By the NumbersPublication Exclusive

Tips for increasing associate optometrist engagement, productivity and retention

Mastering key aspects of the employer-employee relationship can make your practice more successful.

“It is not how much we have, but how much we enjoy, that makes happiness.”
– Charles Spurgeon

“Most folks are as happy as they make up their minds to be.”
– Abraham Lincoln

In the present environment, in which active, fee-generating income is reaching new limits, there are only three principal ways to passively boost surgeon income: Own an ASC, dispense glasses, and employ associate providers who generate owner profits above and beyond their personal compensation.

The most financially effective general ophthalmology practices in America, measured solely on the basis of income per surgeon-owner hour worked, are owned by those surgeons who employ optometrists as enduring non-owner associates.

Said another way, less delicately perhaps, financially successful eye surgeons are capitalists. They own the means of production and employ workers to magnify their personal output. Such surgeons invest their brains, ambition and time — and risk their capital — to get ahead.

We are now approaching about 2.5 optometrists for every ophthalmologist in America. And with this provider ratio, these two professions are managing to serve most of the country’s eye care needs. So it is sensible that if your goal is to have a full-service eye care practice, with mostly surgical work for the surgeons, you should be aiming for this kind of OD-to-MD provider ratio.

However, very few private ophthalmology practices are even close to achieving this ratio. Indeed, even the most progressive, business-like practices rarely crack a one-to-one ratio.

There are several explanations for this:

  • A few remaining ophthalmologists, for reasons all their own, see optometrists as a medical underclass, not worthy of employment.
  • In a low-growth practice, the existing MD-level providers can feel insecure about giving up their primary care patient base to OD-level colleagues, so they never have a chance to try out this practice model.
  • Some practices, having made poor OD hiring or management decisions in the past, remain unconvinced that a higher ratio of optometric staffing can be effective.

To be a successful employer of optometrists, you need to get several key aspects of the employer-employee relationship right. Here is a recap of some of the more important aspects:

1. You have to hire the right smart, experienced, work-hardened, team-ready doctors in the first place. Like medical doctors, half of all optometrists are below average, and you should be looking for the top 10% because ophthalmology clinic patients are mostly older and sicker than optometry clinic patients. Residency training is all but essential. Several years of experience after graduating is helpful because optometry schools are much less hands-on than medical schools. Doctors with prior MD clinic experience, VA and military optometrists, as well as those providing Indian Health Service care are favored candidates; they have seen more pathology and have had to work more independently than their routine family eye care peers.

2. Be collegial and respectful of the optometrists you employ, as well as those in the community. Do not belittle or criticize their care or pace in front of lay staff. Indeed, make sure staff provide an enduring willingness to equally help both the MDs and ODs in the practice.

3. Take pains to professionalize the company, with monthly group MD/OD meetings, a joint quality assurance committee and jointly derived (and written) care pathways. Perform chart reviews. Take a grand rounds approach to meetings, sharing interesting cases. Be especially generous in publicly pointing out examples of exceptional patient care provided by your associate staff.

4. Establish appropriate reporting lines. It is fine for an OD to go to the practice administrator for housekeeping items such as vacations and support staff assignments, but each optometrist in your office should formally report to — and receive their annual reviews from — a partner-level physician or a designated OD who has the title of “optometric director.”

5. Take a formal coaching approach to provider management, reviewing performance statistics regularly. These stats should include monthly graphs showing things such as total visits, collections, average collections per visit, optical sales, new contact lens fits and surgical referrals.

6. Provide competitive pay — as seen through their eyes, not just yours. This does not mean MD-level salaries. Working in an ophthalmology clinic is typically not the most lucrative of optometric career choices. Owning your own optometry clinic, or even working evenings and weekends for a chain store, typically delivers a bigger income than the roughly $150,000 ceiling reached by hard-working ODs in an ophthalmology clinic. A lot of optometric labor relations boils down to managing compensation expectations.

7. Do not use your ODs as “super-techs.” They should have their own longitudinal patient base. Give your optometric staff interesting work to do, not just routine care. Teach your optometrists what you learned in medical school. People who feel smart and have a sense of mastery regarding their jobs do not leave.

8. Assign committee work, outreach duties and staff training responsibilities. Publicly recognize your associate providers’ achievements in each of these supplemental capacities. While your ODs may not have a vote in the board room, always give them a chance to provide input on new policies. Add them to the search committee for senior hires.

9. Office space should be conjoint or at least equitably apportioned between ODs and MDs. Many clinics I get to are set up with large private offices for the MDs and shared offices or a cramped bullpen for the ODs. In such settings, the ODs often feel as belittled as their second-class cabins would suggest. By comparison, when I walk into a new client’s practice and see that the MDs and ODs work out of cubicles in a common, open-concept office space, it is usually predictive of warm, collaborative relationships.

10. Use your practice’s managers as an early warning system. If they see an OD who is frustrated, bored or unsupported, pass this information along to the managing partner for intervention.

“It is not how much we have, but how much we enjoy, that makes happiness.”
– Charles Spurgeon

“Most folks are as happy as they make up their minds to be.”
– Abraham Lincoln

In the present environment, in which active, fee-generating income is reaching new limits, there are only three principal ways to passively boost surgeon income: Own an ASC, dispense glasses, and employ associate providers who generate owner profits above and beyond their personal compensation.

The most financially effective general ophthalmology practices in America, measured solely on the basis of income per surgeon-owner hour worked, are owned by those surgeons who employ optometrists as enduring non-owner associates.

Said another way, less delicately perhaps, financially successful eye surgeons are capitalists. They own the means of production and employ workers to magnify their personal output. Such surgeons invest their brains, ambition and time — and risk their capital — to get ahead.

We are now approaching about 2.5 optometrists for every ophthalmologist in America. And with this provider ratio, these two professions are managing to serve most of the country’s eye care needs. So it is sensible that if your goal is to have a full-service eye care practice, with mostly surgical work for the surgeons, you should be aiming for this kind of OD-to-MD provider ratio.

However, very few private ophthalmology practices are even close to achieving this ratio. Indeed, even the most progressive, business-like practices rarely crack a one-to-one ratio.

There are several explanations for this:

  • A few remaining ophthalmologists, for reasons all their own, see optometrists as a medical underclass, not worthy of employment.
  • In a low-growth practice, the existing MD-level providers can feel insecure about giving up their primary care patient base to OD-level colleagues, so they never have a chance to try out this practice model.
  • Some practices, having made poor OD hiring or management decisions in the past, remain unconvinced that a higher ratio of optometric staffing can be effective.

To be a successful employer of optometrists, you need to get several key aspects of the employer-employee relationship right. Here is a recap of some of the more important aspects:

1. You have to hire the right smart, experienced, work-hardened, team-ready doctors in the first place. Like medical doctors, half of all optometrists are below average, and you should be looking for the top 10% because ophthalmology clinic patients are mostly older and sicker than optometry clinic patients. Residency training is all but essential. Several years of experience after graduating is helpful because optometry schools are much less hands-on than medical schools. Doctors with prior MD clinic experience, VA and military optometrists, as well as those providing Indian Health Service care are favored candidates; they have seen more pathology and have had to work more independently than their routine family eye care peers.

2. Be collegial and respectful of the optometrists you employ, as well as those in the community. Do not belittle or criticize their care or pace in front of lay staff. Indeed, make sure staff provide an enduring willingness to equally help both the MDs and ODs in the practice.

3. Take pains to professionalize the company, with monthly group MD/OD meetings, a joint quality assurance committee and jointly derived (and written) care pathways. Perform chart reviews. Take a grand rounds approach to meetings, sharing interesting cases. Be especially generous in publicly pointing out examples of exceptional patient care provided by your associate staff.

4. Establish appropriate reporting lines. It is fine for an OD to go to the practice administrator for housekeeping items such as vacations and support staff assignments, but each optometrist in your office should formally report to — and receive their annual reviews from — a partner-level physician or a designated OD who has the title of “optometric director.”

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5. Take a formal coaching approach to provider management, reviewing performance statistics regularly. These stats should include monthly graphs showing things such as total visits, collections, average collections per visit, optical sales, new contact lens fits and surgical referrals.

6. Provide competitive pay — as seen through their eyes, not just yours. This does not mean MD-level salaries. Working in an ophthalmology clinic is typically not the most lucrative of optometric career choices. Owning your own optometry clinic, or even working evenings and weekends for a chain store, typically delivers a bigger income than the roughly $150,000 ceiling reached by hard-working ODs in an ophthalmology clinic. A lot of optometric labor relations boils down to managing compensation expectations.

7. Do not use your ODs as “super-techs.” They should have their own longitudinal patient base. Give your optometric staff interesting work to do, not just routine care. Teach your optometrists what you learned in medical school. People who feel smart and have a sense of mastery regarding their jobs do not leave.

8. Assign committee work, outreach duties and staff training responsibilities. Publicly recognize your associate providers’ achievements in each of these supplemental capacities. While your ODs may not have a vote in the board room, always give them a chance to provide input on new policies. Add them to the search committee for senior hires.

9. Office space should be conjoint or at least equitably apportioned between ODs and MDs. Many clinics I get to are set up with large private offices for the MDs and shared offices or a cramped bullpen for the ODs. In such settings, the ODs often feel as belittled as their second-class cabins would suggest. By comparison, when I walk into a new client’s practice and see that the MDs and ODs work out of cubicles in a common, open-concept office space, it is usually predictive of warm, collaborative relationships.

10. Use your practice’s managers as an early warning system. If they see an OD who is frustrated, bored or unsupported, pass this information along to the managing partner for intervention.