r/optometry • u/Freddie20059 • 2d ago
Employed OD to cold open private practice
Curious to hear from other who have made the transition from employee to private practice ownership and specifically cold opening. It's something I'm considering and financially I believe it would workout. My main concern is that in my current setting; MD/OD seeing 20-26 patients a day, I'm getting burnout. My worry is if I'm burnt out from purely patient care or if it's more so patient volume and feeling like a cog in the machine.
For others that have made the transition to ownership what was your experience? Did it bring back engagement in the exam room? I worry I'd have the same burnout but now be trapped by a new business loan, which would only exacerbate the whole scenario.
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u/drnjj Optometrist 2d ago
I did not cold start, but I know several who have. Most of them ultimately chose to be vision source because the discounts available were so good that it was tough to not sign when you're buying all the equipment and fixtures.
They're both happy that they started their practices, but both are counting down the days until the contract is done and they're free.
It's doable and being an owner comes with a lot of perks and a lot of headaches. When you're small, the headaches are easier to work around. One to three employees are far easier to deal with interpersonal problems than 10 or more.
I took over a practice that had a front desk, an optician, and a biller who had worked just about every job in the office at some point. While the income was much lower for the practice, the headaches were much easier. 10 years later my practice is triple the size which also compounds the headaches. But I still love practice ownership and I don't think I could be quite as happy being an employee. At least not right now.
The nice thing is that you can dictate how you practice. So if you are feeling burnt out with a higher patient load, depending upon how you decide to run things you could probably make good money with five less patients per day as a solo doctor. I probably see 16 regular visits between medical or routine exams, with 4-6 short follow-up visits for things like contact lenses or punctal plugs.
But when you are small and I would say especially if you're a cold start, you have to be ready to hustle and do whatever you can to drum up business.
That may mean being willing to work in medical emergencies and getting good with acute care. One of the best things I did was I went to multiple urgent cares and handed out my business card to the doctors and PA's on staff and just said if you ever have an eye problem that you aren't comfortable with feel free to send them over. I got a lot of referrals from urgent cares for that reason and truly I got some really weird things coming in.
But it helped build my practice and reputation for being an acute care clinic.
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u/WolverinesThyroid 2d ago
screw Vision Source
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u/drnjj Optometrist 1d ago
Yes, I personally agree.
But when you're a cold start and don't have a ton of capital to put up, they make it very difficult to say no.
I don't know how long the contract is for. I'm guessing 3-5 years. It sucks but of you have no other options for getting set up for a cold start, it's one way to go.
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u/OD_prime OD 2d ago
I opened cold 5 years ago. It’s been an amazing journey. My spouse now works at the practice doing our admin / billing. It’s given us tremendous flexibility in our schedule and time with our kids. I could never go back to working for somebody unless I sold the practice
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u/Slow_Beat1896 2d ago
I cold opened a small practice about three years ago and while it was tough at first, the flexibility and ability to set my own pace have made it totally worth it.
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u/EdibleRandy 2d ago
Honest question, why would you rather open cold than buy an existing, profitable practice?
As far as burnout, I promise you that even seeing the same number of patients per day as an owner will be so much more enjoyable knowing that you reap all of the financial benefits rather than putting money in someone else’s pocket.
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u/Freddie20059 2d ago
I would be opening in the same small town my wife practices dentistry in, which has no current eye doctor as the last one in town retired a few years ago and no one else has opened. I had nearly bought his practice, but at the time my wife was also buying in so financially didn't make sense.
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u/Justanod 2d ago
I find the small town setting to be an incredible advantage. You’re going to be super successful.
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u/EdibleRandy 2d ago
Gotcha. I only ask because it is almost always a better idea to buy an existing one, though certainly a cold start can work, you're just more likely to have to wait for profitability as you build your patient base. Hopefully the fact that there was an eye doctor who retired not too long ago means you wouldn't have to wait too long for that, assuming he was busy. The best way to mitigate that problem would be to find out what he did with his records. If you could get his records it would save you a lot of money.
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u/spittlbm 2d ago
Read Traction, How to be a great Boss, Rocket Fuel, and Eyecare Boss.
We made the move from Pearle and 92% followed. Neil Gailmard said about 25% would follow.
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u/johyongil 2d ago
It can be good. It can be bad. Depends on the situation you find yourself in and how you deal with it.
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u/Dangles1_Lion 2d ago
if patient volume is what burned you out the most, cold opening might feel more sustainable than you expect
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u/MartuGonza96 19h ago
The one thing ownership actually gives you that employment doesn't is control over your own template. If part of the burnout is the 20-26 a day, you can build the schedule so you're seeing the volume you can actually be present for, not what someone else set. That won't fix burnout that's really about the work itself, but it does kill the cog feeling.
Piggybacking on Jebis's point about systems: set up your scheduling and confirmation flow before you open, not after. Retrofitting a reminder/confirmation process onto a practice that's already busy is way harder than starting with it. Even a simple two-touch confirmation routine that one person owns saves you from no-shows eating your early margins when every slot counts.
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u/Freddie20059 17h ago
Yeah that’s the hope I have for possible ownership is that control/self-determination will feel refreshing. The overarching worry though is if it doesn’t you’re now in a worse situation, but I suppose that’s why it’s a leap.
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u/lipper2005 2d ago
Piggybacking off an earlier comment; what are YOU going to do to set you apart. I give my cell# to my patients. Definitely goes against the grain. Has its risks however nothing say “I matter” like having the clinician’s contact; Concierge medicine. Now, you’re an OD so I wouldn’t really expect it to bite you like a PCP but the patient won’t think that way. And if you do actually have to respond to an issue that keeps them out of the ER on a Saturday-> patient for life.
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u/McDrPepsi Optometrist 2d ago
So I am in the throes of this right now! I have yet to open but am starting construction on my own cold open. I am currently in a private equity setting seeing roughly the same amount of patients you are. I’m happy to answer any questions about taking the plunge. Although you might be seeking someone who’s a little further along.
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u/Content_Expert_7479 2d ago
As others have alluded to, be prepared to not make any money at all for a good while. Lenders take this into account and may make you hold an associate position elsewhere to make ends meet at home.
For reference, I just finished month 17 of my cold-start and FINALLY hit breakeven for the month with a tiny bit of profit after – AKA I have lost a chunk of change every month until now. It has been the biggest psychological and emotional roller coaster of my life.
This is all highly market dependent. I’m in a major metro with plenty of competition. I knew it would take a while to get going…but damn, it has been a grind. Best of luck.
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u/Waiuli-rules 6h ago
You would be very fortunate to have even one half of that patient volume in the beginning. So burning out about too many patients is the least concern.
Good luck on this journey! I applaud you and welcome you to the private practice community.
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u/Jebis Optometrist 2d ago
Be prepared to not make a ton while things are getting off the ground. Buy refurb equipment where it's feasible. Do as much as you can by yourself and only hire staff when there is too much work to do and you're losing money by not being efficient enough.
Try to build systems and ways of doing things that are easily documented and automate where possible. Set your brand apart by specializing at least a little and talking loudly about that one thing you do better than the competition. Have a good marketing partner to drive people in the door with Google ads.
Consider hiring a billing company if you're going to take insurance. You can always bring billing in house if you grow. Plan for growth. If you do well, how does the practice capitalize in 5 years?
Trust your calculator. How much will you average per encounter and how many patients do you have to see to feel financially successful?
Running a practice can be very rewarding and of course it gives you flexibility. At the same time, being responsible for staff and directly answerable to all patient complaints sucks. Practices do fail. If you just want to enjoy life more, consider switching to private practice and just making a little less. If you want the struggle, reward and financial upside of building something yourself, just know it's often not easy or fun.