Ever wondered why stools were once only three-legged? Why would one use a stool that has only three legs when they could have one with four? If you frequent a furniture store nowadays, your chances of coming across a section for three-legged stools is about as likely as having a 100% annual contact lens purchase conversion rate on a day of operation. The reason for use of a three-legged stool is quite simple: they can be used on any surface, regardless of how smooth or rough, and the seated person maintains complete stability.

After several years of helping both practice owners and organizations elevate themselves to their fullest potential operationally, I have come to appreciate the art and beauty of simplicity when it comes to the ‘magic formula’ for success, and I proudly use this analogy with my clients. If you hire a practice management consultant or consult with your C.P.A., they will immediately take you to the drawing board and assess your current profit margins, buying groups, and stock versus purchase upon sale inventory. From here, they will begin to tackle each item, one by one, until you have squeezed every last ounce of wholesomeness out of your practice and sent your employees running for their lives. They may also point out that your 5 series and your trip to Venice to pick out two frames is not exactly a business cost, but that’s beside the point. Trust me when I tell you that this formula may work in the short-term, but its sustainability prognosis is grave at best. 

The private sector, as we know it, is ever-evolving and has changed dramatically over the past several years. Private equity-based firms are buying up successful private practices, paying fractions of their worth, and hiring associate doctors to power the hamster wheel.  Corporate chains are offering 15 minute ‘comprehensive’ eye exams and offering multi-pair progressive sales for less than the cost of many high-quality frames alone. Online giants, such as Warby Parker and Zenni Optical ‘create the monsters’ who drain your chair time and that of your optician, demanding service of the progressive frame and lenses they purchased for $37 dollars (none of which went to your pocket, mind you). And lastly, contact lens giants such as 1800Contacts, Walgreens, and others are selling annual supplies of contacts at 80 to 90% of the traditional cost to the sole-proprietor and, most recently, offering rebates for re-purchase as well.    

Over the past year and a half, I have had a plethora of new patients come to my practice who reported that they came to me because they missed the quality of service and had had enough of ‘just being a number.’ I predict there will be many of these patients for all of us in the private sector in the years to come. Despite the roughness of the modern-day private sector’s terrain, the following three pearls (‘legs’) will ensure that your private practice not only survives but flourishes optimally – regardless of your surrounding market conditions. 

1. Respect your employees

It goes without saying, but I cannot emphasize this component enough. Your employees are the mast of your ship. As the Captain of the ship, it is your duty to provide your employees with guidance, support, and reward. But much like a ship without a mast will float aimlessly, without your employees you will have no practice, let alone a successful one. Take the time to get to know your employees individually (and not just by their employee I.D.) and tailor your leadership, support, and their incentivization accordingly. A good read on the different generations and the most effective leadership modalities thereof is Organizational Behavior: Human Behavior at Work, 14th Edition (Newstrom, 2015). The more accurately (not necessarily highly as is all too often erroneously implemented) incentivized and content your employees are, the happier your patients will be and the greater will be your profits. 

A friendly reminder that when your patients walk into your business, unless they have over-served themselves on Xanax or some other anxiolytic, they will pick up on the mood in the office. They may not exude or report their awareness, but they will certainly feel it, tainting their experience and detracting from their incentive to come back. If significant enough, they may even decide to share it with their friends, family or colleagues, inevitably yielding devastating damage to your brand. Be exceptionally aware and mindful of your employees’ interactions with your patients and make it a priority to nip in the you-know-what any areas of warranted improvement promptly. 

2. Bill your services appropriately and include your patients in the discussion

You are a health care provider. You did not suffer through as much education and training as you did in order to have to settle for a $40-dollar exam reimbursement. Put quite simply and frankly, you deserve to get paid fairly. 

At my practice, it is standard protocol that all patients are informed that they will be billed to both their vision and medical insurance, depending on what the examiner identifies in the exam. This is communicated to them before their appointment, both by phone and by appointment text reminder, at their appointment upon check-in, as well as at the conclusion of their visit. By informing them of this on the front end, it avoids any awkward conversations or confrontation at the front desk or in the examination room. I personally take the initiative to summarize the exam findings along with the planned billing thereof and thank them for being a patient. I highly recommend this approach, as this will mitigate the common occurrence of patients trying to proclaim they ‘did not know’ or ‘were not told by the doctor so they will not do so.’ If a patient refuses to provide you with their medical insurance and wishes to go to a place where they will not be billed to their medical insurance, then it is most likely in both parties’ best interest that they do. 

As a final note on your billing practices, make it a priority to monitor and keep as low as humanly possible your claims bucket. One of my former clients, prior to hiring me as his consultant, had lost on average $60,000 annually because one of his medical billing and coding specialists deliberately did not submit a single form. Upon questioning, she reported that ‘it was too much work and not worth the small amount extra.’ Unsurprisingly, her tenure with that practice was shortly lived thereafter. You work hard enough as it is.  Consider your billing practices as a major linchpin. Do not place it on the back burner. 

3. Find your niche and never stop adapting

Most successful private practices became successful because they were built upon a niche.  A niche can be anything from top notch customer service to pediatric vision therapy to high-end boutique frames and sunglasses. There are no rules to define and no boundaries to limit your selection of a niche. What are you truly passionate about? Do you enjoy ocular disease and geriatric eye care? What about serving the under-served populations? Or how about the art of ‘saving the day’ by intervening and preventing life-long visual debilitation and loss, working with pediatric patients? Personally, I have a hard time envisioning myself spending my entire day, all week long, seeing children who would rather be watching Paw Patrol than you shining a bright light in their eyes and trying to explain your exam findings and treatment plan to a parent playing Candy Crush on their phone the entire time, but I can only speak for myself here.   

If you are not passionate about what you are doing, take some time to decide what your passion is and focus all your energy and efforts on building upon and growing it. Stay on top of the associated research and prioritize your marketing towards this niche. Your passion, or lack thereof, will manifest in your patient care whether you realize it or not. 


Newstrom, J. (2015). Organizational Behavior: Human Behavior at Work. New York, NY: McGraw-Hill Education. 

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