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INVISION’s Latest Real Deal Scenario

The Case of the Baffling Bonus

An office’s bonus structure is giving the team headaches. Should they salvage, scrap or suck it up?

For decades Upper Valley Vision Care had been a tight two-doctor operation, but in the last five years the office moved to a larger building, added three more optometrists and over a dozen staff members, bringing the company head count to 30. Owner Dr. Hyde and office manager Nicole found themselves dedicating a huge percentage of their time to staff needs: scheduling, training and coaching, meetings, interpersonal conflict resolution — but the biggest task was monthly evaluations and bonuses.

Dr. Hyde relied on his comprehensive reviews and carefully weighted reward systems to boost staff engagement, document performance issues and consistently communicate expectations. Over the years, whenever a team member would fall short in an area — attitude, attendance, use of downtime — it was briefly addressed, then added across the board as a metric.

At the end of each month, Nicole crunched data from the practice software, surveyed the doctors and supervisors, collected self-evaluations as well as anonymous peer reviews per department, read patient feedback forms, audited charting and observed staff in action. Mid-month, when she was finally finished, Nicole and Dr. Hyde sat down with every team member to deliver a calculation explanation and suggestions on how to improve before sharing the bonus earned that month. The final coefficients balanced hours worked, individual effort, department output, company growth and seniority, but the strongest factor was practice growth in collections over the same month last year. On average bonuses were $200-300, with shining stars receiving closer to $600.

NATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at [email protected]
Real Deal is a fictional scenario designed to read like real-life business events. The businesses and people mentioned in this story should not be confused with actual businesses and people.

A few months ago, Dr. Hyde had announced that one of the new hires, Dr. Ng, had run out of time on her visa application and was returning to Canada after only a year. It was the first time the office had ‘lost’ a doctor. During the first month without Dr. Ng, production was down across the company. Dr. Hyde worked more patient hours to temper demand, but it wasn’t close to compensating for Dr. Ng. The following month, growth in collections was down enough to drop bonuses by 40%.

Nicole provided evaluations mid-month as usual, taking care to explain the shortfall. She got enormous pushback: Dr. Hyde was always emphasizing the ways in which staff could influence the outcome of a bonus, but what can be done about a doctors’ lost production? Hiring a replacement would take many months.

Nicole continued to emphasize individual and team metrics but as collections remained lower than last years’ numbers, the office culture changed. The department supervisors had been trained to utilize monthly reviews as both carrot and stick, but some team members were resigned to this new normal — and they were dragging everyone else down.


1. Would such a detailed evaluation motivate or demotivate you? Why?

2. Should the bonus formula get adjusted or prorated to compensate for fewer staff members?

3. If a practice wants to use their bonus system as a mana
INVISION’s Latest Real Deal Scenario

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