Practice Management

2 Patient Scheduling Challenges & Solutions = $1,000 Additional Income Per Day

Dr. Licausi (left as you are looking at photo) and Dr. Zilnicki, right, while they were pregnant with their sons, who were born three weeks apart. Strategic scheduling made it possible for the practice to continue serving patients during this time.

Dr. Licausi (left as you are looking at photo) and Dr. Zilnicki, right, while they were pregnant with their sons, who were born three weeks apart. Strategic scheduling made it possible for the practice to continue serving patients during this time.

Solutions to common patient scheduling challenges.

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

Nov. 8, 2023

There are a multitude of leadership challenges when owning a practice. Here are a couple related to doctor and staff scheduling that we successfully addressed in our practice to serve patients better and increase our daily profitability by $1,000 per day.

Navigating Maternity Leave


Between the two doctors, we had six pregnancies in six years, and one staff member had one pregnancy. The two of us even had overlapping maternity leaves with sons born weeks apart!

When someone is out on maternity leave, it leaves a deficit in the office schedule for seeing patients. To tackle this, and minimize the reduction of availability to patients in our vision therapy-focused practice, we implemented action plans to navigate our leaves.

When your schedule is cut back (for whatever reason) it’s important for your patients to not feel the deficit and have continuity of care. In addition, a reduced schedule can mean reduced income, but not necessarily if you plan ahead!


Part of our solution was to hire an associate doctor to help cover our maternity leaves. When we first began having babies, we hired her on a temporary basis for a couple days a week to help cover the office schedule. Now that we are on baby No. 6, she has become a permanent part of our team to help us manage a balance between doctor/practice ownership and family life.

For our upcoming office manager’s maternity leave, we decided to hire someone temporarily to cover a portion of her duties. We are hiring her part-time to cover the reception area, and the remainder of our office manager’s duties will be absorbed by our other staff members and ourselves. This allowed us to cost effectively navigate this time period as we are not hiring an additional full-time staff member. We also decided to leave the position flexible and open-ended.

We plan to assess where we are financially when our office manager returns from maternity leave, along with what her needs are for her work schedule. We may continue to employ the part-time receptionist as needed.

We also manage our vision therapy patients’ courses of therapy to try to get them in for as many of their programmed sessions as possible ahead of our planned leave. We are careful not to have too much scheduled time out of the office, and ask the same of our vision therapists to ensure we maximize vision therapy slots. Even though we have vision therapists, we still see a fair share of vision therapy patients ourselves in our schedule. By having patients complete their program, it frees up the schedule for when we are out.

While the additional cost for an associate doctor is hefty, when we looked at the office schedule and the needs of our patients and staff, it showed us we needed an associate to bridge the gap of our leaves. The tradeoff in financial cost was that we gained comfort in knowing we had coverage for our patients. This led to a slight catch-up on profitability when we returned from maternity leave, but by continuing to provide stellar care to our patients, our vision therapy referrals continued to grow and we were able to not only catch up, but exceed our previous profitability levels.

Our patients never felt like they couldn’t get in with us and knew they were in good hands with our covering doctor. We always instilled confidence in our patients that their care would continue uninterrupted. This is important in any practice, particularly in our specialty practice where our vision therapy patients are most successful when their program is continuous. We both also kept working at a normal pace as long as we could sustain leading up to our maternity leaves.

While hiring an associate is a large expense, it kept our schedule close to normal and allowed continued funds to come in while we were out. It also gave our staff peace of mind that their schedules would be unaffected by one of us being out. All of our staff kept their normal workday hours since we were able to maintain coverage for our doctor schedule.

 Staff-Schedule Management


Every business owner can attest to the fact that sometimes staff can be unreliable. This becomes increasingly challenging in an office setting like ours with vision therapists that see patients. If one of our vision therapists calls out sick, we must figure out how to manage those patients: do we cancel them, absorb them into the doctor’s or other vision therapists’ schedules? It is a logistical challenge, as not just anyone in the office can pick up the responsibility.

We pride ourselves on professional, timely care. Our vision therapy patients rely on consistent bi-weekly appointments to progress in their program.

This is important to practice profitability because if the therapists are not in, we are unable to see those patients (which range between 8-10 patients per therapist in a day). The average vision therapy patient will bring in about $100/patient (this is a rough estimate between private pay/insurance reimbursements), so with a staff member out, we are losing up to $1,000/day (if not more).


On any given day that a therapist calls out we assess what can be done with the schedule to reduce the number of cancellations. Sometimes this means that we have to squeeze patients in between the doctor and other therapists’ schedules or move patients to different time slots. This is a time-consuming, logistical conundrum on days where all the schedules are busy. If we do have to cancel a patient for that day, we always offer any other openings we have for the week to not interrupt their therapy program and progress.

Secondly, we hired a part-time vision therapist who can occasionally fill-in on short notice. She is cross-trained at the front desk as well, so she can slip in from one area to the other easily.

Click HERE to read more about how Drs. Licausi and Zilnicki cross-train their employees.

Adding the additional staff member at $17/hour is a gross cost to the office, but the net gain with her being able to see patients was worth it.

By reducing the number of cancellations, we can have patients who are not frustrated with the office, and their vision therapy program can continue without interruptions.

We try (and admittedly struggle with this) to make it not OK to just call in without advance notice. This is challenging as we are sympathetic to sick children with no other childcare options, family emergencies or sicknesses, but we try to reiterate how much it affects our small office when someone is out. We want our staff to know how important their role is in the office and how much we rely on them to run our business. We also recently saw the need for additional paid time off and worked it into our annual reviews for our staff.

Additionally, we recommend creating a culture in the office in which everyone works as a team and picks up when another staff member is out versus expressing resentment. We try to really compliment team members when they step up and show appreciation for the camaraderie.

Lastly, we strongly feel that sometimes making the initial investment in additional staff pays off in the long-term to keep the office running efficiently. Patients are acutely aware of when an office is short-staffed and how it affects their experience and the quality of care. We never want our patients to feel that they get anything but the best of care and service in our office.

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

To contact Dr. Zilnicki:

To contact Dr. Licausi:

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