Getting Rid of an Associate OD: What to Look For

Bringing on an Associate Optometrist can be one of the more exciting aspects a private practice owner can experience during business growth. However, this process can also prove to be stressful and challenging. The bulk of published content surrounding Associate Optometrists tends to focus on the hiring element of associateship. Very few articles describe dealing with associates from the firing perspective.

Firing an employee is not something to be taken lightly. On the contrary, it can be a very difficult thing to do and is a task that many practice owners are burdened with more often than they would like. Moreover, firing an optometrist places a financial burden on a practice, as there is often a gap in coverage until a new associate is brought on board which lowers overall production for an office. In essence, firing an optometrist is challenging, time-consuming, and expensive.

There are a number of justifications for letting an optometrist go. This article will highlight three reasons you may consider doing so.

 1) Complaints

It goes without saying that one of our goals as eye care physicians is to provide a fantastic patient experience, regardless of our setting or modality. Patients want to feel cared for, appreciated, and overall “wowed” during their time in an eye care office. A terrific patient experience is achieved by positive interactions with office staff during every phase of an office visit, including front desk personnel, technicians, opticians, and most of all optometrists.

Whether we like it or not, the vast majority of patients view their interactions with their doctors as the most important aspect of their eye care visit. Therefore, as eye doctors, we must be on our “A game” with every single patient encounter every single time we step into the office, no matter what. So, if patients begin to share their concerns about poor experiences with an optometrist - those reports should be taken seriously.

Patient complaints may stem from a wide number of possibilities. Some patients may be unhappy with the communication from an optometrist, some may express dissatisfaction with the quality of care received, some may find the eye doctor rude or off-putting, or there could be other reasons. 

It’s not just patients that may gripe about optometrists in the office, but staff members may report problems with the doctors as well. It’s one thing to hear complaints about doctors from strangers (patients), but it’s quite another to hear them from long-time co-workers whom you trust. Obviously, concerns from staff members about doctors in the office warrant further investigation.

What to do

If you fall into the camp that believes people deserve second chances, then your employed associate optometrists who receive valid complaints should be granted the opportunity to address the problem(s) and correct them. Employers should meet with the associate OD and be clear about the concerns. The offending OD may be given time to resolve issues and if not resolved within a certain time frame, the employer must be prepared to make the tough decision of letting the optometrist go. If the employer doesn’t fire the OD, a message is sent to the rest of staff that accountability is moot and credibility is threatened. Being a leader means being able to make the tough decisions, especially when it’s difficult to do so.

 2) Poor production

Optometry schools do a great job of providing the most up-to-date clinical education and information to students, helping prepare the future generations of optometrists to provide comprehensive, full-scope eye care to patients across the country. While the clinical curriculum tends to be excellent, an area that could be improved is teaching students about the business/practice management aspect of eye care. Many ODs run their own practice, but we don’t receive a great deal of business education during optometry school. To the benefit of the optometry programs, it would be challenging to squeeze comprehensive business classes into an already jam-packed class schedule.

With that in mind, many (not all) associate ODs that I speak with do not have a deep understanding of the ins and outs of running a business. They cannot fully appreciate the headaches of staffing, the stress of making payroll, and trying to run an office like a well-oiled machine. Moreover, many employed optometrists are unaware of the importance of business metrics and practice financials. Therefore, production levels of an associate tends to be a nebulous concept.

By and large, practice owners track production of their associate optometrist(s). The complexity is increased given the vast number of terms we use in eye care in regards to production: gross production, net production, collected revenue, net receipts, revenue generated, etc. With that said, associate ODs are (and should be) expected to generate a certain level of production, not only to justify their compensation, but to cover overall costs and (understandably) provide profit to employers.

Therefore, having a low-producing associate optometrist is not an ideal situation for anyone (not even the associate if she/he is paid based on production). There are many possible reasons for low revenue generation, and oftentimes the responsibility is shared by both associates and employers alike. For example, many would argue that it is the employer’s, not associate’s, job to fill the clinic schedule. So if a practice owner runs a practice that is only busy enough to book one patient per hour for an associate - the fault should lie more with the owner. However, if an associate does a poor job of making product recommendations (selling from the chair), lacks knowledge of billing and coding, and does not provide medical or non-refractive care - most would agree that the associate should shoulder the bulk of blame for low production.

What to do

Employers and business owners can help educate associate optometrists on the reasons for making appropriate recommendations. Many associates feel uncomfortable with the idea of prescribing certain lenses or products because they don’t consider themselves to be salespeople. However, associates must understand that “selling from the chair” does not imply using shady sales tactics to get patients to buy. Rather, the importance of making recommendations stems from our role as doctors, which is to discuss what is in the best interest of patients. For example, if a patient is struggling with vision while using their computer, it is a GOOD thing to discuss computer-specific glasses. There’s nothing “icky” about that. Best of all, patients appreciate the discussions. Associates must remember that most patients come to us because they want us to improve their eyes, vision, and health.

Employers can also help stimulate a busier associate OD schedule by getting the OD more involved in their respective communities. However, some practice owners expect employed ODs to partake in community involvement in their own (unpaid) time. Many associates that I converse with would be happy to increase community involvement and grow business, and they generally would like to be compensated for the time spent doing so. Employers can incentivize ODs to increase patient numbers by paying them to do so.

3) Lack of motivation  

First-time parents are madly in love with their newborns. They believe that their child is the most amazing baby on the planet. Likewise, most practice owners view their businesses as the best thing since sliced bread. The fact of the matter is that no one is going to care more about the success of the business than the owner. Sure, employees can (and should) be invested in the well-being of the company, but will never be as devoted as the boss. Associate optometrists are no different.

Many associate ODs are happy to clock-in, clock-out, and head home to enjoy the remainder of their day without dealing with the responsibilities of running a practice. Heck, that’s part of the benefit to being an associate! Moreover, what motivation would an OD have to do “extra stuff” outside of patient care, other than feeling pressured to do so by their employer? Of course, employers believe that associates should do what’s right for the business, but not everyone thinks that way.

What to do

People are encouraged by incentives. It’s the practice owner’s job to find out what motivates staff. That’s what good leadership is. Employers should give the associate reasons to WANT to grow the business. 

Closing thoughts

There is a wonderful book called Extreme Ownership by Jocko Willink. The gist is that everything is your fault (whether you like it or not). Although the concept seems sobering, there’s actually a sense of liberation in assuming “blame” for what goes wrong. The sooner an owner realizes that, the sooner they can assume control and find solutions to the Associate problem.

In a perfect world, a practice owner would hire an amazing associate optometrist and everyone would live happily ever after. That’s not reality. Many business owners grumble about the difficulties in hiring a great optometrist. However, firing one could prove just as challenging.