Photo courtesy of Thanh Mai, OD, who is seen in this photo lecturing to a group at the Vision Source exchange on utilizing artificial intelligence to build an AI assistant that will save them 5,000 hours and double their business in a couple of years, thus providing yet another way to efficiently grow a practice.
Paving the way for profitable practice growth
By Thanh Mai, OD
May 21, 2025
In private practice, growth is always on our minds — but doing more isn’t the solution.
Adding services, hiring more staff, extending hours — these tactics often fail when the real bottleneck remains hidden.
Every practice, no matter how new or well-established, runs into constraints: roadblocks that quietly cap potential.
Think of your practice like a river. If the water isn’t flowing fast enough, you don’t dig the whole river deeper — you remove the one dam blocking it.
This is the essence of the Theory of Constraints:
Find the true bottleneck. Solve it. Growth follows naturally.
In a busy optometric business, the challenge is not figuring out what else to do — it’s identifying what to stop doing and where to focus fully.
Why We Stay Busy, but Don’t Move Forward
Most practice owners (myself included) have days packed with tasks — emails, meetings, minor decisions — that feel important but aren’t transformational.
We focus on what’s comfortable: Tweaking social media posts. Responding to a few more patient emails. Updating a piece of office decor.
It’s easier to check off small wins than to sit down and tackle the one uncomfortable decision that could fundamentally shift the future.
And that’s the trap:
We confuse being busy with making real progress.
The work that truly matters — building systems, investing in leadership, shifting strategy — often gets delayed.
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Meanwhile, we stay busy. We stay stuck.
How to Find the True Constraint
Instead of asking, “What else can I add?”, the better question is: “What’s the one obstacle that, if solved, would unlock the next level?”
Often, it’s not buried in complexity — it’s right in front of us.
Here are two examples that show up consistently in private practices.
Example 1: The Leadership Bottleneck
One of the most common and damaging bottlenecks I see in private optometry offices today isn’t patient volume — it’s leadership absence.
The doctor, who is also the business owner, is trapped. They are the ultimate decision-maker — responsible for vision, strategy, hiring, training, marketing, finance — but they are also buried 40+ hours a week seeing patients.
As a result, decisions get delayed. Strategic moves don’t happen. The leadership team (if there even is one) doesn’t have the autonomy, clarity or support they need to drive the business forward.
The practice stagnates — not because there aren’t enough patients, but because leadership is missing at the exact moments it’s needed most.
The real solution:
Owners must invest in building and empowering a true leadership team — whether it’s an office manager, clinical lead, marketing coordinator or optical manager.
Delegating day-to-day decision-making allows the doctor to move into a true CEO role — even if that means stepping back slightly from the exam room.
The result:
When leadership is no longer a bottleneck, businesses operate more smoothly, strategic initiatives move forward and growth becomes scalable without burning out the owner.
Example 2: Failure to Build Internal Training Systems
Another constraint I often see — especially in growing practices — is the failure to build internal training systems.
The practice relies heavily on “shadowing” for onboarding new employees. New staff are expected to “watch and learn,” picking up systems by observation. The problem is, this leads to inconsistency, confusion and the need to redo work — especially as the team grows.
Small mistakes compound:
- Optical orders get entered incorrectly.
- Insurance claims are filed wrong.
- Patient experiences become unpredictable.
These errors slow down growth, erode profitability and create friction inside the team.
The real solution:
Create simple, repeatable internal training documents and workflows for every major role — front desk, techs, optical, billing and even marketing. Invest time once to build the systems — then update them as needed.
The impact:
When every team member is trained consistently, service becomes scalable. You can hire faster, onboard smoother and maintain quality even as the business expands.
Internal training systems don’t just save time — they create a foundation for real, sustainable growth.
How to Apply This Focus Daily
Once you find your true constraint, focus relentlessly there — and ignore distractions until it’s resolved.
Here’s how:
- Name the Problem Clearly
No soft language.
What is truly holding you back today?
Call it what it is — clearly and specifically.
- Eliminate Distractions
If it doesn’t help solve the main constraint, put it aside for now.
Let secondary tasks wait while you fix the foundation.
- Create Urgency
Don’t allow solutions to drag out.
Compress timelines. Make decisions faster. Adjust in real time.
Speed fuels momentum.
Momentum fuels results.
Leading Your Team Through Focused Growth
Growth isn’t a solo sport.
Your team must be aligned, committed and empowered.
Here’s how to drive focus across your organization:
- Forget the Past: No more blame. No more dwelling. Focus on fixing the future.
- Weekly Alignment: Brief weekly check-ins maintain focus and uncover issues quickly.
- Make Progress Visible: Use scoreboards, dashboards or weekly wins to track momentum.
- Celebrate Breakthroughs: When the constraint is solved, recognize it — loud and clear.
Growth is a Continuous Cycle
Breaking one constraint doesn’t mean you’re done.
The moment you remove one bottleneck, the next one becomes visible.
Maybe leadership was the first constraint.
Next it might be staff onboarding.
Then staff accountability.
Then operational systems.
It’s a cycle:
Identify → Focus → Solve → Reassess → Repeat.
Master this rhythm, and sustainable growth becomes your default setting.
Conclusion: The Real Work That Builds Real Growth
Private practices don’t plateau from lack of effort. They plateau because the doctor-owner stays buried in daily clinical work, while leadership gaps, training gaps and operational issues pile up.
The solution isn’t hustling harder. It’s stepping back and asking: “Where is the true bottleneck?”
Then, have the courage and discipline to attack it until it’s fixed.
The practices that thrive aren’t the ones doing the most. They’re the ones doing the right work at the right time — with clear focus, urgency and leadership.
Read another recent column by Dr. Mai
Read more about professional development in ROB sister publication Independent Strong
Thanh Mai, OD, is an owner of Insight Vision Center Optometry, a Vision Source practice in Costa Mesa, Calif, Optometry Corner, a Vision Source practice in Irvine, Calif. and Eyecon Optometry, a Vision Source practice in in Reseda, Calif. To contact him: tmai@visionsource.com
