How We Deliver On Double-Digit Annual Practice Growth

By Miki Lyn Zilnicki, OD, FCOVD,
and Jessica Fulmer, OD, FAAO, FCOVD

June 12, 2019

Creating a growth plan for a new practice is challenging, as you want to set realistic, yet aspirational, goals. Our two-doctor practice in Long Island, N.Y., which specializes in vision therapy with no optical, was able to successfully do this, so that we now consistently produce double-digit gross income growth each year.

Our practice is technically in its fourth year, however, we opened late in 2015, so we were only open for four months in that year. Based on our annual gross income from 2016 to 2017, we grew 99.6 percent, and from 2017 to 2018 we grew 22 percent. We suspect that the slower rate of growth from 2017 to 2018 was partly due to Dr. Zilnicki being out for maternity leave and staffing changes that resulted in less patients being able to be seen.

In annual gross revenue, we went from the mid-$100,000’s in 2016 to double that in 2017, and then experienced 20 percent growth from there.

We are expecting large growth again this year because we are chugging on all cylinders.We are both working full time in the practice and have hired additional staff, including a full-time vision therapist who sees her own vision therapy patients.

Based on our growth the past few years, we are hoping to see a growth of between 15-20 percent for this year. This goal is high, but one that we still feel is attainable.

Part-Time in Practice First Year
In our first year of practice, we both supplemented income from our own practice by working on a freelance basis in other practices. Fortunately, we were both able to work full time in the practice after the first year of opening. We have been devoting full-time schedules to the office for the past three years.

Because we primarily see vision therapy patients, and are very specialized, I think our growth plan leans more toward hiring vision therapists who can participate in providing additional vision therapy sessions rather than hiring additional associate doctors. Rather than adding additional hours to our existing schedule we try to make our schedule and office more efficient so we can see more patients during our current hours.

Tools to Measure Growth
We use QuickBooks and our EHR system, Crystal Practice Management, to track our financial growth.

QuickBooks is customizable, allowing you to break down each payment and expense into categories to track each category individually from year to year for changes.

Crystal PM allows us to track everything from a patient standpoint, such as the number of patients seen, number of appointments, types of appointments, billing records, insurance, patient receivables and other financial and growth markers.

Taking Small Steps to Grow Big
We focus on small-term goals to get us to our long-term ones. Our goal for each quarter is to grow in terms of patients seen (exams, vision therapy evaluations, vision therapy sessions, etc.), which, in turn, results in a huge growth ratio from year to year. Additionally, we try to continuously improve the efficiency within the office and maintain superb communication with our referral sources.

Tackling Challenges to Growth
We have two big challenges currently that can potentially affect our growth: insurance and space. Firstly, because vision therapy is not covered by most insurances, we only accept the three insurances that we know most often will cover the service. This leaves a large cohort of patients who then have the challenge of paying for the service privately. We also offer CareCredit as an option to help offset the financial burden for patients.

Space is our other key challenge. Our current max capacity is three vision therapy patients in the office at the same time. There is a need for more afternoon sessions for our patient population, but we cannot accommodate that at our current office space.

We should note that, in theory, we could do double vision therapy sessions with patients, but we are adamant that we do not want to sacrifice the quality of patient care. We only allow individual therapy sessions to be scheduled in the office as we strongly value that one-on-one attention.

Assessing Office Space Needs
We were unsure of how long our space would be able to handle our patient load because, as we mentioned above, we did not really have a model to base our office on. One of our colleagues said that after grossing $500,000 her practice moved from a 1,500 square foot office into a larger space.

Our initial lease was set up for five years. Our plan was to assess how this space met our needs during that five years and then make a decision on whether we needed to grow and find a new space when it came time to re-negotiate our lease.

Staffing Just Enough for Growth
We currently have two full-time employees (patient-care coordinator/vision therapist) and two part-time employees (optometric technician/medical biller). We do not have a staffing formula per se, but we communicate with our staff, and when their tasks and expectations become too much, we start the conversation of adding to the team. Our goal is for our employees to be happy and feel fulfilled at work. No one benefits from being overwhelmed and “wearing too many hats.” We have found that when someone is expected to do too much their overall performance goes down.

For example, our patient-care coordinator was handling all front-desk responsibilities, managing insurance processing, answering phones and also pre-testing our exam patients. It became evident as our practice was getting busier that she just could not do everything. This is when we hired our part-time optometric technician to come in on the days that we are busiest with exams, to alleviate our patient care coordinator of pre-testing duties so she can focus on managing the front desk only. Overall, this hire has paid off tenfold in efficiency in the office.

Judicious Instrumentation Investments
We invest only in instruments that will benefit our patients and practice, rather than investing in an instrument because it’s exciting and new. We budget for one potential equipment addition each year.

We recently added the Sanet Vision Integrator to our office, which costs around $8,500, but is a great complement to the services we provide to patients. We worked with the company, and have worked out a payment plan that makes the equipment more affordable.

Plan & Recalibrate
Every January we (the two owners of the practice) devote several hours to meet together uninterrupted to assess where our business is financially, set goals and determine what changes need to be made. Although we meet weekly, those meetings are typically designed for smaller things that need to be discussed and day-to-day happenings in the office. This big meeting sets the tone for the year and gets us off on the right foot.

We highly recommend the book, “Traction: Getting A Grip on Your Business.” This book boils your business’ primary aim, core values and goals down to one page. It helps you look at large, long-term goals, and then helps you set smaller goals to get you to that place!



Miki Lyn Zilnicki, OD, FCOVD, and Jessica Fulmer, OD, FAAO, FCOVD, are co-owners of Twin Forks Optometry and Vision Therapy in Riverhead, NY.

To contact Dr. Zilnicki:

To contact Dr. Fulmer:

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