Managing associate optometrists in your practice, part 1

ByJohn B. Pinto

If you are like the typical ophthalmologist reading this, you’ll see 100 to 200 patients in clinic this week. Unless you’re in an obscure subspecialty niche, or very old-school, chances are you could delegate about a third or more of those patients to an optometrist working on your staff.

Yet fewer than half of the new client practices I serve employ optometrists — although this is up sharply from several years ago when only the busiest, vanguard surgeons were willing to work alongside ODs. If your practice has more patients than professional capacity, you might consider optometric staffing to ease the crunch.

There are both advantages and disadvantages to hiring an optometrist instead of a fellow ophthalmologist. These are summarized in the table below:

Optometrist	Ophthalmologist
Fairly easily recruited; expect a 120-day or shorter recruitment cycle	Can be extremely difficult to recruit quality individuals, especially in recent years; expect a 180-day or longer recruitment cycle
Lower base salaries, in the range of $60,000 to $110,000 to start for higher-level doctors	Higher base salaries in the range of $150,000 to $300,000
Potentially much lower income-generating capacity and payer panel access limitations; practice profit augmentation comes from freeing surgeons to take on more patients with a higher income yield	Potentially much greater ability to generate direct income for the practice
Potentially significant source of revenue from optical dispensing, if allowed to develop their own primary care practice	Limited optical sales augmentation
Limited succession planning ability; an optometrist can only take over a narrow scope of a retiring surgeon’s practice	A professional succession event is relatively easy and seamless
In most state jurisdictions, optometrists can only be business partners with physicians through a labyrinth of shell organizations.	Physicians can readily partner with other physicians, facilitating institutional growth and integrity
Even highly skilled ODs are generally content being permanent associates rather than being partners in the practice; this can be important for surgeon-owners who would prefer to not dilute their ownership position, or who desire passive profits	The best ophthalmologists desire partnership positions, which leads to inevitable issues of profit and control dilution for existing partners; it is somewhat harder to build an organization generating passive income for the founders
Professional boundaries, authority and reporting lines are generally clear; optometrists readily defer medical and management decisions to physician-owners	Struggles for authority and autonomy by junior doctors are far more common; in the best of settings, this results in a stronger organization, but it can also destroy practice harmony