Doctor Patient Relations

10 Things to Build Both Credibility with Patients & Long-Term Practice Profitability

By Alan P. Levitt, OD

April 12, 2023

Managing and growing a private practice over 3-4 decades is both a major challenge and accomplishment. Practice success derives from new patients joining your practice and retaining existing patients.

Despite our best efforts, most practices will typically experience a 20 percent annual loss of established patients due to changes in insurance, moving, perceived savings elsewhere, difficulty getting a convenient appointment, personality conflicts and mortality. To maintain a stable patient base, a minimum of 20 percent new patients is required; a growing practice will need to target significantly more new patients.

If you analyze the cost of acquiring new patients via marketing, you might be surprised to discover it could be as high as $80-$100 per new patient and effectively wipe out most of your profit margin for that first encounter. This deficit can be diminished or overcome by creating enthusiastic new patients who refer multiple family members, friends and co-workers.

Keeping existing patients, who eagerly spread the word about your practice to potential new patients, isn’t possible unless patients find you highly credible, and, as a result, trustworthy. Here are the actions that made the greatest difference for me in establishing credibility with patients during my more than three decades in private practice.

Create an Office Environment & Patient Experience that Instills Confidence: Start with a friendly voice answering the phone and maintain a clean, uncluttered, well-equipped office.

Help Patients Value the Continuity of Care You Provide: Educate patients that strong eye health baselines will allow you to carefully monitor their eye health for years to come during their annual comprehensive eye examinations and quickly identify changes over time.

Offer a Comprehensive Eye Wellness Experience: We grouped screening visual fields and wide-field fundus imaging together as “Advanced Diagnostic Testing” and charged a supplemental out-of-pocket fee. Instead of just taking one central wide-field image per eye, instruct your staff to utilize eye steering and take central, superior, nasal and temporal views of each eye. (Inferior views tend to be less effective.) Require staff to take blood pressure during pretesting before every comprehensive eye examination. After all, isn’t that what medical doctors do?

Have Staff Set You Up to Review Eye Health Screening Results with Patients: Before you enter the exam room, your staff should have these images and results displayed on your exam room screen in addition to the patient’s history, demographic data, and chief complaint. Thoroughly review them with the patient.

Let Patients Know the Full Scope of Your Services: Educate new patients and remind established patients that in addition to providing comprehensive eye examinations, contact lenses and refractions, you also provide specialty care such as myopia control, dry eye, glaucoma, low vision or binocular vision, along with same day/after-hours care for medical eye emergencies such as red eyes, eye injuries and flashes/floaters. Most patients prefer to receive their medical eyecare in the same office where they confidently receive primary eyecare, and you will certainly provide much better emergency care in-office than they would receive at a walk-in center or ER.

Refer Patients to Other Doctors Covered By Their Insurance: When a referral is necessary, first make sure the specialist or sub-specialist you plan to refer them to is part of their major medical insurance plan. Checking this first will avoid wasting time, frustrating your patient and delaying necessary care. Each exam room should have a current list of your favored specialists, their practice locations and which plans they accept.

 Educate & Walk Patient Through Referral Process: Advise the patient on the reason you are requesting the consultation, why you are recommending this specialist, how rapidly they need to be evaluated and the potential risks of not getting the consultation. Provide a succinct referral report for them to hand-carry to the specialist.

Establish an Effective, Consistent Protocol for Working with Co-Managing Doctors: Assign a responsible staff member to call the specialist’s office, make the patient’s appointment and record the referral details in the record and your “tickler system.” In addition, send a copy of the report to the specialist listing the date and time of the appointment, but be aware that staff at busy multi-doctor offices are likely overwhelmed, so the specialist may not see it before the patient is in their exam chair.

Follow-Up With Patients Sent for Referrals. Now your staff can easily track if your patient kept the appointment and that you received a report. Document missed appointments and your team’s efforts to reschedule the patient. When patients miss consultation appointments for serious vision or life-threatening conditions, call them to express your concern, answer any lingering questions, then send a certified letter, return receipt requested, to further motivate the patient and document your efforts.

Let Patients Know You Are There For All Things Eyes. Make every effort to establish in your patient’s mind that your office is the first best place they should consider for all their eyecare needs, including medical eyecare and emergencies, that you and any associates are available 24/7/365 for emergencies, and when necessary, you will send them to the best available specialists or sub-specialists for their specific problems.

The goal is simple: retain as many patients as possible, encourage them to refer others, maximize the ophthalmic services you provide in-house to increase per patient revenue and strive to have other optometrists, ophthalmologists, primary care physicians and medical specialists send you additional patients.

Alan P. Levitt, OD
, now retired, was a practice owner in Miami, Fla, for over three decades before selling his practice in 2021. To contact him:

In 2021, after 40 years in practice, Dr. Levitt sold his solo private practice to a younger colleague and retired. He began practice in 1981 as an associate for his family optometrist; three years later he left to cold-open his own private practice. This article includes several strategies that Dr. Levitt used to build a successful practice, travel the world and fund a secure retirement.

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