Optometric Practice Management

363 Pages·2003·6.283 MB·English

by  Irving Bennett, OD (Auth.)

An Imprint of Elsevier Science
200 Wheeler Road
Burlington, MA 01803
Optometric Practice Management ISBN 0–7506–7428–8
Copyright 2003, Elsevier Science, Inc. All rights reserved.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any
means, electronic, mechanical, photocopying, recording, or otherwise, without prior permission of the publisher
(Butterworth–Heinemann, 200 Wheeler Road, Burlington, MA 01803).
Notice
Optometric practice management is an ever-changing field. Standard safety precautions must be followed,
but as new research and clinical experience broaden our knowledge, changes in treatment and drug therapy
may become necessary or appropriate. Readers are advised to check the most current product information
provided by the manufacturer of each drug to be administered to verify the recommended dose, the method
and duration of administration, and contraindications. It is the responsibility of the treating physician, rely-
ing on experience and knowledge of the patient, to determine dosages and the best treatment for each indi-
vidual patient. Neither the Publisher nor the author assume any liability for any injury and/or damage to
persons or property arising from this publication.
The Publisher
Library of Congress Cataloging-in-Publication Data
Bennett, Irving.
Bennett’s optometric practice management / Irving Bennett.—2nd ed.
p. ; cm.
Rev. ed. of: Management for the eyecare practitioner. c1993.
Includes bibliographical references and index.
ISBN 0-7506-7428-8
1. Optometry—Practice. I. Title: Optometric practice management. II. Bennett, Irving.
Management for the eyecare practitioner. III. Title.
[DNLM: 1. Optometry—organization & administration. 2. Practice Management,
Medical—organization & administration. WW 704 B471b 2003]
RE959.3 .B45 2003
617.75'068—dc21
2002074389
Publishing Director: Linda Duncan
Managing Editor: Christie M. Hart
SSC/MVY
Printed in the United States of America
9 8 7 6 5 4 3 2 1
Dedicated to my wife, Trude
A solid supporter, an excellent critic, and a person who brought me back to real-
ity when I very much needed to be brought back.
The following poem that I learned in childhood, penned by an unknown author,
properly expresses my feelings toward her:
Let the thousand trumpets blare,
Let the music surge and flair,
I would hear no song if you paused from playing.
Let the words and music cease,
Let no sound from any piece,
I would delight in song if you continued playing.
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Foreword
George X. was the smartest student and best clinician in his graduating class.
Everyone predicted great success for him.
But years later, he is plodding along in a mediocre practice with a small patient
base. Why? Because he never properly learned the business, management, and
marketing skills necessary for practice success.
Clinical skill by itself is not sufficient. It does no good to have great clinical
expertise if you have no patients on whom to work that expertise, or if your
practice fails due to a lack of business acumen.
Optometric practitioners are naturally science, rather than business, oriented.
Thus, it is often difficult for them to grasp the necessary business skills Dr. Irving
Bennett addresses in this book.
First written in 1993, this book has proven invaluable not only to students
and new graduates, but also to established practitioners who have found in it the
necessary skills to enhance their practices. This advice has come in the following
important areas:
Professional marketing. You must let prospective patients know you are available.
Thus, you must market, or “sell,” yourself, but in a palatable and professional
manner. Marketing is not a bad word. Even hanging out your shingle and
listing your number in the telephone book are forms of marketing. The trick
is how to market effectively while still retaining your professional image.
Practice management. A national study revealed that 68 percent of patients leav-
ing a health care practice did so because of problems with the doctor’s staff
rather than with the doctor. Proper management of your staff and other
aspects of your practice is vital to your success.
Patient communication. To retain patients and obtain their referrals, you must com-
municate your expertise and caring concern to them. A few years ago, a popular
health magazine did a survey of doctor/patient relationships. One of the ques-
tions asked was, “What qualities do you associate with a really good doctor?”
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“Takes time to answer questions in language I can understand,” was the most
common answer (44 percent).
“Is intelligent, skilled, and up-to-date in his or her field,” ranked only fourth
(17 percent).
Business management. You may be the best optometric clinician in town. Nev-
ertheless, you cannot make it in private practice if you do not manage your
office finances well enough to pay the rent, salaries, and other expenses of
running a practice.
These are the problems Dr. Bennett addresses. But times change. Since he
wrote the first edition of this book, there have been many changes in health care.
Thus, he has completely revised the book to incorporate or update his recom-
mendations, including such areas as:
(cid:2) Changes in managed care, and how to adapt
(cid:2) More information for the growing numbers of female and minority ODs
(cid:2) Part-time practices
(cid:2) Mail-order contact lenses
(cid:2) School debt
(cid:2) Coding
(cid:2) Computerization
(cid:2) Corporate practice
There are four characteristics in particular that make Dr. Bennett uniquely quali-
fied to write this reference that has proved so invaluable for optometrists!
(cid:2) He has the background and expertise in this field to know whereof he speaks.
For many years, he has been recognized as the practice management authority
in the optometric profession. I have learned far more on this subject from him
than from any other practice management expert!
(cid:2) His advice and suggestions are always practical and full of common sense.
(cid:2) He does an excellent job of instructing on how to promote these very neces-
sary business and marketing skills in a manner that does not detract from
your professional image.
(cid:2) He is an excellent writer who makes his material interesting and readable as
well as instructive.
The first edition of this book has helped many ODs to a larger, more efficient, and
more satisfying practice. The new updated version does it even better!!!
Jack Runninger, OD, DOS
Former Editor, Optometric Management
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Foreword
I have had the good fortune to have Irving Bennett, the best advisor on managing
an optometric practice, always as close as my telephone. He is my dad. When I
began practicing optometry 15 years ago, he was there to help me understand and
take the necessary steps to establish a successful practice. Many of my optometric
friends have told me how much they would have appreciated his help. Now,
through this book, you can get the same, common sense advice that my father has
given me through the years.
My father learned about optometric management the hard way, by making
decisions. Some were good and some weren’t. He opened “cold” in Beaver Falls,
PA, selecting that community because it had a large main street, not a very scien-
tific way of making such an important decision. His first office was on the sec-
ond floor above an ice cream parlor, a difficult location for many patients. Yet
even with these missteps, his practice was successful because of the many things
you will read about in this book.
I recently asked my father what was the secret to his success. He said he was
always willing to try something new and different. He was the first optometrist in
the United States to fit modern progressive addition lenses (PALs). At one point,
there were more people wearing PALs in Beaver County than anywhere else in the
country. Although trying new things is natural when you start a practice, seeing
opportunities for change becomes more difficult as you settle in. This book pre-
sents lots of practical ideas for change that could work for you as well as they have
worked for my dad . . . and for me!
My father and I have discussed many optometric issues. Over the last 15
years, we have seen the practice of private optometry change significantly. In
1987, when I purchased a small, very neglected practice, managed care wasn’t
part of the equation. The office had no computer and dreadfully little modern
instrumentation. Superopticals were seen as the possible doom of independent
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xii (cid:2) Foreword
private practice. The use of therapeutic drugs was just beginning. Co-manage-
ment was not in the picture.
However, while things change, the basics of running a practice remain the
same. Even before managed care played a significant role in practice, chair cost
was already important. After all, how could a practitioner intelligently set profes-
sional fees? Some doctors just pick a number without analyzing their cost of
doing business. How to network with other medical practitioners is as important
now as it was then. Communicating and promoting your practice have become
more essential with the passage of time, not less. Unless your practice thrives,
you can’t provide the best patient care you are capable of delivering.
When I speak about my practice, I tell students and colleagues that my prac-
tice is my third child. I have seen it grow from infancy to a mature place of busi-
ness. When I raised my daughters, I often referenced childcare books to help me
through the good and not so good times. I invite you to look at this book as the
Dr. Spock book of optometric management. It will help you to raise a successful
optometric practice.
Linda Bennett, OD
Belmont, MA
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Preface
It is hard to believe that so very much has happened in a decade. To the world.
To our nation. To the optometric profession.
When we did our first book in 1993, the world was more tranquil, the
nation just beginning an era of prosperity, and optometry in a heyday of eco-
nomic growth and professional advancement. The management of the profes-
sional office was a concern, of course, and distaste for actually running the
business of an optometric practice was commonplace. This has, fortunately,
improved somewhat.
In 1993, I prefaced the book with a “sick” joke. There was this specialty
butcher shop in San Francisco near the wharf. This store had all kinds of bizarre
meats for sale, including brains. There were signs such as “Physician Brains, $5 a
pound” and “Dentist Brains, $6 a pound.” There was another sign that read
“Optometrist Brains, $50 a pound.” An OD visiting this store was greatly
impressed, even proud that optometrist’s brains were so highly priced.
The optometrist went to the shopkeeper and asked him why. The reply: “Do
you know how many optometrists you must have to get a pound of brains!”
The moral of that sick joke may have been appropriate a decade ago; it certainly
is not today. Nearly 90 percent of the students entering optometry schools and col-
leges have had four years of pre-optometry, with BA or BS degrees. The graduates
from optometry successfully complete a rigorous course of study with thousands
of patient contacts in a multitude of practice settings. Qualified? These new
optometrists certainly are!
Nonetheless, a void still exists on the business and administration sides.
Unfortunately, the majority of these professionals possess a disdain for business.
Because student debt is so very high, most new optometric graduates seek
employment rather than even attempting to start a practice “from scratch.”
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Study after study, however, reveals that by far most new ODs harbor a desire to
practice in a private setting, in a partnership, or in a group practice. Many
make the transition from employed status to owner or part owner after the
fifth year out of college.
The face of optometric business has changed so very much that good business
practices are more a need and more an asset than ever before. Managed care
plans, discount programs, networking, over-the-counter and mail-order prod-
ucts: formidable challenges to a practitioner who wants success in independent
practice.
But help is on its way. Most of the colleges have finally come around to accept
that their charge in life is not only to turn out the best-qualified optometrists,
but to turn out successful optometrists.
Not too much longer than a decade ago, it was “not respectable” in optometry
to talk about prices of products, sale of merchandise, advertising, or promotion.
In fact, anything vaguely related to commerce was taboo. That time has passed.
At least today, we can call a spade a spade and not be apologetic doing it.
This book is written to help doctors of optometry regardless of their mode of
practice to become better practitioners—economically better and socially better.
And at the same time, the goal of this book is to teach its readers ways to enjoy
practice more and make life more pleasant.
It is my fervent hope that this book reaches that goal.
Irving Bennett, OD
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1
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Optometry in the
21st Century
It isn’t really possible to suggest or recommend solutions to problems
without a full understanding of what the problems really are. Our eye care
field has many unique and sundry conditions, laws, and regulations that
significantly influence the status, the economics, and the well-being of its
optometric practitioners.
Where exactly does the profession of optometry stand today, in the first
part of the 21st century? Like the optimist and the pessimist who see the
glass as half full or half empty, it depends on your perspective.
(cid:2) Are There Too Many Eye Care Practitioners in the
United States?
By eye care practitioners, we refer not only to optometrists and ophthal-
mologists; we refer as well to opticians.
In 1997, the American Optometric Association (AOA) commissioned the
Workforce Study of Optometrists. The results, released in February 2000,
revealed that there were then more than 30,000 practicing optometrists in the
United States. And more than 1,100 more optometrists are graduating from the
17 colleges and schools of optometry annually; attrition due to retirement or
death was pegged at about 550 per year until year 2005, 625 per year from
2005 through 2010, and 825 per year from 2010 until 2020. There is no appar-
ent reason to believe that the number of new optometrists graduating each year
will decrease or increase substantially. The study results raise many questions:
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Does the Dramatic Influx of Female and Minority
Practitioners Make a Difference?
The major demographic change in the profession is the increase in the
proportion of female optometrists. A second major change is the dramatic
increase in Asian-American students in the optometric pipeline.
Why should an increase in female optometrists give cause for discussion?
Quoting the AOA Workforce Study: “Female optometrists work about five
hours per week less than their male counterparts.” That may be considered by
some as the good news because, if this difference in work habits persists into
the future, “the number of optometrists required to provide a given amount of
care will be higher because of the higher proportion of female optometrists.”
Enrollment figures released by the Association of Schools and Colleges
in Optometry (ASCO) for academic year 2000–2001 indicate that more
that 55 percent of optometric students in the nation are female.
There is a substantial gender gap in the incomes of male and female optom-
etrists. The Economic Survey, conducted biannually by the AOA, revealed in
November 2001 that, using year 2000 incomes, female doctors of optometry
(ODs) “earned 25 percent less then male ODs, approximately the same dispar-
ity in median income by gender reported as in 1998.” Only six years earlier,
female optometrists earned 31 percent less than male optometrists.
There appears to be little need in this text to point out the increase in
minority students, particularly Asian-American, in the approaching work-
force. It is mentioned solely because, heretofore, the profession of optome-
try had been overwhelmingly comprised of white men. Previous ASCO data
show that there were about ten percent minority optometrists in the student
pipeline not much more than a decade ago. Now nearly 40 percent of opto-
metric college students are considered minority students.
We can conjecture that the increase in female optometrists and minority
optometrists will affect the economics of the profession not only for income
disparity as noted above but there appears to be a tendency that females
and minority ODs are less likely to practice privately.
Will the Continued Growth of Managed Care
Plans and Their Discounted Fees Seriously
Affect Optometric Income?
Some published survey results seem to indicate that this will not happen;
however, conventional wisdom implies otherwise.