Repositioning your LASIK-based practice back toward general and geriatric eye care

ByJohn B. Pinto

As a continuation of discussions in recent blogs, let's talk briefly about the proper balance you should aim for between refractive surgery and general/geriatric eye care in your practice and how to achieve that balance.

Since the early 1980s, when vision correction surgery first arose as a commercially viable subspecialty in America, surgeons have flirted with the alluring option of focusing all or nearly all of their career attentions on RK, PRK, LASIK and derivative procedures. In the last 20 years, we've now had a chance to see numerous volume downturns, as these procedures have fallen in and out of favor with the buying public, and as consumer discretionary dollars have waxed and waned with the general economic climate. We are now at a new low ebb, with LASIK volumes off 35% and much more.

However, as happens at the end of every boom cycle I've experienced, some refractive surgeons are always left stranded up on the beach when the tide goes out. It's to these trapped doctors that I would like to address the balance of this piece, along with those who feel they have become a bit more LASIK-leaning than is healthy. To attach a number to it, this blog is for anyone with more than one-third of their current (or recent) revenue coming from refractive surgery.

Think of your practice as a composite of many smaller companies. You have the "LASIK Company," the "Cataract Company" and the "Glaucoma Company." And perhaps even the "Dry Eye Company." The list is — and should be — rather long. Each of these practice segments is clamoring for care. They demand capital for specialized equipment. They demand your time to stay current and to orient staff. Each demands your focus — by which I mean you should be conducting every patient encounter with all of your services in mind. Ask yourself, without being overly predatory, "Did I provide every patient I saw this past week with the full array of services they need and that we're in a position to provide? Or was I so focused on finding my next LASIK candidate that I walked right past several opportunities to better serve the patients I do have in abundance?" Your honest answer to this question will not only make you a better physician, but a better businessperson.

Getting back to a greater focus on the general and geriatric eye care sector obviously takes more than just having your head back in the game. It takes specific, focused and sometimes costly action.

One core tactical action may be shifting your marketing and advertising budget. My general client advice for the next couple of years is for the typical LASIK media/marketing budget to pull back 40% and to shift half or more of this back into geriatric and general eye care promotion. Most active LASIK surgeons have already gotten comfortable with relatively high media budgets; all they need to do is shift audience and market segments. In repositioning your practice, you can quickly pass your more timid competitors in the current environment.

If you can accomplish a relative shift in your patient care portfolio, you won't just fill more vacant chair time. Unlike the typical LASIK patient, your senior patient will likely receive services for years. So the global revenue and profit yield per new senior patient is far higher than for the one-time "catch-and-release" patient.

Here are additional check-offs for your repositioning to-do list:

My rule of thumb is that your senior and general practice should be spending about 3% to 5% of the revenue from that part of your practice, year in and year out, on marketing.
Make sure a live operator picks up your phone, if at all possible.
Get back into health fairs, senior nutrition site screenings, OD outreach and other traditional marketing tactics. You'll be amazed how many of these niches have been abandoned in recent years — getting back to them first could be your key to success for the next few years.
If you got into LASIK because you were bored with cataracts, find some new leading-edge aspect of cataract surgery that's interesting. Come to think of it, cataract surgery is refractive surgery, isn't it?
Adopt a zero-defects recall system and polish customer service: A great geriatric eye care advertising program can potentially make wobbly operations fail faster.
Aim to build your total cataract case volumes to 50+ cases a month, alone or in concert with compatible partners or associates, so you can eventually add a surgical facility in many states. Ancillary facility income is critical to replace cataract professional fee income.
Remember that eye care is a largely fixed-cost service business. A 10% drop in revenue typically can result in a 20+% drop in your take-home pay. Sustaining revenue is critical. If you can't sustain revenue by repositioning the practice, you must then redouble efforts to reduce operating costs.

Unless you're nearing retirement, general economic cycles will influence your ophthalmic business affairs, both positively and negatively, several more times in the coming years of your career. Each successive cycle will force important decisions about balancing your service mix.

Each of these decisions requires a rational fit between broad national market trends, your local conditions, your practice's economic demands and, as importantly, your professional standards and interests. Weaving these disparate threads into a viable practice fabric is at once the most challenging and the most satisfying part of owning an independent practice today.