After 18 years in corporate optometry,
Dr. Lowinger has learned a thing or ten
about optimizing an eye care practice.
Optometrists are smart people. We work tirelessly to get through optometry school, passing examinations on optics, anatomy and pharmacology. Next, we learn and master a variety of clinical skills, diagnostic techniques and treatment protocols. Then, with tremendous effort and diligence, we somehow manage to pass our boards and can officially refer to ourselves as eye doctors. Life is good.

But wait… We didn’t learn anything about how to actually get started in practice, establish a patient base or even balance the books!

Following the completion of our formal schooling, learning the business side of our profession becomes one lifelong continuing education program. Unlike the cozy and familiar classroom setting, most of us acquire this knowledge via enrollment in the School of Hard Knocks. In this curriculum setting, daily successes and failures over the course of an entire career eventually help us determine how to run our practices most effectively.

After working in corporate optometry for the past 18 years, I’ve learned quite a bit by watching how my corporate partner interacts with its customers, employees and vendors. This ongoing experience has helped me become a successful optometrist as a leaseholder in a retail setting. And, during that time, I’ve developed a list of 10 fundamental lessons that––in one way or another––effectively translate into all modes of practice and can be applied during any phase of an optometrist’s career.

1. Not all corporations are created equal, and your fit with each type may vary. This is not necessarily the first lesson I learned, but it may be the most important. In health care, not every patient will gel with every doctor, and not every doctor will gel with every corporation.

The long-term goals and day-to-day business activities of corporate practices range dramatically. Some are considered “high-end” locations that see a smaller, select patient population per day.

Doctors at these practices often place tremendous value on the medical care aspect of their eye examinations, and/or strictly market upscale lines of prescription frames and sunwear. On the other hand, there are many “low-end” corporate practices that see a high volume of patients each day and offer budget-price frame lines.

The bottom line: If your skill set is inappropriate for the specific corporate setup you are considering, you may be very unhappy with the results. So, be honest with yourself. Take the time to envision what type of “feel” you’d like from your practice, and then decide if a corporate location suitably matches these preferences.

It’s advisable to take a similar approach when ultimately deciding upon your intended mode of practice, or even your first private location. What do you want it to look like? Sometimes, kicking the tires on a corporate setting can help you determine what type of optometrist you’d like to be when you open your own office.

2. A smaller office footprint means more innovation. Most retail locations tend to be smaller than private offices––especially because, in many cases, the corporate parent generates its revenue on everything other than eye examinations. Because of this, if you are considering a corporate practice setting, be prepared to make some concessions secondary to limited space.

During the first year in my office, we quickly filled multiple file cabinets with patient records. So, I ordered a custom cabinet installation and raced to implement electronic medical records––way back in 2005. In fact, insufficient physical space was the single greatest motivation to become an early adopter of EMR. Similarly, retinal cameras and visual fields machines not only have to pass the “need” test, but also the “fit” test in confined office environments.

When I started, I had no experience in office design. Now, I am a Tetris Master when it comes to making the necessary pieces fit.

3. You have to spend money to make money. Turnkey operations are nice if you simply want to manage a practice and make a nice living. But, if you want to build a practice, you need to show patients that you genuinely care. That means spending money to make the office look nice, purchasing the right equipment, and providing patients with a level of professional expertise that will keep them coming back to you.

Over the years, our office added EMR software; a retinal camera; new flooring and paint; better staff training; and enhanced recall systems. Such prudent upgrades often reassure patients that they have selected the right practitioner to meet their eye care needs. If the comprehensive examination experience at your practice is both comfortable and pleasant, your patient base will expand rapidly.

4. Sometimes, it makes sense to think about a change before actually enacting it. Corporations are like cruise ships––it takes a long time for them to change direction. In some instances, this absolute certainty can cause you to bang your head against the wall. Other times, however, pausing to think ahead and plan accordingly is necessary.

The same is true in our practices. We can wave our magic wands and change how we do things very quickly. Sometimes, this is a smart move. Other times, such unbridled haste leads to gross oversight.

For example, I used to impulsively purchase the latest and greatest equipment as it came out––only to watch it collect dust as I figured out how to employ it in my practice. Now––well before I buy, change or move anything––I make certain that I have just cause, as well as a reasonable expectation of how it will benefit the practice.

5. The customer is not always right. But, it is better to kill them with kindness than be a brick wall. There are plenty of reasons why patients have preconceived notions walking into an eye exam. These days, everyone has an expectation of service that is “100% satisfaction guaranteed.” Educating a patient when they are mistaken is the most difficult part of the job, and in corporate practice, you have to tread lightly during those explanations.

I’ve found that apologizing for the misunderstanding and then educating the patient goes a long way toward helping them feel satisfied, even when they are frustrated. Also, I’ve learned that being right in these situations does not mean that I will win the disagreement, and that winning this battle can actually mean losing the war in terms of patient goodwill. Even when things remain unresolved, being pleasant in a bad situation always pays dividends over the long term.

6. “Refund” is not a dirty word. Continuing the conversation from Lesson #5 … There will be the patient who receives an eye exam from you, goes to his ophthalmologist, and comes back to your office to report: “The eyeglasses you gave me are wrong.” (In most instances, this is because the patient simply doesn’t understand the difference between plus and minus cylinder. But, I digress.)

You can spend countless hours simplifying optics lessons from your second year of optometry school while being as pleasant as possible. At the end of the day, however, patients will still want their money back because “you screwed up” and they are done with you. A refund ends all of that nonsense. I may or may not ever see that patient again––but the truth is that offering a refund gets them out of my life and my practice.

Interestingly, of the dozen or so patients I’ve provided refunds to during my career, about half of them have returned to seek care at some point.

7. The fundamental importance of proper staff training cannot be overstated. In every facet of a retail or corporate setting, some form of education is always occurring.

Whether it is customer service instruction, food safety, inventory tracking, management orientation, loss prevention or general safety monitoring, employees complete hours of on-the-job training to help their corporations remain efficient and profitable. Likewise, in an optometric setting, your staff must be amply trained to provide superior eye care and customer service.

In general, I’ve found that my staff members enjoy learning more about what they do on a day-to-day basis. In doing this, your job becomes easier because they are able to address a greater volume of patients’ questions and concerns. Many large private practices also provide similar training for their staff members.

Further, it is worth noting that paraoptometric training is available at most major conferences and regional meetings, and that multiple periodicals and contact lens companies offer software modules to facilitate the education process.

8. Embrace the medical billing model. More and more retail chains are adding pharmacies, walk-up clinics and even flu shots to increase their revenue. Optometry should be no different. Many corporate practices are starting to partner with eye care insurance to offer one-stop shopping.

Take note that such opportunities do not simply begin and end with the optical. Adhering to the medical billing model is the best way to help our patients without giving away free care or referring them out of our practices. Keeping those patients in house enhances the patient experience, increases your office’s bottom line and expands your corporate partner’s earnings. It’s quite literally a win-win-win for every party involved.

One of my favorite examples is what I call the “Saturday foreign body patient.” At least once a month, I have a patient who is working around his house on the weekend and gets something in his eye. Now, this person can go to the emergency room, spend a lot of money and waste a lot of time waiting around––or, he can come in to see me, pay less and return home much sooner.

Patients love that service and are happy to pay for my time and the convenience of not having to go to the ER. And, without question, I am more than happy to take care of that individual and generate some additional revenue.

9. Get involved in your community.
There are many different forms of advertising, but most business owners agree that the best advertising is word of mouth. No matter its size, being an active part of the community fosters a sense of goodwill that often drives patients to your location. Many larger corporations have a marketing budget that can be applied toward local community sponsorships and outreach programs. Such a philanthropic approach helps establish a partnership between the retail location and the community it serves.

This goes beyond the scope of conventional advertising budgets, and is more of a grass roots approach to building a client base. As eye care practitioners––retail, private or otherwise––being both visible and active in your community will dramatically increase patient traffic. Shortly after word gets around, you will become the community eye care doctor that patients want to see.

10. At some point, most everyone will work in a retail setting.
During the past 18 years here, I’ve hired new grads, old doctors and everyone in between to work for me. Sometimes corporate optometry is a starting point for the new graduate who wants to buy his or her own practice in the future. In other cases, it is supplemental income for ODs who are actively building their practice or those moonlighting during their residency. And in other instances, it is a place for an older OD to keep working a few more years after he or she has sold their practice.

For me, it began as a five-year plan to pay off my student loan debt. Over time, however, I developed a long-term interest in building my own practice in a retail setting. Most of us will work in a retail location at some point, and some of us will remain in that setting because it’s the right fit.

There is no wrong way to practice optometry––as long as you remain cognizant of what’s best for your patients. There is no limit to what you can do when you work hard in any mode of practice. My office has created several professional opportunities, including speaking on behalf of contact lens manufacturers at major CE meetings and publishing in trade journals. I have also contributed research to a few clinical studies because of the size of my practice and its patient base.

Bottom line––whichever mode of practice you choose, you’ll always have the opportunity to do much more than simply prescribe glasses and contact lenses. Many corporate optical chains have national or regional leadership groups. Getting involved with these organizations can help you understand your corporation’s position on a host of issues. Such involvement also will help you get noticed as an opinion leader in the field. Making our practices succeed requires a lot of information that we did not learn in the classroom.

Fortunately, experience is the best teacher. I hope that my experiences in corporate optometry can help you improve the quality and profitability of your practice.

Dr. Lowinger is a graduate of Nova Southeastern University and former chair of the Florida Optometric Association’s Leased Tenant Committee. He has been a Costco leaseholder in its North Miami store for 18 years, and has recently acquired a second lease at the Costco located in Miami Lakes.