When to Hire an Associate OD and How to Do It

Human Resources, Practice, Resources, Talent Acquisition

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You want to create greater access to care for patients, and you want to grow your practice. Those two goals can be achieved by hiring an associate OD, if the time is right for you financially, and if you know exactly what you want the new doctor to add to the services you already provide. My practice partner and I recently hired an additional associate to add to the two we already had on staff to create a five-OD practice. Here are key lessons I’ve learned about the right time to add an associate, and how to do it so the new hire enhances care and revenues.

Financial Tipping Point
We were at 80 percent capacity when we decided to add another associate. If you wait longer before adding another doctor, many current and prospective patients will look for another place to receive care, rather than wait until a doctor becomes available at your practice.

We have 337 exam slots each week. Some 270 of those were full 1-2 weeks out with many weeks fuller than that. The capacity problem we had related to patient-preferred times. We typically will have mid-morning times that remain open for the doctors. Our capacity fluctuates according to time of year, so during the summer months we were at 100 percent+ capacity, whereas some months were 80 percent.

I look at associate ODs as long-term practice investments. Associates are an upfront expense that are like an investment in stock. When you buy a stock you typically don’t get immediate cash returns. However, when you have a practice that’s already staffed, with fixed overhead expenses, adding an associate usually does not add proportional overhead costs.

We put a doctor on salary for the first year, and keep track of their percentage of production. Once they “pay for themselves,” we talk to them about transitioning to being paid based on production only. Our associates have found production-based practice to be the most rewarding both personally and financially. As an owner, I also like to see the doctors have buy-in, and feel like their prescribing habits and clinical care make a difference not only in the care they give, but also in the practice’s revenue per patient.

Dr. Fleming’s practice web site announces a new associate, Melia Nguyen, OD. Dr. Fleming says to carefully calculate your finances, and capacity for seeing patients, before adding another doctor to the practice.

Is This a Person We Want to Work With?
Bill Hybels, founder and pastor of Willow Creek Community Church, has written in his many leadership books about the importance of evaluating for character, chemistry and competency when hiring a new employee. When we look for a new doctor, the most important thing we think about is their character. This is what most helps us determine if the doctor is capable of serving our patients the way we want them to be served, and whether they are a person we would want to interact with everyday as colleagues.

Our practice culture emphasizes the importance of faith and family, so we look for people to add to the practice who also value those things. In the hiring interviews, we listen for evidence that the doctor prioritizes their family, and see it as a strength if the prospective associate notes involvement with a church or other house of worship.

Prepare to Serve a Diverse Community
The U.S. is becoming more diverse with communities across the country experiencing influxes of people with Hispanic and Asian backgrounds, among other immigrant groups. That means that it’s advantageous for our practices to reflect that diversity.

In addition to being impressed with her character and competency as a doctor, we consider the new associate we hired, Melia Nguyen, OD, to have a background that will help us serve our changing community. As an immigrant, who came to the U.S. with her family when she was 12, Dr. Nguyen understands the perspective of other recent immigrants, and can guide us in growing our practice’s reach into those communities.

Don’t Keep Your Search for An Associate a Secret
The more time that you have when looking for an associate the better. I think too many practice owners play a secret game in not telling anyone they’re looking for an associate until they’re about ready to hire. We almost made this mistake, and I would encourage those who have a 2-5 year plan of bringing in an associate that they begin telling people well in advance.

Think About Long-Term Goal: Will This Person Eventually Become a Partner?
We hire our associates with the idea that they will eventually be offered a place on our board of directors as an owner. It is not a prerequisite for an associate to have the desire to be an owner, but we like the mentality of an eventual owner-OD because it gives the doctor a greater personal stake in the success of the practice.

My partner in the practice, Jeff Yarrow, OD, and I are in the process of creating an organizational structure that will allow for the practice positions of CEO, CFO, and we will have a board of directors. Each owner will have a seat, and equal standing, on the board of directors.

Get to Know Prospective Associates
The hiring process we use to add an associate OD is similar to the process used when hiring support staff, but with a longer timeline, and more in-depth interviews, including video teleconferencing interviews, or video “chats.” The first step was a video chat with just myself and potential candidates, which served as an initial screening. From there, we narrowed the pool of applicants, and then had the other doctors in the practice participate in a longer video chat with the potential associates.

Prospective support staff are usually based locally, and so, can come into the office for a first round of interviews. Potential associates often are not based nearby, so the video chats were an important tool in getting to know them. It worked to our advantage in giving us a view of the doctor at home, or in the office where they currently practice. That “natural setting” environment gave us a glimpse into the person’s life. For example, during one of our interviews, an applicant’s dog ran into the picture. Seeing how she handled that situation gave us a sense of how she manages the unexpected. Her calm, graceful response allowed us to see another strength of her personality.

Use In-Person Interviews & Personality Assessments
Once we determined that an OD was a finalist to become an associate, we asked them to visit our office in person, and asked for references. We depended a lot on references, and time communicating with those references, to determine the clinical competency and character of the individual. The interviewee coming to our practice and interacting with our staff and doctors then allowed us to see if they would have good chemistry with us.

We also use the DiSC personality assessment to determine if a doctor will be a good fit for our practice culture, given the personalities of the other doctors and staff, and how we like to care for patients and conduct business. We want to know that the new associate OD would be comfortable with an open culture in which we regularly welcome, and solicit, feedback, and work together cooperatively to better the practice.

 

CHAD FLEMING, OD, FAAO,

Chad Fleming, OD, FAAO, is a partner with Wichita Optometry, P. A. in Wichita, Kan. To contact: optometryceo@gmail.com

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Insight with Dr. Vishakha Thakrar

Insights

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Dr Vishakha Thakrar is the co-founder of Vaughan Family Vision Care.

Expanding on her residency training, Vishakha has a heavy focus on

specialty contact lens fittings and dry eye.

In recent years Vishakha has served as a contributing editor for the journals

Contact Lens Spectrum and the Eye Care Review.

Dr. Vishakha Thakrar

Optometrist, Vaughan, ON

Honours BSc., University of Toronto, 1997

OD degree Ohio State University, 2001

Residency, Cornea & Contact Lens, New England College of Optometry, 2002

 

What is currently the most exciting thing in your field to help patients?

Corneal cross-linking, in my opinion, has had the highest impact on my patients.  When I started practicing 16 years ago, if a patient was diagnosed with keratoconus as a teenager or young adult, often this meant that he or she would be doomed to needing a corneal transplant one day.  Life is very different for a keratoconus patient today.  Corneal cross-linking can essentially save their vision if they receive the treatment early enough.

What is something you have done in your practice to set you apart?

My business partner, Dr. Angela Peddle, and I set out in 2011 to open a practice that focused on our residency training which included cornea and contact lenses, binocular vision, and vision therapy.  Practicing in the GTA, we recognized that the competition for primary care optometry was increasing dramatically.  There were opticals and optometry offices on almost every street corner, not to mention the number of big box stores and commercial settings.  We opened this practice to differentiate ourselves from the competitive environment, but more importantly to use our training to service our patients.

I am residency-trained in cornea and contact lenses.  I had a vision of having a practice with almost exclusively complex contact lens patients, and I am happy to say that I accomplished that dream.  Early on, I reached out to several ophthalmologists, particularly cornea specialists, and educated them on my training and my passion for scleral and contact lens fitting.  As a result, my contact lens practice continue to grow.

Over the years I have also advanced my practice by focusing on innovations in our field .  I opened a dry eye centre as a natural progression to my contact lens clinic.  My practice was also the first in the country to start using EyePrint© Prosthetic Scleral Lenses (Advanced Vision Technologies).  EyePrint© Prosthetic is a scleral prosthetic device that is created from 3-D printing to produce a highly customized lens.. The types of eyes that this lens can fit is amazing.  I use this technology on really complicated cases, for example –Stevens Johnson’s patients, ocular cicatricial pemphigoid patients, asymmetric grafts, and other patients with very irregular scleral and corneal topographies.

What advice would you give a new grad today?

I would advise a new grad to differentiate the way they practice from the time they graduate.  The environment of optometry has changed, and to help ensure success we must differentiate ourselves.  There is a great book by Jack Trout called Differentiate or Die that is a must read for new grads. In fact, this book lead me to opening my practice.

What is your definition of success or what habits make you a successful person?

Rather than giving you my definition of success, I will tell you a story. A patient presented to my office about 4 years ago with RK.  He had a retinal detachment 15 years prior in the right eye, and was correctable to 20/400 with glasses.  In the left eye, he was correctable to 20/50 so was just barely able to drive.  He had been seen by multiple doctors over the years who told him that he would not be able to see out of the right eye again, and essentially this patient had given up.  When he came to my office he wanted the left eye to be fit with a lens, but I felt that he had nothing to lose by trying to correct his irregular astigmatism in both eyes.  I fit both eyes with scleral lenses.  After fitting, he could see 20/50 in his right eye and 20/20 in his left eye.  I cannot express how happy this patient was going from 20/400 to 20/50.

Now after years of wearing the lenses, he is correctable to 20/25 in the right eye.  He considers scleral lenses to be a miracle.  He still cries when he comes to my office.  These are the types of stories that I hear every week, as does everyone who fits specialty contact lenses.

My definition of success is the ability to change a patient’s life for the better, and I hope that I do that every day. The best choice I ever made in my career was doing a cornea and contact lens residency.  This training gave me the technical skills to confidently manage corneal disease patients with contact lenses.  And seeing these patients for the past 16 years has given me the empathy to understand their physical and mental struggles.

It is incredibly powerful to put a contact lens on a patient who hasn’t seen in 5, 10, 15 years, and provide them with 20/20 vision.  Many patients feel that they have been given their life back.  In those moments, I am so grateful that I can help patients in this manner …and I think that there is little more that I can ask for from my career.

Tell me something few people know about you?

I studied French in Nice, France for a summer when I was in university.  Then when I was in optometry school, I did an externship in Guanajuato, Mexico where I replaced all of my 15 years of French education with Spanish. I’m not sure why I can’t just speak both languages….

 

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Quick Fixes: What Bothers Your Patients Most–And How to Address It

Practice, Resources, The Patient Journey

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Bad doctors and nurses aren’t the culprit for dissatisfied patients. Rather, it’s the patient experience that most point to when unhappy with a health-care experience, according to a study conducted by Vanguard Communications, and published last year in the Journal of Medical Practice Management.

Most patients rated their doctors highly, the study found: 61 percent gave five-star reviews, compared to only 23 percent who gave one-star reviews. When patients did leave negative comments, the researchers found that only 4 percent of their complaints were explicitly related to medical treatment. The other 96 percent focused on issues such as inadequate communication, wait times and disorganized operations.

It’s important we fix inadequate communication, unnecessary wait times and disorganized operations in the practice. Let’s consider them one at a time.

INADEQUATE COMMUNICATION
What is the main issue with inadequate communication? George Bernard Shaw nailed it when he said: “The single biggest problem in communication is the illusion that it has taken place.” Looking at malpractice claims shows that George’s statement is correct. A breakdown in communication between the doctor and patient is the “root cause” of malpractice claims. Right up there with this as a primary cause of malpractice lawsuits is the perception by the patient that the doctor is uncaring. It may not be that the doctor was actually uncaring; she may have just rushed the exam, and that led to a communication problem where the patient perceived the doctor was uncaring. Remember, from the patient’s perspective, perception is reality.

Getting patients to follow our treatment plan should be in our top goals for the exam. We are going to do a lot of exams over the course of our career. A doctor will have as many as 192,000 patient interactions over a 40-year career (20 patients/day x 5 days/week x 48 weeks/year x 40 years = 192,000).

With so many patient interactions, clear communication with patients is an essential tool for an effective doctor. There is a large body of research over the last 30 years showing the doctor’s ability to explain, listen and empathize has a significant effect on patient outcomes and patient satisfaction.

But how many doctors actually measure outcomes by measuring treatment plans completed? Practice management rule number one is measure to manage. If we want to improve our patient outcomes, then we should start measuring. Once we begin to measure, then we can begin to make changes to improve our outcomes. As we make changes, remember the importance of improving communications with patients as an effective way of improving outcomes. Work on what to say, how to say it, and in what order to say it.

UNNECESSARY WAIT TIMES
Is the doctor on time or routinely running 40 minutes behind? Where do the bottlenecks occur in the practice? What is the wait time in the optical? These are some of the questions that not only should we know the answer to, but we should also have active plans to fix when they are a problem. Patients hate waiting. Yet in most practices, patients wait. Let’s be honest, patients wait primarily because we do not want the doctor to wait. In most practices, the schedule is built to keep the doctor busy.

Patients also wait because we are inefficient or poorly staffed. Take a look this week at the efficiency of the flow of patients through the practice. Identify where and why patients wait, and fix the problems. It may take another piece of pre-testing equipment, an adjustment to the schedule, or another staff member to fix the flow. Make the fix to improve patient flow.

DISORGANIZED OPERATIONS
Analyzing the work flow in a practice is an important step for all practices because it improves efficiency and reduces disorganization. Here’s a simple process to follow to get this done:

1.    Break your work flow down into as many steps as possible. The more granular, the better.
2.    Lay these steps out using Post-it Notes.
3.    Look for exceptions, and create simple decision boxes to capture the variations.
4.    Look for ways to improve efficiency.
5.    Rearrange your Post-it Notes to show your new, efficient work flow.
6.    Implement your changes.
7.    Re-do this process every three months until you are satisfied you have the most efficient flow, then review it every six months to make sure it is still the best flow.

Focus this week on improving patient communications, reducing patient wait times, and making your practice operations more efficient to improve patient satisfaction and adherence to the practice.

 

References
i. http://ministry127.com/resources/illustration/the-biggest-problem-in-communication
ii. Huntington, B., & Kuhn, N. (2003). Communication gaffes: A root cause of malpractice claims. Baylor University Medical Center Proceedings, 16, 157-161.
iii. Beckman, H. B., Markakis, K. M., Suchman, A. L., & Frankel, R. M. (1994). The doctor-patient relationship and malpractice. Lessons from plaintiff depositions. Archives of Internal Medicine, 154(12) 1365-1370.
iv. http://healthcarecomm.org/about-us/impact-of-communication-in-healthcare/

 

MARK WRIGHT, OD, FCOVD

Dr. Wright is the founding partner of a nine-partner, three-location full-scope optometric practice. As CEO of Pathways to Success, an internet-based practice management firm, he works with practices of all sizes. He is faculty coordinator for Ohio State’s leading practice management program.

CAROLE BURNS, OD, FCOVD

Dr. Burns is the senior partner of a nine-doctor full-scope optometric practice that she built with her husband, Dr. Wright. She is also the COO of a state-wide nursing care optometry practice. Dr. Burns lectures nationally on practice management and staffing issues. Dr. Burns authored the Specialty Practice section of the textbook, Business Aspects of Optometry.

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What Independent ECPs Can Learn from Online Optical Retailers

Differentiation | Business Strategy, Digital Marketing, Marketing, Practice, Pricing

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In recent years, several emerging vendors of optical goods have launched consumer advertising campaigns with claims that they deeply undercut the artificially high prices maintained by the optical industry establishment.

The marketing message of these “disputers,” as trend-watchers like to call them, is that they have the answer: eyeglasses or contact lenses at far lower prices, sold directly to consumers online. They are the consumer’s advocate, they suggest, while optical manufacturers and ECPs are price gougers.

There is a clear fallacy to this claim, of course, but manufacturers and ECPs have a hard time defending their price structures and looking on the level at the same time.

If you take the superior quality argument, you open yourself to criticism that a better pair of glasses can hardly be worth six or eight times as much as the low-cost alternative.

Alternately, if you try and meet low-ballers where they live, you descend to a commodity arena that won’t sustain your practice.

As they say in politics, “If you’re explaining, you’re losing,” and ECPs are challenged by that very dilemma.

Through the years, Review of Optometric Business has argued that the key is to establish a value-based relationship with your patients. We realize that is not easy, but it is imperative. Define what you stand for, explain the difference in the goods you prescribe, and be price-competitive.

But maybe those “disrupters” have a point.

That was the takeaway from a recent conversation with Michael Kling, OD, a highly progressive independent OD who has contributed many creative ideas to Review of Optometric Business. “The disruptors have figured something out about what people want,” he counseled me. “Often times, they have a better idea, and we can learn from them.”

So, before dismissing new and disruptive entries to the retail landscape, take a look at their value statements.

Warby Parker entered the optical arena suggesting that a virtual monopoly inflates the average price of eyeglasses. So, do they sell cheaper products or mark-up less? Not likely. Warby Parker is about buying eyewear in a new way, in a Millennial context, where the shopping process is…awesome. And where your parents don’t shop.

Take a look at the Warby Parker “story” on its web site:Hubble Contacts similarly markets around the concept that contact lens manufacturers conspire to keep the price of contacts too high. Are their contacts cheaper?

“We looked at their deal,” said an independent OD in a group discussion I sat in on recently, “and we’re less expensive than them.”

Again, it’s not about price, despite Hubble’s marketing message that says so. Its about the fact that Hubble offers a new, smarter way of buying: monthly automatic delivery, with an automatic subscription charge that is a line on your credit card statement that you don’t really feel. This is the way people (especially Millennials and Gen Zers) pay for mobile usage, music, razors, groceries, on and on.

Take a look at the “Hubble” story presented on its web site:

Clearly, both Warby Parker and Hubble have compelling stories. In both cases, their value statement is logical and simply stated. Is yours? Is your practice’s value statement working for you in this era of digital communications, online retailing and convenience of payment and delivery?

Optical is not alone in being challenged to defend its margins and delivery standards.

Dentists compete with low-cost alternatives to the premium InvisiLine system and the teeth whitening systems they offer. In hearing aids, low-cost alternatives are emerging, as well, though audiologists complain that those in need may be skipping a comprehensive exam to determine the health of their ears.

Take a look at another “story” about a consumer-friendly avenue to pay 75 percent below what audiologists charge:

Sound familiar?

The lesson: Understand the core appeal of the new retail reality: convenience, fair price, ease of payment and automatic delivery. Together, these factors provide a sense that you’re buying smarter.

The action point for independent ECPs: Compete!

Offer convenience by way of annual contact lens sales and home delivery. There are programs from contact lens manufacturers and OD alliances that help independents to be very competitive. And more such programs are emerging from within optical.

Offer a monthly payment plan or patient financing that eases any financial imposition on patients. Plans are available that shift the non-payment risk away from the ECP.

Define the value that you offer. Independent ECPs are gatekeepers of the most advanced innovative optical solutions that provide their patients with the best possible vision and ensure eye health. When patients seek out low-cost alternatives, ask them a set of questions: “All day long, you look at the infinity screen of a Samsung Galaxy, you work on a laptop with an Apple Retina 4K monitor, you watch Netflix on a 4-K Ultra HD TV…so why are you looking at the world through value-based eyeglasses and contact lenses with 1990s optical technology? Especially when I can offer you the best vision possible with the latest, most innovative optical products? May I show you the difference?”

Offer a great experience. In the end, it is the perceived value of the care and patient experience you deliver, in concert with premium optical solutions that are the best for the individual patient that will make the competitive difference. So, don’t dismiss your new competitors; learn from them.

 

 

ROGER MUMMERT

is Content Director for Review of Optometric Business. Contact: Rmummert@jobson.com.

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Location, Location, Location: Start Me Up Webinar Part One

Buying-Selling A Practice, Finance|Wealth, Practice, Real Estate, Resources, Webinar

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Location is arguably one of the most important decisions that can make or break the success of your new practice. The following conversation among independent OD offices that have been recently establish is excerpted from the Start Me Up Webinar Panel hosted by Jeff and Tina Goodhew on October 18, 2018.

 Panelists:

   

   

Jeff Goodhew: Michael, as far as timing goes, what type of research did you do in finding your location in Edmonton?

Michael Kreuzer (Practice in Edmonton, AB, opening January 2018): It’s an interesting and complicated question because I had two other bids on places before finally determining my end location in the city.

Key things to me were a demographic that had a lot of growth and a lot of younger people moving to it. My current location is on a retail street which has experienced tremendous growth over the past 5 to 10 years The area is under-represented in terms of optometrists. Those were two key factors.

If you find a good commercial real estate broker they should be able to help you with identifying key market demographics. My broker for instance had sent me locations of other optometrists in the city within 1km to 5km radius away. Based on that information you can piece together a decent spot that you can stake for your own.

Another important factor in the location is price. In these high density urban areas in Edmonton there is a pretty big fluctuation in terms of the asking price per square foot. One key piece of information I got from my adviser was to keep in mind that a huge cost that you can control upfront is your overhead,  –  the cost per square foot. Being aware of that and not overspending on your real estate is a great way to get started on the right foot.

Jeff: Your broker obviously went above and beyond. You are saying your broker was the one that sort of mapped out where the competition was, not yourself.

Michael: I was aware of the competition but he definitely went above and beyond, and with that information it allowed me to focus my energy in other aspects of looking at places. That’s the benefit of having a great team from the start, you can piggyback off of the services of other professionals who are way better at this than when you are starting and you have panned in so many different spots. It was a really big help.

Jeff: Laurie, how did you choose where to open your practice back in 2015?

Laurie Capogna (Family Eye Care, Niagara Falls, ON): Niagara Falls isn’t all that large of a city, so I thought about using a real estate broker but in the end, I didn’t. I ended up myself driving around finding every vacant building that was available. I had a bit of a dilemma, at first I really wanted to buy a building. I’d never leased before, I’d always owned the building I was working out of. When I saw there really wasn’t anything available, I started looking into plazas, and I looked at the new ones and the older ones. Based on what was available I actually just took something that I liked and  because it was in the same plaza as a Shopper’s Drug Mart. [Leasing here] actually proved to be very, a very good decision because I can’t tell you how many patients come in say, “I love your location and I see you here all the time and I’m in this plaza all the time.” I didn’t realize the benefit to being in a retail location because I’d always been in a medical building before.

Jeff: Agata, you opened in a highly competitive neighborhood in Toronto. What did you look for when you opened your practice?

Agata Majewski (Owl Optometry, Toronto, ON): In the city, I think it’s very hard to find a place where you don’t have an optometrist next door. My location is at street level in a very family friendly neighbourhood. There are four or five schools surrounding me. I knew the area I wanted to be in and I was driving by and saw this space for lease, which was an old variety shop. It’s a small space but it’s street level and most of our patients are just coming in off the street, I didn’t have to advertise.

Jeff: Can any of you comment on opening a new practice in a medical building versus a sort of street level traditional retail location? Does anyone have an experience around that?

Ritesh Patel (See & Be Seen Eye Care, Liberty Village, Toronto, ON): While we were actually going through the process of where we wanted to open, we created a matrix, and the matrix consisted of the four or five things that were most valuable to us. One of the things on that list was being around family physicians and practitioners, because in Ontario you can consider them a “feeder system” to just have patients come through the door whether it happens to be a diabetic or red eye or annual exams, or children, whatever it may be. In our case we are retail ground floor setting in a relatively high traffic area, but we also happen to be in the same building as 12 to 15 family physicians as well. You don’t necessarily have to choose one versus the other.

Jeff: Anyone else have any comments on location before we go on?

Howard Dolman (Dolman Eyecare Centre, New Hamburg, ON): We are in a very rural setting, a small community and the vast majority of patients drive to our clinic, and so the amount of parking that you have in a rural setting is important as opposed to being in an urban setting where being closer to transit and having easy access for your patients to get to you. That’s certainly one consideration to think of in terms of location.

Tina Goodhew (Abbey Eye Care, Oakville, ON): If you are in the process of still trying to look at an area and you don’t have a broker yet, you can also check with city hall and they often have plans on what their growth and demographics of a neighborhood is.

One of the other tips we give you is to plot your competition. The final thought I have here is that even the location within your location is extremely important. What I mean by that is, we are in a mall that we have been in for 12 years but for 10 of those years we were at one side of the strip and two years ago we renovated and expanded and we moved to the centre of this strip that happens to be in front of one of the driving entrances, and we’ve found that out traffic has jumped significantly. People said that they didn’t know that we were in the mall previously even though we’d been there for 10 years! Again, location within the location is very key as well.

 

Click here to listen to the entire webinar 

 

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Artificial Intelligence: Will It Have a Major Impact On Eyecare?

Practice, Resources, Technology

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Artificial intelligence is unlikely to produce a robo-eye-doc who will replace you, but it is likely to add a new dimension to the service we can provide to our patients.

AI-Powered Patient History Interview
I can foresee a future in which AI will be able to talk with patients about their reason for their visit when they book their appointment online. Advanced AI systems, with voice activation, would be able to talk to patients to take a case history, gathering the important information, analyzing it and then providing the doctor with a preliminary finding, which the doctor can explore in greater detail when the patient comes in for an in-person appointment.

 Click the image above to view two videos on how artificial intelligence might impact eyecare from a presentation given at the 11th Annual VM Global Leadership Summit that took place at Vision Expo East 2017.

Before the Patient Ever Gets to Office

When the patient makes an appointment, AI technology could take information-finding to the next level. The patient would not just fill out a form online prior to their visit detailing their health history and eyecare needs. It would provide an interactive interview.

The system would have a “voice” that would ask the patient questions, such as family history of eye diseases like macular degeneration and glaucoma, and then would ask the next question based on the response it received. For instance, if the patient said “yes” to having a family history of a particular eye disease, the system would then ask which relative(s) in their family had the disease.

Or the system might ask the patient if they participate in sports, and then if the patient said “yes,” the system might ask the patient to say which sport. Then, the system might ask the patient if they were interested in learning more about the sports sunwear the practice sells specifically for that sport.

The key to effectiveness will be the ability of the doctor and optical staff to sit down together and come up with the most helpful questions to input into the system to ask. It’s like the old saying, “garbage in, garbage out.” AI systems are, by definition, “intelligent,” but not so intelligent that they don’t require the inputting of the right information to use as foundation for its interaction with patients.

Click the image above to watch Andy Karp of Vision Monday and 20/20 magazine share his preview of new and emerging technology presented at the 2017 Consumer Electronics Show.

Lay the Groundwork for a More Productive Visit
Before the patient gets to the office, the transcript, in both written and recorded form, would be sent to the patient’s EHR file, with the eyewear-related information sent to opticians.

In addition to giving the doctor detailed information about family history that they could use to ask more informed questions of the patient, opticians would get a jump start on the sales process. They would know ahead of time to have a tray of sunwear specific to that patient’s favored sport ready to show them during their visit.

Interactive Displays in the Optical
The opticians will be better armed with information about each patient’s needs, and the displays themselves could “talk” to patients.

A patient could pick up a frame to try on, and when they pick it up, and when they put it back on the board, an AI system could say: “We have that frame in other colors” or “If you liked that frame, you may also be interested in X frame.”

The system could have an “Ask me a Question” button for every section of the frame board in which the patient can ask questions about the merchandise like they would type a question into Google, and then the system would either give a response or summon an optician to answer the question.

Data Interpretation Help
Diagnostic equipment produces data that historically the doctor reviewed and interpreted. AI would be able to analyze the data and would provide the doctor with a working diagnosis and treatment plan.

AI might be able to run more in-depth analysis on the data than a human doctor could. AI may be better at looking at images than a human doctor both in terms of speed and precision. This would lead to better patient outcomes and the ability to process patients more efficiently.

For example, fundus imaging. AI would be able to track subtle changes to blood vessels, optic nerves and retinal lesions over time. AI would be able to alert the doctor to these changes earlier. This is essential as early intervention often leads to better patient outcomes.

Boost Marketing Efforts
AI would be able to tap into your EHR data and look for marketing opportunities. It would then be able to generate marketing content to take advantage of that information, and would be able to tell you the ideal channels to broadcast those marketing messages based on information stored in the system on what’s worked best in promotion efforts for your practice and other practices.

You and your staff can already use your EHR to mine data to use for marketing your products and services. What AI offers is a helping hand doing that work. Rather than you having to search for, and then look through the data, yourself, an AI system could do that work for you. It might be able to automatically conduct searches for marketing opportunities, and then analyze the data on its own, to let you know, without searching yourself, of needed products and services that your patients may not be receiving as much of as they should be.

This kind of advanced, data-driven marketing would help build practices. Patients would more easily be given marketing messages that were most relevant to them.

How Expensive Will This Technology Be?
With all the great promise of AI technology, a question still remains of how costly it will be to purchase and implement.

It may be that as the technology emerges, it will be prohibitive for all but the biggest, and most profitable, practices, but that five-to-10 years after its widespread availability, it will become affordable for smaller practices.

The important point is to be aware of the coming opportunities to better serve our patients–and to develop plans to eventually optimize that technology so patients are better served, and our practices get a springboard to growth and profitability.

Have you thought about the role AI could play in our practices? What ideas do you have of how you could use this technology in your own practice?

 

 

JUSTIN BAZAN, OD

is the owner of Park Slope Eye in Brooklyn, N.Y. To contact him: dr.bazan@parkslopeeye.com.

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Satisfy More Astigmatic Patients with New Toric Daily Disposable Technologies

Products | Services | Industry News, Resources

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How would you explain to your patient the synergistic performance of the two significant design innovations delivered by ACUVUE OASYS® Brand Contact Lenses 1-Day for ASTIGMATISM lenses? Like wine and cheese, that’s how! Often times when you take one great idea and pair it with another the sum is greater than the parts. It takes the more consistent visual performance of BLINK STABILIZED® Design and combines it with the reduced frictional energy profile of HydraLuxeTM Technology, and the result is a lens that is even more consistently clear and comfortable than anticipated.  With each blink, the world is brought back into sharp focus and because of the tighter crosslinking meshwork the lens slides back into optimal position more effortlessly than ever before. Voila! What a magnificent pairing and what a remarkable way to share performance and innovation with your patients.
–Kent Prete, OD, Calgary Alberta

ACUVUE OASYS® Brand Contact Lenses 1-Day for ASTIGMATISM combine two unique technologies to deliver excellent comfort and clear, stable vision, with the widest parameter range.

Astigmatic patients achieve their best vision when both sphere and cylinder are corrected. However, toric contact lenses have historically been underprescribed relative to the prevalence of astigmatism. Barriers to prescribing toric lenses include limited parameter availability and difficulty achieving stable vision and comfort.

Among those who have been fit in toric lenses, 58% report declining lens performance over the course of a day, with those who experience more activities or more environments during the day being the most prone to declining lens performance.¹

A new daily disposable toric lens, ACUVUE OASYS® Brand Contact Lenses 1-Day for ASTIGMATISM, has been specifically designed to provide exceptional comfort and performance in challenging environments. It combines BLINK STABILIZED® Design, which works with the natural movements of the eyelids to settle the lens quickly and maintain stable vision, with HydraLuxe™ Technology, comprising an enhanced moisture network of tear-like molecules and a highly breathable, hydrated silicone that integrates with the patient’s own tears to help maintain tear film stability.

A subject-masked, one-week dispensing study of 162 habitual toric soft lens wearers (324 eyes) was conducted in the U.S.² Within just 3 minutes of lens insertion, almost all lenses (97%) settled within 10° of nominal orientation (toric lens markings exactly vertical at 12 and 6 o’clock). At 15 minutes, all 324 eyes showed less than 5° movement on blink, which is a key factor in providing stable, predictable vision.

Clinical performance

In a busy practice, I’m looking for a lens that stabilizes quickly. But what is even more impressive to me than fit and stability in the office is how well the lens performs in the patient’s world, during everyday tasks that can challenge vision. In the study, 99% of eyes were successful at one week in the first lens fit, and visual acuity was excellent, with 97% seeing 20/20 or better monocularly.

My patients also loved the comfort of these lenses. They have busy lives and spend a lot of time on digital devices, which tend to reduce the blink rate and increase discomfort. Because it works with the tear film to stay lubricated, ACUVUE OASYS® 1 Day for ASTIGMATISM helped my patients stay comfortable throughout the day.

ACUVUE OASYS®  1-Day for ASTIGMATISM

  • First-fit success rate of 99%
  • Settles within 10˚ of nominal orientation in just 3 minutes
  • All patients achieved 20/25 or better monocularly, and 97% achieved 20/20 or better
  • Available in 2,260 parameters–40% more than any other daily disposable toric lens

Widest parameter range
The parameter range, the widest of any daily disposable toric contact lens, makes this lens very easy to fit. In the past, the lack of oblique axes or plus powers meant that some patients had to accept a level of visual compromise, or forgo the benefits of a daily disposable lens.

With ACUVUE OASYS® 1-Day for ASTIGMATISM, all three cylinder powers (-0.75DC, -1.25DC and -1.75DC) are available in axes around the clock for sphere powers plano to -6.00DS. For patients with higher astigmatism, an additional -2.25DC option is available in the most common meridians. This allows us to bring the benefits of daily disposable toric lens wear to more of our astigmatic patients.

References
1. Mathews, K., et al. AAO poster presentation, Nov 2016. Market research survey on performance throughout the day with toric soft lens wearers. US, n=208, 12% daily disposable toric, 88% reusable toric.
2. Straker B, et al. Global Specialty Lens Conference Poster presentation, January 2017

ACUVUE® Brand Contact Lenses are indicated for vision correction. As with any contact lens, eye problems, including corneal ulcers, can develop. Some wearers may experience mild irritation, itching or discomfort. Lenses should not be prescribed if patients have any eye infection, or experience eye discomfort, excessive tearing, vision changes, redness or other eye problems. Consult the package insert for complete information. Complete information is also available from Johnson & Johnson Vision Care division of Johnson & Johnson Inc., by calling 1-800-267-5098 or by visiting acuvueprofessional.ca.

ACUVUE®, ACUVUE OASYS®, HydraLuxe™, BLINK STABILIZED®, and EYE-INSPIRED™ are trademarks of Johnson & Johnson, Inc.
©Johnson & Johnson, Inc. 2017

 

This article is sponsored by J&J Vision Care Canada.

 

ROXANNE ACHONG-COAN, OD, FAAO, FIAO

Dr. Coan received compensation for her work on this article.

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Start Me Up – Webinar

Practice, Resources, Webinar

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On Monday October 16, 2017 Canadian Eye Care Business Review, hosted a panel discussion on starting your own practice. The panelists shown below shared their experiences on starting the practice of their dreams. The webinar was recorded so you have the option to stream it or download it.

   

   

Topics covered included:

  • Choosing the right experts
  • Choosing the right location
  • Design & build
  • Marketing
  • Day to day operations including staffing
  • Joining a buying group and or hiring a practice consultant

A special thanks to our sponsors, without their support this webinar would not have been possible.

 

Download Now

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Insight with Dr. Riaz Ahmed

Insights

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Dr Riaz Ahmed is the founder of Mission Eye Care located in downtown Calgary, AB.

Since opening his practice in 2005 he has shifted more towards medical eye care

with a special focus on Dry Eye treatment and Corneal Disease management.

Riaz is the Past-President of the Alberta Association of Optometrists,

and does charity eye care mission with Canadian Vision Care.

 

Dr. Riaz Ahmed

Optometrist

B.Sc., University of Alberta, 1993

OD degree University of Waterloo 1998

Mission Eye Care

Calgary, AB

 

Where do you see your practice / eye care in 10 years?

I look back at how I practiced optometry after graduation, and how I practice it now, almost 20 years later. It has only been in the last few years that I can truly say I practice the way I want to. For years we had been over-educated and under-utilized relative to our role in eye care. We are fortunate here in Alberta to now truly be able to practice primary eye care profitably and effectively. I do much more medical eye care relative to routine exams and I foresee this to continue to increase over the next decade. I see greater efficiencies through new technologies. With more patient encounters, comes more opportunity to present products and services, further fueling revenue that ultimately fund more practice building technologies. Our public and private reimbursement model along with scope changes have allowed us to stay profitable and I see this continuing to evolve. Quality medical eye care is something that patients’ value and trust, and I think it is our best way to survive and thrive despite further disruptive changes in the retail landscape.

What changes do you see coming down the pipe?

I see online refractive exams improving to the point of being reasonably accurate. The new iphoneX already promises to revolutionize 3D facial mapping, and with that will come better frame “fit” options, whether 3D printed, made to order, or a selection of mass market frames that will fit your face perfectly. The consumer values convenience, and optometrists will have to offer value beyond retail eyewear sales in order to make consumers take time out of their day to seek our services. I foresee our role continue to evolve as interpreting data rather than gathering it. Wearable health tech is in strong demand, and consumers will likely have a treasure trove of health data sitting in their phones, much of it likely relevant to us. Companies are already evolving contact lenses to both display data to the wearer, and gather it from them. I see the demise of the traditional exam lane, and a role for optometrists in a consultative environment with technologies different from those that will soon be ubiquitous at the consumer level.

What is something new you are implementing this year in your practice?

More in the way of myopia control. As a high myope, I am truly excited that there are now evidence based options for my patients (and my genetically doomed kids). We are already well established as a corneal disease /specialty lens clinic, so with increasing patient awareness of myopia control, I will be implementing more strategic marketing in this regard.

How do you define success?

My definition would be working because you want to, not because you have to. As a first generation immigrant with poor parents, my story is the same as many others. Like Drake says “started from the bottom…”. Going through school, I always equated success with wealth, and to some degree I was right, but I was wrong about what wealth actually is. Having passed my mid-life crisis (some would argue I am still in it), I now see that wealth is a combination of time, family, gratitude and health. Yes, being financially free gives you time, but to me, it is how you use that time that determines success.

Favorite Series?

Yes, I am late to the party but I finally started binge watching Game of Thrones. Call it FOMO, but I had to see what all the fuss was about and I was hooked at episode 1. Since I am terrible with names, I also look at it as a training exercise. I mean who can seriously keep all these people straight? Good thing they keep getting killed off.

Favourite food?

That’s easy – being born in East Africa, our family loved spicy grilled food. There is a place in Calgary that grills the most AMAZING Indo-African spiced short ribs. They are cut super thin and are the most delicious spicy and tangy carnivorous treat on the planet. I’m actually going to stop writing this and go get some.

What’s changed since high school?

Well, I am still quite nerdy, but I shaved that awful moustache I sported in grades 10 and 11. I would have had no chance at a prom date in grade 12 if I hadn’t (chances were slim regardless). Funny that all that facial hair now made a comeback, I would have been like super trendy by age 12 (in case some people don’t know, East Indians are hairy). 

Tell me something you thought was true only to find out later you were wrong?

When I was younger, I looked at all “doctors” with awe and respect. To me, they were miracle workers that had some superhuman level of knowledge and skill. They always had the right answers, somehow guided by a higher power. To then go through school and see classmates (many of whom I thought were less than the sharpest tool in the shed) go on to practice some aspect of medicine was truly devastating. To think, all this time, I too could have had a moron for a doctor! Alas, we are all humans with the same level of infallibility and ineptitude as the general population. A sobering truth indeed, and one that constantly pushes me to be the kind of health care provider that I would want to have.

 

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Tips to Generate Positive Referrals from Friends & Family

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Generating positive referrals from patients is a key to practice growth. Since the inception of our practice in 1969, referrals of family and friends have been the greatest contributors to new patient growth.

Measure to Improve
Like any other marketing technique, measuring and quantifying is a must. Measuring enables us to see what works and what does not work. In the case of referrals, specifying who referred a new patient to our practice lets us further develop our “referral tree.”

Certain patients, whom I refer to as “mover and shakers,” will always be more likely to refer than others. Having a feel for this can help us and our staff cater our language and diction to capture more referrals, especially from our more vocal mover and shaker patients.

Consider a 1.4 million gross revenue per year. Average revenue of $350 per patient with 10% attrition = $140,000 or roughly 400 patients in loss.

We currently average five new patients a week: 5 patients x 52 weeks = 260 new patients x $350 = $91,000 in growth.

We can break this down further. Let’s say we have a mover and shaker patient who loves our practice, and gives us five new patient referrals a year (and in fact we have multiple patients that do this). And then let’s say we have a patient who is warm to the practice, but not as passionately supportive, who may give us one new patient referral a year.

Considering our average per patient in our area is about $350, if we have five patients generating five referrals each, that results in 25 new patients. So, 25 x $350 =$8,750 in extra revenue growth.

To get that growth with our other patients, we would need 25 non-mover and shaker patients to refer an average of one new patient. In addition, these patients would need significantly more resources invested into them to get that “push” to refer vs. our mover and shaker patients who only need the regular excellent service and care we give.

With that math in mind, you can see how quantifying and qualifying your referral sources is much more efficient and effective than blanket-marketing campaigns.

The thank-you letter Dr. Neufeld sends to patients after comprehensive exams. He says sending this type of letter encourages referrals.

Impress Patients with Service
We shy away from signage or incentives for referrals. In our opinion, this appears superficial, and thus, we believe patients may view it as superficial as well.

The process of making a good impression starts the second the patient enters our practice. The tone of our receptionist’s voice, the tidiness of the reception area, and the overall ambience of the practice instantly starts to mold the patient experience. This then continues into the exam room.

In fact, the experiences at the front desk, in the exam room, and in the optical, are paramount for satisfying the patient and starting the referral engine. If I have a pleasant patient (which tends to be the majority of my patients), I often mention that I would love to see more individuals like themselves, such as friends and family. I try to link a personal attribute to this, whether it be the ability to consistently arrive on time, pleasantness, or an interesting personality. Our opticians also will often compliment patients who are easy to work with, or have great taste in optical wear, saying that they wish to see more individuals like the patient.

Incentivizing a patient to refer comes down to appealing to the patient. This stems from allowing the patient to develop a deep appreciation for your services and you as an individual. Once this is established, referrals become second nature and nearly unconscious. To do this, both the staff and practitioners must regard the patient as the highest entity, and center their actions on the patient’s welfare. Most important in this – the patient must be aware that this is how the doctor feels about them.

We feel that generating a deep-seeded appreciation for our services and products produces the most genuine reaction from patients. Referrals “from the heart” are more likely to follow through. More so, we believe that incentivizing through discounts or free material may actually hinder an organic progression of referral due to its “gimmicky” nature.

Dale Carnegie’s “How to Win Friends and Influence People” and Robert Cialdini’s “Influence: The Psychology of Persuasion” are two fantastic books that I recommend every private practitioner read. Understanding the psychological science of how an individual develops fondness and appreciation for another is pertinent in developing a consistent patient who will bring their family and friends to see you.

Ask Patients to “Like” Your Practice Facebook Page
We have invited many of our patients and friends to like our Facebook page. We try to post updates twice a week on social media. Most of our updates are informative in nature or relate to community service. We have found that this style of social media posting (rather than just straight advertising) is most likely to inspire a positive interaction and get shared.

As with our other marketing tactics, we measure by survey how many patients we have seen who heard about our practice through Facebook. We have found that boosting informative posts has helped us gain new patients from social media. We recently had a new patient explain that she viewed us as the “most competent eye doctors in the neighborhood” because of the amount of informative material we publish on social media.

About 90 percent of posts are informative in the sense that they give education on eye conditions, eye health, ophthalmic materials or trivia related to optometry. A little less than 10 percent of our posts focus on local community service such as our work with the Rotary Club. By sending messages from both the educational and community service front, we believe that we can project a more well-rounded sense of caring and expertise to our audience

Send Welcome-to-the-Practice Letters
I send a “Welcome to the Practice” letter to every new patient whom we see. Many patients will respond, and a few have even come back in to tell me how nice and personal the letter was.

Turn Frame Selection Into Referral Generation
Our opticians ask the patient if they would like a family/friend “frame consultant,” when a patient is shopping for frames. This can happen one of two ways:

PUT FRAMES ON HOLD. A few frames are put on hold for the patient, and the optician tells the patient to come back with a trusted friend or family member to provide a second opinion and help make the final decision.

SEND FRAMES HOME TO DECIDE. A few frames are sent home with the patient in one of our boxes. The patient is to have a family/friend help them decide which looks the best. (If you do this, remember to always document thoroughly – we have never had a problem with loss doing this).

The frame consultant scenario enables that person to feel like they have an important role in choosing our patient’s glasses, and subsequently, their style. That transfer of authority and responsibility generates interest in our practice, and many times the person serving as a “consultant” will choose to schedule an appointment with us.

 

AARON NEUFELD, OD

is the owner of Los Altos Optometric Group in Los Altos, Calif. To contact: aneufeldod@gmail.com

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