by Beth Lennox, O.D. Cambridge Eye Care, Cambridge, Ontario.

I often hear, unfortunately, from many colleagues that their contact lens practice is in decline.

In our practice, contact lens revenue has shown good growth in the past five years and accounts for an increasing share of our total revenue. Our growth comes from more than simply upgrading patients from frequent replacement to higher priced daily disposable modality. We are generating new fits and increasing the total sales provided by the tremendous potential of the contact lens patient – not only in contact lenses, but in solutions and other products and services we provide.

The contact lenses conversation starts from the very first contact with our office. When booking an appointment, the first thing that our staff does is ask, “Are you a contact lens wearer?” It’s obviously important to know if they are wearing contacts, but it also opens the opportunity for the patient to indicate their interest in contacts lenses.

During the case history, even if there has been no indication of previous contact lens wear, I’ll ask the patient if they’re a contact lens wearer. It’s important to not to make any assumptions, even if I’ve seen the patient before and know they have not ordered contacts from our practice.

Maybe they’ve ordered lenses online or tried something that a friend or a sibling provided. It gives me the opportunity to say, “Okay, what happened in that situation, why didn’t you continue? Let’s refit you into better technology.”

The Full Potential of a Healthy Eyes Plan.  

If patient stays with you for lifetime, i.e.  about 20 years or so, they are worth about $20,000 in revenue because they tend to spend more every year. They are not only buying an annual supply of contact lenses, but also purchasing other products such as rewetting drops, solutions as well as prescription glasses and plano sunwear.

We’ve created a Healthy Eyes Plan, which bundles contact lenses of every modality into a package of benefits that offers patient convenience and “no-surprise” price transparency.  Patients can opt for a 6-month supply or, for a modest discount of around 5%, a full annual supply.

The HEALTHY EYES PLAN is the driving force for add-on sales to the contact lens patient.

Our Healthy Eyes Plan includes a bundle of contact lens services as well as special offers for other vision care products. It encourages loyalty and compliance using a simplified one-price approach. The Healthy Eyes Plan includes:

  • “20-20 Special Savings Plan” which includes $20 dollars off frames and $20 off ophthalmic lenses
  • $25 or $50 off designer non-prescription sunglasses
  • All contact lens office visits and progress checks
  • Complimentary replacements for torn or damaged lenses

Our professional fitting fees are separate from the Healthy Eyes Plan, but are also presented as a one-price bundle that also communicates the value of our services; including lens and solution selection, training, all sample lenses, and a solution starter kit.

The bundling approach encourages patients to purchase as much as possible with our practice to help with all their vision needs. We highlight UV protection with contact lenses on the Healthy Eyes Plan brochure to reinforce the health message and help patients understand the need for full protection from harmful UV rays. The UV message is also a tie-in with the discount benefit for designer sunglasses. Our goal is to discuss the importance of UV protection with every patient, and present UV protection as an option.

UV Blocking option is offered to every patient.

When a parent is given the choice of UV protection or no UV protection for their child, they will most often choose the protection, as they want them to have the best.

The Healthy Eyes Plan also includes 24/7 contact lens reordering from our website, which is also a great counter to shopping online. The one-stop convenience, and the benefit of bundling solutions for their full eyewear needs, is something that simply cannot be replicated online. The easier we make it for our patients, the greater success we’ll have.

Our approach works extremely well with family members and is often spread by word of mouth and through social media. Recently one daughter came in with the idea of getting contacts. We ended up fitting the sister and mom, all with annual supplies of 1-day modality lenses. Of course, we actively promote contact lenses through our social media sites. When we bring in a new product, like Acuvue Oasys 1-Day, we’ll put that onto our social media feed so that patients know. We find that patients are happy to share their contact lens success even without us encouraging them to do so.

Recently a teenager on the school volleyball team was hesitant and afraid to wear contact lenses. I said, “Let’s have some fun and put a trial lens on your eye to see how they will perform for you.” Now he is a successful 1-day modality contact lens wearer since I was able to remove his fear barrier.

My advice to colleagues who may not be having the same level of success with contact lenses as we have: keep fitting the latest technology, take charge, be the expert and show enthusiasm! Consider a bundled Healthy Eyes Plan like ours to tap into the full potential of the contact lens patient and their social network. It will score points for the patient and your practice.

Dr. Beth Lennox is a Professional Affairs Consultant with J&J Vision Care

BETH LENNOX, OD

Cambridge Eye Care, Cambridge Ontario

Dr. Beth Lennox is a co-owner of Cambridge Eye Care, in Cambridge Ontario, a successful high-growth single-location practice, with 4 doctors and 13 staff.  The office has three lanes running full-time. Cambridge Eye Care is moving to an expanded space in August 2017.


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Scott is a partner in a large, multi-doctor practice in Winnipeg, MB.

He believes in giving back to his profession, having served as president of MAO, CAO, and is currently

president-elect of the World Council of Optometry. 

When not giving back to his profession Scott enjoys running marathons.

 

Dr. Scott Mundle

Doctor of Optometry

Henderson Vision Centre

University of Waterloo 1983

Winnipeg, MB

 

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

For many years we have been part of pre-launch trials with most contact lens companies. As a result, our patients have benefitted from the most current contact lenses available and they have come to expect that if there is anything new, it will be offered to them. As well, they know that if we are at the forefront of contact lens innovations, we are likely at the forefront of most other innovations, whether that be diagnostic services, spectacle lenses, frames, etc. Our patients have come to realize that no other practice has any offering that is superior to ours, so they have no reason to seek care elsewhere.

What advice would you give a new grad today?

Remember why you became an optometrist. Have a passion for our profession. It is not just a job. You will have a tremendous impact on the well-being of your patients that go beyond the care you give. You will give peace of mind to your patients by the care you give them. If every decision you make in your practice is with the patient’s best interest in mind you will never stray from giving the best care and you will never have to explain or justify why you provide the care you do. And finally, give back to the community and the profession. It is the right thing to do and you and your practice will be rewarded in the end.

Which ECP speakers/leaders do you admire?

We all need mentors to become better ourselves. As someone who has been active in the politics of our profession, I have had the pleasure of meeting, observing and learning from most of the optometric leaders from the past fifty-plus years. These would include (in no particular order) Roy Brown, Scott Brisbin, Roland and Margaret Hansen-des Grosseilliers, Jim Kerr and Kovin Naidoo to name a few. Each of them has or continues to have an effect on how I practice optometry and serve both our profession and the public.

What’s your favorite past time/hobby?

Running. I have run 27 marathons. I love the discipline of the training and the challenges of the races. You learn a lot about yourself when you are put in challenging circumstances and the end of a marathon is about as tough mentally and physically as it can get. The other reason I run is to be with the group I run with – The Windchill Warriors (we do live and train year-round in Winnipeg after all!). Oh, and they are all funny!

Describe your perfect day.

Because I like to run and our family members are all physically active, my favorite day is when we all run the relay portion of the Manitoba Marathon. It happens to be run on Fathers’ Day which is a double bonus. We all run a leg of it, have brunch at our house, turn on the TV to watch US Open Golf and I often fall asleep in front of the TV – with my bowl of popcorn!

What was your last indulgence?

Everybody who knows me, knows I love popcorn. I will make or buy popcorn at any opportunity – hockey games, movies, TV shows at home, it’s why I shop at RONA. And the only kind I make is Orville Redenbacher the old fashioned way, with oil in a pot. Everything else is a cheap imitation.


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Under-paying an associate OD can result in poor patient care, and a practice that doesn’t meet growth goals. Pay your associates a fair salary that spurs them to contribute to the growth of your practice.

According to Jobson Optical Research’s 2016 ECP Compensation Study, the average compensation for an owner/partner is $124,134 for a practice with revenue less than $500,000, and $166,827 for a practice with revenue of more than $1,500,000. This compares to employed optometrists who earn an average of $99,663 at the low-level practice revenue, and $117,757 at the high-level practice revenue locations.

Calculate What You Can Afford to Offer
If a practice net is 34 percent, and the associate OD is getting paid 22 percent of production, then the business owner profit margin is 12 percent. Who is making 12 percent in the market or real estate today? It is a great investment.

Understandably, many doctors who push back on paying associates more tend to have practices whose profit margin drops below 10 percent once all doctors, including owners, are paid. By our optometry standards, this would be a practice net under 30 percent. In a true business model, the owner ODs would be paid and then profit margin would be calculated. When the profit margin is below 10 percent, then a practice cannot afford to pay associates well.

When you can afford to pay more, but don’t, it’s a short-sighted victory. Let’s say you pay your associates 15 percent of production (gross collections before office expenses are factored in), and maintain impressive profit margins, but then, each year you need to find and integrate new OD staff into your practice. Recruiting, training and integrating new staff into your practice costs money and time, so you might have been better off just paying the associate a fairer amount, based on what you can afford.

Attract & Retain Talent
If you pay an associate OD well, an owner can depend on them to give more than the minimum required, and if they don’t perform, then there are many other associate ODs looking for a position that rewards them for the responsibility of being an optometrist. The OD is no longer a refractionist, but an active medical professional in the American healthcare system. That carries with it a large responsibility, and it should result in compensation that reflects that responsibility. I don’t think that it is right to pay associate ODs 12-18 percent of production, as many practices, and large corporations, do. With so many associates under-paid, owners willing to pay 20-24 percent of production have their pick of many great doctors to employ.

For any profession, you pay well to get the most out of top performers. An owner may start an associate OD at 20 percent of production, and then increase that as the OD shows their commitment and dedication to the patients and the practice.

Paying an associate OD well also increases your chances of keeping them in the practice. We all are less likely to look around if we are compensated above what is considered fair. When you feel like an employer has been overly fair, you tend to gravitate toward being fair and loyal to that employer in return.

Communicate the Right Message to Potential Partners
Some practices pay associates less in return for an agreement that they will be considered for a partnership in the practice. But if you would like to add the associate as a partner, why would you want to communicate that “we will pay you lower than another associate because you are going to be a partner”? That logic makes no sense. That is like paying a future franchise player in the NFL half the salary because they are potentially good enough to be a franchise player. Rather, pay them more to communicate you want them, and that you are investing in them becoming a partner.

Finding an associate who can, and wants, to buy-in, is not like finding a new sweater. It’s a major process, so if someone looks like they are your future partner, communicate you want them by treating them well. Otherwise, you create a hostile culture. When they get to be partner, you will always be haggling with them because they will still be bitter that you treated them so badly when they were an associate.

When you create a contract with an associate for eventual partnership, you are giving them a letter of intent, or promise, to consider them as partner if you and the associate are professionally compatible. Even with a contract promise, they are not partners until shares are actually sold to them, so that agreement could always be retracted after years of unfair associate compensation, or any other reason.

Factor in Experience Level of Associate
Pay more for an experienced associate OD, especially if they will be bringing a patient base with them. I would initially pay more, in essence, to buy a patient base. This may, or may not, be adjusted down the road as the associate OD’s schedule grows because of an already-established and growing practice that the associate OD benefits from.

Give Associates Compensation Options
We offer two options for new associates. They can either have a percentage of full production that is between 20-24 percent of production, or they can have a salary, and once their salary “pays for itself” at 20-24 percent, then they earn a lower percentage above the base. This has worked out well, and has been a model in our practice, along with other practices that I have had the privilege to coach.

Most associate ODs coming in want a guarantee, so they know that they will be making money, and not living on commission alone. Performance-based incentives are best started one year after the associate OD has settled in, and hopefully, the practice has been able to supply a schedule that is beneficial for both the associate OD’s second year and the practice owner’s investment.

Tip for Associates: Have Options of Your Own to Propose
If you are interviewing to become an associate OD, always have more than one option in mind when negotiating, otherwise, you leave yourself with no negotiating power. In negotiating, an associate looking for a position should be able to give value-added reasons for why they should be compensated at higher levels then 12-18 percent. An associate should have a game plan to communicate how they are going to pay for themselves, and grow the practice, so the owner sees an ROI on the associate. As an associate, be prepared to walk away from a deal, and if you can’t walk away from the deal, then propose a good reason for higher compensation, and negotiate for an incentive-based program. Then deliver by growing your practice.

Consider Non-Monetary Benefits & Perks, Too
Today’s associates want to be paid fairly, but they also want flexibility and autonomy. Many big companies, like Best Buy and Google, are getting the best talent because they work with mantras that let employees know, “we don’t care when, or where, you work. We just care that you get your work done.”

It’s a win for both owners and associates to offer flexible hours that make it easy for a parent to grow their family, while pursuing their career. To allow for flexibility, you may be better off hiring two associates for three days a week each than hiring one for five days a week.

Work together with your associates to find a win-win in salary and schedule for both them, and the practice. It’s worth it because a practice with positive feelings between associates and owners is peaceful, upbeat and productive, rather than full of underlying tension and employment battles.

Finding mutually beneficial arrangements with associates requires a commitment to communication, and a willingness to be a servant leader. In my own practice, it’s a continual work in progress, as I continue to be humbled working with the talented people I have hired.

 

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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An optometry though-leader panel shared their views on the future of independent optometry in Canada in a live webinar on Monday May 29, 2017.   Hosted by Canadian Eye Care Business Review Co-Edits Drs. Jeff and Tina Goodhew, six panelists from vastly different types of practices and business areas, addressed 6 critical issues on the minds of Canadian optometrists.

Panelists included Dr. Daryan Angle, Executive VP, Iris Group, Mr. Ken Barbet CEO of Eye Recommend, Mr. Pierre Bertrand, President, Essilor Canada, Dr. Sheldon Salaba, OD practice owner, Hamilton ON, Dr. Altaz Shajani, OD practice owner, North Vancouver BC and Dr. Al Ulsifer, CEO & President, FYiDoctors.

The webinar, attended by nearly 200 attendees, was the largest ever live web event specifically for the Canadian eye care industry.  Attendees participated in live polls to provide on the fly input to the hosts and panelists as they addressed the issues, and audience questions were fielded by panelists following the discussion.

Critical issues examined included:

  • The impact of supplier side consolidation and its potential effect on independents.
  • The reasons why ODs are selling practices to larger retail groups.
  • How optometry can avoid being swept up in the general sea-change in retail.
  • Importance of the “customer experience” in practice success.
  • The risks to solo practitioners in today’s environment.
  • The commercial opportunity for optometric medical services vis-à-vis retail dispensing

With panelists representing corporate optometry, buying groups and solo entrepreneurial ODs, a rich variety of opinion was expressed.

You can stream or download an audio recording of the live webinar below.

Download Now


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Canadian Eye Care Business Review is proud to announce that registration is now open for their first webinar; “The Future of Independent Optometry”.  The webinar will be available live on Monday May 29th from 8 PM to 9PM EDT.

This format will provide optometrists across the country an opportunity to hear from a group of Canadian thought leaders on topics critical to the future of independent optometry.

Drs. Jeff and Tina Goodhew,
Co-Editors of Canadian Eye Care Business Review will host the webinar with the following panelists:

Dr. Daryan Angle
Executive Vice President Chairman of the Board, IRIS The Visual Group, Waterloo ON

Mr. Ken Barbet
Eye Recommend, Chief Executive Officer, Calgary AB,

Dr. Altaz Shajani
Practice Owner, North Vancouver BC

Dr. Sheldon Salaba
Practice Owner, Hamilton ON

Dr. Al Ulsifer
CEO and President, FYidoctors, Calgary AB

The questions that will be addressed include:

  • What is the impact of supplier side consolidation on independent eye care?
  • Why are independents selling out to larger groups? Fear or opportunity?
  • What are the risks and opportunities in moving from retail to medical?
  • How should independents create great customer experiences and loyalty?
  • How do solo practitioners manage the risk in today’s environment?

We are excited to have a discussion such as this on a very important topic, one that is top of mind for many in the industry.
There is no-cost to register. Please reserve your virtual place by registering online:

We look forward to your active engagement.


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Social media is the means by which many of your patients, especially Millennials, communicate with friends and family. Understanding the kind of social media posts that will capture their attention, and bring them into your office, is essential to building a profitable practice.

Depending on the demographics of your practice, one channel of social media, versus the others, may be preferable for you. In my practice, I utilize both Instagram and Facebook. Regardless of the platform, your social media posts should always keep four goals in mind:

1.    Reflect your practice’s vision/mission
2.    Brand your practice in your community
3.    Attract potential patients who identify with, and buy into, your brand
4.    Retain loyalty of your existing patients

At our practice, we dedicate one hour of time per week, and $0.00 to social media, which is our central marketing effort. It is paying off in an average of four recurrent patient visits a week, two new patient referral visits per week, and an increase in the average frame purchase price of $100, and in premium daily lens sales. Our primary focus is on high-end frame lines and in premium contact lens technology.

If you are looking for a simple way to evaluate return on investment for the time and money spent on social media marketing, one of the best resources I have found is this short guide, “The Delightfully Short Guide to Social Media ROI” by Kevan Lee. This blogger has a formula to calculate the exact monetary value of each of your likes, comments or interactions. It’s important to have a specific goal such as “gain new followers” or “increase online purchases of x.”  Secondarily, track this goal by tracking your social media analytics using an online resource like Buffer.  Thirdly, assign a value to that specific goal like “average sale” brought in by an Instagram follower.

Here are six kinds of posts that have worked for my one-OD practice in Charlotte, N.C., in generating interest in, and visits, to my practice.

Before and after shots of one of Dr. Dryer’s patients, who signed off permission, allowing the practice to use her photo for marketing purposes. Dr. Dryer says photos like this show potential patients the difference your practice can make in their lives.

Before/After Photos
Why does it work?: This kind of post is successful because it involves your patient in the eyewear selection process. Patients love getting their picture taken, and they get excited about their appearance in their new frames.

Additionally, this particular type of post also showcases the expertise of your staff in frame selection. When the new frame accentuates the patient’s best features, and updates their appearance, potential patients recognize the talents of your optical staff.

Your practice is no longer just an eyecare facility, but a destination. Your staff is sought out for their skills. This is key to separating your practice from online glasses sales.

What resources are needed?: I love the app Polamatic, which I paid about $2 for. It adds a border to your photos, so they look like old-fashioned Polaroids. These are particularly successful with my Millennial-based practice due to the resurgence of all things retro and vintage.

How do you measure its success?: I primarily use Instagram to connect with my patients. It’s difficult to measure the success of an Instagram post. Mostly, success is based on likes and/or comments. I typically post twice a week, and expect anywhere from 50-70 likes. We have around 530 followers. I also take note of people who follow me on Instagram after a post. If it’s a local company or person, I consider my post successful. I’ve made someone aware of my business and what we offer to the community.

Dr. Dryer’s selfie in her practice’s optical. Dr. Dryer says posts that show you and your staff in your office help patients get to know you, and feel comfortable with coming in for a visit.

Doctor and Staff Photos
Why does it work?: I find that the posts that receive the most overall involvement by current patients are those that involve the doctor or staff. If you’ve been successful in winning them over during their eye exam, they feel connected by social media. In my practice, when I include photos of myself, I try to showcase a new frame or capture my “fun” side, whether it be holiday or sports team wear.

What resources are needed?: Creativity! If you aren’t the creative type, engage your staff. What things are you passionate about outside of optometry? What do you want your patients to know about you that they might not learn during an eye exam? What would make your patients tell their friends about your practice?

How do you measure its success?: I’m not convinced these types of posts are best for bringing in new patients to your practice, but they are successful in engaging already-existing patients and retaining their loyalty. Patients like to connect with you, to share your interests, and to know you have a life outside of optometry.

Dr. Dryer says showing patients all of the products you sell, including contact lenses, gives them a better idea of how you can help them, and why they should book an appointment.

Product Promos
Why does it work?: At 4 Eyes Optometry, we pride ourselves on having the newest and latest from contact lenses to frame lines. I spend a lot of time educating patients on why I prescribe what I do, and why we carry the products we carry.

This type of post is effective in targeting both existing patients and new patients. I’ve dedicated posts to both eye conditions and products, and I get the most response with products.

Instagram is primarily known for its visual content and product sales. A showcase of our products is what customers expect from this type of social media.

What resources are needed?: A camera and a new product.

How do you measure it’s success?: This has been the easiest to measure. Since I’ve started introducing lens technology, I’ve had several existing patients come in and specifically ask for the contact lenses featured. I’ve also had patients come in and ask for a specific frame I’ve featured.

Dr. Dryer salutes St. Patrick’s Day, reminding patients in the process of her practice, and why they should schedule their next visit.

Holidays, Community or Special Events
Why does it work?:  For holiday posts, the goal is not to be too cute or redundant. Too many reindeer, or back-to-school apples, take away from what makes your practice unique. Do holidays, but make it reflect your practice. Your practice, or your products, should always be the main event. Less is more.

Anytime I participate in an optometry-related event, I think, “How can I share this with my patients?” Patients enjoy seeing their doctors involved in activities relating to their community or their profession.

What resources are needed?: No financial investment.

How do you measure it’s success?: Social media site likes and comments are an easy way to measure success.

One of Dr. Dryer’s patients shows off how happy she is with the new eyeglasses she got at Dr. Dryer’s practice. The practice got permission from her to use her photo for marketing purposes.

New Glasses Photos
Why does this work?
: The key to this post’s success is to re-post it from the patient’s Instagram account. This gives your business maximum publicity. Those who follow your patient’s account will see it, along with your patients. If your patients are influencers in your community, you could see a even bigger response!

What resources are needed?: Your patients and customers involvement is key! Additional monetary resources may be needed if a partnership is to be formed between key influencers.

How do you measure its success?: The success of this post is dependent on the number of followers that your patients have. Many small businesses elicit the help of influencers, bloggers or community leaders to wear their products. Forming these types of partnerships can be mutually beneficial to small businesses.

Dr. Dryer says re-posting to her practice’s social media pages favorable posts like this can be a powerful marketing tool. Patients read first-hand about another patient’s positive experience, want to experience it, too.

Social Media Reviews Re-Posted
Why does it work?: This is extremely effective because it’s your patient’s words about your practice. Word-of-mouth is always your best marketing technique. If potential patients only visit your Instagram account, they will miss your fabulous Yelp reviews.

What resources are needed?: Reviews are easily pulled from your other social media pages. If you don’t have any, actively ask your patients for them, or you may consult with other paid sources like Weave.

How do you measure its success?: Online reviews are now my No. 2 source of referrals, just behind word of mouth. When I ask patients how they hear about us, they will say “you have good reviews.” Every practice should keep track of the ways patients hear about their practice to make good investments in marketing dollars. We track this by asking “How did you hear about us?” on patient intake interviews.

Action Plan: Additional Tips to Get the Most from Social Media

GET PATIENT SIGN OFF. Make sure you have your patients fill out a HIPAA marketing release form before using their images or private information in social media posts, or other marketing.

EXPERIMENT WITH HASH-TAGGING. “Trial” your hash-tagging on posts to find the most popular hashtags for bringing in new patients. You may look at popular bloggers in your area for ideas.

ASK PATIENTS TO POST. Encourage patients to post directly on their social media and “tag” you. This is a great way to generate more awareness, and will likely bring in more new patients (their followers).

ASK PATIENTS TO “LIKE” YOU. Actively promote your social media among your patients. Ask them to “like” or “follow” you.

COURTNEY DRYER, OD

is the owner of 4 Eyes Optometry in Charlotte, N.C. To contact her: cdryerod@gmail.com


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Negotiating a lease is not something that you’ll do very often. Prepare for the discussion and take heed of the following seven tips for success:

  1. Initially offer about 20% less than asking net rents
  2. Know that net rent is the negotiable portion of the deal. The additional rent or taxes, maintenance and insurance (TMI) are actual costs that are passed directly to the tenants and are not negotiable.
  3. If you are a new practice go for a shorter initial term, such as three or five years, with a couple of five year renewal options. This provides an escape if things don’t work out.
  4. If you are an established practice or very confident of success, a longer initial term (ten years) will enable you to fix the rents for a longer time and get a tenant improvement allowance (TI) from the landlord.
  5. Go for as much free rent as possible….try to get three months totally rent free (no net rent or TMI) for your practice buildout, plus three more months net rent free to get established up and running.
  6. Make sure your lease is assignable so you have the option of selling your practice in that location.
  7. Insist on an exclusivity for all optometric, optical and ophthalmic activities.

THOMAS A. BOLLUM

Tom Bollum is a former retail optical executive and now a commercial real estate broker with Avison Young. He has sourced and negotiated locations for many optical stores across Canada.


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SYNOPSIS

High per-patient revenues are the core of practice profitability. Six steps get you there.

ACTION POINTS

CALCULATE PER-PATIENT REVENUE.Divide receipts by number of refractions.

PRESCRIBE FROM EXAM CHAIR. In your exam, recommend lens treatments and explain lifestyle benefits.

EDUCATE STAFF ON PRODUCTS. Have lens and contact lens vendors present to staff on how products provide solutions to patient visual challenges and eye comfort.

Our practice consistently achieves a high per-patient revenue (PPR) of $400 to $410 every year. Six steps keep our PPR high.

The optical dispensary in Dr. Click’s office makes eye wear very accessible to patients.
CALCULATE PPR

We use a very simple formula to track our PPR daily. Total receipts divided by number of refractions = PPR. I understand that this is a big picture number and that it does not separate out the medical visits or contact lens follow-ups from the routine eye exams.

DOCTOR PRESCRIBES FROM EXAM CHAIR

My staff of three and I practice chair-side doctor recommendations. I always recommend AR and Transitions to everyone. AR is standard on all lenses and is only not on lenses unless the patient specifically states they don’t want it and understand how they will be negatively impacted. When the lenses are presented to the patient we name all of the lens benefits without naming the brands.

We educate the patient how each benefit will directly impact their lifestyle issue or complaint. We also let them know the amount of savings they will have by using their vision benefits. If a patient decides they don’t want a specific item then we tell them what feature they are giving up. Most of the time patients decide not to downgrade their lenses once they understand what it means to their daily life. But sometimes they do and we try to make sure they truly understand everything, and aren’t making their decision based on misconceptions.

TALK PPR IN STAFF MEETINGS

We talk about the PPR at our weekly business meetings. I always believe the entire staff should know what all the goals are and how we are tracking because each staff member directly impacts the total patient visit. In our staff meetings, we teach the front desk to set the stage with a friendly, positive attitude. When the patient perceives that it is a warm, friendly and professional office, the patient is more likely to purchase glasses and/or contact lenses from us. I think the more knowledgeable each staff member is about their role, the more competent we are, and thus, the higher our perception of value.

PROVIDE NEEDED STAFF EDUCATION ON PRODUCTS

Everyone is encouraged and supported to obtain as much CE or courses as they can. The insurance specialist attends webinars and seminars about insurance updates. The optician and technician attend classes to keep their certification up to date. We also have vendors come in at least once a quarter to educate us. We recently had a Nike sunglasses seminar and we have a scheduled Transitions meeting in a few weeks. I have the entire team attend a portion of the meeting so that they know that we offer the product and know who to refer to within the team for more information if needed. My goal is to make sure that every team member knows what we are capable of doing for our patients even if they won’t be a part of the resolution.

HAVE VENDORS HELP STAFF PRESENT NEEDS-BASED SOLUTIONS

All the vendors are great in helping the practice improve PPR. Essilor is excellent at staff and doctor training for needs-based solutions. Needs-based solutions are where the entire team is recommending products that fit the patient’s needs. It involves everyone being more involved with the patient by asking detailed questions that lead to conversations about what people do for work, fun and hobbies. Every team member who works with a patient is encouraged to have three questions that they ask the patient to facilitate conversations.

Contact lens vendors are great in strategizing ways to increase annual supply sales, and our frame vendors help with frame board management so we can make sure we have fashionable and good quality frames. Our frames have a built-in two-year warranty, which increases the value of the frame because patients know they are covered if something unforeseen happens.

KNOW & ADDRESS COMMON CULPRITS BEHIND LOW PPR

I have found two main reasons for us having a lower PPR than expected some days. The first occurs when see a lot of patients who do not have a prescription need. We try very hard to educate all parents on the importance of children’s eye exams and we do see a lot of kids annually who don’t have a prescription need.

Fortunately, patients who have not had a prescription change still often purchase new eyewear because we reference our vision treatment plan from the previous year and base our recommendations on the part of the plan that wasn’t filled.

The second situation in which we see a lower PPR is when the practice is under-staffed. It is very important to have a well trained team as we have seen it negatively impact our bottom line.

RESOURCE ON INVENTORY MANAGEMENT

A detailed discussion of managing eyewear inventory is found in Key Metrics: Assessing Optometric Practice Performance, from the Management & Business Academy, sponsored by Essilor. For specifics on stocking inventory, see “Frames Inventory and Turnover” on page 28 and “Soft Lens Inventory by Practice Size” on page 37. –ROB editors

MAINTAIN ADEQUATE STOCK OF KEY INVENTORY

The effort to increase per-patient revenue starts in the exam room with the doctor and is then reinforced in the optical. But you have to have a good selection of merchandise inventory. It is disappointing when a patient is excited to buy and then decides not to when you don’t have the frame look they want.

Our goal is to have a 3x turnover per year per frame. So, a smaller practice like mine has about 400 frames in inventory as our goal of refractions is 1,200 this year. In contact lens inventory, we stock 100 one-day boxes: 50 from two individual vendors. In contact lens trials, due to space, we have trials of the lenses that we prescribe the most. If someone wants or needs a different brand, we order in the trials as needed. The trial sets are big and different sizes; we don’t have the room to have all the fit sets available, but we make sure that we can always give patients something at the date of their exam.

RACHAEL CLICK, OD

Rachael Click, OD, is the owner of Preferred EyeCare Center in Mount Pleasant, SC. To contact her: drclick@preferredeyecarecenter.com.


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SYNOPSIS

Adding employees can boost overall profitability–when the timing is right and the selection process is efficient. Learn key steps to hire well.

ACTION POINTS

DETERMINE HIRING NEED. When your staff is overloaded, look at the financials to see if the numbers justify including another staff member. Employee expenses should be around 20 percent of gross revenue.

GET INPUT FROM EXITING STAFF. Ask the staff member to write a description of what they do and make notes for the new team member. Discuss good applicants with them to get their opinion.

NARROW DOWN APPLICANTS. If you have 100 or more applicants apply, call about 20 of those for a phone interview. Have about five in for in-person interviews with the office manager.

My practice prides itself on the high level of customer service that we deliver to patients. That service begins with recruiting the right employees to serve patients. Over the years we have developed a system to decide when new employees are needed, and then to find and hire the people we feel are best matched with our practice mission and patient needs.

Our practice has grown over the past 16 years to over $2 million in gross annual revenues, 11 full-time employees, one full-time OD and two part-time ODs. We have tried to stay ahead of, and encourage, growth by hiring customer service-oriented personnel when opportunity warranted it, and the financial metrics indicated it was the right move.

Our office manager is in charge of our hiring process. She approaches me when she feels there is a need for a new staff member and we discuss the situation. If the numbers confirm the need for a new hire, she begins the process, keeping me updated, and consulting with staff members who will be helpful in the decision.

Staff photos and certifications in the hallway near the practice’s pre-testing room. Dr. Cass says it is important to carefully screen applicants, by e-mail first, then by phone, and then up to two times in person. His office manager, and sometimes the out-going employee, are involved in the hiring process, in addition to himself.

DETERMINE THE NEED TO HIRE

Our practice focuses heavily on customer service, so when we find that our staff is overloaded we begin to look at the financials to see if the numbers justify including another staff member. One of the first numbers that we look at is employee expense.

Employee expenses should be around 20 percent of gross revenue. While not a hard number, it can serve as a guide–anything lower may indicate that our staff is stretched too thin, and anything higher may indicate inefficiency.

Staff are usually quick to tell the practice manager, or owner, when they think additional staff are warranted. When this occurs in our office, it would be discussed at our monthly staff meeting and we would look at the numbers with the staff to see if an additional employee was justified.

I always point out to staff that if we hire an additional staff member, we expect revenues to go up, and therefore, would increase monthly collection goals. Since we bonus our staff on monthly collections, they are less likely to make an unnecessary recommendation for additional staff.

We also look at gross revenue per staff hour. Management & Business Academy statistics list the median revenue per staff hour at $83. Anything above $100/staff hour could indicate the staff is stretch thin, and anything below $70 could indicate inefficiency. Additionally, a rule of thumb is four staff per full-time equivalent OD. These numbers are just guides, though, and practices like ours, that focus on customer service, are not afraid to be slightly over-staffed.

PROTECT YOUR PRACTICE: KNOW WHAT NOT TO ASK

Languages spoken. In general this question should be avoided unless the need to communicate in a given language is essential, but even in that case, be careful not to imply that it is a requirement.

Age. The Age Discrimination in Employment Act technically applies only to employers with greater than 20 employees. Despite this restriction, regardless of staff size, it is a very bad decision to ask an applicant’s age, or make any hiring decision based on the stated or perceived age of the applicant.

Medical history. There is no universal prohibition on obtaining such information, but the Genetic Information Non-Discrimination Act of 2008 specifically prohibits any employment decision based on any information obtained regarding applicants genetic data, medical or family medical history. Obtaining medical information only sets up an employer to explain hiring decisions they would likely wish to avoid having to explain.

Criminal arrest and conviction records. This is a growing area of discrimination retaliation, and should be approached with caution. The Equal Employment Opportunity Commission has challenged the use of background checks, and is encouraging a “Ban the Box” movement, eliminating any potential investigation into an applicant’s records. Unless a mandate of state law, arrest record checks are a bad idea, and criminal checks should be conducted only if allowed by state law, and then only if truly necessary.

Credit checks. This should be avoided unless the position the applicant is interviewing for would require such scrutiny. The Federal Fair Credit Reporting Act does not prohibit obtaining credit checks on job applicants, but it does establish that an employer has liability if conducting a credit check in any way could, or does, adversely affect the applicant’s credit status. Some states have specific laws related to credit checks.

Aptitude tests. While not illegal, or even a bad idea, you need to be careful you are not imposing a discriminatory situation based on the construction of the test. Basic math, spelling or general information tests are all fine as long as they do not pose an advantage to one applicant over another.

Drug testing. Legality and application of drug testing for job applicants is almost exclusively regulated by State law. In the absence of State-specific law, employers should be careful in the application of drug testing for applicants. In most cases, it would be advisable to mandate drug testing only after a job offer is made with that offer contingent on a negative drug test outcome.

 

CREATE & IMPLEMENT A SYSTEM TO HIRE PERSON YOU NEED

When a new staff member is needed, we follow a step-by-step approach for searching and hiring. Having a system in place is essential, as the average job listing brings 250 resumes, with each requiring five minutes to sort through, according to Local Eye Site’sreport, The Real Cost of Unqualified Applicants. That totals 20+ hours of work basically to sort out the unqualified.

POST OPPORTUNITY. We use a local site called www.southeasttexas.com. A single ad is free, premium ads, or multiple ads, are available for a small fee. We give a clear description of the job, and ask for applicants to e-mail a resume to our office. We also ask existing staff members to encourage people they think would be a good fit for the practice to apply.

SUBMIT BY E-MAIL. All the resumes submitted by e-mail are reviewed by my office manager, while any resumes submitted by fax or mail are shredded. The ability to follow instructions and use a computer are job requirements.

CALL FINALISTS. Applicants with resumes that show promise are called for a phone interview. We typically call about 20 percent of the applicants who properly submit a resume.

NARROW FIELD. Applicants who do well on the phone interview are invited to the office for an in-person interview with our office manager.

MEET IN PERSON. Applicants who do well in the in-person interview are invited back for an interview with myself and the office manager.

BREAK A TIE. In the case of a tough decision, we might ask two applicants to come and work with us for one day and be paid for that one day. We let them know that it is also an opportunity for them to see if they would really like working in our office.

INVOLVE EXISTING STAFF IN RECRUITMENT

If an existing position is vacated under good circumstances (moving, taking another position elsewhere, wanting to be at home with children), we try to include the out-going employee in the process. We ask the staff member to write a description of what they do and make notes for the new team member. We would also discuss good applicants with them to get their opinion.

Having the out-going staff member sit in on the interview can be a good idea, however, it is generally not advisable to have the applicant “interview” with other members without the office manager present. The applicant can be introduced to the staff member as part of the interview process, but an applicant should not be left alone with a staff member who is not trained in what may or may not be appropriate to discuss with the applicant.

NARROW DOWN APPLICANTS

We often have 100, or more, applicants apply. We would typically call about 20 of those for a phone interview. We would usually have about five in for an in-person interview with my office manager.

We usually ask about salary requirements in the initial phone call. We confirm the amount needed at the in-person interview. We try to be very competitive with pay. We want to pay more than our competition, so that we get the best candidates. We also let potential applicants know that we have many perks and offer a bonus system which can typically boost income by the equivalent of almost $2/hour, or more, in a good month.

I think it is very important for the office manager to like an employee and take ownership of the decision to hire the employee. If a doctor makes a bad hire, it creates tension between the office manager and doctor, and it can be more awkward for the manager to approach the doctor about the mistake. However, if a manager makes a bad hire (which happens with even great office managers), the doctor can easily forgive the manager and move on in the hiring process.

I usually share my opinion with the office manager and let her know what I like at each step of the process. I review the resumes she picks, I talk to her about her notes from phone calls, and her notes from interviews, and give her my honest opinion on the in-person interview I am involved in. I stop just short of telling her who to hire. That was even true even when a friend of a friend applied for a job. The applicant made it all the way through the process, and it was down to the final two, before my office manager asked my opinion. She was hired, and has been a great employee.

Research from the Management and Business Academy, showing staffing levels according to practice size. Dr. Cass says he would always rather be slightly over-staffed than under-staffed, as having slightly too much staff gears the practice toward growth and ensures topnotch patient service.

CHOOSE DISCUSSION TOPICS FOR INTERVIEWS

Recommended discussion topics during the interview include describing the business to the applicant and the general aspects of the job they are considering, asking them about their past job experiences, asking them to describe their strengths and weaknesses as an employee and asking them to describe how they would handle particular job situations or challenges.

The goal of the interview is to get the applicant to talk, not to talk to the applicant.

The applicant interview process is a time to get to know the employee as a person and potential member of your team. We look strongly at communication skills, how the applicant carries themselves, their attitude and professionalism.

NARROW DOWN TO FINALISTS

We usually do two in-person interviews, which are an important part of our process. We ask for references, but don’t always call them since most applicants will choose people who will say great things about them. We are more concerned with past work experience, and would prefer to call a previous employer.

Obtaining references is a standard practice in the hiring process, but no applicant in their right mind would ever provide a reference who would not provide a stellar recommendation for the applicant.

We want to know from past employers if the employee was dependable, friendly, and got along well with other staff. When talking to a prior employer, simply asking if the applicant would be eligible for re-hire at their business is often the most telling piece of information.

RECRUITMENT RESOURCE: QUESTIONS FOR APPLICANTS

CLICK HERE to download a complimentary PDF with questions to ask applicants for employment in your practice.

 

HIRE FOR PERSONALITY & TRAIN FOR SKILL

Skills and experience can be a plus, but personality, and how they would fit with our team, count for much more. We can train someone to do most of the tasks in our office, and in fact, we often prefer to train them rather than work to correct habits or processes that don’t work for us.

We require all of our staff to be certified through AOA, ABO or JCAHPO. Employees not certified are not eligible for bonuses, so we provide full support for certification. We have training materials in the office, we will work with and tutor employees, and will pay for the first attempt at the certification exam. We also constantly train, partnering with vendors to provide training in our monthly meetings and taking staff to education meetings (in fact, we just took three staff to Vision Expo West 2016).

MAKE THE OFFER

My office manager calls to make the job offer. These are very pleasant phone calls usually, as the applicants who have made it through our process are sure they want to be employed by us, and therefore, happy to hear they have been chosen. We let the employee know that employment is probationary for the first 90 days, and that permanent employment will be offered after successfully completing 90 days.

PETER J. CASS, OD

is the owner of Beaumont Family Eye Care in Beaumont, Texas, and president of the Texas Optometric Association. To contact: pcassod@gmail.com


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John is a partner in a 2 location, multi-doctor practice in Windsor, ON. 

Currently he sits on the board of directors of FYIdoctors 

and is the past president of the Ontario Association of Optometrists. 

Learn his thoughts on the patient experience, hiring on personality and his favorite flavor of ice cream!

 

Dr. John Mastronardi

Doctor of Optometry

Windsor Eye Care Centre

University of Waterloo 1996

Windsor, ON

 

Why did you choose your field?

I always had an interest in science and math as a student. I had the opportunity in grade 12 to participate in a co-op position at a laboratory at H.J. Heinz. At the end of the year, my supervisor there said that I did a great job but she couldn’t see me working on the pH and colourimetrics of baby food the rest of my life. She said, “I could see you being an optometrist” and the rest is history. I am forever grateful to her and think it’s important to give back by mentoring whenever the opportunity presents itself.

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

We have tried to create an environment and experience that really gives our patients no reason to leave and every reason to refer their friends and family. That process started a decade ago by merging a few smaller clinics into a larger, fairly central location with easy access and parking. While you can never be everything to everyone, we forged a plan to address the most commonly sought after desires of our patients over the years: knowledgeable and empathetic doctors, a clean, state-of-the-art, welcoming environment that is a coalescence of healthcare and retail, a large selection (in style, brands and value) of ophthalmic and sunwear, and a support team dedicated to delivering unparalleled patient care and fashion advice. They were lofty goals but the ongoing positive feedback from our patients reaffirms that we didn’t do a bad job. Paying meticulous attention to every detail of the patient experience is something that set us apart years ago and something that we continue to dedicate ourselves towards under our new banner of FYidoctors.

How do you hire new staff? What is the process and who does the hiring

While staffing and HR will often be listed as the single biggest challenge to running a practice, finding the right candidates is absolutely the key to success of a building a great practice; I would say it is equally or more important than having very good optometrists.
Our office manager does the hiring for both of our locations. He will initially cast a net for new candidates by placing ads online (workable, kijiji, facebook), checking with industry contacts and reps, or actively soliciting “stars” based on comments from our patients that buy their eyewear elsewhere in town. He will sift through the resumes looking primarily for backgrounds in customer service excellence, hospitality and/or the fashion industry. Personality trumps previous ophthalmic experience every time!
Candidates will be invited in for an interview where we will have a minimum of two to three team members present to ensure we get different perspectives. Candidates will also be asked to answer a 20-30 minute multiple choice test on Talentsorter.com to determine if there is a fit with their personality, drive and other factors. From there, we decide quickly and don’t give a great candidate a chance to take another offer!

What’s your favourite past time/hobby?

Travelling the world with my family would be my favourite thing to do when outside of the office. Whether it’s a five day raft trip down Desolation Canyon off the grid, a river safari in Botswana, or a 4 generation family supper on a remote countryside in Molise, Italy, family time exploring off the beaten path is just utopia for me. Some will say our three children are spoiled because of this; I will argue that I’m the spoiled one with priceless memories that we share. Next up in 2017… gorilla trekking in Rwanda.

What is your favourite TV show?

I will agree with our colleague Wes McCann here – Schitt’s Creek. It’s the only show you need to watch for a great laugh.

What was your last indulgence?

This morning at work….. Ben and Jerry’s The Tonight Dough ice cream. It is stocked in our freezer at the office at all times and serves as the perfect filler when I have a no-show in the schedule.

 


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