What 25 Years of Owning a Practice Taught Me About Growth

Share

Share

Share

Share

Email

Comments

By Bethany Fishbein, OD

July 16, 2026

Quick summary:

• The biggest lessons from 25 years of practice ownership center on thinking bigger, leading intentionally and growing with purpose.
• Early success came from reinvesting heavily, building year one to compound future growth and pushing past what felt “safe.”
• Leadership had to be learned the hard way, with mistakes, books and experience revealing that owning a practice is also a separate job.
• Staying grounded in the numbers helped separate real problems from temporary panic and guided better decisions.
• Growth was often driven by people—partners and staff—whose potential required a bigger platform to keep them challenged and growing.

In July of 2001, my husband Jonathan Fishbein, OD, and I opened Somerset Eye Care as a cold-start practice. We were young, hopeful and (to be completely honest) probably a little naive about what we were walking into. Maybe you have to be to actually do something like this!

Our 25th anniversary has me reflecting on the most valuable lessons we’ve picked up along the way; I hope they are useful to you.

THINK BIGGER THAN YOU THINK YOU DESERVE

People ask about the most important thing we think sets our practice apart, and it’s undoubtedly this. Before we even opened, Jonathan and I decided on what we thought was our ultimate future goal: build a practice collecting $350,000, and take home $100,000. In the year 2000, this felt ambitious enough to us.

When we shared this with an advisor, he looked at us and said matter-of-factly, “Okay. What do you want to do in the second year?”

Later, the same advisor said something that I printed and taped to my computer: “The first million is easy. You should get that just for showing up.”

This perspective completely changed how we thought about building the practice. All of a sudden we weren’t building to $350,000, we were wondering how to start there. And we decided that if we were going to grow some percentage year over year, then the most important thing we could do was make year one as big as possible, because everything would compound from there.

So we didn’t take a paycheck that first year, and we put every dollar we could into marketing the practice. We drove around the community, looking for neighborhoods and streets that seemed high-potential and reverse-searched addresses to build a mailing list (this was pre-Google– today you could do this in five minutes on a website like DataAxle). We sat with our one staff member, folded letters and stuffed envelopes, dropping our “little workers” into the mailbox to introduce people to our practice. And we celebrated when the phone rang. Every appointment was a victory, and our goal became to take such great care of each patient that they’d have to refer someone else.

Our EHR numbered our patients sequentially, and it’s thrilling to see some of those original patients still come in today.

Funny enough, we are using the same approach for an office we opened earlier this year. We bought the mailing list instead of making it ourselves, but the “little workers” are still doing just as well. Some things don’t change.

Takeaway: Push your vision (or surround yourself with people who will push your vision) bigger than feels safe. Re-invest as much as you can to build year one like it matters; because every year after is going to grow from that.

“LEADER” IS A JOB

Like many new practice owners, I assumed the people part would be easy. In my mind, everyone would get along and have a great time, just like my previous lifeguard team at summer camp! I had zero training in running a business or leading a team, and it honestly didn’t even cross my mind that I needed any.

I learned quickly that “leader” or “practice owner” was an entirely separate job, for which I was highly unprepared and unqualified. The first time I had to let someone go, I was terrified. The first time an employee left on her own, it was even worse. She had believed in my vision enough to follow me from her previous job, and I handled her departure so poorly that she walked out in the middle of a day. We haven’t spoken since, and I still carry that.

I remember the morning of September 11, 2001. We had only been open a few months. My dad called me to make sure I turned on the TV. As the news trickled in, patients were still coming in, but our one employee wanted to leave to be home with her family. We let her go home, and this was maybe the first time I realized how much my decisions would affect other peoples’ lives in very real ways.

When we hired our first employee who had children and genuinely needed her paycheck to make ends meet, that felt even heavier than anything before it. Someone was trusting her family’s well-being to our business’s success—what a responsibility!

Takeaway: Leadership is a skill, not a personality trait. It has to be learned. Most of my leadership learning was on the fly–through mistakes, through books (“E-Myth” before we opened, “Radical Candor” later and probably not soon enough), peer interactions and workshops. The sooner you accept that you don’t know how to do it, the sooner you can start.

SLOW DOWN (AND LOOK AT THE NUMBERS)

Early in my ownership, I reacted to everything—and fast. A slow day on the schedule felt like a crisis. A low bank balance felt like the beginning of the end. A staff member would tell me a patient was “absolutely livid” and I’d be in fix-it mode before I knew what had actually happened. (And nothing actually happened. The staff member was having a bad day, and the patient was just checking on their order. Now I don’t let one complaint change my protocol, which is what I wrote my last column about. Check it out here.

What I’ve learned over 25 years is that the feeling of crisis (or elation) is almost never the whole story. The most grounding thing I’ve done as a leader is build the habit of looking at our key metrics: collected revenue, exam volume, capture rate, insurance aging. These tell a very different story than a slow afternoon or a three-payroll month. When practice owners feel like the sky is falling, it’s usually a cash flow timing issue, not a real emergency. But without the habit of checking, it’s easy to make reactionary decisions—putting everything on sale, cutting a staff member, getting a second job, questioning all of your business and life decisions—based on feelings instead of facts.

Takeaway: Build the habit of watching your numbers regularly so you can lead with facts, not fear.

GROWTH ISN’T JUST ABOUT THE BUSINESS

We met our partner Tobin Ansel, OD, when he was a pre-optometry student. When he left for school, something shifted in me. I wanted to build something that he could come back to, at a level that would make sense for him.

A lot of our growth has been like that. Not so much “We need to expand” but “The people around us have more potential than our current practice can hold.” Our additional locations have been in part so that our partners can have the joy (and pain!) of building something from the early stages, not just stepping into something already built. There’s something amazing about that early ownership feeling. I want our partner ODs to experience it, if that’s something they want for themselves.

We’ve also grown for staff members who’ve wanted more—more growth, more responsibility and more income than our one-location practice could provide. In some cases, the only way to keep great people is to build something big enough to keep them challenged and growing.

Takeaway: Pay attention to what the people around you are capable of. Sometimes the most motivating reason to grow is to raise the ceiling for someone else’s potential.

WHAT WILL THE NEXT 25 YEARS LOOK LIKE?

I talk about vision and goals a lot in my columns, so it feels a little bit uncomfortable that I don’t have a clear answer for what Somerset Eye Care will look like on its 50th anniversary.

In 2051, Jonathan and I will be in our early 80s (well, I’ll be 79…). I guess what I hope for is simple: that Somerset Eye Care is still in business and still serving our original mission of taking care of people the way we’d want someone to take care of us and the people we love.

I hope our partners and team members have gotten what they were looking for and deserve—financially, professionally and personally, and that we’re still in good relationships with all of the people who’ve mattered along the way.

Most of all, I hope we’ve inspired a few people to do more, become more and think bigger, the way someone did for us 25 years ago.

Read more insights from Dr. Fishbein here.

Bethany Fishbein, OD, is a practice owner, practice management consultant and certified executive coach. She can be reached at bethany@leadersofvision.com