Professional Development

2 Books that Showed Us How to Create Office Systems, Become Practice Leaders & Pay Ourselves

Drs. Licausi and Zilnicki celebrating the opening of their cold-start practice. They say that creating systems to run their office, and taking time to lead the practice, rather than just work in it, has helped them to be successful.

By Miki Lyn Zilnicki, OD, FCOVD,
and Jessica Licausi, OD, FAAO, FCOVD

April 20, 2022

In building our practice, and becoming leaders of our business, we sometimes need help from beyond optometry. In our case, two books were instrumental in guiding us to better run our office and lead the practice to become what we had envisioned when we first opened.

There are two books that shaped the way we practice, which we want to share with you: “The E-Myth: Why Most Small Businesses Don’t Work and What to Do About It,” by Michael E. Gerber, and “Profit First: Transform Your Business from a Cash-Eating Monster to a Money-Making Machine” by Mike Michalowicz.

Here are the key lessons we learned from these books.

The Importance of Creating Systems to Run Our Office
Since we opened our practice together cold, we had the opportunity to form our vision for our practice and implement the systems we needed to create that vision from the get-go. “E-Myth” recommends following a planning triangle comprised of the business plan, the practice plan and the completion plan. To create these plans, the book advised us to ask ourselves: Who are we? What do we do? How do we do it? We found that by following these planning steps, and verbalizing/putting down onto paper the answers to the questions we asked ourselves, we were able to create simple, efficient and sustainable systems to help us consistently meet our goals and grow our practice.

From the beginning of our practice, we strove to create systems for every task/job to help the office be consistently efficient. These systems have evolved and changed over time, but we are always aiming to make things more seamless and efficient.

Initially, putting in writing how we wanted everything done was time-consuming, but doing this proved well worth it. We have manuals that spell out tasks as simple as, “how to answer the phone?” to more complex tasks such as billing insurances. Once your systems are in place, the time to maintain them is much less. As our staff’s roles and responsibilities evolve, and as we introduce new technology, we update our procedure manuals to reflect these changes. Over the last couple years, we were able to delegate some of our procedure-updating responsibilities to our full-time receptionist, who evolved into an office manager role.

Running our business systematically enables us to ensure a consistently high level of service for our patients. Every time they visit our office, they can expect prompt service, superior care and above-average communication. They also can expect consistency in their care, regardless of which doctor or employee works with them because everyone in the office is following the same set guidelines.

Having systems in place takes the focus away from the individual when mistakes happen, and shifts it to the system we all are following. In other words, if a task is repeatedly not done well, we look at the system related to that task, and ask, “how can this be done better?” Yes, there are always employees who do not do what is asked of them, but having these systems in place makes it easy to look at where the breakdown is happening, and ask that employee what is preventing them from completing the task. This creates a great work environment and team approach to problems versus assigning individual blame.

The other big takeaway from “E-Myth” is that as a business owner, you cannot run a successful, efficient practice by doing everything yourself. Once you create your systems, you can allocate your time to other aspects of running your business.

Creating systems is not a one-time process. We believe in following these concepts with new goals that arise as we run our practice to ensure we stay on task to meet those goals. We tend to both have lofty goals for our practice. Following the lesson of adding systems to our office helped us go from just talking about our goals to implementing our ideas.

Work ON your business, not just IN it
When you open a business (no matter what it is) you are the entrepreneur, the technician and the manager. If you work solely as one of these, the other parts of the business will fail. From Gerber’s perspective in “E-Myth,” being the entrepreneur and figuring out where you see your business going, and how to make it grow, is the most important piece of the puzzle. If you don’t focus on these things, your business will stay stuck no matter how hard you work.

We allot time weekly to perform administrative tasks such as writing reports, reviewing vision therapy plans, accounting, payroll and connecting with other practitioners to maintain and gain referral sources. We also connect with each other to discuss how the business is running, set new goals and address changes we need to make. Since the start of the pandemic, we are no longer in our office at the same time, so maintaining good communication between the two of us about what we are seeing has been crucial to the continued growth and sustainability of our practice.

One change we were able to make by stepping back and working on the business happened about a year after we opened. We initially decided to outsource our bookkeeping. We came to this conclusion because we wanted to ensure all financial information was monitored closely and set up correctly from the beginning stages of our office planning. About a year in, we realized that while we were getting wonderful financial support from our bookkeeper, we were only seeing big-picture financials. By the time we submitted everything she needed, and she reviewed monthly revenue and expenses and inputted it into QuickBooks, it would be 1-2 months later before we received a profit-and-loss statement.

We sat down together and realized we both felt that we were getting caught up in the daily duties of being eyecare providers and missing out on a strong sense of where we were day-to-day financially. It is crucial to have a pulse on your business in its earliest stages, so we knew we had to make a change. Dr. Zilnicki was interested in pursuing accounting early in her academic career, so she decided to learn how to become a bookkeeper! While this pulled her away from patient care, it allowed us to view our financials on a daily, weekly and monthly basis and better learn the cash flow of our office and how to run our business more profitably.

We take away time slots from patient care to have administrative time during office hours. Some doctors may think we are crazy to lose that time and profit from exams, but we value the break between home and office. Both of us have young children at home, so we often do not have time to work uninterrupted when we are not in the office. We have discussed the cost/benefit of taking weekly administrative time. We feel it makes sense for us to continue to do so because it allows us to stay on top of running our practice beyond providing patient care.

When we outsourced our bookkeeping, we paid $200 per month for the bookkeeper’s services, resulting in a $2,400 per year cost to the business. By bringing bookkeeping back in-house, not only did we gain better perspective on the inner workings and financial flow of the business, but we also saved ourselves a big chunk of change that we then reinvested into the practice.

It’s easy to get lost on the hamster wheel of seeing patients, but it’s important to remember that you cannot be the busiest optometrist and run a successful practice simultaneously (at least not without burning out!). It is crucial to take time away from patient care to run your business and ensure you are properly assessing finances and human resources and identifying areas of growth for the practice. This will translate into better patient care and happier staff (including you!) when your practice runs smoother and more efficiently.

The author of “The E-Myth” co-wrote a follow-up book specifically for optometrists,“The E-Myth Optometrist: Why Most Optometry Practices Don’t Work and What to Do About It,” which incorporates the principles of running a successful optometry practice.

Think About Profit Differently: Don’t Forget to Pay Yourself
The premise of “Profit First” is to flip the traditional way of thinking about profit on its head. The old-fashioned formula for profit is: “Income- Expenses = Net Profit.” This book contends that we should think of it this way: “Income- Profit = Expenses”

Why would you run a business this way? One, it helps you become more conscious of where and how you are spending your money on overhead like rent, salaries, utilities, etc. It also helps you develop and decide how much you need to invest into your quality of life.

As a new business owner, it is easy to go months and years without paying yourself because you are putting everything back into the business. This is not sustainable or enjoyable (search the question of when to start paying yourself on ODs on Finance and you’ll find threads with too many practice owners who have been in business for a long time without paying themselves as much as they should).

When we read this book, we were about two years into running our business, and were finally starting to make money, have a full schedule and were transitioning to both of us being at the office full-time and not doing fill-in work on the side. We were unsure of how to manage allocating funds toward profit, taxes and reinvestment into the practice. We found small monthly expenses creeping up.

The main premise of “Profit First” is you pay yourself before your expenses, rather than with what is leftover. The book helps you set predetermined percentages into different bank accounts (you’ll need multiple) that cover all the areas of your business. You determine where your current financials are being spent and then figure out the goals for your finances and set your percentages to ultimately get there. We utilize two main bank accounts: one for primary accounting where all revenue gets pulled in and expenses are pulled out. Our secondary account is our “profit account” where we pull a set percentage into and utilize these funds toward our salaries.

The author’s website has a section with free resources that you can utilize to help figure out where you are, and how to get to where you want to be.

There is a whole Facebook Group dedicated to “Profit First” for eyecare professionals. You can find it HERE.

We do not follow this program to a T, especially after COVID-19, and how it affected our practice in 2020. However, we are getting back on track with this system, and regaining an awareness of our spending and being in tune with our needs to ensure that our practice is fueling the life we want to live.

Employing the “Profit First” lesson takes no additional money, but time initially to set up multiple bank accounts and analyze your current expenses, profits and compensation. Once your system is in place, little additional time is needed. Just a few minutes daily reviewing your bank accounts, and knowing what is coming in and going out on a daily basis, can keep you on track to meet your set percentages and know how to funnel them to the appropriate account. As we discussed in lesson #2, taking over our own bookkeeping made following this system much easier since we are constantly tapped into our practice financials.

When a practice’s business side is running efficiently, and the doctors are being adequately paid, it trickles down to patient care. As business owners and doctors, we feel that our hard work is being compensated, and enjoy showing up. The money we aren’t frivolously spending can be reinvested into the business for new equipment and technology that enhances care.

Miki Lyn Zilnicki, OD, FCOVD, and Jessica
Licausi, OD, FAAO,
FCOVD, are co-owners of Twin Forks Optometry and Vision Therapy in Riverhead, NY.

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