Practice Management

How We Changed Course to Grow 20% in Gross Revenue in One Quarter

The staff of an optometry practice poses for photos. The owner of the practice says its better to let an under-performing staff member go than to have them stay be a burden to the rest of the team.

Dr. Cargo’s practice team. He says that it’s better to let an under-performing employee go than to bring down the morale and efficiency of the whole team by keeping them on staff.

Improvements in staff management that make patient experience and profitability soar.

By Jonathan Cargo, OD

Sept. 13, 2023

Practice ownership requires constant attention to what you could change to better care for patients and enhance profitability. That includes how you manage staff. Here’s how to realize tremendous gains in patient experience and profitability by adjusting how you manage under-performing employees.

Letting Go of Under-Performing Team Members Faster

When we hire a new team member, we have great expectations and hope that they will be with our practice for many productive years. However, some either lose their passion or never have the work ethic we’re looking for. Sometimes this can even happen with a long-term employee, and I’ve made the mistake of keeping them out of fear of not being able to function without them.

Often, other team members have to work around this unmotivated team member. This creates frustration and negativity within the office. It also makes more work for the other employees, who often must fix the under-performer’s mistakes or cannot depend on them.

Short-Staffed Better Than Having Poor Performer on Team

I was always concerned that we’d be short-staffed, but the team consistently has told me that they would rather be short-staffed than have to work around someone who isn’t a team player.

I like to address under-performance directly with the staff member. I recently read the book by Brene Brown, “Dare to Lead.” Brown emphasizes that to be clear is kind, to be unclear is unkind. I talk about our expectations and ask why the employee’s performance has slipped. This gives the team member the understanding that the work isn’t up to our expectations and that they need to improve.

When It’s Time to Cut Ties

Unfortunately, this conversation sometimes doesn’t permanently resolve the issue. I then ask myself if this is a training issue or a character issue. If I determine that training won’t fix the issue, then it’s time to consider releasing the employee.

I used to be concerned about losing a team member instead of focusing on the opportunity. Every time I have released an under-performing team member, the rest of the team is grateful. They also are able to take on new tasks, and are excited about that opportunity. Plus, it allows us to find that next rock star to join our team. I have found many great employees who were far better than the one we released. Overall, the team is happier and the culture in the office grows and improves.

Although patients miss some long-term employees who move on, they are usually  happy when they are served by an employee who is passionate about their eyecare. Overall, their eyecare is improved by us having better support staffing.

Impact on profitability: During the great resignation of 2021 we lost several team members who had been with us for 10 or more years. This could have been considered a major step back, however we reduced our schedule and hired some great new employees. Several of them had no previous eyecare experience, but we trained them, and got them back up to speed, and were able to grow by 20 percent  in gross revenue the following quarter.

I think most of us have heard the advice to “hire slow and fire fast,” but this is easier said than done due to the demands of running our service-related business. However, I think more damage is done by keeping someone who isn’t performing. Take action and control your business by having the best team, and don’t be afraid of making a change for the better.

Jonathan Cargo, OD, is the owner of Cargo Eye Care, a Vision Source practice in Irving, Texas. To contact him: 



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