Dr. Neil Gailmard On Practice Growth And Delegation

Dear Jerry,

I have been reading the comments from other ODs about when I should take in an associate and think there are many very valid points.

Delegating certain portions of the exam is something I have a hard time with. I am adding more tests to the tech’s pretest routine to cut my chair time back. That should allow me to see possibly 2-3 more patients per day.

I need to find the right balance between efficiency and appropriate face time with my patient.

One my concerns is that I think my practice growth is in part due to the fact that I spend time with my patients listening to their concerns and offering solutions.

What are your thoughts? How much time should the doctor personally spend with the patient?

Dr. Sacha Nichols

Dear Sacha,

In my experience, the two biggest limiting factors to practice growth for private practice ODs are:

For more on those topics, I asked a true expert in this area, Dr. Neil Gailmard. Neil owns one of the largest single location private practices in the country and employs several ODs.

Here are his thoughts.

Regards,
Jerry Hayes, OD

Hi Jerry,

I read the post by Dr. Sacha Nichols who has the very nice “problem” of rapid practice growth and a three to four week backlog of patients.

I also read and agree with the comments by the other docs that followed. Most of them suggested holding off on hiring an associate, but instead increasing delegation to staff.

Dr. Nichols agrees that she should delegate more but has a concern about finding the right balance between efficiency and the face time she believes has led to her practice growth.

First, Dr. Nichols, I congratulate you on your phenomenal success in practice after opening cold only two years ago! Clearly, you are doing many things right!

But looking ahead, the best advice I can offer is to start now in building a system that does not depend solely on you.

It’s pretty common in the first few years to do just the opposite and to try to be in control of everything. I was certainly like that at one time.

But, I soon realized that I could never build my dream practice that way. I eventually got tired of everything depending on me, especially having to produce all the practice income.

I wanted my patients to accept my staff handling more of the data collection and to eventually accept an associate doctor. I decided to build patient loyalty to my practice — not to me personally.

I think you are right about your instincts that your practice growth is due to patients loving how you listen to their concerns and offer solutions.

But, here is the trick I have learned. They will love anyone in your practice who does that! Don’t make the mistake of thinking that you have to do it all.

Begin now to teach your patients that you have a team of eyecare professionals who are all great at what they do!

You have already started to develop a great customer service culture in your practice. Now all you have to do is continue to train your staff in that concept and supervise your operations to ensure that service never dips.

You will need an office manager who thinks like you do and who can assist with this mission (if you don’t already have one).

I know how good it must feel to be on track to gross $700,000 in 2009! My advice is to think even bigger.

A single optometrist can gross $1.2 million fairly easily if fees are set properly and if she does 20 to 25 exams per day (a mixture of all types). With proper support from a good staff, that number of exams is not difficult at all.

Even with your 25% net, that would produce a personal income of $300,000 for you.

Hiring an associate OD is a great goal and it may not be that far off.

If you can increase your gross revenue to over $1 million and stay solidly booked ahead for about two weeks, I think you should then hire a full-time doctor.

At that time, I would advise you to cut back on your patient care days and spend more time on the management of your practice.

As your practice grows, it will need more high-level leadership and vision that can only come from you.

The goal will be to encourage some of your patients to move over to the new doctor. Don’t worry about that, by the way, you have plenty of patients and they will be loyal to your practice.

Best wishes for continued success,
Neil Gailmard, OD, MBA, FAAO

(A note from Jerry) In addition to being one of optometry’s top speakers and writers, Dr. Gailmard is also available for one on one practice management consultation at neil@gailmard.com. Any doctor looking to grow his or her practice is encouraged to contact him.

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Disclaimer: The information and opinions contained on this site are for discussion purposes only and are NOT intended to serve as legal, accounting or investment advice. ©2009 Jerry Hayes, OD. Not to be reproduced without written permission of the author.

Jerry, Thank you as always

Conway Cox OD - 07/21/2009 - 12:23 pm

Jerry,

Thank you as always for this forum. Gross revenue is frequently discussed on your blog site, generally without any qualifying information (such as patient care hours / geographic location / insurance saturation). I try to gauge my practice, but is difficult with just the gross revenue. It would be helpful to know the setting / hours / insurance saturation that was involved in producing that number. Dr. Gailmard writes above about a single optiometrist practice grossing $1.2 million annually. Assuming 5 day /week and allowing 1 week vacation and 1 week travel for CE, that would be 250 practice days, requiring an average daily gross of $4800 to reach the goal. Using his maximum number of 25 exams per day, you would need to gross on average $192/patient. Is this truly realistic? I would like to know also if the above scenario has the optometrist performing or delegating refraction.

Conway Cox OD.