Vision Therapy

The $150,000+ Annual Difference Adding 1 New Full-Time Employee Made

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

Feb. 5, 2020

One new staff member can make a huge difference to a practice, both to patients in increasing access to care, and to the business of the practice, adding to revenue generation.

In 2019, our vision therapy-focused practice added a new full-time vision therapist, and we are reaping great rewards for this investment. This was by far our most profitable investment of last year.

Know When Time Is Right For New Staff Member
Prior to hiring a full-time vision therapist, both of us were the sole providers in the office for both examinations and vision-therapy sessions. We made the decision to hire a vision therapist once our two schedules were fully saturated and there was a demand for additional vision-therapy slots. We felt this first in the late afternoon/evening therapy session slots, which are at high demand. We only do one-on-one therapy with patients, as we feel it is the most effective in facilitating patient progress.

To find a vision therapist, we marketed the position through and our own social media. While interviewing prospective candidates we focused not necessarily on experience, but rather, personality of the interviewees. A vision therapist is a unique position in which one has to be adaptable to working with a large range of patients with various issues and comorbidities. Additionally, because we are a small office, it was important to us that our new vision therapist fit well into our office dynamics.

Initial Cost, Great Long-Term Gains
Adding a full-time staff member is initially a large cost in both time and money. Monetarily our vision therapist was on payroll from the onset of hire. This initially manifests as a loss for the business because, until training is completed, no additional revenue is being brought into the practice. To offset this, we provide a training-period salary. Once training of the vision therapist has advanced to the stage where they are capable of seeing their own patients–typically three months–we compensate accordingly with a pay raise.

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Adding any staff member is also an investment in your own time initially, which is hard to quantify. Administrative time is reduced and spent on training and education. Again, this takes time to see a return on your investment, but in the long run will end up saving you significant time as you can begin to delegate tasks previously performed by yourself.

This particular loss of time applies to hiring a vision therapist, where an extensive amount of training is involved in all areas of the visual system and patient care. Even a year after working as an active vision therapist, we are still teaching and working with her to further develop her knowledge base for more complicated patients.

Nevertheless, the return on investment has been measurable:

Number of VT sessions/week for the vision therapist: ~ 45 sessions slots available (we run bi-weekly vision therapy sessions, so that allows for 20+ active VT patients being seen by the vision therapist alone)
Let’s say 80% filled: 36 sessions/week
Rate: varies depending on private pay vs. insurance, but average VT session reimbursement is around $90 ($130 for private pay and insurance varies from $45- $110+). That breaks down to:

$90 x 36 sessions/week = $3,240/week

$3,240/week x 4 weeks/month = $12,960/month

12 months at $12,960/month = $155,520/year

This increase in revenue does not account for the additional exam/vision therapy slots this opens for the doctors, but that is hard to predict in terms of exact quantitative value.

We think it is important to recognize that sometimes taking a short-term loss on hiring a new employee is worth it when there is a long-term ROI that benefits the office in efficiency and profit.

Create a Schedule To Optimize New Staff Member
Once our vision therapist was trained by us, we opened up a schedule for her to see her own vision-therapy patients under our supervision. This enabled a large increase in our patient time slots and availability of vision-therapy services. With the addition of our therapist we are now capable of seeing three vision therapy patients at any given time.

The only increase in monetary cost is the salary of the vision therapist. All other chair-time costs, such as additional staffing (i.e. reception) and utilities, have remained constant. This means that the additional patient who is being seen is essentially all profit for the practice. Patient care improved with more time slots becoming available to our vision-therapy patients. It also enabled us to free our schedule up and become more available to perform examinations rather than conducting all of the vision therapy ourselves.

Provided Support to Get Most Out of New Staff Member
During our interview process we emphasized that a large amount of training would be provided in the early stages of the position. This training was provided through written training materials, books and one-on-one discussion sessions with both of us. Early in her tenure, the therapist would sit in on our sessions to observe how we interacted with patients and the flow of vision-therapy sessions.

We then progressed to the hands-on learning of how to guide patients through activities, in which we became observers within the therapist’s own sessions. Once vision-therapy sessions were being run independently by the therapist, we began to remove ourselves from the room more and more. We ultimately gave our therapist autonomy with her own schedule.

Training is a never-ending process in the field of vision therapy, as each patient is unique and requires a different approach to therapy. We are constantly in contact with our therapist to discuss our evaluation findings and to help guide her through each patient’s therapy program.

We also hold bi-monthly vision therapy meetings in which we discuss each current therapy patient, their progress and future plan. We encourage our therapist to participate in continuing education opportunities by attending annual COVD meetings and local vision therapy meetings, such as the Eastern States Optometric Congress meeting.

Introduce New Staff Member to Patients
One of the challenges we encountered was making the transition of patient care from ourselves to someone new. Patients had become accustomed to seeing one of the two of us for all of their care including examinations and vision-therapy sessions. We helped facilitate this transition by being present within the therapy sessions initially, then slowly removing ourselves. We also conveyed the upmost confidence in our therapist’s capabilities to our patients. This was reiterated by the rest of the staff who handle scheduling of patients.

Make Ongoing Changes to Grow & Maximize Staff
We recently made the decision to hire a second part-time therapist to aid in our growing vision-therapy schedule. This has changed the role of our current vision therapist, as she has been a huge asset in the training of our new addition. This has enabled us to increase vision-therapy slots with less of an investment in our own time in her training.


Left to right: Jessica Licausi, OD, FAAO, FCOVD, and Miki Lyn D’Angelo, OD, FCOVD

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

To contact Dr. Zilnicki:

To contact Dr. Licausi:

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