Photo Credit: Dr. Nick Lillie
How focused simplification and specialization beats being everything to everyone
By Nick Lillie, OD
April 20, 2026
When I started my practice cold in 2011, I had just graduated. I honestly felt like I could do anything my optometric license would allow.
In the early days, I treated glaucoma, did vision therapy and prescribed glasses and contact lenses. I would take calls 24/7, and I would not say no to a patient willing to pay for my services. In essence, I was trying to be everything to everyone.
A FAST PATH TO BURNOUT
The beauty of optometry is that we are licensed to treat a multitude of things. You do what you need to do when you have zero patients and are starting from scratch. However, as your staff and patient base grow and your time is more limited, being everything to everyone is a one-way street to burnout. It can stagnate an office’s growth.
It’s an important lesson to learn across all small businesses and not just in optometry. The Fast Company article, “Why Small Businesses Must Go Narrow (Extremely Narrow) to Survive,” details how the path to success runs through radical specialization. The author emphasizes that, as small-business owners, we do not have the resources to compete purely on hours, service or price. Our advantage is the ability to go from generalist to specialist.
It’s challenging to stay up with what’s new on dry eye, glaucoma and binocular vision alone. I invite you to think about how much bandwidth you have to do optometry well. When we dabble in all of the above, we can fall down a path of becoming a jack of all trades, but a master of none. The better strategy is to become masters in our niches and refer to other ODs who are specialists in the areas we are not, or employ associates that specialize in areas that complement your skill set.
STEPS TO STRATEGY SIMPLIFICATION
The strategy of simplification is much easier to talk about than to actually put into practice. Often the systems we put in place are creating more complexity rather than simplifying what we are doing. When we are constantly adding complexity, it not only confuses your staff, but patients get overwhelmed. They may walk when there are too many offerings because it’s difficult to make a decision.
When we simplify and specialize in how we run our practices, it makes our staff better at what they do, our office more efficient and provides better outcomes for patients.
Here are five steps to take to simplify.
STEP 1: DEFINE YOUR TERRITORY (SPECIALTY)
The broader your offerings, the more competition you face. Patients will see what you do as a commodity, and then it comes down to price and convenience. This is the case with glasses and contact lenses. Not only are we competing with our fellow ODs, but there are numerous corporate entities and online store fronts that have the power of scale. They can offer pricing we cannot match.
When you serve a specialized niche, you face little to no competition because your offerings are so specific. This is great in theory, but to be successful, you need a patient base that knows about or values your services.
As a result, I am not suggesting you stop doing everything all at once. You are the CEO of your business and need to have a strategy to scale. In my office, we specialize in dry eye and ocular surface disease. We still do primary care and sell glasses and contact lenses, but primary care exists to detect our dry eye patients. Dry eye is not an add on; it is our clinical focus. We are not trying to compete with the commodities. We merely have them as a convenience as we scale what we specialize in.
STEP 2: IDENTIFY THE ONE SERVICE OR OFFERING (PER QUARTER) TO STOP DOING
How do you do this in a systematic way? Once you figure out what you want to specialize in, you need to identify one high-impact service or offering that you are going to stop doing. Then, repeat this process quarterly.
Do an inventory of your current services or offerings and run them through a filter that will answer the following questions:
- Does it directly increase identification or conversion to your specialty? If the answer is no, move to question 2.
- Does it require a lot of mental bandwidth with low return? If this answer is yes, move to question 3.
- Would your competition miss it more than you? Thinking about the competition is not your main focus as you are optimizing what you do, but if they would miss it more than you, they probably have more skin in the game to make it successful. This helps judge your commitment to the process or offering.
Here’s how I applied this process in my practice over the past two years:
We stopped low-margin optical sales. If a patient is price conscious and cares merely about price, then they are not going to like what we offer. We still have an optical, we just focus on high-end frame lines and premium lens options.
Patients who value care over price self select in. Our practice does not just sell glasses, we solve eye problems.
We stopped treating mild dry eye symptoms casually. We know the road our patients are on, and we want to stop them before it becomes severe. As a result, we screen every patient and discuss strategies for improved lid hygiene and ocular surface with every patient.
If there are symptoms or clinical signs, there is an issue and we are going to treat it just like we would if they had an elevated IOP or an enlarged CD ratio.
We stopped trying to specialize in everything. At a certain point we dabbled in scleral lenses, home vision therapy and orthokeratology. But our staff can only handle so much. Chair time is a premium, and we were not fully committed to any of these.
By referring these to other providers, training is easier, marketing is easier and our patients know what to expect from us.
STEP 3: MAKE THE SUBTRACTION OPERATIONAL VS. THEORETICAL
Once you decide what task you are going to stop, make sure everyone is on board with the change. Your job is to relay the message and keep repeating it. In this case, you go from CEO to CRO, the chief reminding officer.
All staff and doctors need to know about the change. It is very easy to have legacy patients or the desire to make an exception here and there. However, that is not true subtraction. It will only create confusion and mixed messaging. Exceptions create chaos. You need to avoid chaos.
Make sure to reassure your team that fewer services and offerings leads to better systems and better patient care. You are doing this to improve patient care, not reduce it.
STEP 4: MARKET YOUR MESSAGE WITH INTERNAL AND EXTERNAL EFFORTS IN ALIGNMENT
The next step is telling the world what you do. You have to align your website, social media pages, Google Business Profiles, etc., with the new messaging.
I have separate websites, social media pages and YouTube channels for Family Vision Optical (my primary care office) and Rejuvenation Dry Eye Center. The messaging is complimentary, but distinct for each.
My staff is also trained to separate the two when speaking to patients. This has helped us attract the patients that value our services. We are not the right office for everyone, but the people that value the best possible clinical care love what we offer.
STEP 5: MONITOR KPIs, REFINE AND REVISIT QUARTERLY
Remember that business is dynamic and always changing. Our job as CEO is to see 10 years into the future and guide the office to where we will be most successful. This is not done blindly or on gut feelings.
Monitor your KPIs, constantly refine and improve your systems and process and revisit the subtraction list quarterly. You will be surprised with the results that you see.
In my case, one specific metric we started tracking were our TFLs (tear film and lid evaluations). We noticed that we had a huge demand for our dry eye services and had to make room on the schedule. When we looked at the numbers, these were the patients we wanted to see—patients who got value from our services and grew our dry eye specialty. The problem was we had a lot of need and not a lot of space on the schedule.
Then, we compared that to our scleral lens fits. They were profitable, but ate up a lot of chair time and required multiple visits. When we looked at the numbers TFLs were the priority and sclerals had to be subtracted. We opened up space by referring to a local OD, and he has sent us some of his more complex dry eye patients. It was not merely about profit, but chair time and space on the schedule also helped drive this decision.
START TODAY ON YOUR OWN STRATEGY SIMPLIFICATION
This final thought motivates me through these changes: The moment we stop trying to be useful to everyone, you become indispensable to someone.
Read more from Dr. Lillie here.
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Nick Lillie, OD, is the owner and founder of Family Vision Optical and Rejuvenation Dry Eye Center in Allendale, Mich. He is also the host of the weekly podcast, “Optometry: The Ultimate O.D.” To contact him: drlillie@therdec.com. |
