It has been said that rewatching a television series can be restorative. I confess I have rewatched my favorite series, F.R.I.E.N.D.S more times than I can count and it always puts me in a good mood. Maybe this is because there is a sense of comfort in knowing what comes next, which is a stark contrast from the unpredictability of day-to-day life.
In 2021, my husband and I became the owners of not one but two private practices within a 3-month span. To say that these acquisitions have been an adventure is a gross understatement. There are countless late nights and multiple obstacles that we have had to overcome as new owners. Sometimes, you have to put on a brave face, conjure up a smile and just power through the day. I am sure there are many practice owners out there who can relate to the several little fires you have to put out on a day-to-day basis.
Over the past three months, my late night T.V. watching has significantly increased, if only for 20 minutes with one episode of Friends. Sure, some of you may be thinking I could have spent that time reading or exercising, but after one of those tough days, sometimes, you just need a quick fix. Today, I am going to let you in on some adventures that we encountered in the first quarter of private practice ownership. Hopefully, if you are a new owner, you will read this, chuckle, and realize that you are not alone! While at first these problems threw us for a spin, they also helped us learn to be accommodating and how to deal with hardships. While I can say that it does get better, sometimes when it rains, it pours! So here it goes, the challenges in our first quarter of ownership as told by three episodes of F.R.I.E.N.D.S.
The One Where No One Gets Their Glasses
As doctors, we have mastered the art of performing an eye exam. While most of us may remember a few things from optical, the expectations are kicked into high gear when you become a new owner….with no Optician. For the past 3 years, I had been working in a vision therapy clinic so fitting glasses, processing insurances, and working with labs were some forgotten skills.
As if the joy of struggling to get on insurance panels wasn’t enough, we now had to figure out how to use these insurances to price out glasses and submit jobs to labs, all the while patients hover over the front desk (why do they always hover?!). I couldn’t help but have a flashback to my third year of optometry school where I was exhausted after seeing a full day of two patients! I remember thinking, am I ever going to get better at this?
One of the best assets about purchasing an established practice is an active patient base; this is also one of the challenges. Patients don’t typically pause their demands just because there has been a change of ownership. It was up to us to learn on the job, as fast as humanly possible, or else no one was getting their glasses on time, if at all.
Did you know there are multiple different websites for multiple insurances which require you to use their exact platform to submit orders? Also, spectacle orders can have mystery charges like “technical add-on” and “UV backside”…don’t even get me started on orders for prescription sunglasses.
Luckily, we were not above asking for help when we clearly needed it. We connected with an awesome representative in the industry who had worked with the previous owners. She had useful knowledge about lens designs, coatings and working with labs in the area. In order to streamline our process of ordering glasses, we decided to stick to one trusted manufacturer that both of us had good experience with. Long ago, when we were designing our business model, we had decided that we were only going to offer premium products at our practice because this would ensure the best outcome for our patients. The benefit of this model was also that we didn’t have to troubleshoot with various lens designs if there were any problems. So that is exactly what we did. We designed a competitive price list for our premium quality products and used it to price out glasses orders. After a couple of weeks, we even expanded our insurance game. Before we knew it, we were submitting jobs, printing packing slips and sending orders out to the lab. Even though it took weeks to get this done, when that first job actually made it back from the lab we couldn’t help but toast to our small victory.
The One With The Blackout
In our third week of practice ownership, things were starting to run smoother. We had become more familiar with the layout of our new work home and were becoming comfortable managing patient encounters. We had even hired our first employee! One of our initiatives at the practice was to turn this paper practice into an electronic one to maximize efficiency and save some trees in the process. We had recently installed our new phone system, Weave, which is an internet-based phone system. We had connected our new payment portal, Clover, which was very user-friendly. We had even managed to finally transfer the ATT account over to us. For those of you who have never had to do this, working with ATT to get an existing account transferred to us was more difficult than getting on any insurance panel. Finally, our health records were now electronic. Most importantly, all our devices were cross-communicating in an effort to make life easier for us.
It was a Tuesday afternoon. I had just finished examining a patient and our lovely new optician was helping him pick out glasses. The next patient was running a few minutes late. We had scheduled a meeting with a representative to continue our learning about lens products and she had just walked in the door. With a few minutes to spare, I jumped in on the frame selection process for my patient…this is the fun part of the job! As I handed him a frame, all of a sudden, the light from his face fades. I am puzzled. I look around the room to notice that all the lights in the front of the office have turned off. In the distance, I see a lone phone charger that had been plugged into the wall moments ago–the culprit. It took me a few seconds to realize that the entire front office was in a blackout. Fortunately, it was daytime and our office is pretty-well lit, so one may think that we could manage with the frame selection. However, remember those wonderful technological devices that we had running, which were all cross-communicating? Turns out, without power, they don’t function. So this meant, not only were we out of lights, we didn’t have wifi so no active phones, no payment portal, and no EHR.
When we took over the practice, we didn’t think to find a local electrician just in case the power went out. We were too busy trying to figure out the 500 other aspects of running a practice. However, that day, at record speed, we contacted every electrician in the area with hopes that one could save us.
Remember that patient that was running late? Well they showed up, to a dimly lit optical. We updated him with the ongoings of the day but assured him that we could still see him because the exam room was functional (so I thought). Did I mention that we also have the electronic phoropter? I soon found out that the monitor was plugged into the ONE outlet which was linked to the front wiring. So this meant the monitor, which had the acuity chart, was not functional and we did not have a paper acuity chart to hang on the wall. So what do we do?
I excused myself and went to relay to the front that we needed to find the longest extension cord possible to try to connect the monitor to the pre-testing room which had a functional outlet. Meanwhile, I began performing every test in my arsenal besides acuity and refraction. I even got through performing my slit lamp exam. Just when I thought I had run out of tests, supplemental tests, and the last bit of my cool, the monitor turned on!! The longest extension cord I had ever seen was charging the monitor. In the corner, I could see the electrician had arrived and was troubleshooting the problem. I wiped the sweat off my brow and stepped back into the exam room. After the exam, I thanked the patient for his patience and understanding as a few of the lights slowly turned back on. He thanked us for giving him an extra-thorough eye exam.
The One Where No One Shows Up To Work
It is no secret that there is a staffing shortage in the midst of this pandemic. We have heard from many colleagues and friends that hiring staff has been difficult. So imagine our surprise when we found not one, but two, great employees. The Indeed gods smiled upon us and matched us with two great, experienced, Opticians. With the new addition, our workload as owners had decreased; the opticians were taking on more responsibilities. In all honesty, this was a huge factor in why we felt encouraged to take on the responsibility of a second practice.
A bonus of the second practice was also that it already had existing employees who knew the routine of the practice. This acquisition would be easier. Little did we know, winter was coming. The week after we got the new practice, there was a huge surge in COVID cases in San Diego, similar to the rest of the country. Patients were calling left and right to reschedule appointments. Also, one of the long-term employees decided she was retiring so we were now down to 1 employee–difficult, but within reason.
We still had two amazing employees at our first practice to hold down the fort and we could turn our focus to the second location. This wasn’t our first rodeo; we were accustomed to a steep learning curve. Now, at least we had some basic knowledge under our belts and weren’t starting from square one. Managing a new practice with one employee would be doable…we were not prepared to do so with no employees. Yet, this is exactly what happened.
For health and safety reasons we have advised all our employees to be extremely cautious. Due to this our new location now had zero employees and 1 doctor. My husband and I couldn’t physically work together to manage this hardship because one of us had to doctor the first location which was also, now, down to one employee. So we were left with 1 employee and 2 practices. Remember when it rains, it pours!
COVID has been extremely difficult on business owners, and I am not going to pretend to compare my current state to what some owners went through in 2020. However, this was a very real experience of that hardship and it was not pretty. Our options were to either close down the brand new location or figure out a way to manage the day. We chose the latter. We installed a camera in the front to monitor traffic, put up a sign asking for patience, and spread out patient encounters so we could finish each encounter fully before beginning the next one. At one point each of us was there, by ourselves, doing the job of 3 employees. Such is life as a practice owner.
Luckily, our first practice had forced us to be cross-trained. We had learned to work as a technician, optician, receptionist and cleaner all the while being a doctor. So while this was unchartered territory, it wasn’t completely foreign. After a tough two weeks, we had expanded our team, welcomed back old staff, and were ready to take on the next challenge that came our way!
Life as a practice-owner is never boring. There are little fires everywhere that need your attention. However, recognize that you have done it once so you can do it again. It is worth the time and effort because, despite the hardships, the reward and fulfillment from ownership are unparalleled. I can honestly say, this is the most invested I have ever felt in my career. So while tonight, I will probably rewatch another episode of Friends or (maybe Schitt’s Creek) to calm my nerves, I am still excited about the prospect of tomorrow. Stay tuned for more episodes from the next quarter!
