Practice Management

Changes We Made that Generated $2,600 Additional Revenue Per Week Per Doctor & 20% Higher Per-Patient Revenue

Dr. Rettig’s office in Altoona, Penn. Dr. Rettig says strategic changes to how he and his partners handle hiring and staff management have made a huge difference to the practice.

By Eric Rettig, OD

April 27, 2022

There are improvements you can make that enable patients to have a better experience in your office and the practice to maximize profitability. Here are a few changes we made in our office that significantly impacted how well our office runs and the level of care and service we are able to deliver.

Assigning 2 Technicians Per OD & More Delegation
We decided to assign each of our practice’s four doctors two technicians. We then started delegating more of the examination to the technicians. Work like performing pupil testing, versions (EOMs) and dilation were added to the pretesting protocols. We also allow them to perform additional testing based on past diagnoses or complaints which the patient may have.

For example, if a patient tells us they started taking hydroxychloroquine, the tech will automatically know to get testing (10-2, OCT macula, autofluorescence). A history of glaucoma suspect and dry eye? OCT nerve and tear osmolarity testing is already done by the time the patient sees the doctor. This allows the doctor to have all pertinent data right when they enter the exam room. It also reduces the number of times the patient has to leave the room for testing and then come back for the doctor to review.

We did this because we realized we could be seeing more patients per hour while still being able to spend time explaining diagnoses and treatment plans and educating patients. In fact, doctors now spend even more time educating the patient. Additionally, we realized that our doctors simply didn’t need to perform every aspect of the exam.

The biggest cost in making this change was the hiring of three more technicians. The average salary for a technician in our area of Pennsylvania is around $30,000-40,000 annually.

On average, I am able to see one additional comprehensive exam (including refraction) per hour. We average approximately $400 per patient. Averaging 6-7 patient care hours per day in a five-day week equates to $2,600 of additional revenue per full-time doctor. Each doctor spends 15 minutes per patient with an extra 6-7 patients seen per day.

Patients have expressed to us that they are impressed with how skilled our technicians are and how efficiently we are able to work in our office.

Hiring for Personality in Optical
Instead of worrying about optical experience, we started hiring people based on their personality and ability to work with people. We still have key members of our optical team who have decades of experience, so we can easily train a new employee with the right personality who doesn’t have that previous experience themselves.

We found that when we hired people with years of experience, they tended to be set in their ways from previous jobs and had a much harder time buying into the approach we like to take in our office to patient care and customer experience. There were even times when staff members, who came to us with years of previous experience, felt they knew what was best for the patient and went against what the doctor had prescribed.

We slowly rid ourselves of these toxic opticians, and during the hiring process, found people who are easy to get along with and fast learners.

Making this change to our optician hiring practices had the side benefit of helping us to save money. “Less experienced” opticians don’t demand as high pay as those with previous experience. On average, we pay our new optician hires $2-3 dollars less per hour.

Patients love our optical staff. They often request to work with specific opticians and tell us how much they enjoy their experience when picking out glasses.

Aside from the savings from the lower pay rate, we found that, after hiring opticians for personality, our revenue per pair of glasses increased 10 percent, frame capture rate and frame sales both increased by 10 percent and our overall revenue per patient increased by 20 percent.

We spend less time worrying about our old “toxic” staff members and more time thinking about practice management and ways to further grow the practice.

Created Key Leadership Positions for Each Area of the Office
We always had an office manager and assistant manager, but we didn’t have departmental leadership. So, we created a leadership role in each department: front desk, technicians and optical/contact lens.

We wanted to give more responsibility to our most experienced and skilled staff members. We chose individuals who are capable of handling questions from staff and troubleshooting problems with patients. About once a month, our head of personnel does what we call rounding where he checks in with each leader to get ideas for improving that department and to help address any potential issues that may have arisen.

We let our staff know our plan, and anyone could apply to be the department leader. We then chose the person we thought would fit each role the best. We wanted knowledgeable individuals whom the rest of the staff respected and looked up to. We gave each individual promoted to a leadership position a slight raise of $1-2 an hour.

Having departmental leaders made troubleshooting much easier. Small problems that would previously have fallen to the managers or doctors are now handled by the leaders. Issues are resolved much faster, so patients are no longer kept waiting for solutions. We are also able to implement changes and new ideas in a more organized way.

The leaders are directly involved in the management of our practice, and are aware of our key performance indicators, which they track themselves on a weekly basis. This allows for a more real-time metrics tracking in the office. It has increased our optical sales by 15 percent overall. In our technician department, our special testing has increased and become much more efficient.

Eric Rettig, OD, is a partner with Mountain View Eye, a Vision Source practice in Altoona, Penn. To contact him:


To Top
Subscribe Today for Free...
And join more than 35,000 optometric colleagues who have made Review of Optometric Business their daily business advisor.