Photos courtesy of Dr. Licausi and Dr. Zilnicki. Building a strong team starts with hiring. Here, the doctors are keeping the staff engaged with an escape room outing.
Are the best hires for your practice right in front of you?
By Jessica Licausi, OD, FAAO, FOVDR, and Miki Lyn Zilnicki, OD, FOVDR
Dec. 7, 2025
When we opened Twin Forks Optometry & Vision Therapy a decade ago, we thought hiring would be straightforward: post a job ad and choose the best resume. We quickly learned that hiring is much more complicated, and a large applicant pool doesn’t guarantee the right fit.
Hiring is one of the single most important yet difficult decisions a small practice owner makes. Today, we hire deliberately and with a clear philosophy: know the role, match candidates’ strengths to it and protect both the professional boundaries and the culture that keeps us a thriving team.
WHAT’S WORKING FOR US
Our current team is small but nimble. We have a full-time office manager who also handles billing, a full-time lead vision therapist, a part-time receptionist/vision therapist and one associate doctor. That’s a far cry from our early days, when a single full-time employee did everything.
That model felt efficient until the employee left—overnight we found out how vulnerable we were when critical responsibilities rested on a single person. As we scrambled to fill multiple roles, we learned an important lesson: distribute responsibilities, build systems and hire to sustain operations rather than to plug short-term holes.
A big part of our hiring philosophy is the belief that you must hire for the role, not just for general potential. We don’t subscribe to the “hire for personality, train for skills” maxim without nuance. Some skills are intrinsic to certain roles and can’t be taught.
Conversely, for vision therapy positions, we look for candidates who show compassion, empathy and the ability to connect with patients. The actual therapy techniques can be taught on the job.
We source candidates in three ways: personal and social connections, our own patients and traditional advertising. Each has its pros and cons, and which we choose depends on the role we’re hiring for.
HIRING PERSONAL CONNECTIONS
Personal connections have been invaluable. Our first full-time employee came to us via a trusted mutual contact. Having insight into her work ethic and values made onboarding quick and smooth. Similarly, our office manager started as a close friend with optometry experience and has become one of our most committed team members. When you already understand someone’s temperament and learning style, you can more readily position them for success in the right role.
HIRING YOUR PATIENTS
Hiring patients has been an unexpectedly rich source of talent, especially because we specialize in vision therapy. A former patient who completed therapy after a concussion initially offered to fill in at reception. She learned quickly, transitioned into a part-time vision therapy role and brought an empathy to patient care that couldn’t be taught.
Patients who’ve experienced your treatments can become incredible clinicians or front-line staff because they understand the patient’s perspective. Some of these relationships may even inspire your patients to pursue optometry school and eventually return to the practice as associates.
We treat friends, social connections and patients like any other candidate: a sit-down interview, documented expectations and standard review and compensation. From the very beginning, we make it clear that workplace dynamics differ from personal relationships and set firm boundaries—defined duties, regular reviews and no favoritism. Open communication and addressing issues early also help prevent personal fallout if the professional relationship falters.
Dr. Licausi and Dr. Zilnicki with their team on a special staff dinner outing over the summer.
HIRING THROUGH TRADITIONAL ADS
Traditional advertising still has its place in hiring. Posting positions online will usually produce the largest candidate pool but doesn’t necessarily equate to the best fit. It also means more screening work.
We’ve refined the process to be efficient: our office manager screens applications, schedules brief prescreening phone interviews to eliminate noncommittal applicants and invites two to three top candidates for in-person interviews. The prescreen call is especially useful—no-shows or folks who don’t follow through are eliminated early.
THE COST OF A BAD HIRE
Hiring the right people does more than keep staff happy. It affects throughput, collections, patient satisfaction and the bottom line. We learned this the hard way through one costly misstep. Early on, we leaned on a once-committed but increasingly remote employee for collections. Without day-to-day oversight and solid checks and balances, follow-up fell apart, timely claims were missed and some denials couldn’t be corrected.
Once we brought billing back in-house and hired the right person—organized, communicative and business-minded—our insurance write-offs and receivables fell by about 33%, immediately improving cash flow and cutting down the time spent firefighting billing issues.
LEARNING FROM OUR HIRING EXPERIENCES
Because of experiences like that, we measure staff performance with concrete metrics: receivable aging, insurance write-offs, recall percentages, no-show rates and conversion rates for recommended therapies. Those numbers tell me whether the systems we’ve put in place are working and help target where we need more training or a different hire.
Our one piece of advice on hiring in your practice is this: be intentional. Assess whether better systems could solve your pain before hiring more bodies. When you decide to hire, match strengths to roles, use multiple sourcing routes, maintain checks and balances and measure outcomes. Hiring well protects your culture, your time and your bottom line—and in a small practice, that payoff is enormous.
Read another story from Dr. Zilnicki and Dr. Licausi.
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Miki Lyn Zilnicki, OD, FCOVD, and Jessica Licausi, OD, FAAO, FCOVD, are co-owners of Twin Forks Optometry and Vision Therapy in Riverhead, N.Y.
To contact Dr. Zilnicki: DrZilnicki@twinforksoptometry.com. To contact Dr. Licausi: DrLicausi@twinforksoptometry.com |
