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This article originally appeared in Advanced Ocular Care

Lessons Learned

Optometry school teaches you how to be a doctor, but not how to run a practice.

When I think of all the things that I encounter in clinic daily—between seeing patients and running our office—I often think to myself, “I wish I had learned that in school.” Without too much thought, the list becomes rather lengthy. In order to be an effective clinician and business owner, I sometimes think I should have earned a PhD in psychology, business administration, billing and coding, accounting, and human relations/public relations with an emphasis in marketing and social media—maybe even a master’s degree in organizational behavior—before I ever went to optometry school.


Educating yourself on evolutions in billing, marketing, and business management can elevate your practice and keep you on your toes.


Coding and billing were not discussed when I was in school (or perhaps I was sick on those days). Effective coding is as important for accuracy in reporting as it is for proper insurance reimbursement. That lesson was learned during my residency at the George E. Wahlen Department of Veterans Affairs Medical Center, when my level of coding was constantly being critiqued by my attending. It was something that was foreign to me, as I’m sure it is to most new grads. But thankfully I had a year to grasp the concept before I was on my own and had to rely on proper billing and coding to ensure correct reimbursement from insurance payers. I am still far from an expert on the subject, although I continue to build my knowledge as I become a more experienced optometrist. Coding is something that constantly evolves; as such, what was true 1 or 2 years ago may be very different now. My advice for optometrists entering private practice is to attend a few continuing education lectures on the subject and read every article you can to stay current.


Again, these were not covered in optometry school. Luckily, I was fortunate enough to have some friends who graduated 1 or 2 years ahead of me, who set me up with some very good, very knowledgeable, and not terribly expensive lawyers and accountants. I have relied on their expertise ever since. Perhaps the lesson to be learned here is that you should know what you don’t know—and what you likely don’t know are the nuances of business legalese.


Marketing is something that has a steep (and dynamic) learning curve. Salespeople will beat down your door, show you charts and graphs, and explain why it is imperative for you to place ads in the Yellow Pages or to invest in search engine optimization. With the advent of social media, some of today’s marketing tactics do not resemble those of a decade ago. It will take time and experience to determine which marketing strategies offer a measurable return on investment and which do not. Marketing means something different to every doctor. Try new things. Some will prove fruitful; others will be learning experiences.


The optical dispensary is something that is touched on in school—at least, it was in mine. However, it was more about how to work in an optical environment, adjusting frames and training on contact lenses, etc. I would have benefited from learning how to run an optical practice. Innovations in lens treatments are always happening, and an education in those treatments would be more useful than getting the news from lab reps.

An even more important lesson would be how to manage margins. When I ask colleagues about pricing, the answers they provide usually concern a simple markup multiplier. If you do not know your margins, that number is useless. It takes time to learn things such as frame purchasing, consignment, and frame board management. It’s just as important to be aware of margins on frames as it is with lens treatments. Which frames to purchase and which ones to take on consignment can vary with your type of practice and your patient demographics.


Managing employees can either be a blessing or a burden. You must be aware of local employment laws, which can be researched most easily by an accountant. An accountant will also be able to advise you about laws associated with hiring, firing, and payroll deductions. The human resources department is an evolving arena in optometry; it requires constant education, including research into federal and state laws and guidelines.

Similarly, equipment purchasing can be a cumbersome expense in new practices. There are options other than purchasing brand new equipment, a lesson with important applications when opening a practice. For example, refurbished or leased equipment can offer enormous savings. Talk with your accountant about creating a separate corporation that purchases equipment and leases it to the practice.

Contracts are a necessary evil for all clinical practices. Unfortunately, these are typically so full of legal jargon that they might as well be written in another language. The last thing you want to do is spend more money on an attorney, but the money spent on legal services now will often save you a great deal of heartache (and possibly money) down the line. Always have your contracts reviewed, even if they seem clearly worded and straightforward.


Remember that patients are people—not procedures, diseases, or codes. Keep in mind that your patients assume you are a good doctor. They do not ask where you went to school, what classes you took, or if you were at the top of your class. They do not care if you publish or if you do a lot of speaking. What they know is whether or not you listened to them and made them feel heard; if you solved the problem; and if you shook their hand and called them by name and introduced yourself. They care about how they felt after the exam. You do not have to be the doctor all the time—sometimes, you can just be a person.

So much of what was missed in your optometry curriculum can be learned and absorbed after your schooling is finished. Likewise, a great deal of what is taught is not understood until it is experienced. Your education is what you make of it, and it should never end. Indeed, what you learn after your formal education is often more valuable than what you learned while in school.

Justin Holt, OD