Alan Saks Looks to the Future

Over the past few years the business of optometry has shifted due to the stronger position of corporates. How do you think it is faring right now?
I believe that savvy practice owners who’ve kept up to date, are doing rather well. Investment in high technology, a web presence, practice refits and the provision of the cornerstones of quality and service are key. Services like contact lenses, Ortho-K, myopia-control, behavioural optometry and low vision are great examples of how to create a niche market that is relatively free of competition.

The right staff is another key as is connectivity, integration and things like text reminders. These all go a long way to maintaining loyalty, which is critical to long-term success. It is way less costly to keep a patient than to gain one. A collegial referral network also provides consistency of care and the maintenance of the patient pathway that Gen-X, Y and Z demand! Building relationships with other health care providers and in particular ophthalmology, with shared care, while encouraging return referrals for complex eye problems, works very well in practice building.

A great example is borne out by an email received as I was penning this Q&A. One of my long term RGP wearing aphakes came in to see me as she felt her right RGP needed cleaning as things had been ‘hazy’ the past month or so. With some careful questioning and a few critical tests (like an Amsler grid and retinal imaging) I could tell the reason was not the lens. Her left eye has only light perception and she is under the care of various ophthalmologists. I referred her to the retinal specialist son of one of her former ophthalmologists who is now retired.

It goes beyond our practices to the ophthalmologists we refer to and other specialists in the patient pathway…

She sent me this email;

“I received the LOBOB cleaner today, thank you, and for referring me to xxxx. (A definite chip off the old block). The examination showed that I now have AMD – the dry kind. He provided an Amsler Grid as a fridge magnet and an informative pamphlet.

I appreciate your wonderful expertise.”

So here is an elderly lady with complex problems, who although receiving some bad news is still appreciative of how we manage the whole patient pathway and maintain relationships, all in a matter of days, at the highest level of quality, with efficiency and easy communication.

There are of course many other things that differentiate the successful from those who simply whinge and moan and eventually fall by the wayside.

What proactive changes have you seen successful independents initiate to keep ahead in the changing world of optometry?
Some of the aforementioned tips are evidence of what proactive practitioners do to survive and indeed thrive. Finding a point of difference, clever marketing and the increasing use of social media/social proof (five star ratings), by happy patients is working well for many. Active involvement in societies such as the Cornea and Contact Lens Society Australia (CCLS), Optometry Australia (OA) and Australian College of Behavioural Optometrists (ACBO), writing of articles in the professional and lay press and being on the lecture circuit impresses patients and encourages referrals. Providing the latest in spectacle and contact lens technology further reinforces the fact that you are at the cutting edge and worth seeing. Blue-blocking occupational lenses and high tech contact lens materials also convince patients that you offer performance enhancing and preventative options and that you have their best interests at heart.

What do you believe a successful optometry practice looks like?
A successful practice of course incorporates many of the things I have just mentioned. The practice environment is immediately appealing from the get-go. From the outside, a modern clean look and exciting window displays make an impact, if that is the environment in which you operate – some of course do very well in upstairs medical rooms that do not have a strong retail presence. This is where the internal layout and presentation is even more critical. It should be clean and neat with a lack of clutter, with well-presented reception, waiting and dispensing areas. Frame displays need to be uncluttered and modern with a range of ‘exclusive’ highend brands with functional eyewear, sport and occupational options. One should not forget that some patients simply cannot shell out a grand for a top end frame: good quality, value for money, functional frames that still look good, fit well and are long lasting should thus also be available. I note that those who do not cater to such patients simply lose them to competitors that do.

On the clinical side consulting rooms should impress the patient with modern LCD charts, equipment and a lack of clutter. Bits of paper, used contact lens cases, untidy trial sets, dirty basins and surfaces are a no-no! Special testing rooms with an OCT, retinal camera, topographer, perimeter, autorefractor and the like, should be well laid out for easy patient flow and lack of congestion. This allows for multiple patients to be screened and measured with privacy, ease of access and a lack of waiting. All the equipment must be integrated into the practice management system and accessible from all workstations and branches with easy ability to email images and the like for referral and/or to the patient.

How important is a strong patient pathway to delivering best patient outcomes?
As mentioned the patient pathway is critical to success and long term patient retention. It starts with the first contact – the first time they see the practice and their first encounter with the ‘director of first impressions’, which is typically the receptionist. Obnoxious, obtuse and incapable staff do untold harm to the patient pathway and relationship.

Whether you do all the testing yourself or use skilled technicians, the clinical pathway is very important to patients. They don’t want to feel rushed or pressured and they appreciate obvious signs of hygiene and care. Thorough explanations, supported by images and data makes a strong impression.

The same applies when it comes to dispensing.

The whole process needs to be seamless with great communication. Allowing patients the ability to see what they are doing in a frame selection, with a pair of trial contact lenses or an image from an iPad, is often appreciated and makes for a better end result and satisfied patient.

It goes beyond our practices to the ophthalmologists we refer to and other specialists in the patient pathway: Patients are very appreciative and often rave about the service, professional skills and environment they experience from top drawer cataract and retinal specialists.

What is the outlook for the next five/ten years?
In a nutshell it will be business as usual. Keep up to date on all fronts: marketing, knowledge, IT, the web, and up-skilling. Don’t keep looking over your shoulder but at the same time use the benefit of hindsight to develop a farsighted strategy. Look at the latest technology and trial it. For instance a super-wide-field imaging system can pay for itself with just a few imaging sessions a week. The information gleaned is invaluable even through hazy lenses, distorted corneas and pretty small pupils. Patients are almost always blown away by such technology.

Although the market is pretty saturated, the chains will continue to expand and new players will enter the market. Be prepared for a competitor to open up on your doorstep and have plans in place to deal with such potential threats.

Myopia control and ocular surface management are growth areas.

How do you believe the economy has impacted optometry over the past five years and what is the outlook?
Optometry like most other professions and industries, has suffered. The Global Financial Crisis had wide-ranging impacts on people from all walks of life. That said I, and many others, have noted improved turnover and sales, with greater expenditure in recent times. One cannot just look at the economy alone. There is no doubt that the commercialisation of optometry over this time frame has had a significant impact. The founders of Specsavers did not get to be in the top UK billionaires’ list, in just a decade or three, by not being successful and taking a significant slice of the pie. There are only so many dollars to go around. One has to have strategies in place to retain a share of the pie.

Are optometrists focused enough on business management – benchmarking, strategies etc… how should they be shaping their business strategy?
Simply put, no. Traditionally optometrists were more ‘technical’ in nature; many were not great on the business side of things. Today’s breed of optometrists are much more academically selected and trained. Some do not have the bedside manner required for success in what is after all a people game. Some are also not interested in business management and are more medically inclined. Owning a practice requires a massive input of time, money and effort. By day, one has to practise, while every gap – and many hours beyond – are taken up by practice management issues.

Compliance demands alone are a significant burden. Staff and human resources issues are also a major part of ownership. The information technology side of things is also a massive investment and requires constant attention, data and network scrutiny. A few necessary or desired toys can easily suck up a quarter-million dollars.

Fortunately there are many who do these things extremely well – some obtain a Masters of Business Administration. Through the varying generations of optometrists we are fortunate to have some fantastic personalities; incredible minds with a few eccentrics thrown in for good measure.

I could cite a number of passionate, intelligent people who are focussed and effective and doing very well. Partnerships help spread the load, blend a variety of skills and create some very effective practices. Blending business, professional and retail aspects is critical.

There’s no question about the need for and value of data analysis, benchmarking and effective business strategies. This is quite simply a necessary part of what one has to do to stay ahead of the game.

Innovation, flexibility and custom services are things to focus on for the future. There are many new technologies coming to light. As in many areas of our lives the technological aspects of our rapidly evolving profession are simply fantastic.

The Sci-Fi of our youth is now reality.

Increasing therapeutic roles are as certain to come as day follows night; as we’ve seen in the US model and fuelled by the ageing population.

Many have fought long and hard to propel the profession forward: full credit to them.

We should not however lose sight of our core skills. It is always best to add to a profession rather than replace a cornerstone with a current trend.

If one doesn’t have the business acumen or interest then hire someone who does. There are plenty of good business coaches. Work closely with an accountant. Regularly review key indicators and set budgets. Plan ahead and reserve some funds for capital expenditure. There are many who have the house, the boat, the car and all the toys but have failed to invest in their business. They are then surprised to find their practices are hard to sell when they want to and then at an ego-bashing fraction of what they thought it would be worth.

What are optometrists doing differently to survive and flourish today as compared to five years ago?
Essentially they have to be leaner and meaner. The ‘good old days’ of optometry are behind us, as they are across the board in the world today. Five or more years ago it was easier to make a living, there was a less powerful and less pervasive corporate presence.

It is what it is however. Some not only survive but thrive and are doing many of these things and offer numerous other service enhancing options.

Whether it’s a coffee machine, iPad, video information system, courier delivery, contact lenses for frame selections, interesting newsletters or automated payment/service plans, they all work to some or other degree. Careful buying and stock management are ever more important. Negotiating with suppliers is often worthwhile: you make your profit when buying, not selling.

What else should they be doing?

• Avoid complacency and stay focussed.
• Treat staff and patients with care and respect: a happy team is a way more effective team. Bad management and bad attitudes do more harm to businesses than many other things.
• Attend conferences and trade shows to stay up to date.
• By all means make a profit: it is not a four-letter word. Success ultimately demands profitability and some would define it as such.
• Be nice, be happy and be healthy.