No man is an island, the poet John Donne said nearly 400 years ago. Are optometrists finally starting to see the wisdom in that? Let’s hope so. It’s going to be vital to your future.

Solo private practice remains the goal of the vast majority of optometrists. The notion of being your own boss is compelling. But a number of trends today are converging to make solo practice increasingly difficult to sustain, at least without accepting a number of trade-offs and sacrifices.

As we report in this month’s annual income survey, the earnings gap between solo practitioners and those in group practice continues to widen. Reporting on this year's Income Survey results, Executive Editor John Murphy lays it out in black and white: Optometrists in group settings earned one-third more than solo practitioners.

Group practices can spread out the cost of expensive equipment or major investments like an EMR system across multiple doctors, and each optometrist added to the practice obviously brings in another revenue stream. With its higher gross revenue and better return on investment, group practice wins hands down. Financially, at least.

Taking on a partner also gives you some much-needed breathing room in the schedule. You’ve got someone to pick up the slack when you’re away—and the cash flow doesn’t dry up when you take a vacation or reduce your hours.

Those willing to bring in an associate (see Dr. Cheryl Murphy’s article, When Is the Right Time to Add an Associate?) will have their pick of the litter, given that there seems to be a glut of O.D.s entering the market—at least judging from the online commentary one sees among disillusioned optometry students and recent grads. They’ll go work for corporate optometry if they must, but they’d rather work for you. And if you don’t hire them, the local ophthalmologist just might, leaving you suddenly at a competitive disadvantage. Set the terms of the buy-in to suit your priorities—you’re still calling the shots while lightening your workload and laying the groundwork for your practice’s future.

Collaboration can take many other forms, and need not always include an equity split. While taking care to avoid any appearance of collusion, there are a number of smart ways for a group of like-minded optometric colleagues to share costs and pool their collective expertise.

Lots of O.D.s are already part of a buying group, and these seem to be offering ever more than just a great deal on your optical inventory—pooled marketing strategies, web commerce solutions, search engine optimization, billing/coding expertise and other overhead chores can be less of a burden, financially and otherwise, through shared efforts.

For the truly ambitious, the outright merging of optometric practices is being discussed more frequently. If there’s another solo O.D. in your neck of the woods with whom you have a good rapport and mutual respect, it might be worth a conversation. In fact, in some areas of the country, a dozen or more optometric practices have merged into a regional powerhouse, gaining enviable buying power with vendors—and name recognition in the community. Just imagine what the other O.D.s in the area who didn’t join up (or weren’t asked to) must think of that!

Not interested in optometric partnerships? Ophthalmology practices need a constant supply of patients to keep their surgical suite booked, so you could partner with an M.D. group, bringing your practice under their umbrella. Or consider the inverse and bring a part-time ophthalmologist in to your shop. For instance, an oculoplastics specialist might come in one day a week to perform in-office procedures. Your patients get the convenience of “one-stop shopping” and you set your practice apart from others nearby.

Lastly, although the impact of healthcare reform on optometry is anyone’s guess—let’s wait until after the election to see if Obamacare will even survive long enough to be implemented—it’s undeniable that insurers are looking to contract with large, efficiently run groups.

You may ultimately decide that “island living” is indeed what you prefer. Just know what you’re sacrificing: competitiveness, extra income, work/life balance, an heir apparent for your practice and the ability to practice full-scope optometry at the peak of your skills. That’s a pretty steep price to live on Bali Ha’i.