• John B. Pinto, Practice Consultant and OSN Section Editor, focuses his blog on ophthalmic strategic planning, economics and benchmarking, marketing, cost containment, revenue enhancement, physician leadership and personnel/physician career development issues.

Thursday, July 24, 2014

Managing associate optometrists in your practice, part 3

John B. Pinto

Hiring a new optometrist — or properly managing the doctors you have — should start with a position description. This should include the following elements:

Scope of practice

The practice’s optometrists will practice to the highest levels permitted by state practice regulations and payer stipulations, and within the boundaries set by the medical director.

Supervision

Optometrists will report to the medical director of the practice (or can report to the optometric director, a chief OD selected in larger practices, who in turn reports to the medical director.)

Thursday, July 17, 2014

Managing associate optometrists in your practice, part 2

John B. Pinto

The first step before you start placing ads is to clarity of scope of work actually needed in your practice. Optometrists can fill several different, sometimes overlapping roles. Here are the most common: 

Refractionist or ‘super-tech’

A few surgeons use optometrists as refractionists only. In my view, this is a vast underutilization of resources. In the most efficient practices, technicians (and technology) do the refracting, and patients just have to see one doctor during a visit, an optometrist or ophthalmologist, based on their needs.

Friday, July 11, 2014

Managing associate optometrists in your practice, part 1

John B. Pinto

If you are like the typical ophthalmologist reading this, you’ll see 100 to 200 patients in clinic this week. Unless you’re in an obscure subspecialty niche, or very old-school, chances are you could delegate about a third or more of those patients to an optometrist working on your staff.

Yet fewer than half of the new client practices I serve employ optometrists — although this is up sharply from several years ago when only the busiest, vanguard surgeons were willing to work alongside ODs.

Wednesday, April 23, 2014

Practice lessons from naval submarines, part 2

John B. Pinto

Consider the following practices, Practice A and Practice B, I am about to describe. Practice A’s routine procedures are in writing, and these reference materials are easily accessed when a question surfaces. Practice B’s procedures are all in people’s heads, and the operational integrity of the practice degrades every time a staff member leaves. Initial training at Practice A is formalized and intensive; new staff are competent in their jobs before being allowed to operate c...

Monday, March 31, 2014

Practice lessons from naval submarines, part 1

John B. Pinto

Living in San Diego in the shadow of America’s nuclear navy, I once had the privilege of touring a real, live submarine, courtesy of an admiral friend. In 60 minutes, I learned more about the value of staff cross-training than I had learned in all the previous years as a practice consultant. I also picked up lots of other management pearls. I’d like to share a few of these insights with you. Virtually all members of a 135-man submarine crew (U.S. submarines are essentially all-male...

Friday, March 14, 2014

Is your practice large enough? Part 5

John B. Pinto

This topical blog series on practice scale would not be complete without an acknowledgement that not every surgeon needs to be in a growing practice to be happy. Although it’s rare today, many of us can still remember when a significant percentage of specialists would actually close their practice to new patients. Some surgeons in today’s over-amped, multitasking world are considering the modern equivalent of downsizing to limit the practice to their core interests. I visit with an i...

Thursday, March 6, 2014

Is your practice large enough? Part 4

John B. Pinto

Development in all its forms — adding new services, new facilities, new staffing or new patient volumes — is often perceived to be the foe of smooth operations. So doctors who don’t think their practice is prepared for growth will keep holding up progress. This is extremely frustrating for their lay managers. It’s clearly true that growth in any form will be accompanied by operational snags. And the faster a practice builds, the more snags will arise. Try to not use these...

Wednesday, February 19, 2014

Is your practice large enough? Part 3

John B. Pinto

In a practice eager for sustained growth, there are usually one or more defining incentives. These usually take the form of personal financial rewards for the surgeons, although there are prominent exceptions. I have more than one client for whom profit growth is mainly an opportunity to fund their charitable work. For most, old-fashioned competition is a common motivation: “Dr. Winters has just eclipsed my case volume — I’m no longer the No. 1 surgeon in town.” However, ...

Friday, February 14, 2014

Is your practice large enough? Part 2

John B. Pinto

The largest single influence on a practice’s development trajectory is doctor ambition and a willingness to risk both capital and colleague jealousy. A gung-ho physician in a tough, doctor-saturated market is generally far more successful than an average doctor operating in a market that is underserved and ripe for conquest. The same competitive instincts that drive some surgeons to the top of their class often lead them to be winners in a raw commercial sense, as well. A manager’s a...

Tuesday, February 4, 2014

Is your practice large enough? part 1

John B. Pinto

The concept of homeostatic “set points” is well-understood in biology and medicine. A healthy 6-foot male patient of average build will settle in at about 180 pounds. A healthy ecological niche will reach a carrying capacity of just so many frogs or robins, and no more. Healthy cells will grow and divide to make a tissue; healthy cells don’t grow rampantly to form a cancer. But what about a healthy practice? What should be the set point of a growing solo or group ophthalmolog...