Professional Development

OD Under Pressure: Signs You’re NOT OK & How to Get Relief

By Pamela Miller, OD, FAAO, JD, FNAP

March 9, 2022

The pandemic has been with us in the U.S. for two years. It started with a two-month loss of routine eyecare services for most practices, and is ongoing in the continued disruption of life as we once knew it. The financial and emotional stresses that have been placed on practice owners since the start of the pandemic are substantial. If you feel overwhelmed, are short-tempered, can’t sleep, or are running low on energy, you’re far from alone. It may be time for a mental and emotional health check-up.

Here are tips for recognizing the negative psychological impact the demands of the pandemic are having on you, and what to do to better cope.

You’re Having Trouble Meeting Demands as the Pandemic Worsened
The pandemic worsened the stresses that were already present in many of our lives. You may have always worried about staffing, for instance, but now you have employees quitting because we’re in an employee market in which more is expected of employers and many small businesses are having difficulty keeping or hiring new employees.

You always worried about your practice’s finances, but now you may still need to catch up and fully recover from the months when your office was closed and then reopened to a lower-than-average patient volume. Meanwhile you still have to pay back the Paycheck Protection Program loan(s) you took, as well as any additional loan funding.

You also may be caring for children and elderly parents whose schedules and routines were impacted by the pandemic, putting additional pressure on the care you provide to them.

Signs the Worsened Pressure is Getting to You
As practice owners, we’re taught to swallow our stresses and keep the business running, whatever it takes. This mentality can make it possible for your business to endure great hardships, but may wreak havoc on your health. The stresses you are keeping to yourself can result in physical symptoms like digestive troubles, headaches and increased fatigue. Don’t overlook seeing your physician to confirm that your overall health is not at issue.

In addition, unexpressed stress can cause you to snap at patients and staff when they ask questions. A staff member asking for a day off the following week might receive a more unfriendly, stern response than you intended to deliver. The patient, who wants to review his treatment regimen with you one more time, may get snapped at instead of receiving the kind, deliberative response you intended.

When the Pandemic Pressure Cooker Bursts
If left unexpressed, the practice owner may advance from not feeling great and not managing employees and patients well to having thoughts of hopelessness and futility.

That could lead the practice owner to decide to look for a private equity firm or another buyer to sell to, closing the practice, or even alcohol or substance abuse and suicidal thoughts.

Looking to Productive, Positive Solutions With Your Staff
Since the answer to worsened pressures is not to lash out at patients and staff, or to abuse yourself, and because most practice owners would like to avoid selling their practice under duress, it’s best to seek other solutions. Your staff can be your most valuable resource in finding solutions to business challenges.

One solution to reduce pressures is to share some of what you are experiencing with your staff. If the office is under increased financial pressure, your staff probably has already figured it out. They may be worrying about it too since the collapse of the practice would mean the collapse of their livelihood.

“As you probably have noticed, we are not generating the level of profitability we did before the pandemic. We want to be able to continue providing our patients with the same high level of care that we always have, but we need to find places where we can cut costs. Does anyone have any ideas?” You may be surprised at what your staff comes up with. Being on the front lines of office operations means they may know a particular service or product you have been paying for is not being put to good use, and can be discontinued without negatively impacting patients.

“I have noticed that our patients primarily favor appointments later in the day, and that not as many as I originally anticipated want to see us on the weekends. What would you think about starting later in the day during the week, while keeping the same closing time and only offering Saturday hours every other weekend rather than every weekend? This may impact your income, so I wanted to see how you felt about it before I made these changes.” Some staff may be upset at the loss of income, but others may welcome the break from early mornings and Saturdays devoted to work.

You also can come up with compromises with staff in which a smaller number of staff come in early in the morning, rather than having the full office show up at a time when the patient volume is typically low.

In my own office, my staff and I decided that it made sense for us to reduce our hours on Mondays and Fridays to 1 p.m.-4 p.m., and to only be open for appointments two Saturdays per month, while maintaining our regular hours the rest of the week. This compromise may not work in a more urban or central city location.

The solutions to business challenges, such as cost-cutting and creating a more livable work schedule, will vary depending on your patient demographics and financial situation. What is always true, though, regardless of the practice, is it’s worth collaborating with your team to find solutions rather than throwing up your hands and giving up without asking for help.

Making Changes to Your Personal Habits
Developing an interest outside of your work can be a great stress elixir. Those interests can include participating in local charities or in pastimes like sports or crafts. Among other activities, I donate my time to animal rescue. This is a great passion for me that does good while taking my mind off of work challenges and stresses. Even just adopting one pet can be a huge stress reducer and mood lifter. Research shows that spending time with animals often makes people feel better.

Adjusting your diet and exercising can also boost your mood and help you better manage stress. In addition, enforcing a consistent sleep schedule can do wonders, as stress becomes harder to manage when you’re tired.

Getting Professional Psychological Help
Sometimes the pressures you are experiencing will not be sufficiently relieved by changing your personal habits and working with your staff to find solutions to business challenges.

In those cases, you can benefit from the services of a professional psychologist or licensed therapist. If you have a family doctor who you know takes a more holistic approach to medicine, this doctor may be able to give you a good referral for a psychologist or therapist. However, it’s important to recognize that many primary care providers will refer a patient in need of psychological help to a psychiatrist rather than a psychologist or therapist. That could result in a greater focus on the prescribing of medications versus long-term talk therapy as a solution. Whereas a psychologist or therapist will assess whether medication is likely needed, and if needed, refer you to a psychiatrist. If you are utilizing your insurance, then you may have little or no choice in who you see, which can create even greater stress, if you don’t ‘gel’ with them.

Another approach that can result in finding professional psychological help is to Google “psychologist in X city” and research the credentials and Google Reviews of the doctors that come up in the search listings.

With the right support from your practice team and, when necessary, professional psychological help, you will be given the extra lift you may need to keep both yourself and your practice running.

Pamela Miller, OD, FAAO, JD, DPNAP, has a solo optometric practice in Highland, Calif. She holds a law degree and a therapeutic license, is California State Board-certified and glaucoma-certified to prescribe eye medications, and offers comprehensive vision care, contact lenses, visual therapy and low vision services. To contact her:


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