Photo Credit: Getty Images
By Thanh Mai, OD
August 13, 2026
This is that rare article that you’ll probably want to reread multiple times over the years. You’re welcome!
Most “growth strategy” content for ODs is a TED talk. It’s vague, inspiring and useless on a Tuesday morning when revenue has been flat for three months and you don’t know why.
Here’s what nobody tells you when you’re building out of a single location: Growth in optometry isn’t one strategy. It’s a stack of completely different business models. Almost every owner only ever runs one of them which is usually “see more patients.”
Some get you more patients. Some get you more locations. Some have nothing to do with patient volume at all. They’re about who owns the margin, the data or the purchasing power sitting underneath the clinic you already built.
1. The Market Share King: own your local market before you chase a new one
This is the default strategy for almost every OD I talk to, and there’s nothing wrong with it.
- Get more new patients.
- Improve your recall rate.
- Convert more of the exam chair into the optical.
- Add doctors.
- Extend hours.
- Layer in specialty services such as myopia management, dry eye, vision therapy or specialty contact lenses on top of routine care.
That’s also the case for going full-service instead of staying boutique. A single-specialty office has real charm, more personalized, tighter focus, but it caps your own market share by design. It turns away exactly the volume a full-service, multi-specialty operation is built to absorb.
Probably 90% of independent ODs run some version of it as their entire growth plan. It’s a fine strategy. Just don’t mistake it for the only one available to you.
2. The Geographic Expansion Play: copy the machine into more markets
You’re not trying to squeeze more out of one market. You’re taking a model that already works and installing it somewhere new one location at a time. You can open cold or acquire new locations.
This only works if what you’ve actually built is a system, not a personality. Maybe you run the Entrepreneurial Operating System (EOS) or a Scale Up model. You have a way of greeting the patients, mastered the flow, have awesome hiring and onboarding systems, and great marketing magic.
The real test of whether you have a replicable machine or just a very successful job for yourself. If new locations need you to thrive, you don’t have a growing empire but a growing list of jobs.
Monday morning: Write down the 10 things that make your current location work. Then ask honestly whether another doctor, in another building, could reproduce those 10 things without you standing there. Whatever can’t be replicated yet is the actual bottleneck to opening location two and not the real estate search.
3. The Merger and Acquisition Play: buy small, build big, capture the arbitrage
This gets confused with geographic expansion but it’s uniquely different as a strategy. Merger and acquisition (M&A) isn’t about opening in more zip codes. It’s about capital allocation and enterprise-value arbitrage, you could roll up three practices on the same street and this thesis still holds. The value driver is the consolidation itself, not the map.
Say a solid $1M-revenue practice sells at a typical single-practice multiple such as example $650K. Now imagine 25 of those practices, still fully independent, each selling one at a time: 25 × $650K is about $16.25M combined, on $25M of aggregate revenue. Now merge those same 25 locations, same patients, same buildings, same revenue, into one professionally managed platform and a sophisticated buyer isn’t pricing it like 25 separate optometry practices anymore. There’s less key-man risk, diversified revenue and professionalized management. That platform can sell for double the aggregate value, or more, for the exact same underlying business.
Then there’s a second layer most owners miss entirely: operational arbitrage. Buy a practice running thin, install centralized billing, vendor contracts and management infrastructure and improve the margin. You didn’t just buy revenue, you bought underperforming cash flow and repriced it. That’s the core of an M&A thesis: target practices where the owner-doctor is 60%+ of production with high key-man risk and replace them with an operator-doctor incentivized to protect and grow the number post-close.
4. The Vertical Integrator: stop paying someone else’s margin
Every practice bleeds margin upstream and doesn’t notice, because the bleeding gets itemized as “cost of goods sold” instead of “money I gave away.” Lab fees, frame programs, contact lens wholesale all flows out to someone else’s (profit and loss) P&L.
What if you owned a lens lab? What if you created a few frame lines? Your cost of goods expense on your P&L now becomes a chance for you to become a big customer for another company in your vertical that you can own. Specialize in vision therapy? Start manufacturing your own vision therapy supplies and then sell them to other optometrists.
5. Picks and Shovels: sell the tool you had to build
Some of the more reliable fortunes in any gold rush weren’t made by the miners. They were made by the people selling picks and shovels to every miner in the field.
What if you created an EMR for your own business that was so good you could sell it to other people? Other examples are software tools like Arrellio, SolutionReach, ABB Verify, GPN Edge and the list goes on and on. You create software that you need to scratch your own itch but then realize colleagues would benefit from it greatly as well.
6. The Guru Play: charge for the expertise you’re giving away
Every doctor who’s built something accumulates a second asset nobody puts on the balance sheet: the knowledge of how they did it. Most of us package all of that IP under one highly sophisticated monetization strategy, free coffee with colleagues.
That’s the virtuous nature of most ODs. We are happy to stand at a podium and give away pearls of wisdom for almost no compensation. But what if you monetized your advice into a consulting service? What if you sold courses on how to crush it in dry eyes so others could emulate your system and dominate their local market as well? You’d help more ODs succeed and you could also make a side hustle that could eventually become a main hustle for yourself.
7. The GPO Play: stop renting your buying power, own it
When I graduated there were so many buying groups that I had no idea where to start. There was PRIMA, Red Tray, Vision Trends, Vision Source and a brand new one that came to my school and hosted a meeting that I attended as a student called PERC.
Once upon a time, many of these groups, like PRIMA, just started out as a band of friends sharing ideas and negotiating buying power together. Well, you could, in theory, make your own buying group. You could negotiate special vendor deals and take a small percentage of sales. Perhaps layer in other ancillary services like practice consulting and credit card processing, and you’re on your way.
8. The Payvider Play: own the plan, not just the exam chair
Most ODs treat insurance as something that happens to them. The patient has a plan, the plan sets the rules, the doctor provides the care, and the practice lives inside economics somebody else designed. Zoom out, and the most valuable companies in eye care don’t just deliver care—they control access to the patient before the patient ever sits in the chair. That’s the “payvider” model: provider and payer combined.
What if you offered your own vision plan in your area? You don’t start by trying to rebuild a plan that already exists. You start with a local employer who wants a better benefit, or your best patients who’d pay for a membership that bundles exams, discounts and specialty testing. You keep slowly selling more contracts and you get other local optometrists to participate as well. And then you’ve just created a new vision plan that in theory you could keep expanding.
Now pick your genre
These aren’t eight marketing tactics. They’re eight different businesses hiding inside the one you already run:
- Market share: dominate one local market
- Geographic expansion: replicate your operating system across more locations
- M&A: acquire, improve, consolidate and capture the multiple arbitrage
- Vertical integration: own more of your supply chain
- Picks and shovels: turn your internal tools into a product
- The Guru Play: monetize your expertise, reputation, and data
- GPO: aggregate purchasing power instead of renting someone else’s
- Payvider: move upstream toward owning the benefit and the patient relationship
You don’t have to pick only one, and they compound in a specific order. Geographic expansion feeds M&A. More locations create purchasing leverage. Purchasing leverage makes vertical integration worth doing. A bigger platform throws off more data, and that data can become the software or information business. A large enough provider base can eventually support its own employer contracts or benefit design. One strategy unlocks the next.
You don’t need to build all eight. But you need to know which game you’re actually playing, and stop assuming there’s only one. Pick the strategy where you already have an unfair head start, a market position, a system, a dataset, a vendor relationship, a piece of software you built out of necessity and give it a real budget, a real owner and a real number to hit.
Read Dr. Mai’s latest insights here.
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Thanh Mai, OD, is the co-founder and CEO of Insight Vision, a multiple location optometric group. To contact him: tmai@visionsource.com |
