Optometrists Building Empires

## The short version Half of U.S. optometrists are burned out, and what separates the burned out half from the other half is not effort or love of patients. It is workflow. This episode uses one imaginary patient, Denise, to show how a practice can lose revenue and lose its doctor at the same time, from the same root cause: too much happening at once and no signal anyone can act on. ## The 2:15 problem Denise is not real, but she behaves like a lot of your patients. Tuesday afternoon, sitting in a parking lot, phone in hand, 15 minutes before her next meeting starts. That gap is the only reason she is calling today. Meanwhile your front desk is checking out the 1 o'clock exam and the rest of the team is working insurance. Nobody is slacking. Everybody is doing the job they were hired to do. The phone rings four times, five times, and she is gone. Out of 10 people like Denise, how many call back? Most owners guess six, seven, even eight. The research puts it closer to one and a half. About 85 percent never call again. ## Why it never gets fixed The number stings, but the bigger issue is that the call left no evidence. No voicemail. No note in the system. No report unless you go pull one from the phone system, assuming your phone system even lets you. Denise never appears anywhere. Three weeks later the schedule is soft and you spend a Sunday afternoon researching marketing companies in the OD groups. That was never the problem. You did not have a marketing problem, you had a 2:15 problem, and the 2:15 problem never generated a signal anyone could act on. ## The burnout numbers - A University of Colorado study of U.S. optometrists found 53.6 percent burned out, at varying levels. Roughly one in two doctors. - The entire distance between the most burned out doctors in the country and the least was four tenths of a clinical day, roughly three to four hours on a given day. - More clinic time correlated with more burnout. More patients correlated with more burnout. - Doctors using an EMR ran 17 percentage points higher on burnout. Treat that as correlation, not causation, though most of us feel intuitively that the software is sometimes served better than the provider is. - Doctors 30 years into practice showed much lower burnout. Some of that is survivorship bias, and some of it is that after 30 years they have run the experiments and found a working flow. ## The exercise: check your ratio Make a list of everything you do at work, including inside the exam room. Then ask one question: how much of this is work you were trained to do as a doctor, and how much is everything else? That ratio is a large part of the burnout story. Last week's guest, Dr. Fred Cho, did not notice he was burning out. His wife noticed and told him he did not look happy at work. What he changed was not his volume. He changed the ratio, moving away from admin and back toward practicing medicine. ## Two experiments you can run this week 1. **Get the phones off the exam floor.** Phones stop interrupting the exam, the flow improves, and the team stops splitting attention. Most optometry groups answer 75 to 80 percent of their calls. Aim for 90 percent. From that day forward, create the evidence Denise never left: a real process to call missed calls back and close the loop. 2. **Every exception that is not you gets an owner.** Credentialing, the one-off vendor issue, the odd insurance question. If it lands on your desk by default, name someone else who owns it. ## If you are considering more help Remote staff or additional in-office staff can work, but only if the financial decision is sound and the role is defined: clear deliverables, clear work instructions, a clear picture of what the person is supposed to do, and a clear definition of what success looks like for them. Defined properly, it takes weight off you. Defined vaguely, it adds to the pile. ## The takeaway Every other optometrist in the country is burned out right now, and it is probably not only the U.S. What separates the two halves is how the workflow is managed. Take inventory of where your time actually goes, then eat the elephant one bite at a time. Pick one process, automate it or hand it off, and watch what happens to both your schedule and your Sunday afternoons. ## Also mentioned - Last week's episode with Dr. Fred Cho on noticing burnout late and changing the practice model. - If you want help, book a conversation about what has worked for other offices, and we will send you a copy of the host's book.