Dr. Foster (center with red-framed glasses) with her practice team. Dr. Foster says she leaned heavily on more experienced practice owners for guidance when starting her own practice.
Challenges of starting an optometry practice
By Kara Foster, OD
March 5, 2025
When I graduated from optometry school and opened my practice, I was filled with excitement and optimism.
However, I quickly encountered challenges I hadn’t anticipated.
The journey of starting my own practice was not just about providing excellent eyecare; it was also about mastering the complexities of running a business.
Here are some of the top challenges I faced and how I navigated them with mentoring from seasoned practice owners.
The Complexity of Team Management
One of the first hurdles I encountered was managing a team.
I quickly realized that leadership, conflict resolution and cultivating a positive workplace culture required skills that weren’t covered in my training.
I had to learn how to motivate my staff, address conflicts and create an environment where everyone felt valued and engaged.
Offering Constructive Feedback
Providing constructive feedback became a crucial part of my role as a leader. Early on, I noticed that some team members were unsure how to handle difficult patient interactions. Instead of criticizing their approach, I took a different route.
I organized role-playing opportunities and provided scripts to empower them with confidence and practical strategies. This improved their skills and fostered a sense of teamwork and support.
Another area I focused on was streamlining processes, such as patient check-ins. I encouraged feedback from my team to identify bottlenecks in our workflow.
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Together, we refined the process, and I made sure to praise their input and efforts to adapt. This collaborative approach not only improved efficiency, but also strengthened our team dynamic.
Learning Through Uncertainty
There were specific moments when I didn’t have all the answers, and that’s when the support of colleagues became invaluable.
One significant decision I faced was whether or not to accept insurance in my practice. Initially, I was unsure how patients would respond or how it would impact our revenue.
A mentor in primary care offered me some sage advice: focus on the quality of care and build value around the patient experience.
They helped me map out a communication strategy to clearly explain the benefits of our approach to patients. This guidance was instrumental in building trust and loyalty among our patient base.
I ended up creating a practice that did not accept any patient insurance, and by working with my mentors and team to effectively implement this strategy, we saw per-patient revenue soar. It went from $264 to $634.
Resolving Staff Conflicts
Another challenge arose when I struggled to resolve a conflict between two staff members that was affecting morale.
Feeling overwhelmed, I reached out to a colleague who shared an effective method for mediating disputes. They suggested that I sit down with both individuals separately first, then facilitate a joint conversation focused on shared goals rather than personal grievances.
This approach worked wonders, and I’ve used it multiple times since.
A Staff Conflict Example and Resolution Process
One of the more challenging staff conflicts I had to resolve was between my front desk coordinator and my optician.
My front desk coordinator felt like she was being taken advantage of—she was constantly juggling patient check-ins, phone calls and paperwork while my optician wasn’t stepping in to assist when things got busy at the front.
When I spoke to my optician, I realized she hadn’t intentionally avoided helping—she simply assumed the front desk preferred to handle their own responsibilities, and she didn’t want to interfere. The issue wasn’t unwillingness; it was a lack of communication and unclear expectations about teamwork during high-traffic times.
When I brought them together, I focused on the fact that both of them had strong work ethics and wanted to do their jobs well, but they needed to better align on how they supported each other. We agreed that the optician could step in during peak times to assist with quick check-ins or phone calls, while the front desk would be more direct about asking for help when needed.
To reinforce a culture of teamwork and appreciation, I had my entire team take the Workplace Appreciation Language assessment (based on Gary Chapman’s “5 Love Languages”), so we could all learn how to express appreciation in ways that resonated with each individual.
Some employees value words of affirmation, while others prefer acts of service or quality time. This simple, but powerful, exercise helped us work more cohesively and made sure everyone felt seen and valued in their roles.
After implementing these changes, my front desk coordinator and optician worked much better together, and the workplace as a whole became more collaborative.
This experience reinforced the importance of setting clear expectations, having open conversations and making appreciation a core part of our work environment.
Embracing the Learning Curve
Starting my own practice has been a journey filled with unexpected challenges and valuable lessons.
From managing a team to making strategic decisions about patient care, I learned that adaptability and collaboration are key. Each challenge shaped my practice and helped me grow as a leader.
As I continue on this journey, I remain committed to creating a positive workplace culture, providing excellent patient care and embracing the learning curve that comes with being a practice owner.
If you’re considering starting your own practice, remember that challenges are part of the process, and seeking support from colleagues can make all the difference.
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: drkara@directcaredifference.
