By Ian G. Whipple, OD
Jan. 5, 2022
Independent practice ownership comes with a multitude of challenges. Here are three I am confronting at the moment, including the solutions I am implementing to create a better practice for patients while maintaining profitability.
Difficulty Hiring During “Great Resignation”
We are experiencing what has been called the “Great Resignation.”
Challenge: The number of job openings decreased to 10.6 million on the last business day of November, the U.S. Bureau of Labor Statistics reported in its latest Jobs Openings and Labor Turnover Summary (JOLTS). However, hires were little changed at 6.7 million and total separations increased to 6.3 million. And within separations, the quits rate increased to 3.0 percent, matching a series high last seen in September.
It seems like every business has a “now hiring” sign, and companies throughout the world are facing a labor shortage. Not surprisingly, this shortage is affecting many optometry practices. My two-doctor, 15-support staff office is no exception. We are having difficulty finding top-quality candidates, and our open positions are taking significantly longer to fill. Prior to this labor shortage I would receive around 100 resumes for each open position. I would interview half a dozen and would usually end up with one or two stellar candidates. I have been trying to fill one position in my office for more than a month. I would rather leave a position unfilled than hire out of desperation, and so we continue the search for a fantastic teammate.
Solution: I am continuing to train my current employees, search for additional labor and redefine our current employment strategies.
I am acutely concerned about potential burnout of current staff members. We have tried to automate as many processes as possible to reduce the current workload. Processes such as trial contact lens ordering is simplified by using a trial lens scanner, which automatically orders replacements from our distributor. We have used CLX for several years to assist patients in reordering contact lenses without the need for staff intervention. We use Weave for automated appointment confirmation and other automated communication with patients.
The biggest change we are making to confront this challenge is evolving the phone receptionist position so the receptionist can work from home. This helps us socially distance and removes the task of addressing inbound calls in our in-person office. We have completely shut the inbound lines off in the office. Only the remote receptionist can field phone calls. We have not yet perfected this process, but the results are positive so far. My office staff can more easily focus on the patient in front of them and can trust that our virtual receptionist is managing the schedule and phone calls.
To make this change we had to purchase new computer/phone software and hardware. My office has spent roughly $2,000 on moving the receptionist position off-site.
We expect that once this virtual receptionist is fully trained, it will save us about two hours of staff expenses per day. My staff will be able to communicate via text and instant messaging instead of waiting on the phone for each other. Saving just two hours per day will add up to significant payroll savings. I plan to reinvest these payroll savings by offering higher wages to all employees so that we can continue to stay competitive and attractive to both current and prospective employees.
My support staff has probably spent a collective 80 hours on implementing this change. I have personally spent 20 hours researching and implementing this new evolution in our practice.
The at-home virtual receptionist position is appealing for a different type of job-seeker who might not apply for my in-office positions. This position should be easier to fill and keep filled. Patients will learn to expect that there is just a single staff member answering the phones in my office now. This single person also has the advantage of working in relative isolation.
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When I moved my billing specialist to an at-home work environment she was quickly able to do her same 35-hour per week job in just 20 hours. This increased efficiency happens because there are fewer distractions and friendly (but sometimes unnecessary and/or inefficient) conversations with co-workers.
Challenge: Inflation surged 6.8 percent in November, even more than expected, to fastest rate since 1982, according to CNBC. Inflation means that the products our practices need to operate and sell to patients have become more expensive.
I still accept insurance and am in-network for several vision insurance plans. I cannot increase prices for most of my goods and services because insurance contracts will only reimburse for the contracted amounts. Increasing prices can work for self-pay patients. We are implementing several increases in prices (for example: we are raising our contact lens evaluation fee and refraction fee.) But even these increases are modest and will only offset a fraction of inflationary pressure.
Solution: Several frame vendors have increased prices on the products we purchase from them. We are responding by dropping the frame lines that don’t continue to make sense from a profitability standpoint. We are also actively looking at other cost savings measures.
For example, I have used ScentAir since we opened our new practice. While I love the customized scent that this product provides, temporarily dropping this product from our practice is an easy cost savings move for us. (Many patients can’t enjoy the product with their masks on anyway.)
We have also been successful in renegotiating terms with Pitney Bowes for our in-office postage meter. In addition, I tasked my staff to find other smart ways to cut costs or increase revenues in our office.
I have previously written about non-insurance-based revenue generators in our practice and specialty care such as aesthetics, medical emphasis, vision therapy and low vision. All of those services could open additional sources of revenue which could help offset inflationary pressures.
I want to continue to provide the best service and products to my patients. I hope they will understand that in order to do this, we are slightly increasing our prices for out-of-pocket services.
I analyzed our current pricing and found there was one contact lens, which, though I didn’t fit it often, was priced incorrectly in our system. A handful of patients have been ordering it for less than it costs me to purchase it! The last time I updated the price of that lens was 2014. Good thing we only sell 10 boxes per year of this product, but without having performed this exercise I might have continued losing money on this product for a long time to come.
COVID Vaccine Mandates
Challenge: Optometrists have the opportunity to define what eyecare is and how it’s delivered. I have previously shared how I want optometrists to control the evolution of optometry, rather than have outside entities (insurance and/or industry disruptors) define where optometry is heading.
The COVID vaccine mandate has been a controversial topic of discussion in our state groups.
Centers for Medicare and Medicaid Services (CMS) issued an emergency requirement that all healthcare workers receive the COVID vaccine. The American Optometric Association (AOA) clarified that most optometry offices won’t have to comply with the CMS or the related OSHA guidelines.
One colleague shared with me that he agrees that optometrists should enforce the COVID vaccine mandate, but that he’s desperate and has “made concessions” with his staff to avoid staffing shortages.
Solution: If optometrists claim they are doctors (which we are!), we need to act like doctors and stand our ground firmly with the science and medicine that we understand and use to treat our patients.
I have had to pass on otherwise qualified candidates because they would not accept a COVID vaccination requirement. Perhaps this hurts in the short-term, but I know my office staff, doctors and patients are safer because of this.
All of my current staff are fully vaccinated and all new job offers are contingent on the applicant being fully vaccinated. I recognize that doctors and owners need to do what they feel is best for their business and their patients. However, I think it is a severe disservice to optometry, and the public in general, to employ somebody who 1) either doesn’t understand the medicine/science behind infectious disease and vaccinations, or 2) does understand the medicine and science of vaccinations, but chooses to let politics, personal opinions or other beliefs be more important.
It is possible to create an office of 100 percent vaccinated employees. Creating a scientifically grounded office outweighs the risk of narrowing my potential employee candidate pool.
If I can prevent even one case of serious COVID among my staff, my employee vaccination mandate will be worth any difficulties that come with it.
We have patients tell us every day they are grateful that we’re still taking COVID precautions in our office. We don’t advertise that we have a fully vaccinated staff, but we do share that we’re taking every precaution and that our office stands with science and medicine.