Photo courtesy of Dr. Zachary Holland, who is seen with his associate optometrist, Helene Pippin, OD, FAAO, ABO. Dr. Holland shares tips for making a profitable new associate hire.
Crunching numbers to ensure a profitable new associate hire
By Zachary Holland, OD, FSLS
Sept. 24, 2025
If you are considering hiring your first associate in your practice, I’ll admit it: The process can be stressful.
Some of us wait too long and slow down our growth curve. Others hire too soon and find the new associate isn’t set up to excel.
When I finally brought on my first associate, I made sure we had the space and patient flow to support her. She started at three days a week, and within six months her schedule grew to three and a half days.
Projecting 18 months, we’re on track for her to be covering 4.5 days a week.
Here’s an inside look at my practice numbers after a year of working with an associate.
Clinic Capacity and Staffing: Maximizing What We Had
One of the first things I learned: We didn’t need extra staff. After hiring my associate, we actually went from 16 to 24 doctor days a month, just by making better use of the team and space we already had.
Our clinic was built out with five exam lanes from the start because I always planned on growing. Even as non-doctor payroll costs rose about $14,000 since 2023, our staff payroll as a percentage of collections actually dropped 2.9 percent.
In short, opening more appointment slots led to higher revenue without bumping up staffing costs.
Revenue per Exam vs. Revenue per Day: The Trade-off
My favorite KPI to track efficiency is “revenue/exam.” When we shifted from 16 to 24 doctor days a month, appointment availability jumped and patient wait time dropped. That change caused total revenue per doctor day to dip by 21 to 30 percent compared to previous years—a big number and an expected side effect of adding capacity.
Here’s the good news: Revenue per exam only fell by two to five percent. So even working three days a week instead of 4.5, I kept almost the same revenue per patient, even though the revenue per day was down.
Owner Profitability: The Big Question
Let’s talk about what kept me up at night—what happens to your own profit if you delegate patient care? Would my associate produce at my level?
For anyone wrestling with this, here’s what happened for me: Over the first year, my average monthly profit jumped by more than 80 to 130 percent after reducing my schedule from 4.5 to 3 clinical days a week. I got days off to work on the business instead of just in the business, and it drove both growth and profit.
Patient Care Expanded—Without Adding Days
I worried at first that dropping my own clinical days and replacing them with my associate would stall the business. I incorrectly assumed that no one could do it as well as I can. Instead, we saw appointment availability increase. Total appointments completed went up 10 to 15 percent, and total comprehensive visits climbed by 14 percent.
Our clinic is highly medical, so our cost of goods stayed flat—COG increased zero percent. Meanwhile, clinical revenue climbed 19.5 percent. If you are highly optical based, don’t expect this.
Key Takeaways From Adding My First Associate
By hiring my associate for three to 3.5 days a week, I was able to drop my own patient care from 4.5 to three days.
- Non-doctor staff costs, occupancy and equipment costs all stayed nearly the same.
- Revenue per patient barely dipped, while my take-home pay rose 80 to 130 percent.
- Visits per month grew 10 to 15 percent and comprehensive appointments followed.
- No new equipment was needed and owner W2 salary was unchanged despite working fewer days.
Peer-to-Peer Advice
If you are thinking about hiring an associate, make sure your clinic can handle expanded capacity, and don’t underestimate the impact on your personal (and business) life.
Adding an associate let me reduce my time in the clinic and dramatically grow my business, all while serving more patients.
The OD wage might look scary at first, but with some careful planning it can be the best move you make for your practice and your own quality of life.
Read another article by Dr. Holland
Zachary Holland, OD, FSLS, is the owner of Cornea & Contact Lens Institute of Minnesota. To contact him: drholland@corneaandcontactlensinstitute.com
