care in the process.

Dr. Shaeffer’s practice is medically focused, but that’s not necessarily the right model for everyone. “Some people are going to want a more medically based practice, some are going to want a more refractive-based practice and both models are acceptable,” he says. He stresses that if practitioners prefer to focus more on spectacles and contact lenses, that’s simply a different level of care. 

In fact, there are several models of eye care practice, and it’s incumbent upon the OD to select the one most likely to provide a path to success. Various options also exist for practitioners who are not prepared to be full-time business owners. Being your own boss sounds great, but it requires capital investment, risk and managerial know-how. For this reason, employment—by another OD, an MD or a corporate franchise—suits many just fine.

According to Kirk Smick, OD, co-founder of Clayton Eye Center in Morrow, Ga., the different optometric practice models are setting the discipline itself on the trajectory toward becoming two distinct, and equally necessary, professions. “One profession is where you go when you break your glasses on Saturday” and need a quick fix, so “you run to the mall with the express purpose of getting a refraction and a new pair of glasses.” The other is a medically based practice, which Drs. Smick and Shaeffer use. 

Practices focused on vision care and dispensing may deprive themselves of growth opportunities in medical care, Dr. Smick says. And therein lies the future of optometry, as he sees it. “From an economic point of view, reimbursements are going down and so traditional optometry is not nearly as financially rewarding as it was 10 or 20 years ago. But, by incorporating medical procedures, your income can come back because you’re providing a lot more services to the same number of patients.”

How Can I Be More Efficient?
One need not run a 16-location practice like Shaeffer Eye to embrace the lessons of a high-volume practice. Even small locations with only a handful of personnel can root out inefficiencies. In fact, one of those inefficiencies may involve that personnel. 

“You can’t run that kind of practice without high quality staff,” Dr. Shaeffer says. “And you have to have staff training and enhancement programs because the staff has to grow and has to learn.” To keep your staff highly trained is an investment, just like new technology is an investment. 

Being efficient doesn’t mean it’s time for doctors or their staff to cut corners, says Dr. Shaeffer. “You have to want to deliver the highest quality of care that you can possibly give and become very efficient at managing that care. You can’t say ‘OK, I’m only going to dilate these patients’—all patients need to be dilated,” he says. “All patients in my estimation should also be offered a visual field screening” and a comprehensive medical exam if warranted, regardless of the co-pay or the deductible. “It’s about the disease process and not about what insurance the patient has. Those are the boundaries you have to set for yourself and your staff.”

The real secret is in delegation. The more you’re able to delegate to staff, the more efficient your practice is going to become. That’s why Dr. Smick’s practice boasts a staff of 85—in addition to seven full-time optometrists and four full-time ophthalmologists.

One step you can take to tighten up efficiency is to ensure your staff members are multi-talented and cross-trained for various responsibilities, says ophthalmic consultant Bryan Rogoff, OD. He says ODs should ensure that everyone in the practice is contributing “to the utmost capacity.”

“Our secret to growth was adding more [insurance] plans and more doctors and staff,” says Dr. Smick. “I have a lot of friends who have a three-week backlog. That’s fine for them, but the patient who calls can’t wait three weeks. So, they call my practice, because we have availability today.”

What Makes Me Unique?
In a crowded market, optometric practices need differentiating factors that make them stand out. Some may develop expertise in contact lenses, pediatrics or low vision. Others embrace surgical eye care. “A key element, if you want to grow, is being able to offer ophthalmological services,” says Dr. Smick. Many solo optometrists simply have an ophthalmologist come into their practice once every week or two, saving up those patients who need such services. Others refer to nearby MD practices and comanage patients actively. No matter how care is delivered, offering that wider scope of care means you’re going to attract more patients, according to Dr. Smick.

The fact is, the discipline is changing. With Kentucky, Oklahoma and Idaho all permitting ODs to perform some laser procedures, the privileges are, indeed, expanding. Perhaps due to the increasing need for eye care as the baby boomer population eases into retirement age, or perhaps due in part to the decline in new ophthalmologists (a recent study determined that “there continues to be a gradual erosion of the role of ophthalmic medical education in the standard medical school curriculum”), optometry is slowly but surely expanding its scope of practice.2 But it’s also partnering with ophthalmology to provide top-quality patient care.

“As we look forward to the next 10 to 15 years, there’s going to be a real shortage of ophthalmologists,” says Dr. Smick, given the projections for increased rates of cataract, AMD and other age-related eye diseases—routine care simply can’t be managed by MDs at their current capacity. “Optometrists who practice the medical model are really going to become busy. They’re going to be seeing a lot more glaucoma patients and doing the bulk of the pre- and postoperative care,” Dr. Smick says. He adds that many of the big surgical practices have optometrists working side by side with them. “That’s how the manpower distribution is going to be able to work out,” he predicts.

Partnering with ophthalmology is nothing new, but it’s something that optometrists may benefit from more than ever in the very near future. Doing so can provide your patients a level of care your competitors cannot. The first step is to set up an old-fashioned face-to-face meeting.

“It’s networking 101,” Dr. Rogoff says. “Set up a lunch. Engage with that person. And, keep up that relationship. Suddenly, MDs will be sending patients your way.” 

How Can I Best 
Accommodate Patients?
If you’re finding yourself with downtime for a significant portion of the day, your problem might not be your schedule so much as it is your patients’ schedules. 

Many practices could add a couple of late nights per week, maybe staying open until 7pm, and open a few hours Saturday to wrest back clientele lost to big mega-chains who can afford to be available more often, says Dr. Rogoff. “A lot of middle class people work two jobs” and simply can’t see you during normal business hours. “You can choose to be either proactive or reactive about it,” he says. 

Incidentally, Dr. Rogoff adds, when you’re thinking about increasing hours, that might be the right time to also consider bringing a new OD aboard who will be eager to have the work and provide you a well-deserved rest.

To best accommodate them, you have to know your patients, and that means studying the demographics of your area. To previous generations, that might have required a consultation with the local chamber of commerce, but these days such research is often just a click away, says Dr. Rogoff, as analytics are abundant in the digital era.

Those demographics could help you decide which model to practice, or where to practice. For instance, if your community’s demographics skew to the young and healthy, the medical model might not be appropriate. However, that population may be ripe for dry eye or specialty contact lenses. Studying your demographics can reveal something as simple as whether your area has a large percentage of young athletes whose parents want to invest in sports goggles and safety lenses. 

In addition, you should consider your patient base’s access to medical care. “There is still a significant population in the United States that live in rural towns of 10,000 or less,” says Dr. Smick. 

That patient base may not have as much selection, but they will have eye disease. “If those doctors are still going to be successful, they’ll have to provide a variety of services.” 

How Can I Improve Revenue?
Reimbursement rates are low, and it can be frustrating to know that optometry is reimbursed at a lower rate than ophthalmology for some of the same services. With all the other burdens insurance places on optometrists, it’s enough to make some want to drop insurance altogether and go private-pay only. 

Dr. Rogoff advises otherwise. If you drop vision plans, he says, you’re really doing a disservice. “How are you going to be able to gain that market share back if you’re losing 10% or 20% of patients? Even if it’s not an ideal reimbursement, you might have to spend two to three times more on marketing trying to capture that share back,” he says. 

In addition, “there’s a sort-of fear factor of managed care,” according to Dr. Schaeffer. On its website, his practice offers to accept a wide variety of plans and promises to assist patients in determining the best use of their insurance benefits. 

He adds that the dispensary at a medical-based or integrated health-based practice carries the dual benefit of providing patients with increased care and providing physicians more opportunities to increase revenue. “If you’re going to operate at this level of practice, first of all, you’re going to have to have the product,” Dr. Shaeffer explains. “You shouldn’t put the same contact lenses on every patient.” Rather, be well versed in all options and tailor the care to each individual. “And you have to have staff who understand that just because a person sees 20/20 and says they feel OK, that doesn’t mean [what they’re wearing] is the best product.” Careful attention to detail in on-eye performance will ensure long-term success—and justify fees commensurate with your level of care.

“Now you have an eye exam, you have a contact lens evaluation and you have a contact lens follow up, and that is required in a high level of care practice,” says Dr. Schaeffer. “It’s not optional. It’s required to be comprehensive. That’s the minimum a doctor can do. And you should have fees tied into that.”

Contact lens technology is currently at a point where every patient should be offered multifocal lenses, “but sometimes the multifocal evaluation can take three to four visits to make sure you have the perfect prescription,” according to Dr. Shaeffer. This often deters ODs. Bill for each or bundle them together—but charge for your expertise.

Bravery, in a New World
What Dr. Smick and others are noticing is that the majority of optometrists no longer come into the discipline to take over their family business. The new crop of optometrists appear more likely than previous generations to embrace employment and, for those who choose that path, plenty of options will be available. However, this generational shift should not be seen as the beginning of the end of private optometric practice. It takes a good deal of planning, but by evaluating your patient base, the services you’re able to offer and your methods of delivering them, you can still find room to let your entrepreneurial spirit and individualist drive lead you to success.

1. American Optometric Association/Lewin Group. Eye Care Workforce Study: Supply and Demand Projections. Executive Summary. April 25, 2014.
2. Shah M, Knoch D, Waxman E. The state of ophthalmology medical student education in the United States and Canada, 2012 through 2013. Ophthalmology. 2014; 121(6):1160–3.