How to Open a Practice Cold

After 5 years of working for other optometrists (who, by the way, had amazing practices), I decided to go out on my own. I tried to buy one or two existing practices but quickly found that the costs were higher than I was willing to pay.

So I started my own practice. I was equal parts terrified and exhilarated at the prospect, but I can now tell you that I only wish I had done it sooner.

I would argue that the most important part of the entire process of starting cold—and what has set the stage for my success in practice 5 years later—was the work that was done in the year prior to starting cold. Yes, the decisions about layout and equipment are important. Yes, each and every examination and experience and job hire is important. But if you start with a really good foundation you’ll emerge successful in your own eyes, and isn’t that what really matters anyway? In this article, I offer tips for starting your own practice from scratch, based on what worked for me.

DETERMINE YOUR “WHY”

You will have a lot of decisions to make as you embark on starting your own practice from scratch. But ultimately, once you’ve determined your “why,” you’ll always be able to use that, along with your core values, to make sound decisions for you.

Here’s some homework: Read “Start With Why” by Simon Sinek¹ or watch his TED talk. From there, start to ruminate on your own why. Why do you want to start your own practice? What do you want your practice to be known for? Whom will it serve? How would you describe your ideal patient? What do they do for a living? Where do they live? What do they worry about? Once you’ve started to build this dream picture of what your practice can be, you’ll be able to make the myriad decisions to come.

Here are two examples of questions that your personal why can answer for you better than I can.

Should I buy an OCT right away? If it aligns with your why and your practice mission, then yes. Are you building a medical practice and planning to have a large glaucoma patient population? Does your demographic research support the need for an OCT? If it makes sense for you, then do it.

Should I open on Saturday mornings? For me, a core value is family, and family time is important to me. I’ve been known to say, “I didn’t start my own practice to have to work Saturdays.” Because being open on Saturdays doesn’t align with my core values, this question gets a “no” answer from me.

Another big advantage of taking the time to determine your why and your values is that it will help you to be consistent as a leader, and you’ll therefore find that it’s easier to build your team. At the beginning, as I was building my true core values, I showed some inconsistency in my leadership, and this was reflected in my team. I’ve since refined and clarified my mission, which keeps my decisions and attitude consistent and is reflected in my team. Find your why and your core values and you’ll be well on your way to making decisions that build the practice of your dreams and define your version of success.

ZIP UP YOUR FINANCIAL SITUATION

By no means do you have to have zero debt to start a practice, but having a handle on your financial situation is a must. I spent a lot of time cutting costs in the year before my launch, and I did my best to pay for as many practice expenses as possible instead of financing. In the end, I financed only the large purchases, including equipment, frames, optical shelving and furniture, computers, and our computer system. My practice broke even and was even profitable in the first month because I had few expenses.

In addition to my practice, I do work as a speaker for pharmaceutical and contact lens companies, and I found that with one or two speaker events a month and 1 to 2 fill-in days per week I had more than enough to cover personal expenses and give me a little spending money.

The practice was extremely lean at that time, with just one employee, an old-school recall system (postcards), and lots of cheap do-it-yourself and free marketing. Starting lean is extremely helpful and, if done right, it can help you jump-start your cold-start practice.

Another tip is to get comfortable with your personal and projected practice expenses. One of the best tools with which to approach a bank for financing is a projected revenue workbook for the next 1 to 2 years, known as a pro forma. With my personal debt paid down significantly, a well-thought-out practice financial projection in hand, and my business plan, I found that financing was not difficult to obtain. In fact I was able to get multiple quotes and shop around for the best loan deal.

PLAN FOR CHAOS THE BEST YOU CAN

I purchased a large binder with dividers, and in the front I created a master startup checklist. This planning kept me together and allowed me to get a sense of where I stood on the big items. Categories for a checklist include insurance credentialing, equipment purchases, optical setup (acquiring frames, choosing a lab and one primary lens company, creating easy-to-use packages), and office buildout.

When I was starting my practice, I used to say that each individual component wasn’t particularly difficult, it’s just that there were a lot of things happening at once.

All SYSTEMS GO

In the beginning you will be rich in time. Use this time to develop your systems. You’ll inevitably go through some employees, especially at the beginning, and it’s helpful to have scripts and systems in place for how you want everything in the office to be done (eg, answering the phone, scheduling appointments, performing workups, optical check-in of glasses, and dispensing of glasses). These systems will define the care your patients receive.

This will be the best time you’ve ever spent, as you’ll reap the rewards of your systems in 3 to 5 years. I was obsessive about my systems, and now I walk into the optical and see my team performing certain tasks and I say, “How do you know how to do that? That’s just how I would’ve done it!”

GUERRILLA MARKET YOURSELF

In the year that I started the practice, my focus was on name and brand recognition. You could have found me at every event in town that year. My face was everywhere, and so was my logo. I had cheerleaders at all the local high schools throwing out footballs with my logo. People were fanning themselves with a fan with my logo at the local Fourth of July extravaganza.

If you’re starting cold, my advice is to have a strong digital presence, including your website and social media. Beyond that, put in the work with your community. Partner with local boutiques, support local causes, and make your face and brand known.

Survey your market and get a good sense of what you’re offering that the other docs in the community aren’t. What type of patient is searching for a doc like you? After you’ve built awareness of your brand, it will be time to start drilling down and letting people know what you can do for them.

FOLLOW YOUR ARROW

There’s no greater satisfaction than creating something amazing from your own simple idea. It truly blows my mind that 5 years ago I was afraid that nobody would come see me, and now we’re highly successful and have more than 120 5-star Google reviews. If you have that pull in your soul to start something of your own, I’m here to tell that it’s not only possible, … it’s really awesome.