Three Strategies to Create Practice Growth by “Going Small”

by | Oct 19, 2022 | Entrepreneurship, Ownership

If you pay any attention to optometry social media groups or listen to many of the speakers in the optometry arena it’s easy to think that when it comes to practice bigger is always better. I’ve read so many articles explaining how to squeeze 5 or 10 more patients in your day by maximizing efficiency. While being efficient is important for any practice, for many, myself included, seeing that many patients in a day is nightmare fuel. Are doctors like me doomed to failure? I would answer a resounding NO! Just as there are benefits to building bigger there are also benefits to staying small and you should not let trying to keep up with the Dr. Joneses lead to practicing bigger than works for you. Going smaller can allow you to both create space in your life and increase your satisfaction in practice. 

What do I mean by going small? A small schedule is one that allows for no more than 2-3 patients per hour and/or seeing patients a maximum of 3-4 days per week. Basically going small means fewer days and/or fewer patients and if you are feeling exhausted, stressed and burned out, it can be a game changer.

How does a practice stay small, without sacrificing net or stagnating growth? With fewer patients seen each week maximizing revenue per exam becomes even more important. A focus on a premier experience for patients as well as the addition of specialties such as dry eye and myopia management; premium frame and lens offerings; focusing on maximizing patient insurance benefits; and continual training and support of the practice team are all ways to ensure your per exam revenue stays strong. 

Consolidate Patient Schedule

Who can succeed by going small? Let’s consider two different practice scenarios. Practice one is a recent cold start or maybe they are 5-6 years young and still in an early growth phase. Practice one starts “going small” by grouping patients into fewer days. Instead of 6 patients spread through the day and five days a week, those 30 patients can be seen in 2.5-3 days of patient care. This can yield several benefits. In fewer days per week less staff is needed on days with no patient care, the owner has time to do community engagement outside of the office, and space is created -space for time with family, friends and for having fun. 

Once you fill those 2.5-3 days per week you can decide what the next step looks like as you become more like practice two.

Consider an Associate

Practice two is booked out 3-4 weeks, maybe the owner is stressed and quickly burning out and needs to make a change but they also want to continue to grow. This owner has two good options for getting, or staying “small.” The first option would be to consider hiring an associate. Remember small in this context means keeping a schedule small, not necessarily keeping your practice at a small gross. Speaking to a practice consultant may help you decide if it makes sense for your goals.

Be Selective About Managed Care

The second option for practice two to consider is to start dropping vision plans. Fewer vision plans accepted will decrease demand allowing for a smaller schedule but generally the change will increase per exam revenue. At some point they can consider doing both!

Why consider going small? Patients can also benefit when practices go small. In my practice having a small schedule has had several positives. I have more time with each patient, often spending 15-20 minutes with each person after my technician completes their initial testing. This means more time for education and more comprehensive patient education has translated into patients being more likely to follow my recommendations, better compliance to prescribed treatments, increased capture in specialty care as well as in our optical and ultimately an increase in per exam revenue. 

Obviously going small is not for every owner or every practice, just like seeing 50 patients a day isn’t for everyone. A great thing about our profession is that we get to decide what type of practice works for the life we want and we can be successful with whatever we choose.

By Samantha Hornberger, OD

Advocating for optometry and excellent care.


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