Practice Management

Business Ideas that Created a Practice Grossing $100K+ Monthly Seeing 8-12 Patients Per Day

Dr. Foster, center, with her practice team. She says that taking a direct-care approach, keeping it small and offering appointments only during weekdays have helped build a highly profitable practice.

Ideas from outside optometry that changed patient care and profitability.

By Kara Foster, OD

Nov. 1, 2023

Your most valuable ideas for running your practice won’t always come from within the optical industry. Our practice has incorporated a few powerful ideas from outside the world of optometry that have transformed our service to patients and our profitability.

Direct Eyecare

I borrowed this idea from direct primary care and fee-for-service dentistry, adapted to fit the eyecare industry. I use a fee-for-service system where patients pay my office directly, with no involvement of the insurance company. It’s “direct care” because it’s a direct relationship between doctor and patient without the insurance middleman. It allows me more quality time with my patients. The overall goal is to provide patients the best possible care.

We dropped all insurances and created a fee-for-service price sheet that we shared with patients, along with our values statement for becoming a direct-care practice.

Direct care has allowed us to keep our staff small to maintain focus on our team as individuals and keep them happy, which has helped our staff turnover rate. Patients love seeing the same faces each year when they come in, and we love being able to get to know them on a personal level. Direct care also allows us to have more time to spend with each patient to help improve our patient care and rapport.

The greatest costs in transitioning to direct care were in team training and updating the website to reflect our new practice structure, along with sending a letter to our patients explaining the change. There was time spent in perfecting the explanation of direct care to patients, and explaining the difference in what they could expect at our practice.

Our practice continues to grow each year with word-of-mouth referrals. Patients are able to receive all the time they need for us to troubleshoot any concerns, answer all of their questions and build a strong doctor-patient relationship, which in turn, improves compliance and referrals.

While maintaining our 30-60 minute appointments, we have increased our per-patient revenue significantly each year, all while including a screener OCT and fundus photos on every patient:

2022: $564
2021: $553
2020: $456
2019: $451
2016: $300

Direct care, taking back the control of our practice from insurance companies, has allowed my team and I to love coming to work every day. We look forward to helping our patients, and it shows in our patient care.

If going full-on direct care seems like too much at once, start small to begin with. First, train your team to exemplify direct care in the office, and slowly start dropping insurances one at a time. Your patients will continue to return to you because of the level of service they have come to expect at your practice, whether or not you take their insurance.

>>Click HERE to read more about how Dr. Foster successfully dropped managed-care plans, and is now helping other practices do the same.>>

Keeping My Practice Small

The idea that my practice could perhaps be best if kept small came to me from the book, “Small Giants,” by Bo Burlingham. I continually use the concepts presented in this book to evaluate how I want my practice to grow and maintain the small feel that our patients have grown to love. I wanted to maintain a sense of community while effectively serving our patients.

Patients love the small-town sense of community in our office and high level of customer service they receive. By keeping our practice small, we can continue providing amazing customer service, which helps patients understand why we are a direct care practice.

Our small practice is able to gross over $100,000 per month seeing 8-12 patients a day with six doctor days per week (one OD Monday-Wednesday and two on Thursday, two on Friday which is a half day).

Keeping your practice small allows for greater peace of mind, fewer employees to be concerned with and patients who truly value your services.

Consider how you want to practice. Growth is not the only way to increase revenue. Often, growth increases expenses without the corresponding increase in profits, leading to additional stress. Keeping it small allows more peace of mind in your day-to-day life, less to worry about for your practice and the ability to create the practice of your dreams.

Limiting Hours & No Weekend Hours

I decided to forego weekend hours after noting how few dental practices seemed to see patients on the weekend, and after reading “The 4-hour Workweek” by Timothy Ferriss.

We aren’t open any weekends and close at 1:30 p.m. on Fridays. This has helped my team and I find and maintain work-life balance

I have taken this approach to our work schedule since the beginning of the practice. As a mom and wife, finding work-life balance is extremely important to me.

Patients understand that, in addition to being a doctor, I have a family. This helps create deeper connections and rapport between us, and when we have that trust, they are more likely to spend their money at my practice, supporting local families.

My practice is able to generate $7,000-$8,000 on a Friday from 9 a.m. to 1:30 p.m., with hourly patients, two doctors and three employees. And we still get to go home early and be closed the whole weekend.

I don’t believe that Saturday patients are the patients who most value your services. They’ll go anywhere that’s open on a Saturday, and don’t appreciate that you are taking time away from your family to be there. Don’t feel like you have to dedicate your entire life to your practice. Create your practice around your life and your patients will see and respect that.

Don’t wait until retirement to try to find work-life balance. Retirement isn’t guaranteed. Use the leverage you have now as an OD and practice owner to create the life you want. The patients who value you will continue to support you.

Kara Foster, OD, is the owner of EyeCare for You in Apex, N.C., and now also helps other practices reduce, or eliminate, dependence on managed care. To contact her:

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