By Tom and Amee Lecoq, Lecoq Practice Development
One of our favorite things is working with new optometrists to start a vision therapy (VT) practice. There have been varied situations to be dealt with, ranging from cold startups of VT only practice, to going in with an established primary care practice to start a VT department.
Most recent grads have a lot of debt to contend with, so working in a corporate setting is often necessary. But that does not preclude setting up a VT only practice. Many of our clients work 3-5 days in a commercial setting to pay the bills and open a small office where they see therapy patients and gain experience and confidence. As the therapy case load rises, the doctor reduces their corporate practice days until the therapy practice produces adequate income. Then the doctor concentrates their effort and attention on VT to make it grow rapidly.
There are many myths about vision therapy: that it is not profitable or that you have to deal with insurance to make it work. Let’s handle profitability first. With fees properly set, it takes about 150 therapy patients per year to produce a $1 million practice. If you are willing to do community outreach, that level is not so hard to reach. Realistically, it will take some time to hit that goal because you will need to develop your own skills and to train and develop therapists and other staff. Insurance is a complex issue if you enroll in plans. We recommend that you operate as an out of network provider and fill in billing paperwork for the patient to submit. But if you are actively reaching out to the community for patients and referrals, insurance issues diminish. In fact, vision therapy is a specialty which can liberate doctors from managed care hassles.
Introducing VT in an existing, private, primary care practice is another way of starting. Many ODs see Vision Therapy as a service that would work well in their practice, but choose not to do it themselves. They are looking for new doctors who have had some extra work or a residency in VT. If you receive such an offer, make certain that you will be able to restructure the intake process, particularly the initial phone call, or that you will have separate staff sufficient to handle marketing and intake.
If you are going to succeed in this setting, you will need to have vision therapists. (The patient – therapist ratio is important. In 40 hours, a therapist can expect to handle 30 patient visits. More than that and you will have turnover. Training costs are considerable since it can take 3-6 months to have a therapist competent to work with only light supervision. Developing a master therapist can take several years.
This brings up the question of education and training. Most colleges only offer a smattering of vision therapy, and most new ODs do not feel confident about their VT skills. It is worthwhile to enroll in one of the training courses offered by the Optometric Extension Program Foundation (Clinical Curriculum) or Bob Sanet’s Powerful Vision Therapy Seminar Series. You can have a therapist attend with you so you both develop skills and confidence together
Another important point for new VT practitioners is to refrain from taking complex cases. We recommend emphasis on what we call “Sweet Spot Kids,” who have visual skills deficiencies with some perceptual problems, but no significant developmental delays or other complicating factors (like puberty!) Strabismus and amblyopia cases can range from fairly easy to complex and resistant to treatment. Decline to take on complex cases until you have had more experience. We are working on a course series called the Ideal Vision Institute Clinical Course, which we will announce officially early next year.
Find a mentor. Vision therapy doctors are extremely friendly and open to helping any new O.D. get going. Other VT ODs are colleagues, not competitors. Attend the various courses and forums in vision therapy and get to know the doctors there. If you need help, you’ll have someone to call. You may also wish to join DOC-L, an online discussion group. Email us at firstname.lastname@example.org to join. Give us the email address you prefer to use, as there may be 40-60 emails per day as discussions wax and wane.
Occasionally, we see an older therapy oriented doctor who wants to pass the practice along to a younger associate. These often fail because the older doctor over values the practice. Any buy in should be based on the new OD’s marketing efforts.
Financing a cold start or expanding an existing practice costs nearly the same amount. We recommend that doctors arrange credit lines of $90,000 to $120,000 for VT only. A simple dispensary with children’s frames is all that is needed. Used equipment for a lane works fine, particularly since so many tests are done in free space. A facility of 1,400 sq ft will suffice for 2-4 years (keep leases short with first right of refusal for renewal or expansion). Bank of America and Wells Fargo both have professional financing arms and will tell you their requirements. There are other options, but beyond the scope of this article. Warning: Many people hope to grow from cash flow, but a standard banking ratio is that growth of more than 25 percent from cash flow will inevitably lead to bankruptcy. So it is important to have sufficient reserves and or a credit line to handle growth.
Lecoq Practice Development has generated two courses that may be useful. The More Patients Breakthrough Course teaches communications and marketing vision therapy. Our new VT Bootcamp course is a primer on how to organize, operate, staff and manage a successful VT practice, it also helps with avoiding common pitfalls.
We are always happy to discuss plans with students or recent graduates as they begin laying out their careers. There is no charge for an initial phone conversation. At this time, VT ODs provide care to less than 3 percent of the people who need vision therapy. We hope you will consider VT and help expand the number of patients who get the help they need.
Photo: Copyright: shalamov / 123RF Stock Photo
Thomas and Amee Lecoq are the owners of Lecoq Practice Development, which gives doctors the tools and a powerful system to ensure success with vision therapy.