Practice Management

Inside the Decision & Planning to Add an Associate Projected to Deliver 16-20% Annual ROI

Dr. Cappacioli (center) with his team at Peak Eyecare in Durango, Colo. He says that an associate will both make care more accessible and allow his practice to grow in volume and profitability.

By Davis Capaccioli, OD

Feb. 22, 2023

An associate optometrist can expand access to and quality of care. After launching a cold-start practice a little over a year ago, I decided that I am now at the point where my patients and practice would benefit from an associate OD.

Here are the logistics of adding an associate so that our needs are met while increasing profitability.

Why Now?
The building I purchased was previously owned by a retiring ophthalmologist, and there is space for four lanes. With just me, I am only using two of those lanes. I am also working one day a week as an employee in a highly medical OMD/OD office serving the Navajo Nation, which I find rewarding, and I am not ready to give that up yet.

Therefore, by the end of the year, I plan to add a part-time associate OD, who could work in our office 2-3 days per week. By adding an associate, I would better use the space that I am in (which has a fixed cost), and be profitable on the days that I am not in my own office.

What Needs to Happen to Profitably Add an Associate?
Actions I plan to take to make this investment by the end of the year:

  • Post the job listing on surrounding states’ optometric association websites and talk to my reps to let them know that I am looking for an associate OD.
  • I will need to finish equipping the two extra exam lanes to get them up to date.
  • Currently I have four team members. I will need to have a total of 6-7 team members to support a two-doctor office. Hiring has been challenging.
  • Need to build out an office space for the new associate and make improvements/find solutions for ongoing problems before the new associate is hired. There are many things in my exam flow that are not perfect that I just deal with, but which I want to fix ahead of adding an associate. Examples include:

I do not have a good notification/paging system to communicate with my team when I am in the exam room. My EHR system works well, but still leaves many things desired. I will need to decide if I will stick with that system or try another one.

I can deal with the extra steps required when these things do not work correctly, but I don’t expect an associate to do the same. I want to either replace the unsatisfactory systems in our office or find ways to improve what we have.

What Goals Have Been Set to Make Hire By Year’s End?

  • By the end of Q1, I will have decided whether to change my EHR. I will also have job postings live.
  • By the end of Q2, I will have added two more team members and have decided on a notification/paging system for my team. If I have not received sufficient applications for an associate doctor, I will consider paid job listings.
  • By the end of Q3, I will have built out the two exam lanes and made an office space for the associate doctor.

What Staff & Doctor Training Will Be Necessary?
There will be training that is needed for our employees to adequately support both me and the new doctor. The new associate also will need training in the culture of our practice and how our office operates.

I will need to train my front desk team to be more mindful in how we schedule patients. If we are scheduling for two doctors, we need to make sure that we don’t schedule two patients at the same time who both need a full glaucoma work-up, for example.

I will need to make sure the new doctor understands my practice’s values and what we are trying to accomplish in Durango, Colo., where our office is based. It will need to be a perfect fit if I am going to bring someone on so early on in my cold-start practice.

Bottom Line: How Much Will All this Cost & What Will the ROI Likely Be?
Cost: I expect to spend $170,000 in time and money for hiring new team members and purchasing the needed equipment to outfit the other exam lanes.

ROI: After the associate OD is up and running, seeing patients 2-3 days per week, I expect to see an annualized return on my investment of 16-20 percent.

Davis Capaccioli, OD, is the owner of Peak Eyecare in Durango, Colo. To contact him:

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