In my fourth year of optometry school, at the conclusion of my externship, my mentor asked me a profound question that I think all optometrists will either directly or indirectly ask themselves over the course of their careers.
Would you say you're an optometrist who enjoys the business side of optometry or a business person who happened to fall into optometry?
What an interesting question.
Understanding the “business of optometry”
I knew that the psychology of consumer upselling was more interesting to me than the clinical skill of refracting. I recalled the single most important leadership lesson from optometry school, when my then Private Practice Club Treasurer, James Forde, OD, reminded me that there is “strength in delegation” (he was right!).
I even reflected on the 4-hour “business lecture” and the partially plagiarized practice management paper that checked off our graduation requirement. But up to this point in my career, no one had really posed the “business of optometry” to me in such a way. This moment was different: it was an honest question of self-reflection.
“After a moment of thinking about all of this, I replied with a simple, ‘The latter.’”
Having business acumen isn’t a prerequisite for practicing optometry, but it is an adjunct skill integrated into nearly everything we do. Knowing how the business operates will allow you to negotiate better as an associate or even leave a current practice when you realize you have what it takes to make it on your own.
So any time a student, new, or seasoned optometrist asks me, “How were you able to start a specialty dry eye clinic?” My response is, “I thought of the owner’s interest first.”
What experience do new optometry grads need to start a specialty?
If I were an owner allowing an associate to start a specialty, I would first want to know how much experience the associate had with that specialty.
- Did they do any additional training, like a residency?
- Have they worked for several months in a successful clinic? Could they mold ours similarly?
- If they lack direct experience, do they have close mentors or another associate they’re embarking on this journey with?
Many owners are more comfortable walking a road that has been walked before, but inexperience is not the obstacle to innovation: It simply poses an increased risk. Therefore it is the associate’s job to show how that risk can be reduced by factoring in the following considerations: Haves, needs, and wants.
Nailing down your haves, needs, and wants
Before signing a contract, I asked the practice’s partner to invest in intense pulsed light (IPL) therapy. After listening to my passion and excitement for the technology, the partner asked what the cost of the device would be. I went blank. Admittedly it wasn’t my finest moment, but I realized quickly I had some homework to do before coming to the table again. If I was going to request capital, I needed to consider exactly how it would be used.
That’s why I recommend considering and comparing your practice’s haves vs. needs vs. wants. First, what does the practice already have to work with? Secondly, what does the practice absolutely need before getting started? Lastly, what does the practice—or you—want to help differentiate and grow the specialty?
The capital you request may be used for acquiring basic medical supplies and equipment, hiring or promoting employees, marketing expenses, and saving for future investments/refilling supplies. Each aspect may vary based on your unique practice setting, but sorting each element into their respective have vs. need vs. want category will give you a targeted approach that is more digestible to the practice owner.
What to have before starting a specialty
The biggest have before starting any specialty is the patient base. To determine if the practice had the right patient base for advanced dry eye procedures, I thought it worthwhile to calculate the prevalence of dry eye disease in the practice.
I asked my practice administrator to determine how many ICD-10 dry eye codes (H16.223, H04.123, H02.88x) were used per patient in the last calendar year. This gave us a rough projection of how many patients in the practice could benefit from the addition of advanced procedures.
I also took that figure and compared it to the practice’s total patient population to help determine if the practice was underdiagnosing the disease. While the true prevalence of dry eye disease varies in the US, studies suggest there is a pooled prevalence of ~8.1%.
The practice had a dry eye disease prevalence of ~13%, and while there were limitations to our calculations (like practitioners using ICD-10 codes that may not differentiate aqueous-deficient dry eye [ADDE] vs. meibomian gland disease [MGD]), these simple calculations gave the partners confidence that we still had a population that was worth investing in.
What you need when starting a specialty
The needs may include the time, equipment, and resources in which to invest prior to starting. The time you spend doing your research will be proportional to the success of the specialty. But keep in mind that blocking time during clinic hours may result in a loss of practice revenue—not a great way to start.
In my scenario, I had a few weeks as we waited for credentialing to set in, and used my time accordingly. As I approached my second year at the practice, I was able to negotiate for additional clinic hours to spend on further development.
Resources can be anything from mentors—shout out to Melanie Denton, Jackie Garlich, Inna Lazar, Carly Rose, and Damaris Raymondi—to your equipment sales representatives or even group social media pages. Utilize these to garner as much information about what you need prior to starting.
Integrating a new specialty into clinical practice
Surprisingly, most of my time was spent working with our practice administrator to build a “dry eye consultation” into our electronic health record (EHR) and scheduling system, organize our fees as well as create financial agreements, consents, practitioner treatment logs, and pre-/post-treatment instructions. Additionally, I created marketing materials and dry eye treatment folders for patients.
Luckily our practice “haves” included LipiFlow and BlephEx, therefore the biggest financial “need” at the time of our proposal would surround the investment of IPL therapy equipment, including the device, ocular laser shields, tongue depressors/cotton tip applicators, ultrasound gel, and other miscellaneous items.
What you might want when starting a specialty
The wants are extra things that enhance the vision and experience but aren’t vital to getting started. For us, it's a spa chair, noise machine, and facial camera. Initially, I thought a need was a treatment counselor to come in after and discuss finances.
Unfortunately, who we envisioned in the position left the practice. As time went on and practice priorities changed, this “need” turned into a “want.” I was, however, able to negotiate for more allotted time per dry eye consultation slot.
Final thoughts on starting a specialty
Sometimes your haves, needs, and wants change as your clinic continues to develop. The first step is to think like your owner and understand how each component best fits when it comes to the operation of your clinic.
