In what optometrists perceive to be the ongoing battle against managed care and national chain stores, a trend among practices we�re consulting with in the southeast is for independent optometrists to join forces with other O.D.s or even M.D.s. While there are advantages to be gained by this�most notably increased purchasing power, capital, and staffing�there are also pitfalls that most doctors fail to address.

The most basic of these are the individual philosophies�professional and business�of the participating doctors. Independent optometrists are in a very unique situation: They basically operate a retail store inside of a medical practice. This opens the door to problems which other practitioners would never face in combining practices.

Glaring Differences

Just because optometrists may be excellent friends or have gone to school together doesn�t mean that their practices can be as good a match. In one situation where we were involved, two optometrists with very dissimilar practices located 22 miles apart decided to merge.

One doctor enjoyed treating eye diseases more than complete exams, and as a result his patient base was relatively old, and he saw as many as 40-45 patients in an average day. He treated his patients like family, had a very loyal staff of 14, stayed mostly in his exam rooms, and let his office manager run his front desk and his licensed optician run his dispensary. 

The other doctor was a little younger with a younger patient base, did more complete exams, and saw an average of 14-16 patients per day. He also tended to micro-manage his practice, utilizing and analyzing his practice management reports and managing his staff of four.

Both doctors decided to keep their separate offices�with each of them switching sites one day a week and some staff being forced to rotate. They were using different frame vendors and labs.

While on paper the merger made sense�two doctors with different strengths combining forces�not enough attention was given to the differences between the doctors and their staffs.

What we advise our clients who are considering taking such a step is to take a hard look at their present situation from a professional, geographical, and business point of view.

Without taking this step, you won�t be able to accurately determine where it is you ought to be going.

Here are some questions to ask yourself about three different aspects of your operation.

1. Professional Perspective

• What are the strengths and weaknesses of your practice?

• Who are your patients and why do they come to you? Have your patients fill out a short patient feedback form.

• How does your income break down by percentages?

• What managed care plans do you accept and why?

• What practice management software do you utilize?

2. Geography of the Practice

• Will you be going to a new building or staying in separate locations?

• If it is a new building, how accessible is the location for your current patients?

• What is the market in the area of the new building (competition, average income, and education, etc.)?

• Is the new building being designed with the present patient load in mind or planning for growth?

• Is there proper space allowed for strong points of the doctors, such as a large contact lens room if one doctor fits mostly contacts or a large dispensary if another writes a lot of Rx�s?

• If all the doctors are to be in one location, can the building comfortably hold all patients and staff members?

• Will doctors and staff be forced to travel to different locations?

3. Business...from a retail perspective

• What is the total cost of your frame inventory?

• Which vendors do you use? 

• What labs do you use?

• What percentage of dispensed lenses are AR coated, polycarbonate or high-index, photochromics, Rx sunwear, and plano sunwear?

• What percentage of your multi-focal patients purchases progressives?

• What is the average selling price for frames, lenses, and contact lenses?

• What is your PAL of choice?

• Do you edge or surface in-house?

Talking Turkey

Sit down with the other doctors in the proposed merger and compare notes. If there are major differences in professional and business philosophies, then there will have to be significant discussion and compromising by all parties.

Here are just a few questions that need to be addressed: How much are you willing to compromise and on what issues? What do you expect to gain from the merger, and is it worth it? Will it affect patient perception?

Finally, look at how a merger would affect your staff. In a 1998 survey in Eyecare Business, patients rated the professionalism of staff members just behind the reputation of the doctor and explanation of procedures as factors in how they chose their eye doctor.

Staff...the Key Ingredient

Indeed, the one constant we have seen in all successful practices is the quality of the staff. Big practice or small, new building or old building, urban or rural setting, the staff is responsible for at least 80 percent of a patient�s perception of your practice. Next time you attend an optometric conference, take a look at who brings their staff along. Usually, it�s the doctors with the most successful practices. Did you ever consider that perhaps it�s one of the reasons why they�re so successful?

Yet when doctors discuss merging, the staff is often the last consideration. So drag out that legal pad again, and start making notes:

• If all doctors will be in one building, how many staff members will be needed? Who stays and in what capacities, and who goes?

• If there are different locations, will the staff be required to travel?

• Who will manage the staff or staffs?

• What�s the chain of command?

• Each staff and doctor has their own ways of doing the same tasks. How will this be decided? 

If there is to be a merger, it has to be done with the best interests of the patients in the forefront. There should be continuity in procedures no matter how many offices are involved in the overall practice so that the patients have the perception that you are all one practice. If there are multiple offices, make sure that each is staffed with a doctor and staff at all times to avoid the perception that it is a �part-time practice.�

Time and again we have seen doctors maintain a satellite office in a neighboring town for one or two days a week, only to be disappointed in the results. Then another doctor opens a full-time practice in the same town and goes gangbusters. People want to know that they can go to you when they need you, not when you happen to be in town.

By way of example of what can be done when problems exist, let�s go back to the practice we�ve been describing. When we came on the scene, the merger had been complete for six months, yet the two practices had yet to hold a joint staff meeting.

Our first task was to put the focus back where it belongs�on the patients.  Staff members were so caught up over the day-to-day differences of the employees that both patient care and profitability were suffering.

Next, we had meetings with each staff as a group and as individuals, hearing their perceptions of the problems. From our observations of the practices we concluded which problems were real and which were just differences�and brought these to the doctors� attention.

We then set up a meeting to be held with both doctors and staffs to determine the procedures that would be followed in both offices.

Finally, we sat down with both doctors and staffs to determine which procedures would be in the best interests of the patients. With that as the baseline, both doctors and staffs were quickly willing to come to an agreement.

Unfortunately, one of the consequences of managed care is that doctors have to see more patients to make the same amount of money. As a result, they are forced to stay in their exam rooms most of the time and depend on their staff to keep the office functioning properly. If you are serious about merging, you need to make your staff part of the process in determining how the new office(s) will be run.

If you are going to merge with other doctors, it is too big and career-changing a decision not to do it the right way. The eyecare highway is littered with the remains of practices with the best of intentions but no attention to detail. EB

Cliff Capriola is president of Focal Point Marketing, Inc. He can be reached at focalpoint@mindspring.com