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Hello all.
I have been a sporadic watcher of this forum for several years, and only now decided that I might have something on here worth saying. What I am going to do is tell you where I am professionally, where I think it is headed overall, and some other random stuff Im sure. I was very glad to read recently a few lines that made me have a little hope from posters like Schnurck and Meibomian. I think my story illustrates it well, as they said, that this is not a profession to be an employee in. Doing well is equal parts business sense, flexibility, boldness, and luck. It is long to read, but I hope that it is worth it when you are done. Here goes:
I graduated from school ten years ago now, in May of 2002. I spent my last year rotating through VA clinics, but do not have a residency. At first, the job offers were a little scarce for real, full-time work that had a solid salary. I was limited to South FL at the time (is and has always been the valley of death for just about anyone in anything medical, much less ODs), and took my first job at a Lenscrafters that was in a parking lot stand-alone. I got paid 82k that year. Looking back, it was one of the worst years of my life, for reasons anyone that has worked under that constant lease pulling fear, pressure for sales, many other facets, do not need reiteration. I took on 2 additional associate part-time things my 2nd and 3rd year out, working many times 6 days a week. In those 2 years, I brought in 105k and 110k, but keep in mind that I worked like a lunatic, took absolutely any offer to work at any notice, etc. I dont like to repeat the figure to anyone, because 6 figures while putting it 700 hour work-weeks in not an accomplishment in my book, it is misery.
In Feb of 2005, I decided that I was going to do the insane: I was going to open a practice solo, cold. I moved out of FL and up to New England near my hometown, to a mid-size town that was, to put it lightly, very saturated. I loved the town, got a small 1500 square foot place with a lot of foot traffic, and made the leap. I took out almost 200k in loans to start the business, including all of my equipment, opening inventory, about 50k in renovations to the space, and another 50k to keep on hand as opening capital. Added to my school debt, I was 280k in the hole in 2005.
My first year was rough, as I know it always is for someone trying to start out. I had days when not a single patient walked in that door. I had to keep my expenses to next to nothing, driving around an old Subaru and renting out a farm house outside town for $650 a month. I did not look the part of a doctor and business owner, that much I know. With all of this and a low patient count, I took a loss of about 40k that first year, once you factor in hidden costs. It did not look like this was a very good idea.
Going into my second year, I had one employee, but built in an extra exam room to try to accommodate what had become a very picky patient time demand reality. Basically back then, I got busy twice a day at lunch hour and after 5. I had only one demographic, and no established regulars to keep the flow consistent With that all said, I never took a day off. Non-work days were for advertising, canvassing the local college, internet work, doing my own accounting, cleaning, billing, you name it. I realized that one of the local chain-stores, which thankfully there were few to begin with, had shut-down. (This was a major factor to my moving there. It was saturated, but it was mostly private due to zoning laws) I worked much more than I ever had doing part-time gigs strung together, but it was for me and for my name, not anyone elses. Walking into my business every morning and saying to myself, This is mine is a very powerful motivator.
By the start of year three, the business had started to move forward, all things considered. I saw an average of 11 patients a day, which for the segment I was targeting and fees I had, did enough to grow the cash flow. Even with all of this though, my actual take home was only about 80k, but this includes 35k going to loans. If there were a way to attach, I would show my balance sheets for those years to explain how a quarter million in revenue dwindles to 80k take-home, but that is the math. By the time my vendors, Wells Fargo, and Uncle Sam took their piece, I was left with about a quarter of my revenue.
In 2008, in the middle of my growth and likely the most critical time for my business, the economy fell part. My area was especially hard hit due to the industry in the area, and my revenues flat-lined. I had spent a lot of time and energy growing a blue-collar base to my normal college crowd (great to help growth, little in the balance sheet) and older boutique buyers. The first time I had a local machinist at the tractor factory come to me mid-day with an FB removal I nearly did backflips in my office and the economy tanked a lot of that progress for a time.
A year and a half later, the only private OD in my immediate vicinity (they were a small group about 2 miles away, established but never thriving) closed their doors. It is only due to my constant work through social media, hiring students to do odd-jobs and advertise for me, and other aggregated small things, that I was able to grow during that period. At one point I had a 20 year old IT major expanding my website and installing an online appointment making device, a 19 year old graphic design Jedi producing little tote-bags for every patient (so they can walk onto that busy street carrying MY LOGO with them! Muahahaha!) , and a 46 year old housewife tasked with making a play room for families with kids. I wanted cheap talent, and did whatever it required to procure them without any commitments. I had my name put on the HS baseball field in town, tried to expand my family demographic, full in sports VT, anything to keep the recession from claiming my scalp as well. The Yankee Candle and the bookstore on both sides of my place were at one time, in the peak in early 2009, both black boxes. It was nasty up here.
Now almost 4 year since then, I do not recognize my life. Fiscal years 2010 and 2011 had about 600k in revenue, which of course disappeared into about 130k and 160k take home. I saw 22 patients today, have 4 permanent staff, 2 techs, and no longer clean my own toilets. I cannot really make any more than the above unless I bring in a partner or vastly change by business plan, which may work briefly but would ultimately get me shut down. I work about 45-50 hours a week, but anyone that thinks these numbers are relevant to your lifes reality has not owned their own business. It never ends. And off day becomes a very relative term. For the first time in years, I took a 3 week vacation over this past New Years. To wake up and not have the white coat on ten minutes later felt so foreign.
Now, here is the hard part to say what I did has become very close to impossible. Explaining to a say, a student as to how they can do it, it would take many books to fill. But notice that I did not say impossible. It CAN be done, and I believe the rewards are almost impossible to match in most other fields. You actually can be relatively well-off, answer to no one, spend every day helping people, and have something you can sell one day and walk away from with a lot to live off of....Apparently getting that is hard to do. Most people will fail at it, and do not let a school or another doc or association say differently. The window to making a good life in this profession is open about an inch, and closing more all the time for next 5-10 years. That is the reality.
So in closing, here is what I would tell a young version of me, back there in school or thinking about it.
1) There is a ridiculous oversupply in many places and new schools turning out new docs all the time .relax. There will always be places like the one I found, where the oversupply is just evidence that there is demand in the area. If you build it, they will come to you, and not to the oversupply. Apple did not try to go to where there was no Microsoft product, they made sure they could BEAT Microsoft. Why anyone thinks we someone are exempt from this kind of thinking, by virtue of being doctors, I have no idea.
2) Know your community, and know it well. More importantly, know your competition. It is not about being everything to everyone there. It is about being the only thing for a certain group. I built mine on young professionals, college students, and VT/pediatrics. A colleague I met in Boston last year did it on low vision and specialty CL fits. Have a niche.
3) Study business with the same fervor as you would optometry. You provide a service, and it must have good value for whatever it is you charge. You are not a sight oracle. Our profession is blessed with a lot of very altruistic people, sometimes to our being pushed around, but ultimately you are in the business of helping people.
4) You do not sell glasses or contacts or LV devices. You do not sell eye exams or PDR diagnoses. LensCrafters has all of these things. You sell YOURSELF. If you cannot speak coherent sentences, have no charisma, do not have core values that your patients can instantly detect, there are plenty of associate jobs around.
5) Optometry as a rule has very spineless leadership .that is the difference between us and medicine. As it was put to me once by an epidemiology healthcare lobbyist in Connecticut, Its as if you all want everyone to be your friends. You have very jovial, nice people as your leaders. You have the most popular kid in class as your leadership .Medicine does not do that. They want to run you over. It is war to them. They elect the most angry, loud, brash, maladjusted person with Dr in front of their name and put him/her out there. So, if you are expecting pushback to stop new schools, adjust entrance requirements, etc, it is not going to happen. They are toothless paper tigers. Get used to it.
6) The harsh reality, if at least a bright one if you are different, is that there are a huge number of business in eye care that have no idea what they are doing. It is like this in restaurants, retail, or anything else, and our profession has more than its share. There are simply a lot of people in business that have no concept, no real marketing, no long-term plans, no modernized recall devices, etc. I think that some of the best motivation for someone to want to open up their own place is just to go into 5 eye care places in your city. I would bet 3-4 of them look disorganized, unattractive, stuck in 1981, or just plain depressing. (A personal favorite is an office about an hour from my own that has totally blacked-out tinted windows, a small sign that you cannot read unless you are 20/15 and right in front of it, and carries no frames under $150 once you realize there is a doctor in that cave somewhere, presumably whom is making money)
7) Live like a homeless person if necessary to get out from under the cash flow demands when you get out of school. Working corporate in many places has become a zero security, no benefits, shark attack where you get to play the seal. Unless you have a good contract or an absolute need for cash, get out. Nothing is worth the uncertainty that is that kind of work.
8) The oversupply issue is going to remain for a long time, at least the next 5-10 years. At this point a large portion of the population will not only be prebyopic x1000 but also retired. There will be a labor shortage across many high-education fields that even the constant new schools may not be able to keep up with, so relax .but I wouldnt put it past them J
9) Modernize. When I had a patient get a text reminder that her glasses were finished along with an automatic E-card of a monkey doing back flips in new glasses to her email, she must have told a dozen people about me. If I get bored I used to go onto the sidewalk and play music in my white coat as if it were totally normal. Dont take yourself too seriously and have fun.
10) What you are about to see under this is a deluge of negativity about the profession that is mostly correct. Like I said, the window is very narrow. You must have the ability to secure capital, flexibility of where you want to move, the right community, and merge this all with business sense, a niche you spotted, charisma, and a willingness to clean your own floors for several years. It didnt used to be like this, and it is very sad to me .but dont let anyone say it cannot happen. Like I said, apparently becoming wealthy, autonomous, secure, all while helping people and having time to relax is hard to do. I still am not there and it may take many more years and guitar sessions in my white coat to do it, but I love my job and am happy with the choices I made. If I won that 650 million lottery the whole country is talking about tomorrow, I think the only thing that I would change is maybe a few extra lanes, a better OCT, and several antique cars outside. This is not a profession to work for someone else. If you do not think you can be a true entrepreneur and manager, I would advise you not to enter this profession. There are simply too many fish in that pond, ready to be eaten up by the few that go into this as equal parts doctor and businessperson. If this is not going to happen for you, do something else. Your life will be much easier as an employee in another profession....But speaking only for me, it has been rewarding beyond my hopes and gives me a great life. At last, that is all I can truly speak for.
Thank you.
I have been a sporadic watcher of this forum for several years, and only now decided that I might have something on here worth saying. What I am going to do is tell you where I am professionally, where I think it is headed overall, and some other random stuff Im sure. I was very glad to read recently a few lines that made me have a little hope from posters like Schnurck and Meibomian. I think my story illustrates it well, as they said, that this is not a profession to be an employee in. Doing well is equal parts business sense, flexibility, boldness, and luck. It is long to read, but I hope that it is worth it when you are done. Here goes:
I graduated from school ten years ago now, in May of 2002. I spent my last year rotating through VA clinics, but do not have a residency. At first, the job offers were a little scarce for real, full-time work that had a solid salary. I was limited to South FL at the time (is and has always been the valley of death for just about anyone in anything medical, much less ODs), and took my first job at a Lenscrafters that was in a parking lot stand-alone. I got paid 82k that year. Looking back, it was one of the worst years of my life, for reasons anyone that has worked under that constant lease pulling fear, pressure for sales, many other facets, do not need reiteration. I took on 2 additional associate part-time things my 2nd and 3rd year out, working many times 6 days a week. In those 2 years, I brought in 105k and 110k, but keep in mind that I worked like a lunatic, took absolutely any offer to work at any notice, etc. I dont like to repeat the figure to anyone, because 6 figures while putting it 700 hour work-weeks in not an accomplishment in my book, it is misery.
In Feb of 2005, I decided that I was going to do the insane: I was going to open a practice solo, cold. I moved out of FL and up to New England near my hometown, to a mid-size town that was, to put it lightly, very saturated. I loved the town, got a small 1500 square foot place with a lot of foot traffic, and made the leap. I took out almost 200k in loans to start the business, including all of my equipment, opening inventory, about 50k in renovations to the space, and another 50k to keep on hand as opening capital. Added to my school debt, I was 280k in the hole in 2005.
My first year was rough, as I know it always is for someone trying to start out. I had days when not a single patient walked in that door. I had to keep my expenses to next to nothing, driving around an old Subaru and renting out a farm house outside town for $650 a month. I did not look the part of a doctor and business owner, that much I know. With all of this and a low patient count, I took a loss of about 40k that first year, once you factor in hidden costs. It did not look like this was a very good idea.
Going into my second year, I had one employee, but built in an extra exam room to try to accommodate what had become a very picky patient time demand reality. Basically back then, I got busy twice a day at lunch hour and after 5. I had only one demographic, and no established regulars to keep the flow consistent With that all said, I never took a day off. Non-work days were for advertising, canvassing the local college, internet work, doing my own accounting, cleaning, billing, you name it. I realized that one of the local chain-stores, which thankfully there were few to begin with, had shut-down. (This was a major factor to my moving there. It was saturated, but it was mostly private due to zoning laws) I worked much more than I ever had doing part-time gigs strung together, but it was for me and for my name, not anyone elses. Walking into my business every morning and saying to myself, This is mine is a very powerful motivator.
By the start of year three, the business had started to move forward, all things considered. I saw an average of 11 patients a day, which for the segment I was targeting and fees I had, did enough to grow the cash flow. Even with all of this though, my actual take home was only about 80k, but this includes 35k going to loans. If there were a way to attach, I would show my balance sheets for those years to explain how a quarter million in revenue dwindles to 80k take-home, but that is the math. By the time my vendors, Wells Fargo, and Uncle Sam took their piece, I was left with about a quarter of my revenue.
In 2008, in the middle of my growth and likely the most critical time for my business, the economy fell part. My area was especially hard hit due to the industry in the area, and my revenues flat-lined. I had spent a lot of time and energy growing a blue-collar base to my normal college crowd (great to help growth, little in the balance sheet) and older boutique buyers. The first time I had a local machinist at the tractor factory come to me mid-day with an FB removal I nearly did backflips in my office and the economy tanked a lot of that progress for a time.
A year and a half later, the only private OD in my immediate vicinity (they were a small group about 2 miles away, established but never thriving) closed their doors. It is only due to my constant work through social media, hiring students to do odd-jobs and advertise for me, and other aggregated small things, that I was able to grow during that period. At one point I had a 20 year old IT major expanding my website and installing an online appointment making device, a 19 year old graphic design Jedi producing little tote-bags for every patient (so they can walk onto that busy street carrying MY LOGO with them! Muahahaha!) , and a 46 year old housewife tasked with making a play room for families with kids. I wanted cheap talent, and did whatever it required to procure them without any commitments. I had my name put on the HS baseball field in town, tried to expand my family demographic, full in sports VT, anything to keep the recession from claiming my scalp as well. The Yankee Candle and the bookstore on both sides of my place were at one time, in the peak in early 2009, both black boxes. It was nasty up here.
Now almost 4 year since then, I do not recognize my life. Fiscal years 2010 and 2011 had about 600k in revenue, which of course disappeared into about 130k and 160k take home. I saw 22 patients today, have 4 permanent staff, 2 techs, and no longer clean my own toilets. I cannot really make any more than the above unless I bring in a partner or vastly change by business plan, which may work briefly but would ultimately get me shut down. I work about 45-50 hours a week, but anyone that thinks these numbers are relevant to your lifes reality has not owned their own business. It never ends. And off day becomes a very relative term. For the first time in years, I took a 3 week vacation over this past New Years. To wake up and not have the white coat on ten minutes later felt so foreign.
Now, here is the hard part to say what I did has become very close to impossible. Explaining to a say, a student as to how they can do it, it would take many books to fill. But notice that I did not say impossible. It CAN be done, and I believe the rewards are almost impossible to match in most other fields. You actually can be relatively well-off, answer to no one, spend every day helping people, and have something you can sell one day and walk away from with a lot to live off of....Apparently getting that is hard to do. Most people will fail at it, and do not let a school or another doc or association say differently. The window to making a good life in this profession is open about an inch, and closing more all the time for next 5-10 years. That is the reality.
So in closing, here is what I would tell a young version of me, back there in school or thinking about it.
1) There is a ridiculous oversupply in many places and new schools turning out new docs all the time .relax. There will always be places like the one I found, where the oversupply is just evidence that there is demand in the area. If you build it, they will come to you, and not to the oversupply. Apple did not try to go to where there was no Microsoft product, they made sure they could BEAT Microsoft. Why anyone thinks we someone are exempt from this kind of thinking, by virtue of being doctors, I have no idea.
2) Know your community, and know it well. More importantly, know your competition. It is not about being everything to everyone there. It is about being the only thing for a certain group. I built mine on young professionals, college students, and VT/pediatrics. A colleague I met in Boston last year did it on low vision and specialty CL fits. Have a niche.
3) Study business with the same fervor as you would optometry. You provide a service, and it must have good value for whatever it is you charge. You are not a sight oracle. Our profession is blessed with a lot of very altruistic people, sometimes to our being pushed around, but ultimately you are in the business of helping people.
4) You do not sell glasses or contacts or LV devices. You do not sell eye exams or PDR diagnoses. LensCrafters has all of these things. You sell YOURSELF. If you cannot speak coherent sentences, have no charisma, do not have core values that your patients can instantly detect, there are plenty of associate jobs around.
5) Optometry as a rule has very spineless leadership .that is the difference between us and medicine. As it was put to me once by an epidemiology healthcare lobbyist in Connecticut, Its as if you all want everyone to be your friends. You have very jovial, nice people as your leaders. You have the most popular kid in class as your leadership .Medicine does not do that. They want to run you over. It is war to them. They elect the most angry, loud, brash, maladjusted person with Dr in front of their name and put him/her out there. So, if you are expecting pushback to stop new schools, adjust entrance requirements, etc, it is not going to happen. They are toothless paper tigers. Get used to it.
6) The harsh reality, if at least a bright one if you are different, is that there are a huge number of business in eye care that have no idea what they are doing. It is like this in restaurants, retail, or anything else, and our profession has more than its share. There are simply a lot of people in business that have no concept, no real marketing, no long-term plans, no modernized recall devices, etc. I think that some of the best motivation for someone to want to open up their own place is just to go into 5 eye care places in your city. I would bet 3-4 of them look disorganized, unattractive, stuck in 1981, or just plain depressing. (A personal favorite is an office about an hour from my own that has totally blacked-out tinted windows, a small sign that you cannot read unless you are 20/15 and right in front of it, and carries no frames under $150 once you realize there is a doctor in that cave somewhere, presumably whom is making money)
7) Live like a homeless person if necessary to get out from under the cash flow demands when you get out of school. Working corporate in many places has become a zero security, no benefits, shark attack where you get to play the seal. Unless you have a good contract or an absolute need for cash, get out. Nothing is worth the uncertainty that is that kind of work.
8) The oversupply issue is going to remain for a long time, at least the next 5-10 years. At this point a large portion of the population will not only be prebyopic x1000 but also retired. There will be a labor shortage across many high-education fields that even the constant new schools may not be able to keep up with, so relax .but I wouldnt put it past them J
9) Modernize. When I had a patient get a text reminder that her glasses were finished along with an automatic E-card of a monkey doing back flips in new glasses to her email, she must have told a dozen people about me. If I get bored I used to go onto the sidewalk and play music in my white coat as if it were totally normal. Dont take yourself too seriously and have fun.
10) What you are about to see under this is a deluge of negativity about the profession that is mostly correct. Like I said, the window is very narrow. You must have the ability to secure capital, flexibility of where you want to move, the right community, and merge this all with business sense, a niche you spotted, charisma, and a willingness to clean your own floors for several years. It didnt used to be like this, and it is very sad to me .but dont let anyone say it cannot happen. Like I said, apparently becoming wealthy, autonomous, secure, all while helping people and having time to relax is hard to do. I still am not there and it may take many more years and guitar sessions in my white coat to do it, but I love my job and am happy with the choices I made. If I won that 650 million lottery the whole country is talking about tomorrow, I think the only thing that I would change is maybe a few extra lanes, a better OCT, and several antique cars outside. This is not a profession to work for someone else. If you do not think you can be a true entrepreneur and manager, I would advise you not to enter this profession. There are simply too many fish in that pond, ready to be eaten up by the few that go into this as equal parts doctor and businessperson. If this is not going to happen for you, do something else. Your life will be much easier as an employee in another profession....But speaking only for me, it has been rewarding beyond my hopes and gives me a great life. At last, that is all I can truly speak for.
Thank you.
