Photo courtesy of Dr. Julie Helmus, who shares key occupancy metrics for ensuring your investment in office space is as profitable as possible.
Key occupancy metrics
By Julie Helmus, OD
Sept. 17, 2025
My favorite private practice metrics, or key performance indicators (KPIs), can be divided into six categories: occupancy, doctors, staffing, optical, billing and profit and loss (P&L). The focus of this article is occupancy.
Within occupancy, I look at revenue capacity, sales per square foot and optical square foot percentage of total square footage, and more. Your office size and optical size can give you insight into your revenue potential. I also use capacity to help inform my budget and monitor occupancy-related expenses. Big picture: It’s hard to increase revenue year over year if you don’t have the physical space.
Square Footage as an Indicator of Potential Practice Revenue
A general rule of thumb is to multiply $1,000 by your total office square footage to get your potential gross revenue (sales). I’ll use my office as an example. We have 4,300 square feet. Times $1,000, I can expect to generate a maximum of $4.3 million in revenue.
Right now, we’re on track to hit $4.1 million. I don’t have much more physical space to grow. That’s a good time to start thinking about a second location. Most small offices with one optometrist are between 900 and 2,000 square feet in size. If your sales are static and you’re feeling stumped, it may be time to expand your footprint.
Sales Per Square Foot
Sales per square foot is an important number for many major retailers like Target. Most OD offices can generate $500 to $700 per square foot. Compare that to Lululemon, which can do $1,600 per square foot, Tiffany at $3,000 per square foot or Apple at $6,000 per square foot. Using my practice again as an example, if we’re doing roughly $4 million in sales, divided by our square footage of 4,300, my practice is producing around $930 per square foot.
Optical Square Footage as a Percentage of Total Office Square Footage
No matter how hard working and efficient the doctors are, much of the revenue in optometry practices is generated by the optical area. Layout and design of the optical can have a big impact on total sales in any practice. Ideally, the patient should enter and exit through the “gift shop,” which in our case is the optical.
Exposing patients to your high-quality space at the beginning and end of their visit will increase sales. If the patient can get out of the office without going through the optical, you’re going to lose out on potential revenue.
So how big should your optical be? The ideal size is 15% to 25% of the total square footage of the office. Take advantage of windows and lighting. I love a circular flow, so there is no backtracking or traffic jams. I refer to our optical as a “frame gallery.” My optical is too small, at 600 square feet. Using my practice again as a case study: optical square footage divided by total office square footage (600 / 4,300) x 100 = 14%. I wish it were easier to expand into my parking lot.
Exam Capacity and No Show Rate
How many comprehensive exams can your clinic conduct a month? This is determined by many factors, including but not limited to your number of pretest rooms, number of exam rooms, support staff per doctor, clinician pace, EHR efficiency, physical layout and other factors. You want your patients to move throughout your clinic smoothly and quickly. I think of real estate as “revenue generating,” such as exam rooms and optical, versus “non-revenue generating,” such as staff lounge, manager offices, bathrooms and so on.
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If your layout, staffing, and systems allows you to conduct 150 comprehensive exams per week, do you allow for 150 openings in your patient schedule? No. You want to build a schedule with 180 openings, or 20% above the 150. The reason to over-book is due to no-shows and cancellations, which will occur even if you institute a “no-show” fee.
No-show rate is an important metric that few practices tend to track. However, it must be measured in order to be managed. No-shows will erode your practice profitability. It’s an easy metric to calculate, and it’s tracked as a percentage.
We track it manually at my practice: number of no-shows divided by total number of scheduled appointments, multiplied by 100. Ideally, you want this to be in the single-digit range. For the first six months of 2025, our average no-show rate was 9%, up from 8% during the same time period in 2024, despite instituting a no show fee of $35. Time to raise the fee?
How can you use your exam capacity to set a budget? Say you’ve determined that you can conduct 600 total comprehensive exams in a month. Now, what’s your average revenue per patient (also known as revenue per refraction)? Keep in mind that many of these industry standard metrics ignore medical visits or follow-ups and just count comprehensive exams. If you can do 600 exams per month and on average generate $450 per refraction, then 600 multiplied by 450 equals $270,000 — your monthly budget. This is a quick and simple budgeting benchmark.
Occupancy as a Percentage of Income
Lastly, how much should you be spending on total occupancy? First, define total occupancy: This includes rent (or PITI if you own your building), utilities, landscaping, security, window cleaning and janitorial. In your chart of accounts, make sure all these categories fall under occupancy. Bookkeeping software such as QuickBooks lets you run a P&L report that compares all expenses as a percentage of income.
Anticipate spending 6% to 8% of your sales on total occupancy. For example, if you’re generating $1 million in sales annually, you are likely spending $60,000 to $80,000 a year on total occupancy. If it’s any more, look for leaks. Very high-cost areas such as New York City, or Santa Monica, California, will be outliers. For those that own their practice real estate, I see this metric in the 8% to 12% range, since as the landlord, they often charge the corporation a higher rent.
Geography Matters
As always, keep in mind that these general KPIs are national averages and do not account for local or regional differences like payroll and occupancy costs.
Study Your Practice
The point is to be your own “business scientist” and document your own metrics over time. Look for growth or decline. Use your metrics to help determine your practice’s strengths and weaknesses, set goals and take action to increase your sales and profit.
Read another article by Dr. Helmus
Julie Helmus, OD, is a second-generation optometrist and owner of Helmus Optometry in Davis, Calif. To contact her: dr.julie.helmus@helmusoptometry.com
