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Population Smallsville

Opticians, eye docs and marketing experts’ 21 solutions for 17 marketing challenges faced by small town ECPs.

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The icon of small-town retail, the general store, may be a thing of the past, but one thing hasn’t changed. In a small market, word of mouth business building inspired by quality service remains paramount, and should still be the starting point for any marketing discussion. But that doesn’t mean innovations aren’t transforming smaller markets, just as they are in urban centers. Residents of small towns aren’t who they used to be, often commuting to larger cities to work, or working remotely. And for independent business owners, navigating social media and online marketing poses unique challenges in a small-town context. We quizzed opticians, eye doctors and marketing experts far and wide to come up with the following 21 solutions for 17 common marketing challenges faced by ECPs in small markets.

We’re a tight-knit town with a lot of young families. How do I make my optical a household name?

In Dansville, NY, little league teams are named for the organizations they’re sponsored by. Vying for the pennant with the Lions and Rotary Club squads is the Mill Creek Optical team. Owner Jennifer Leuzzi sponsors it for $250 a season. Families come to watch, or listen on the radio. “My business name is mentioned over and over. I also have a sign on the outfield fence advertising sports goggles and repairs! I feel good about supporting community sports to keep kids active,” she says.

Similarly, Brad Dobson, OD, owner of Bee Cave Vision Center in Bee Cave, TX (and a second location in nearby Dripping Springs) often turns up at school functions, talking about what his practice has to offer. “We support most school sports, clubs and fundraisers. Taking time to judge science fairs and discuss vision screening results with school nurses creates a rapport and shows you want to be involved with the kids and families.” He’s also had success going to seasonal festivals, where staff set up a booth and give away promotional sunglasses, koozies and T-shirts, which he says gets his name out.

Our small-town market is home to a lot of Medicare and Medicaid recipients. It wasn’t the demographic we envisioned when we set up shop here, but how do we reach these folks?

A few years ago, Pend Oreille Vision Care in Sandpoint, ID, launched a coupon in a “Local Deals” glossy that goes out monthly. The magazine runs discounts and coupons for hair salons, restaurants, contractors, etc. The coupon, for half off lens treatments, was supposed to advertise deluxe upgrades, but the response was poor. “We didn’t realize the choice of publication was everything.” By chance, the coupon featured a summary of the business’s services, including the phrase “We accept Medicare, Medicaid, and other major insurances.” So, while the upgrade outreach bombed, according to business manager Jan Heller, “During that same period, our Medicaid new patient exams increased by over 30 percent. Since Medicaid pays well in our state, we more than made our money back, albeit in a different area of our sales than we anticipated.”

 

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My desert town is wealthy with modern infrastructure, but it’s filled with retirees. Since the demographic doesn’t lend itself to social media, what aspects of my online presence should I be thinking about other than my website?

In less populated areas — and this goes for just about all small communities, not just the kind described above — it’s important to register your business with online directories like Google My Business, Bing Local, Yelp, Superpages, Yellow Pages, Whitepages, MerchantCircle, Yellowbot, CitySearch, Yahoo! Local, and the like. A Google listing gets you on Google Maps, for a start. This’ll bring in people who might otherwise just drive on by. Make sure you fill out all the fields a particular service asks you to, and keep the information consistent across all services.

We’ve got the opposite problem! Many of our rural clients still lack decent broadband and use mobile devices for just about everything. How do I make sure I’m reaching them?

According to Sharon Strover, director of the Telecommunications and Information Policy Institute at the University of Texas at Austin, 39 percent of Americans living in rural areas lack residential Internet access that meets even the FCC’s minimum definition of “broadband” service. Believe it or not, high-speed Internet is still a prohibitively costly option for some rural residents. That means your business needs a mobile-responsive website. Remember, Google is getting tough on websites that are not optimized for mobile devices, ranking them lower in search engine results. To see if your website is mobile responsive, plug your URL in here: invmag.us/061802.

We envy the immediate feedback on product and service trends that big-city ECPs enjoy. Our small town has changed in recent years. How do we get a better sense of who our market is, exactly, and how they might respond to a new product or service?

Sometimes you’re better off letting the pros handle it. There are various sites online that allow you to ask marketing professionals for advice, and even offer you the use of their research tools. Some are free, others aren’t. Sites like Marketing Sherpa, ResearchInformation.info and MarketingProfs.com have a range of resources. Thrive Hive offers a free downloadable guide with six sample marketing plans for small businesses.

 

Folks around here tend to be set in their ways. I’m sure if I could get them to try these unique frames made from old vinyl records and lacquered bird feathers they’d love them. How do I get them to take the plunge?

 

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Dr. Scott Keating at Vision Trends in Dover, OH, has an idea. “I fit key people in key business locations with free unique eyewear. I fit some of the grocery store checkout ladies in fun frames. Think about all the people who go through their checkout lines.” To ensure it is cost effective, let your rep and lab know about the plan and ask for a discount on that frame, Keating advises. “The patient/customer becomes a walking model for several years. This is a great return on investment.”

What hours should an optical/optometric business be open in a small town?

The question of opening hours is a particularly tricky and important one in a small market. According to SmallBizSurvival.com’s 2017 Survey of Rural Challenges, small business owners said staying open later with no success was their number one challenge. U.K. marketing expert Dr. Scott Dacko coined the term Time-of-Day Marketing. His study, which relies on psychological, geographical and marketing data, shows that different types of people shop at different times. Elderly, “non-time pressured” and non-working people, as well as “variety-seekers” and families with small children are more likely to be morning and afternoon shoppers. (Women tend to do more morning shopping than men, while youth, people looking for a new experience, and those without kids tend to shop in the afternoon.) Busier people shop in the evening. “A retailer can adjust…strategy and tactics dynamically throughout the day to be in tune with potentially important…customer characteristics,” a summary of his findings reads. Retailers “can alter their environment, pricing, promotions and…staff for different shoppers that…frequent their stores at different times.”

Social media isn’t working for me in this rural bedroom community of professionals who work in a nearby coastal city but local residents are tech savvy and well heeled. I’ve studied optimization, I tend to my Instagram daily, we’ve even dabbled in Facebook Events. What am I doing wrong?

That may be what your customers are asking themselves when they finally make it into your store. The double-edged sword that is social media can be particularly sharp in a small market. “When you live in a smaller community,” says Dr. Zachary Dirks of St. Peter and Belle Plaine Eyecare Centers in Saint Peter, MN, “fewer people ‘find you’ on social media, big mailer campaigns or even radio ads. Most people know you are there.” If you want to retain those people and have new ones trust you, he says, they are going to need to hear it directly from someone. In other words, in a small town, word of mouth can make you or break you, and social media’s role in this is amplified. Back up the pretty pictures with excellent service, or it could backfire.

⇢ William Chancellor of Eye Can See Eyewear in McDonough, GA, says his use of Facebook and local county discussion pages really boosted Eye Can See’s two small practices. “It’s amazing how well the positive feedback from those who do post to Facebook discussion pages has increased our walk-in traffic,” he says. The practice’s online posts include everything from educational tidbits to promotions and recognition/appreciation for customers. “Our practices are situated in smaller towns so our word of mouth and social media referrals are very important.”

We’re located on Main Street, but most of our customers in this rural town drive in for 30 minutes or more to reach us. We’d like to attach our name to an event that brings people together. Any ideas?

No need to re-invent the wheel on this one. Many of the tried-and-true marketing techniques take on a special power in a smaller market. Take trunk shows, for example. “Chatter,” according to Leah Johnson, optical manager at Central Texas Eye Center in Kyle, TX, “is important in a small town. The more we can get people to talk about us the better.” CTEC hosts a trunk show for one day every other month, showcasing a different brand each time. Each party has a theme, and themed drinks and small bites are served. “We send email invitations and pay for Facebook advertising. Customers feel special because we ‘invited’ them to a party.”

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I spend a lot of time on Instagram. There are more interesting folks than I thought in this small town; and I thought I knew everyone. How can I use this to help my business?

Welcome to the world of micro-influencer marketing. According to smallbiztrends.com, the aim is to leverage the local clout of those people in your town who actually do know everyone. You’re not looking for just anyone; the mailman may be on a first-name basis with the whole town (and he may be a lovely guy) but you’re looking for people with shared values. Start paying attention to the folks in your town who follow or like your optical on social media. Look for those who have the biggest followings of their own and who seem to post things that gel with your tastes or target customers. It could be a hip record store owner or a rabbi with digital eye strain. By leveraging their local clout, you can increase awareness of your own brand and lend it a little authority. To make this work, think of a way to engage them; offer to fit them for free or discount some frames. In return, they post images of their experience at your business. This could work well for Facebook, too.

We’re a small town that gets tourist traffic due to some local sites of historic interest. We’ve advertised in guidebooks and pamphlets but it didn’t do much for us.

Remember that what tourists are after these days are “authentic” experiences. According to SmallBizTrends.com, “Instead of checking famous sights off a list in a guidebook, they’re seeking out the local artists, authentic foods and hidden gems recommended by friends and fellow travelers.” These are the people you want to be cross-marketing with. According to David Brown, president of the Edge Retail Academy, “Stores can really celebrate their localness, their quirkiness, what makes them different. Celebrate your localness and try to make the experience unique.”

We’re a new optical in a semi-rural area. What’s the best way to get our marketing off the ground in this small market?

Here’s an oldie but a goodie: mailers. Dr. Danielle Jackson at Jackson Eye in Fairburn, GA, sent out postcards to the surrounding neighborhoods and subdivisions when the business first opened. “That initial campaign has had the largest ROI so far,” she says.

We’d love to do something for the community but don’t know where to start. We’re looking to engage with people, not just stick a donation box in a corner of the optical.

Community relationships and charity involvement are a particular strong suit for Jocelyn Mylott, director of optical operations at D’Ambrosio Eye Care based in Lancaster, MA. They even have an internal committee that plans upcoming events and fundraisers. That’s an idea you might think about if, like D’Ambrosio Eye Care, you’re running more than one practice. When it comes to outreach ideas, take your pick: “We may do a staff and patient fundraiser and donate funds or supplies to local community outreach like homeless children birthday gifts,” says Mylott. “Just recently we fundraised for a local police department to help outfit their new canine unit with a bullet proof vest.” Staff also visit assisted living facilities to do eye screenings and eyewear repairs, or even just stop by with flowers. “In the end, a lot of the town in some way has been positively on the receiving end of what we try to do through kindness. The mayor shops here, the emergency room and school nurses refer here, etc. because of the care we provide and the kindness we try to provide locally.”

⇢ Dr. Robert Easton Jr. of Easton Eye Care in Oakland Park, FL, summed this up in two words, “community action,” which he defined as “being active in my 160-member Rotary Club, doing projects to raise funds for scholarships, ‘sweat equity’ projects to help injured vets in the community, providing youth exchange from different countries to help build world peace, and more.” Easton was also active in Leadership Broward for years, a leadership networking group out to help Broward County prosper with planned growth and opportunities.

Our town just doesn’t have the planning resources that bigger towns and cities do. Wouldn’t I be better off moving to a bigger market so I can benefit from these?

⇢ Stop and think about the aim of most urban planning: Walkability, public spaces, a sense of community and locality: Basically, they’re trying to make cities more like small towns. SmallBizTrends.com reminds us that in terms of your town’s core, you probably already have these features. They just need to be revitalized. Get together with your business neighbors and get a project going.

We’ve always been curious about selling private label, but our business just isn’t big enough to justify the risks or support the large orders. It seems online should be a good option for small town retailers, but we don’t have the distribution know-how or financing to gear up for it.

Trigger alert: This item discusses online sales, and, yes, Amazon. We know this will be a red flag to a bull for a lot of independent optical retailers, but this is an article about small towns and marketing — and what is Amazon if not a market place swarming with millions of people brandishing credit cards? The service known as Fulfillment by Amazon basically allows small manufacturers to piggyback on their order-filling service, so if you’re, say, a frame retailer you can store your products in Amazon’s warehouses, sell the goods online, and they will deliver for you. It’s potentially a new twist on the private label experience, one that taps a marketing and logistics behemoth with few equals in terms of scope. The benefits for retailers in small markets, who are not located near logistics hubs, should be obvious.

We’re a one-doc practice in a small town. We’d love to expand our services but don’t know if our small client base can support such a move.

Obviously, you’d need to do your homework, but we suggest you consider the case of Family Vision Care in Alma, GA. They’re based in a county with just 13,000 people but their full-scope optometry (everything from glasses and specialty contact lenses all the way through to amniotic membranes/stem cell treatments) has such a reputation that 45 percent of patients are from the greater surrounding area; the service here stands out so markedly it sells itself. Says owner Dr. Blake Hutto, “Being in a small town you’re often the front line, and the final leg of treatment for some complex cases. It’s literally solving puzzles all day…and we love it!”

We don’t buy the idea that TV is dead. But is TV advertising worth it?

Many people assume TV advertising is prohibitively expensive, but in fact it’s usually cheaper than radio and has certain advantages that work particularly well in a small-town context, such as building facial recognition for staff. Caitlin Bruno at Binyon Vision Center in Bellingham, WA, was surprised at first when a TV ad through Comcast became the store’s most mentioned campaign. “We had a local production company shoot a 30-second commercial of a patient moving through the office with a voice over. The production was high quality so it has lasted four years and still looks good.” The local Comcast rep has even tailored airing times both on major cable channels and network cable websites (like espn.com) to fit the store’s budget.

Texas State Optical of Nederland, Port Arthur, TX, was similarly surprised when TV worked for them. They had long assumed it would be too expensive, but, “We were able to co-op an annual package of air time with other associate practices in the area and are very pleased with the results,” says office manager Pam Housley.

 


This article originally appeared in the June 2018 edition of INVISION.

 

After years covering some of the farther flung corners of the world of business journalism, Heath has more recently focused on covering the efforts of independent eyecare professionals to negotiate a fast-changing industry landscape. Contact him at heath@smartworkmedia.com.

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Endings: Owners Share How and Why They Closed the Curtain on Their Eyecare Businesses

No two exit strategies are exactly the same.

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They say all good things must come to an end. In this industry, we often focus on the numbers when it comes to the sale or closing of a business… What sort of revenue did they have? What kind of deal did the owners get? How much did they sell for? But for business owners, there is an entire emotional and psychological journey when they are exiting the businesses they have poured money, sweat, and often, tears into.

No two exit strategies are exactly the same, and in the following pages we profile four business owners who have transitioned, or are looking to transition, out of ownership. What was their motivation? What did the process look like for them? How did they communicate their exit to their patients and staff? How did leaving their business make them feel? And what do their lives look like post-ownership?

LIFE SOMETIMES HAPPENS

Bryan Finley, LDO | Island Opticians, Palm Beach, FL | DATE CLOSED: May 2016

Bryan and Amie Finley

The original founder of the business, Stuart Villars, worked at Lugene Opticians on Worth Avenue, the luxury-shopping destination in Palm Beach, until they closed unexpectedly. Shortly after, he opened Villars Opticians on Peruvian Avenue, one block north of Worth. The business moved twice, but always stayed on Peruvian. In 2010, Mr. Villars decided it was time to relax a bit, and listed the business for sale. I was living in Oklahoma but saw the listing at a continuing education event I attended for licensing requirements in preparation for a move to Florida. I contacted Mr. Villars about purchasing it but, unfortunately, my then wife wasn’t interested in moving to Palm Beach, even though it was a tremendous opportunity. Mr. Villars sold the business to Christopher Moné, who renamed it Moné Optical Gallery.

After a short time in Florida, my marriage ended and I moved back to Oklahoma. I met Amie and we married. Again, I was looking for work opportunities in Florida when I saw a listing for a Moné Optical Gallery in Palm Beach. I told her: “No way, surely not!” She was excited about the prospect of owning our own business, so we contacted Chris Moné and struck a deal. We took over ownership and re-opened as Island Opticians on our first wedding anniversary, providing independent eyewear to the people of Palm Beach.

Although a bit stressful due to seasonality (Palm Beach has about 2,000 year-round residents but swells to 9,000 in winter), we loved our little 300 sq. ft boutique … But then life started to happen. Three months after opening, one of our daughters told us she was going to have a baby. Then, four months after that, another daughter called with the same news! Suddenly, we were going to have grandkids 1,500 miles away. Not long after the grandkids were born, our parents started having some medical issues. We tried traveling back to Oklahoma frequently to see the kids, grandkids and parents, but eventually we decided it was important and necessary to be near our family on a regular basis, so we made the difficult decision to sell the business after only two years.

We listed the business for sale on several optical forums and sites. After several inquiries, we reached an agreement in principle to sell to an optician, so we finalized all of our moving plans. One month before the sale was to be finalized, our buyer and her financier went in a different direction. Suddenly we had no buyer and no backup plan. With no time left to find a new buyer, we went into liquidation mode. We quickly had mailers printed to send to all of our clients and potential customers, with an aggressive going-out-of-business campaign. Everybody loves a good deal, even affluent people, so we were able to sell the majority of our product in one month. I ended up staying in Palm Beach a few weeks longer than Amie; she had already committed to a start date on a new job.

Since we were an LLC, the transition was fairly simple. We just had to notify the state that we were ceasing operations. As for communicating our plans to employees — no employees, so that was easy!

The first lesson we learned was: Have a good long-term plan and plenty of capital! Realize that starting or selling a business, should the need arise, doesn’t happen quickly; have patience. Be flexible. At the end of the day, integrity is the most important thing you offer as a proprietor.

Our advice for others is to have a Plan A, Plan B and Plan C!

QUICK Q&A

What was your greatest concern about giving up ownership?
Would we recover our investment? Would we ever have such a unique ownership opportunity again? After being owners, could we be happy working for someone else? Can we trust someone else to take care of our long-time clients?

Is there a patient encounter that stands out when they found out?
Many clients called in that last month to express their disappointment. Tears were shed. Mr. Villars, upon hearing the news, called to express how crazy he thought we were, but I think he was mostly sad to see the business close. One client offered to buy the business if we’d stay!

How would you describe the emotions you went through?
It was a bit heartbreaking. I felt like I was letting Mr. Villars down, and I was sad that my “retirement plan” wasn’t going to come to fruition. But we were both excited to spend more time with family.

Would you do anything differently?
I wouldn’t have been in such a hurry to sell.

What did you do to help overcome doubt?
We just reminded ourselves of the importance of family, and that things don’t create happiness.

How do you feel about the outcome?
We’re okay with how things have turned out, and plan to return to Florida, but as retirees instead of owners! We miss owning Island Opticians, but there is a certain level of anxiety that comes with ownership that we don’t miss.

Now what?
We tried working in private practice again, but just couldn’t get past knowing how to get things done better than our employers, because we’d been both opticians and owners. So, we decided to become brand ambassadors for some of our favorite independent lines. We still work together and are able to plan our travel schedule around our family activities. We do things a lot differently than most frame reps; we bought an RV that we live and travel our six-state territory in. This way, we’re “home” every night. We’re still technically owners as independent contractors, but have a little less anxiety now!

 

HANDING OVER YOUR BABY

Shimul Shah, OD | Marysville Family Vision, Marysville, OH | DATE SOLD: September 2018

The practice began as an ophthalmology practice. I purchased it in 2012. I practice general optometry and the patient base is very family oriented.

Accepting it was time to end ownership was a slow, painful realization that finally took a friend telling me that I would be just signing up for years of being unhappy and financially unsettled if I didn’t. It took a lot of introspection to realize I wasn’t able to accomplish what I wanted. I am very risk averse when it comes to money, and the one thing you need in growing a business is the ability to invest in it financially.

I had started asking around a little but was not actively looking for an exit strategy. When two different people gave me the same name to reach out to, I thought I should give it a try. I was hesitant to make promises and was willing to hold off until I knew that the practice, patients and my staff would all be treated with care.

A lawyer generated a Memor­andum of Understanding to get my intentions on paper and list what I wanted and was not willing to budge on. An accountant helped come up with a price and negotiate the sale. The biggest help was my family, who served as my sounding board.

Shimul Shah, OD

When it came time to communicate the change, I spoke with each employee and made sure they knew that a part of my agreement with the new owner was their position, the hours they would be working and the pay. I needed them to know it was something I had to do for myself and that I had made every effort to make sure they were taken care of.

We sent emails to all patients letting them know the business was turning a page but the doctor, staff, products and service were not changing. They seem accepting of what has occurred.

One surprise is that I find myself slightly disconnected from the profession at the moment. I went to a conference recently where I found myself wanting to attend and listen to practice management talks but didn’t know how I could implement anything now that it wasn’t my position to worry about those things anymore. I want to refocus on patient care, but changing gears has been challenging.

The process of deciding to give away ownership of something is a grueling one. I had to really think about my life and what I wanted out of it, and whether the good outweighed the bad. I learned on a deeper level what my strengths and weaknesses were and how each contributed to the conversation, and the ultimate decision, to start placing my efforts elsewhere and to pass the practice on to more willing and able hands.

My advice to others is to have good advisers in your corner. Be specific and diligent about what you want, but know that without compromise you will probably never find anyone that’s good enough to take over your “baby.”

QUICK Q&A

What was your greatest concern about giving up ownership?
Being an employee in a space where I’m used to being in charge. Secondly, I was nervous I would lose the passion I’d had for the practice’s success.

Is there a patient encounter that stands out when they found out?
Every encounter I’ve had has been positive and supportive! I don’t think patients care so much about the behind-the-scenes stuff as long as there is continuity of services.

How would you describe the emotions you went through?
I felt a myriad of emotions ranging from failure to anxiety, sadness, and excitement. At times, I felt I was abandoning my patients, staff and Marysville. At others, I felt like I was letting down all the people that had so much faith in me. Now that it’s over, I feel peace, stability and anticipation for the future.

Would you do anything differently? No.

What did you do to help overcome doubt?
I reminded myself that the current situation was unsustainable. I could potentially keep going for another six months, maybe even a year, but ultimately that would just be delaying the peace of mind I was so desperate for.

Are you happy with the outcome? Yes

Now what?
My plans include making more time for traveling, cooking, reading, and spending time with friends and family. I may get involved in the political and legislative branches of optometry and see how I can use my talents to help optometry grow in a different context.

 

PRIVATE PRACTICE TO PRIVATE EQUITY

Carol Record, OD | Drs. Record & Record | Charlottesville, VA | DATE SOLD: February 2016

Steve Record and I graduated from SUNY Optometry in 1982. It was the heyday of extended wear contact lenses and retail optometry was just beginning to advertise for eye exams, eyeglasses and contact lenses. We moved to upstate New York and worked retail optometry as our first jobs. We saw many patients and fit lots of contact lenses. We wanted to work in private practice and eventually own a practice, but not in upstate New York. The population was not growing. We felt we needed to move south to a town that was experiencing growth; preferably a college town.

After exploring established practice opportunities in Virginia, none seemed quite right. Once we accumulated enough capital to open a practice we moved to Charlottesville and opened cold. We opened in August 1983 and were the first in town to advertise our services for eye exams and contact lenses. Looking back, it is hard to believe we survived and actually made enough to pay our bills. Fortunately, we were able to live off the income we made from optometric employment and both had part time jobs working one hour away. Within five years we gave up all outside employment.

Our practice grew from zero patients, to two offices, four doctors, and over twenty employees. We embraced medical eyecare, added new equipment each year, and were fortunate to experience growth every year we were in practice.

Before we knew it, our children graduated college and we were advised that we had enough money saved to retire whenever we wanted. We were in our late 50s. I still had the mindset of growing the practice, perhaps adding an additional location, but Steve wanted to retire and I did not want to do it alone. We sought the advice of Al Cleinman of Cleinman Performance Partners to map out our options. We learned there were fewer buyers able to purchase a large practice as a whole. The better option was to sell each location. We were also informed it usually takes a few years to sell, so we retained him to help us transition our practice.

Selling a practice takes time and there are lots of facets to it. Finding a buyer willing to provide a fair deal is perhaps the hardest part. Legal and accounting documents will be needed. Will you work for the new owner? For how long? What will your employment contract look like? What will you do with the real estate? We were lucky to have an unsolicited offer from MyEyeDr that we could not walk away from. Cleinman, having brokered many practice sales, knows a good offer from a bad one and advised us as such. He also walked us through the details, along with our attorney, financial planner and accountant. From the time we decided to look for a buyer to the time we actually sold took about 2.5 years and MyEyeDr purchased all the assets.

We have many colleagues who are transitioning their practice. In all cases, the employees are informed of the sale of the practice once it is definite that the deal will go through. In our case, we informed our employees one month prior to closing. Since Steve and I were employed by MyEyeDr, MyEyeDr informed our patients of our new affiliation. As it came closer to the time when I would retire, I thanked my patients, hugged them and told them it would be the last time I saw them professionally. Often it was my retired patients who said “You can’t retire. Who am I going to see for eyecare?” Most patients thanked me for their care and congratulated me.

I consult with doctors at least once a month about practice transitions. The first thing I tell them is “no matter who you sell your practice to, your practice will change.” Second, I inform them that “the best deal for your practice is the deal that is best for you.” Everybody’s situation is different. The longer you work in the practice after the sale, the more valuable the practice is.

For the doctor who is unsure they should sell their practice I’d ask first, “What do you plan to do after? Will you continue to work? Will you change careers?” If you plan to retire I can assure you, you will be surprised at how busy you will be. Volunteer opportunities abound. New hobbies and games are ready for you to explore. New friendships will form, and the extra free time you now have will let you experience life’s moments with greater joy and enthusiasm.

QUICK Q&A

How would you describe the emotions you went through during the process?
I was consumed by worry about giving up control… but I found it quite liberating to see patients and go home. Once I left the office, work was behind me.

Would you have done anything differently?
I speak at Cleinman’s Practice Transitions Conference and have learned a lot about transitioning a practice. There are various options you and your new owner may have that I was unaware of. This type of meeting did not exist when I sold. I wished it had. The transition will go a lot smoother if you allow someone who has experience in practice transitions help you.

What did you do to help overcome doubt?
I reminded myself that the business of health care was changing and eyecare was no exception. Colleagues I respected and considered good businessmen were also selling their practices to private equity. Health care professionals may not think of their practices as businesses, but they are and business models change.

Are you happy with the outcome?
If you are anything like me, your practice is something you are very proud of. It is very emotional to give up what you have taken years to build, you want to be sure your patients will be cared for the way they need to be taken care of. Fortunately, the next generation of optometrists are very bright and take very good care of patients. Throughout the sale process, even up until the last week, I wondered if I was making the right decision. My husband encouraged me it was the right thing to do. Now, I am so happy I sold.

How are you spending your time post-ownership?
I have been fortunate to continue my optometric affiliations by serving as secretary treasurer of AOA’s Optometry Cares Board, co-chairing the HEHC community grant program, speaking on optometry topics, and up until last fall, serving on the disbanded Essilor Advisory Board. Not a day goes by however, where I don’t think about starting a venture to bring new optometric services to the members of my community.

 

LEAVING A LEGACY

Michael Cohen, OD | Four County Family Eye Care Center, Winslow Township, NJ | Sold business: TBD

our County Family Eye Care Center opened on Sept. 11, 1973 in the Winslow Professional Center of Tansboro/ Berlin/ Winslow Township, NJ, three months after I graduated from Pennsylvania College of Optometry. My father, Dr. Philip Cohen, learned about the center from a patient of his who was friendly with the building’s owner. We decided it looked like a good place to open a new optometric practice, signed a lease, and began planning to lay out and equip the office.

My wife and I made address labels on a typewriter and had announcement cards printed. We mailed out thousands of cards and on the day we opened, I prayed for good business. In those days, if I saw one or two patients a day, I considered myself lucky. I spent most of my time watching General Hospital and writing a digest for my wife, who was keeping us afloat teaching at a local school. I grossed $33,000 that first year. No insurance. No credit cards. Cash only. I made patients’ glasses by hand in my optical lab.

A couple years later, the owner lost the building in a bankruptcy. I decided to look for real estate to purchase and build a new office on. A patient and local realtor, Ursula Christinzio, found me a location nearby; a vintage 1850s farm house sitting on 1.5 acres on the highway at an intersection with a county road. I opened Four County Family Eye Care Center on June 1, 1979.

I’ve been in optometric practice in Winslow Township for 45 years offering comprehensive eye exams, diagnosis and treatment, and contact lens and eyeglass fitting. We counsel patients about LASIK and do the follow-up care, treat glaucoma, and make referrals to many ophthalmic sub-specialists in the region. I have three full-time staff and three part-time. My office manager started working for me at 17 years old; she is now 47. People tend to stay on for years; it is better to pamper your staff and keep them happy, than it is to abuse them, lose them, and train new people!

Michael Cohen, OD

I realized it was time to think about ending my ownership and retiring when my wife informed me that she hates the cold and would like to spend winters in a warmer clime. Also, I noticed that most of my patients my age are now retired and very few of my peers were alive and well and still running their own practices.

My ideal exit strategy would be to find an honest, talented, skilled, clever, caring, and compassionate OD who would be willing to purchase both the real estate and my practice and allow me the luxury of still seeing patients.

I worry that, if my staff get wind that I am thinking about retiring, they will look for employment elsewhere. Hiring and training staff is costly, time-consuming, and fraught with peril. Also, is it fair to hire someone when you are planning on leaving? When I have confirmation I am throwing in the towel, I’ll meet with my employees and lay my cards on the table.

I lead a very busy life now. Selling my property, as well as my practice, is time-consuming. I’ve spoken to a number of professional practice brokers, all of whom concur my gross revenue does not justify them getting involved. They all said I should sell it myself and I would like to continue seeing patients for two more years, provided my health holds up.

Every day, my long-time patients query me about my plans. I’ve been honest with them. I’d love to slow down but I don’t see any way out. Everyone encourages me to stay on … then they tell me how much they enjoy their retirement. My advice to other ODs looking to transition out of ownership is to try and build a business that has sufficient gross revenue to justify a professional broker skilled at doing all of the things that I must now do myself.

QUICK Q&A

How would you describe the emotions you are experiencing as you begin this process?
I am feeling quite inadequate to meet this challenge. I have a fear of failure.

Is there anything you wish you had done differently to prepare for this?
I did it my way! I have always been true to myself, my family, my staff, my patients/friends. If I have to turn off the lights, lock the doors, and not look back, I really have no regrets. I’ve helped a great many people over the years.

What do you do to help overcome doubt?
I talk to friends who are older than I am and find out how they were able to live so long and so well. I attend religious services weekly to meditate through prayer. I’ve discovered that Tai Chi and Quigong help me divest myself of my monkey brain. I call this my standing meditation. I occasionally use a therapist friend to bounce ideas off, when I cannot seem to move a big rock that is blocking my progress.

What would make you happiest with the final outcome?
I would love to see someone take the baton and run with it after I am gone.

How do you plan on spending your retirement?
Workout at the gym ten hours a week, travel to new places, spend time with my children and grandchildren and maybe spoil them a bit. Find people less fortunate and extend a helping hand. Go to synagogue on Saturday mornings, read the classics, watch great shows, eat great food at the best restaurants, and take in some Broadway shows now and then.

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Cover Stories

Escape From Insurance: Words of Wisdom From Eyecare Practices That Made the Leap

They left managed care and went to private pay.

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If you feel you’ve reached a point in your practice where you no longer want to be held captive by the low-margin traffic generated by insurers, you may be wondering how to break free. We reached out to eyecare businesses to find out what steps they took to throw off the shackles of dependency on vision plans. None of these tips will work unless you’re able to engender patient loyalty — and you don’t need us to tell you where that comes from ­— but here are eight tips to help you plot your escape from insurance.

1 Secure sources of self-pay patients that continue to deliver. Buena Vista Optical in Chicago, IL, is taking what co-owner Diana Canto-Sims calls “pro-active baby steps to transition away from vision plans.” After they run quarterly reports of the vision plans with the lowest reimbursement, they’re on the way to finding self-pay patients to replace those patients the next quarter. Among the places they have found them are career days at local schools — they send every student home with information including a package of exam and glasses for first-time patients with no vision plan — and collaborations with organizations that reach out to the uninsured, such as the consulates of Latin American countries. (Buena Vista has a fully bilingual staff). “These organizations are very appreciative that we collaborate with them and they send us self-pay patients weekly,” she says.

2 Brace for a pre-cutoff influx; remind patients to check their medical coverage. Whelan Eye Care in Bemidji, MN, quit taking VSP almost two years ago. Bridgett Fredrickson warns ECPs that there will be patients that get upset. “We are honest and tell them to check with their medical insurance as it may cover their exam as well, or they are always welcome to self-pay and we give them a 20% discount for same-day payment. Remember, she says, that you will need to send all of the current households a letter letting them know that you are no longer going to be accepting their insurance with an effective date and they need to receive the letter at least 30 days before that effective date. “With this, expect an influx of patients that want to get in before that date,” she says.

3 Phase your plans out. Dr. Robert Easton Jr. has had a solo practice in Oakland Park, FL, for 37 years. One year his CPA told him “that since I was providing comprehensive eyecare, my vision plan base was increasing faster than my major medical, PPO and Medicare patient base. We were concerned that vision plans were taking over my practice, which could eventually put me out of business.” After careful analysis, Easton eliminated the three lowest-paying plans first and kept the other two as a cushion. As the other two continue to become more corporate in nature and their low reimbursements fail to meet his cost of doing business, Easton plans to eliminate those one at a time.

4 Get your team up to speed. Jenna Gilbertson says dropping VSP was the best decision McCulley Optix Gallery in Fargo, ND, ever made. However, she cautions, “Before you ever send the termination letter to the insurance company, have a plan in place. Make sure all staff is on board. Have scripts for what to say. And have a plan for your patients. Be over-prepared for every situation. We ran role-plays with our staff, and had them think of all the questions a patient might ask.” They marked everyone who was pre-appointed on the schedule. They then went through each of those patients to see who had a calendar year plan, and called those patients, explained the situation, and rescheduled them for before our termination date. Yes, it meant the doctor had to work extra days and times, “but it was totally worth it to make those patients happy,” she says.

5 Keep a list of complaints about the plan you’re dropping. Last year Focus Eye Care in Hackensack, NJ, made the decision to jettison Davis Vision. Prior to this, the largest employer in the area had switched from VSP to Davis, while a big-box retail chain associated with the latter began advertising discounts. Before Focus could make the split it endured a period in which patients had a long list of complaints about jobs that were now going through Davis. Managing licensed optician Vlad Cordero took notes: “We used the list of complaints to train our front desk and optical staff on how to handle objections when Davis members call in to schedule an appointment or inquire about eyewear.”

6 Find a niche, or team up with an OD who has one. “The most important key to dropping insurance is having a niche,” says Dr. Pauline Buck, a vision therapy specialist at Behavioral and Developmental Optometrists in Miami, FL. “I was building that practice up while slowly dropping off insurance panels.” Next is the hard part. “You really need to get out into the community and speak about your specialty. I host quarterly lectures with dinner in my office for other professionals… The cost of the dinner is offset by a single referral.” Finally, “for non-optometric professionals who would like to break the bonds of insurance I highly recommend approaching specialists and seeing how your services can help them… I refer out 80 percent of my glasses prescriptions,” she says.

7 Help patients collect out-of-network benefits. The Visionary in Allen Park, MI, took a long look at their profit margin with EyeMed and decided it was time to split. They knew they had patient loyalty on their side. And, says Annette Prevaux, “We make it easy for patients to get their OON reimbursements by having the forms ready when they come in.” She expects to keep about 60 percent of her EyeMed patients.

8 Switch to independent brands; consider an OON service. Krystal Vision in Logan, UT, is in the process of dropping most vision plans. According to Travis LeFevre, being insurance-free goes hand-in-hand with carrying independent brands. “It’s an easy jump to make once you look at your margins while taking insurance compared to cash pay and filing a simple claim for the patient out of network,” he says. He cautions that “creative marketing is a must to stay relevant after dropping managed plans.” And after initially being unimpressed, Krystal Vision now uses Patch, an “online insurance assistant” that helps ECPs and patients negotiate out-of-network benefits and claim them digitally. LeFevre says Patch is now offering a better product than it did three or four years ago. “It allows us to know the exact amount of a customer’s OON benefits for their vision insurance. It gives us a breakdown … depending on the plan and insurer. Another useful part of Patch is the ability to accept payment for VSP and Cigna claims; this allows us to give the patient the reimbursement savings up front rather than making them wait [for the] check in the mail.”

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Cover Stories

How to Improve Your Kids Business

6 experts explain how to win them over early.

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Transforming the medical side of your practice is obviously not a step to be taken lightly, particularly if you’re looking at expanding your treatment of children. The challenges are many, but the rewards can be great, personally and financially. To help those of you thinking of boosting your optometric offerings for kids but wanting to know what that could entail, we assembled an impressive panel of experts in pediatric eyecare, and its related specialties, for a rundown of the main areas you should be looking at. If children are the future, and the future is now, what are you waiting for?

Specialty
PEDIATRICS

EXPERTS:
Dr. Dominick M. Maino, professor, Illinois College of Optometry/Illinois Eye Institute, associate, Lyons Family Eye Care, Chicago, Il; and Dr. Nathan Bonilla-Warford, OD, Bright Eyes Family Vision Care, Tampa, FL

ASSOCIATIONS OR GROUPS AVAILABLE:
College of Optometrists in Vision Development (covd.org); Optometric Extension Program Foundation (oepf.org), Binocular Vision, Perception, & Pediatric Optometry (BVPPO) Section of the American Academy of Optometry; Optometric Extension Program (OEP) Foundation

Dr. Don Teig

TRAINING OR CERTIFICATION NEEDED?
Dr. Maino:Not necessarily needed but a residency in pediatrics/binocular vision would make you stand out from the crowd. A Fellowship in COVD would do the same thing.

Dr. Bonilla-Warford:Generally, yes, additional training is beneficial outside of typical optometry training. A one-year optometric residency in pediatric vision care is an excellent way to become specialized. Beyond that OEP offer courses that cover the clinical care of infants and children as well as the practice management of the specialty.

SPECIALTY EQUIPMENT OR TOOLS REQUIRED?
Dr. Maino: Yes, but most ODs have much of what they need already.

Dr. Bonilla-Warford: The retinoscope is standard equipment, but many optometrists are not comfortable with it. Practice! Also, the pediatric-sized trial for refraction and probing refractive error without a phoroptor. A digital randomized visual acuity chart with movies for fixation and pediatric option acuity symbols. The Lang stereo test is a simple tool for assessing stereopsis without polarized glasses. Prism bars and loose prisms for binocular testing. And toys, finger puppets for entertaining little ones. They make a little booster for exam chairs that are perfect for kids who are independent enough to not sit on a parent’s lap but are still small.

Matt Oerding

ADDITIONAL EXAM LANE OR TESTING SPACE NECESSARY?
Dr. Maino: Not unless you are doing developmental vision/vision perception testing and in office VT.

Dr. Bonilla-Warford: Not necessary. It is common to have one exam room that does have a few extra items for kids, but it can be used for adults as well, so it doesn’t really require extra space.

ADDITIONAL MARKETING REQUIRED?
Dr. Maino: Definitely. You need to get the word out about your expertise in this area. Use social media.

Dr. Bonilla-Warford: Very smart [if you do]. Add children’s specialty services with info and descriptions on your webpage so patients can find and learn about them. Informative displays about children’s vision are an inexpensive and easy way to raise awareness. Networking with referral services is very effective.

HIGHER AVERAGE REIMBURSEMENT OR REVENUE PER PATIENT?
Dr. Maino: Yes. You often need to not only do a comprehensive examination but also a sensorimotor assessment and other testing as well. Frequent follow up appointments are often necessary.

Dr. Bonilla-Warford: For typical children’s primary care, the reimbursement is somewhat lower because they often do not need glasses or contacts. However, specialty services such as myopia control and vision therapy are significantly more because they are often higher-end self-pay services.

Dr. Dominick M. Maino

IN SHORT:
Dr. Maino: When I work with my optometry students, I always tell them that a smile is the best piece of equipment you could have. You must be genuine. You should keep up on the current research in this area and be ready to take that extra step. You are not just working with a pair of eyeballs, but also with the child and the whole family. It is fun, challenging and fiscally rewarding.

Dr. Bonilla-Warford: Working with children is so fun. It is very rewarding to see them grow and develop and to know that you are helping them reach their goals, whether it is in school, sports, or overcoming symptoms. However, it can be challenging. You have to be honest with them in a way that they can understand. Children will not hesitate to tell you “I don’t like you! I am never coming here again!” If staff sets the tone so the child can feel that you are on their side, you will be amazed how much clinical information you can get from them at very young ages. Knowing when to stop or change a particular test or activity is essential. Most importantly, have fun! And get good at retinoscopy.

Specialty
MYOPIA MANAGEMENT

EXPERT:
Matt Oerding, co-founder/CEO, Treehouse Eyes, Bethesda, MD and Tysons, VA

ASSOCIATIONS OR GROUPS AVAILABLE:
“The International Myopia Institute provides evidence-based treatment guidelines for this specialty; American Academy of Orthokeratology and Myopia Control (aaomc.site-ym.com)

TRAINING OR CERTIFICATION NEEDED:
No. Any optometrist can technically perform pediatric myopia management. However, specific CE/education is required to become proficient at the various treatments proven effective. These are currently orthokeratology lenses, multifocal soft contact lenses and atropine.

Dr. Charlene Henderson

SPECIALTY EQUIPMENT OR TOOLS REQUIRED:
Yes. A practice must have a good topographer as a highly accurate map of the cornea is critical to success. Additionally, a device to measure axial length is highly recommended.

ADDITIONAL EXAM LANE OR TESTING SPACE NECESSARY:
No. This can be done within an existing exam lane or space.

ADDITIONAL MARKETING REQUIRED:
Yes. Currently pediatric myopia management is not covered by vision plans, so it is a private pay procedure. Due to lack of parental awareness of the risks of progressive myopia and the availability of treatments, marketing is critical to generate interest. At a minimum marketing to existing primary care patients via email, newsletter and in-office marketing is required. To gain new patients for pediatric myopia management, social media, PPC and PR are all proven techniques.

HIGHER AVERAGE REIMBURSEMENT OR REVENUE PER PATIENT:
Yes. Because this is a private pay procedure and children are likely to be in treatment for several years, the revenue per patient is significantly higher than a typical optometry patient. Fees vary widely, but typical is $2,000-3,000 for the first year of treatment.

Dr. Pauline Buck

IN SHORT:
Pediatric myopia management can be an incredibly fulfilling specialty when done correctly, as you are helping a child see better today and reducing their long-term risk of serious eye diseases associated with progressive myopia. Offering these services can generate significant patient/family loyalty to the practice, as treatment typically lasts several years and successful patients are proven to be great referral sources to others in the community.”

Specialty
VISION THERAPY

EXPERT:
Dr. Pauline Buck, Behavioral and Developmental Optometrists, Miami, FL

ASSOCIATIONS OR GROUPS AVAILABLE:
The College of Optometrists in Vision Development (COVD); Neuro-optometric Rehabilitative Association (NORA); Optometric Extension Program (OEP); College of Syntonic Optometry (CSO).

TRAINING OR CERTIFICATION NEEDED:
Post-graduate training is very much needed. A new graduate from optometry school has the basics to begin a vision therapy program. Yet a successful vision therapy doctor will stand on the shoulders of their predecessors by learning what has already been learned. COVD and OEP provide training. OEP has regional seminars. COVD has state study groups and their annual meeting. Mentors are provided to assist when there are questions.

SPECIALTY EQUIPMENT OR TOOLS REQUIRED:
Yes and no. Bernell is a great resource of vision therapy equipment. There are many computer-based programs as well. However, I know many experienced doctors who have used something as simple as a stick and a straw to illicit a change in their patient’s visual system. This ability comes back to the training. When you really understand the system, you can make changes using just about anything.

Dr. Nathan Bonilla-Warford

ADDITIONAL EXAM LANE OR TESTING SPACE NECESSARY:
Again, yes and no. Yes — the functional vision evaluation is done in the exam room using the phoropter and equipment that is standard to the profession. No — I have an entire room, ‘the play room,’ dedicated to the testing of physical performance. How do the eyes affect a person’s ability to perform an everyday task? I also have another room for the testing of classroom skills, which contains a desk, slant board, and a lot of paperwork.

ADDITIONAL MARKETING REQUIRED:
Yes. ‘If you build it, they will come’ doesn’t work. I have gone out in the community and lectured about vision therapy. I have spoken to therapists, doctors, teachers, parents and other professionals about the visual system and how it can affect performance. Those individuals eventually become referral sources. I am constantly practicing my elevator [pitch] of what I do.

HIGHER AVERAGE REIMBURSEMENT OR REVENUE PER PATIENT:
Yes. Most optometrists will see a patient once a year for their annual or several times throughout the year for care of ocular disease. When a patient is doing vision therapy I see them for their annual, their progress evaluations every 10 weeks, and weekly for the therapy sessions.

IN SHORT:
Vision therapy is understanding the nuances of the development of the visual system, how it can change behavior, and how it can alter a person’s performance. It can benefit children and adults with brain injury, children with difficulties in the classroom, individuals with autism and down syndrome. When all other professionals have told a person that there is nothing else to do for their condition and they come to me for a glimmer of hope, I offer the potential for change. When their symptoms decrease and their performance improves, those are the moments of my greatest job satisfaction and I am thankful that I have a ‘tool box’ large enough to have made that possible.

Specialty
SPORTS VISION or VISUAL NEURO-COGNITIVE TRAINING

EXPERTS:
Dr. Don Teig, founder/CEO, “The A Team” High Performance Vision Associates, Hollywood, FL; and Dr. Charlene Henderson, Blink Eyecare and Eyewear, Charlotte, NC

ASSOCIATIONS OR GROUPS AVAILABLE:
Dr. Teig: This niche or specialty has always been referred to as “sports vision” but more recently as ‘visual neuro-cognitive training’ given the attention to the impact concussions and chronic traumatic encephalopathy (CTE) has had on sports. I also often refer to it as ‘high performance vision.’ I am the founder and executive director of ‘The A Team’, High Performance Vision Associates (highperformancevisionassociates.com), there is also ISVA (International Sports Vision Association, sportsvision.pro).

Dr. Henderson: High Performance Vision Associates and the AOA.

TRAINING OR CERTIFICATION NEEDED?
Dr. Teig: Yes. I provide a 16-hour course with certification (ultimateevents.com.) I also travel to provide this training. ISVA is working in conjunction with me to develop a certification program.

Dr. Henderson: It is necessary to understand the sports you are working with and how vision plays a role in success. Sports vision training by people who have pioneered the concept is invaluable. We went to Don Teig’s Sports Vision training weekend, and Fred Edmunds Xtreme Sight sports Vision training weekend. They are both excellent. We also did several Sports Vision AOA courses and read all the books out there.

SPECIALTY EQUIPMENT OR TOOLS REQUIRED?
Dr. Teig: Yes. The A.M.P. System (Achieving Maximum Potential), an immersive virtual reality technology; Senaptec, a digital testing and training instrument; NeuroTracker, a multi-object awareness trainer; FitLight motion and light sensors; and Quick Board, an eye to foot training tool.

Dr. Henderson: Yes. When we built our new building, we added lots of exciting equipment like Vision Coach, Fit Light, Senaptec, and the Bassin anticipation timer among others. We still use traditional VT equipment like Marsden balls and flippers and balance boards. The athletes like the bells and whistles of the digital devices.

ADDITIONAL EXAM LANE OR TESTING SPACE NECESSARY?
Dr. Teig: Yes. At the very least a room that is 10′ x 12′ is a must.

Dr. Henderson: Yes, for testing space. You need room to swing or jump or dribble a basketball, for example.

ADDITIONAL MARKETING REQUIRED?
Dr. Teig: Yes, by all means! Internal marketing with videos, pamphlets, etc., in your office and external marketing through social media, TV, radio and print.

Dr. Henderson: Yes. Internally tell all your sports-minded patients. All our patients walk by our sports vision room. You should reach out to teams and clubs and let them know what you do.

HIGHER AVERAGE REIMBURSEMENT OR REVENUE PER PATIENT?
Dr. Teig: Yes! A typical Sports Vision patient can generate revenues of up to $3,000 each if they complete an eye exam, a Sports Vision Workup, a Sports Vision Training program of 12 weeks minimum; specialty contact lenses or sports eyewear and goggles.

Dr. Henderson: Yes. Sports vision training is an additional service not covered by insurance. So, it is up to you to set the fees you think are fair for your time for the evaluation and then training sessions.

IN SHORT:
Dr. Teig: Having been a pioneer in this field for almost 40 years, I can confidently say that sports vision is both emotionally and financially rewarding beyond belief. However, it doesn’t happen overnight and requires continual hard work. That being said, if you love sports like I do, it’s well worth the ride.

Dr. Henderson: It can be really rewarding if you have a passion for sports and working with highly competitive people. The niche does require training, equipment, space and active marketing. So, it will not just fall in your lap. But it is a great way to help people achieve their goals and use our skills as vision experts.

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