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Handling Tough Talks

Your employees keep coming in late. Your sales rep can't seem to get orders right. Your managed care provider keeps screwing up your reimbursments.

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With additional reporting by DEIRDRE CARROLL | Illustrations by MAR JEFFERSON GO

These days it’s hard to escape Donald Trump. Open a paper, turn on the TV and there the presidential hopeful is. But let’s not forget how he became a household name:

“You’re fired!”

THERE IS SOMETHING “succinct and very beautiful about the words … they’re so definite and final,” he once told Newsweek of the signature line of his former reality TV show, The Apprentice.

He may find those words beautiful, but there are very few others who do. For most of us, those words are almost unutterable, no matter how badly they need to be said.

Much more likely is a rambling speech that starts off something like: “Listen John, I’m not quite sure how to put this to you, but I’m afraid we’re probably going to have to let you go. I hope you can understand. Sales are down, and it, um, doesn’t look good. And then there’s my wife. She said we need our employees to show up on time, be polite to customers, make sales, you know, that sort of thing. As for me, I’d love to give you another chance, but you understand, right? My hands are tied …”

So how’d you do there? Well, you blame-shifted, told about three lies, all whoppers, and were barely coherent to boot. And this is probably after spending weeks or even months, dwelling on the issue and thinking of ways to approach it.

Let’s face it: As a species, most humans are not very good at managing difficult situations. No matter what the situation — dealing with an irate customer, a partner we don’t believe is fairly sharing the load, a longtime supplier who is no longer price-competitive, a repair man who always charges more than his quotation, or even an employee with a body-odor or chronic tardiness problem — most of us will do nearly anything to avoid these little conflicts.

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But in business, such avoidance comes at great cost. It leads to what consultant and author Susan Scott calls a “culture of terminal niceness.” Everybody evades or works around difficult employees, problems don’t get tackled, and mediocrity is tolerated.

There are also personal and psychological costs for managers and staff when issues aren’t addressed effectively or honestly. Trust diminishes and misunderstandings multiply. Festering problems consume huge amounts of emotional energy and sap creativity.

In some cases, when the situation finally becomes unbearable, we do take action. But we invariably go about it the wrong way. We vent, point fingers and lay blame, leaving hurt feelings and the seeds of a new misunderstanding in our wake.

In contrast, when conflicts or difficult conversations are managed well, better decisions are made because goals are clear, teamwork and productivity increases and workplace morale surges. Conflict resolution, done effectively, also helps foster a climate of learning that allows people to learn from their mistakes and encourages managers to provide critical feedback.

But how to do it?

Dr. Tim Ursiny, author of The Coward’s Guide to Conflict, says there are seven ways of dealing with a difficult situation:

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1. AVOID IT.

(Bad, for the reasons stated above.)

2. GIVE IN.

(Bad, because we don’t permit our- selves a chance to properly remedy the problem. We let someone else win the argument and then we feel bitter about it. Sometimes the other per- son knows we’ve surrendered, but most of the time they don’t have a clue and go about their business as always. Grrrr…)

4. BE PASSIVE-AGGRESSIVE.

(Like when you huff and puff and scowl when someone uses a mobile phone in a movie theater. This is about as effective as giving in, even if we do make an effort to ensure the person knows our feelings.)

5. COMPROMISE.

(Now we’re getting warmer! But still, compromise suggests that neither party got what they really wanted. After all, the focus of compromise negotiations is what you are pre- pared to give up.)

6. HONOR THE OTHER PERSON.

(Sound sappy? You’re right, and this is a solution best saved for situations involving family and significant others. This is where you make a choice to give up something and enjoy the sacrifice — say, you decide to forego a disputed bit of parking space to help out a neighboring businessman.)

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7. PROBLEM-SOLVE TOGETHER.

(You’ve probably guessed; this is the best way to go.)
Now, suggesting that you “solve the problem” might seem excruciatingly obvious — but what Ursiny, who is an executive coach and psychologist by training, is really advocating is the use of a technique that invites mutual analysis of an issue, takes into account the emotions on both sides, and results in a win-win situation.
Easy to say, but surprisingly hard to achieve. And that’s because most of us are thoroughly inept at doing the basic things required to achieve such a goal, oh like listening properly, understanding the other person’s point of view, and refraining from making critical judgments.

We’re here to help you better navigate your way through difficult conversations, but first we need to address the 800-pound gorilla in the room. And its name is … fear.

Our behavior in times of looming confrontation is invariably driven by fear. Fear of physical harm, fear of rejection, fear of losing a relationship, fear of anger, fear of being seen as selfish, fear of saying the wrong thing, fear of failing, fear of hurting someone, fear of getting what you want, fear of intimacy, fear that people will think less of us.

Sometimes these fears are rational or based on experience. You may have tried confronting someone before and it went badly. Or maybe you worry that talking will only make the situation worse.

And sometimes our fears are irrational. She’ll be crushed and kill herself if I tell her our clients hate her coffee. He will hire a Cessna and drag a 200-foot sky banner over my neighborhood telling everyone what a cheapskate I am if I don’t give him the pay rise.

Or maybe the anxiety wells up because of something that happened way back in your formative past — something at the very core of your identity. You’re afraid what the looming conflict will reveal about you as a person.

One of the things about the problems life throws at us on a daily basis is that we know deep down inside that the best way to deal with them is to put aside our worries and tackle the situation head-on. Don’t believe us? Think about your reaction the first time you saw Nike’s old “Just Do It!” ad campaign. You probably went out and did something … didn’t you? With that campaign, Nike proved that they knew the shadows that lurk deep in our hearts. Everybody wants to act forcefully, without restraint. Few do.

And “just doing it” is still one of the best ways to summon the courage. No, that doesn’t mean that you should simply jump right into your difficult conversation without preparation. But you should commit to doing it as soon as possible, and then start taking the necessary steps to make it happen. Weigh up the pros and cons and focus on the long-term benefits. Recall a case where you confronted a problem and it worked out well. Except for those cases where there is the genuine possibility of a physical harm, tell yourself that the conversation won’t destroy you, that you
can handle it, and most important, that it is the right thing to do. The relief you stand to gain will be permanent — as opposed to the temporary respite avoidance provides.

To give you that extra edge for your upcoming difficult conversation, we’ve compiled some expert advice from masters of the art of conflict resolution. Using it, you’ll find that disagreement is not only nothing to fear, it can be healthy. You’ll grow from it. Trust us.

But first, let’s examine the nuts and bolts of the conversation you are about to have.

 

PREPARING FOR THE MOMENT OF TRUTH

The first thing to do when preparing for a difficult conversation is to pick the right time and place. It’s pointless to start such a conversation if you don’t have the time to do it properly or are going to be constantly interrupted.

Then, ask yourself some questions:

Why are you having the conversation? What do you hope to accomplish? If you think, “I just want to get something out in the open,” or “We just need to talk,” that’s not good enough. Your purpose is too vague, and vague goals almost always mean disappointing results. Your purpose needs to be forward-looking.

You also need to question your objective. You may think your motives are honorable, like educating an employee. But as soon as you start talking, you notice yourself lapsing into language that is highly critical or condescending. (And believe us, the employee does as well.) This is also a good time to think about how you contributed to the problem.

Work on yourself so that you approach the conversation with a constructive aim and see it as an opportunity to learn about the other person’s point of view. Think “I wonder why he keeps doing that?” instead of “That’s it. I’ve had it with the way he keeps doing that and I’m really going to let him know it!”

Second, investigate what assumptions you are making about this person’s intentions. You may feel intimidated, disrespected, or ignored. But you shouldn’t automatically assume that this was the other person’s intended aim.

Third, start thinking about the other person’s viewpoint. What might they be thinking about this situation? Are they even aware of the problem? If so, how do you think they perceive it? What fears and needs could they have? What solution do you think they would suggest? Stop looking at the other person as an adversary — instead, see them as your partner in solving the problem at hand.

Finally, ask yourself what reaction the other person might have that is most likely to throw you off balance. What if they accuse you of picking on them or acting unprofessionally? Identify which reactions would be the toughest for you to deal with and plan how you might respond if the other person breaks down in tears, gets angry, or withdraws. Don’t just “wing it.” If that’s your approach, you won’t be very effective.

 

GRABBING THE BULL

The best way to start is much the same way you would for a meeting: Set out an agenda. This outlines the problem to be discussed, establishes that you want to hear the other person’s perspective, that you want them to hear yours and that you would like to do some joint problem-solving. Use the opening part of a conversation to be upfront about why you’d like to talk and what your main point is. You’ll engage the interest of the other person and help them understand what follows.
When describing the issue at hand, state it neutrally, the way a mediator might. For example, instead of saying, “I want to know why you insist on making the staff wear these silly Santa hats,” you can begin with, “It’s obvious we both care about the business. And we both want to do what we think is best. But you and I have different approaches to marketing. Let’s see if we can talk about that and find some middle ground.” This approach includes bits and pieces from both sides and seeks to close the gaps between your two perspectives. No one will feel attacked and you’ll be off to a smooth start.

Then, invite the other person to share their side of the story first. Don’t feel compelled to dive in with your perspective. You’ll actually be more persuasive if you let your counterpart get their side out first.

This way, you get to learn what they care about, how they see the problem, and you can respond accordingly. Also, until the other person feels heard, they don’t have the mind-space to hear you. It’s infinitely harder to persuade someone who hasn’t felt heard than someone who has.

Remember too, as Stephen Covey, author of The Seven Habits of Highly Effective People, says, “to listen to understand and not to reply.”

Often one of the things blocking our pursuit of the truth is that we think we not only understand our own point of view, but we also believe we know for sure what the other person did, said, and thought on the subject. He always does that because he knows it irritates me. She intentionally came in late to make me mad. She knows exactly what is expected of her, but doesn’t want to do it.

The problem is, such tough discussions are not about things that can be shown to be right or wrong, say Douglas Stone, Bruce Patton and Sheila Heen, authors of Difficult Conversations: How to Discuss What Matters Most. They involve facts, but they are not at heart about facts. They are about conflicting perceptions, feelings and values. They’re not about what a contract says, they’re about what a contract means. They’re not about which sales technique is most popular; they’re about which sales technique the store should employ. Finally, they’re not about what’s true, they’re about what is important.

If you automatically think you’re right, the conversation becomes one of trying to get the other person to admit he’s wrong. As strategies go, this is a poor one — the other person immediately becomes defensive and closes down.

The mistake of assuming we’re right leads to a second common error: We don’t ask enough questions. Studies have shown that about 90 percent of what is said during a failed conversation is advocacy, and only 10 percent inquiry. That means, the two parties find a lot of different ways to state their own views over and over again. Understanding is never reached. And too often, poor decisions result.

One of the first things you’ve got to do to get through a tough talk is to understand how the two of you see things differently. And doing that requires questions, questions and more questions.

 

YOUR TURN

When you sense that the other person has been able to unlock some of their energy and express the essence of what they want to say on the topic, it’s your turn.

From what they’ve told you it should be clear what they don’t understand about your position. Start by trying to clarify your view without minimizing theirs.

Be quick to identify the problem areas that remain. Be authentic too. There is something in us that responds to people who level with us, who speak from the heart.

Regularly summing up what you’ve said can boost the quality and accuracy of the dialogue — and eliminate many of the problems caused by misunderstandings.

Use words that reflect the other person’s meaning as well — “What you’re saying is that you feel that when I’m busy, I’m prone to treating people like they don’t exist. Am I understanding you right?” This way you demonstrate empathy and also get the chance to confirm that you’ve got it right.

If the conversation becomes heated or adversarial, go back to asking questions. Asking for the other person’s point of view usually neutralizes emotions. The challenge is to reframe the conversation from “whose fault is this” to “where did the misunderstandings occur, and how can we correct them so we can move forward?”

If the other person keeps saying everything is your fault, you can say, “I know I’ve contributed to this problem. Let’s talk about that, and we should also make sure to discuss ways that you’ve contributed to the problem as well.”

Be persistent in your efforts to keep the talk constructive.

 

FIX THE PROBLEM

Once you know what the other person wants and they know clearly what you want, then it’s time to find a solution. There is no guarantee this will be easy but at least both sides now are aware of all the factors in play.

Remember to keep asking questions. Ask your colleague what they think would work. Whatever they say, find something that you agree with and build on that.

Often such discussions get caught on the question of what’s fair. But, remember, fair is a subjective matter. What is a fair salary when the economy is doing badly? What is a reasonable vacation policy when the company is under-staffed? Your opinion and that of your counterpart are almost certain to differ. Of course, this scenario is specific to employee conflict, but the underlying principles remain the same.

The best, most straightforward way to approach any issue is to put on the table what both sides want and then brainstorm to see what is doable. In this instance, maybe a higher rate of commission based on achieving a new sales target would better reflect the economic conditions and the employee’s performance.

BREAKING BAD HABITS

Start by knowing why your brain acts the way it does.

They often don’t seem it, but almost all conversations are incredibly complex.

“Lovely day outside,” the cashier says as she rings up your toothpaste.

Was that sarcasm, you wonder. Why was she smiling at the cereal I was holding? Maybe she was flirting?

And that’s an easy conver- sation. difficult ones are so much more complex.

In their book Difficult Conversations: How to Discuss What Matters Most, Douglas Stone, Bruce Patton and Sheila Heen theorize that each difficult conversation is really three simultaneous communica- tions.

There’s the standard “what happened” conversation, with the two sides’ competing ver-sions of the “facts” and their significance.

Second, there’s the “feelings” conversation, with unacknowledged emotions running amok.

And there’s the “identity” conversation, which affects our sense of self in the world.

The question of how to deal with feelings in the workplace is complicated. Some conversations are at heart about feelings, and the only way to communicate efficiently is to acknowledge them. If you don’t raise feelings of fair treatment, for example, morale drops, and more “positive” feelings, like passion and respect, fade away. This is significant. Studies suggest that almost 50 percent of people who leave jobs quit because they feel underappreciated.

The other thing about feelings is that no matter how hard you try to suppress them they will be heard, either in your tone or body language or some other way.

Obviously, you can’t spend time processing everyone’s feelings. But be aware the “check your feelings at the door” ethos can be harmful.

“Identity” conversations are hard because they pose a threat to how we see ourselves. One mistake many make when they feel their identity is being impugned is to take the criticism as absolute. But criticism is not all or nothing. A manager who makes a mistake is not a bad manager. The store owner who says “no” to a day off is not an evil slave driver. Becoming familiar with the identity issues that are important to you allows you to look out for defensive reactions.

The psychology of tough talks is that they tend to expose us for what we are: complex beings riddled with competing emotions and conflicting needs.

It is because we lead our lives according to “Big Assumptions,” say Robert Kegan and Lisa Lahey, psychologists and the authors of How the Way We Talk Can Change the Way We Work: Seven Languages for Transformation.

“Big Assumptions” are ideas we accept as truths. They once may have been true, but now it is no longer necessarily the case. Nevertheless, these assumptions are difficult to change because they’ve been reinforced so many times.

The authors suggest the answer lies in reflection and experimentation. Once you become aware of these patterns, try to transform using a three-step approach.

First, be on the lookout for when a Big Assumption is guiding your actions. Secondly, explore its validity, and finally, test it. Refuse a small request and see what happens. Then try a bigger one.

 

PRACTICE, PRACTICE, PRACTICE

A successful outcome will depend on two things: how you act — centered, curious, persistent — and what you say. Don’t expect to handle every difficult conversation with ease and poise. At the beginning, you may be tongue-tied, scared and inarticulate. That’s OK. Your goal is not eloquence. It is openness and honesty. As with any other skill, you will get better with practice. Keep in mind that failure is the best teacher.

It is also worth noting that there are times you should walk away from a difficult conversation. There isn’t enough time to confront your partner, boss, staff or clients every time they annoy you.

But if walking away ends up being your response most of the time, you’re on the wrong track. Your feelings will fester. And in the long run, if you don’t raise important issues and have those difficult conversations, you will damage the relationship you were hoping to protect.

 

TOUGH TALK TIPS

Here are some more tips and a few conversation starters to help you:

Don’t aim for perfection. Difficult conversations are tough for a reason. Aim for gradual improvement each time.

You don’t win a difficult conversation. Your goal is not to get the other person to capitu- late and admit that you were right all along. It’s to express your feelings, allow the other person to express theirs and hopefully reach an understanding you both can live with.

Need to deliver bad news or fire someone? There are no magic words that will somehow make it less upsetting. The best you can do is be honest, to the point, and sympathetic. You can’t take responsibility for the other person’s feelings. If your accountant is inept and messed up your books, you need to let him go. His feelings are immaterial to the outcome. It is only the facts relating to his poor performance that matter. The success of a conversation should not be judged by whether someone gets upset or not. (And don’t try to trick the person into accepting blame first.)

Don’t waste time and energy defending the weak parts of your argument. In any tough conversation, no one is 100 percent right or wrong. Each side has weaknesses, and it is wise to acknowledge the problems. Take responsibility for your share and focus on a solution.

Controlling your emotions is crucial to avoiding a destructive argument. You need to look forward — not try to defend a position or win an argument. If a conversation is getting heated, use silence to slow it down, says Scott.

Stay with the issue; straying will always sabotage your mission. You’ve had a great year and you would like to discuss bonus levels with your sales manager. But he notes how two years ago, he didn’t get a bonus when (he believes) one was promised and doesn’t feel he can trust you in this discussion. Suddenly you find yourself debating your role in the conversation. In such situations, refocus on the future.

Use “I” statements rather than “you” statements when discussing your thoughts and feelings. “I” clarifies for the other person what you think and feel while “you” can make them feel criticized. “I” reduces defensiveness and fosters communication. Good “I” statement: “I feel uncomfortable when you interrupt me during meetings. I feel it shows a lack of respect.” Bad “you” statement: “You always interrupt me during meetings. You have no respect for me!”

Say “and,” not “but.” The word “but” has the power to erase everything good said before it. For example, “Joe, I really liked the way you closed that sale, but next time don’t spend so much time talking about how bad insurance reimbursements are.” Far better to say, “Joe, I really liked the way you closed that sale and I think it would be better if you didn’t mention our issues with the patient’s insurance provider.” This is something improvisational actors are taught. The basic premise is not to reject what is proposed and focus instead on elaboration, to create new ideas and move forward.

Similarly, avoid negatives and absolutes as they shut down communication. Example: Negative: “Why can’t you …” Positive: “What if we …” Absolute: “We must do it this way.” Non-absolute: “Here’s a good idea to consider…”

Avoid judgmental words like “bad,” “ugly,” “wrong,” and any that imply fault like “unprofessional” and “inappropriate,” Ursiny recommends.

The same goes for you. Many misunderstandings arise from faulty assumptions. So when in doubt, say what you mean. Hinting isn’t good enough. Don’t rely on subtext.

Remember that acknowledging the other person’s feelings is not the same thing as agreeing with them. Saying “I can understand this is really important to you” indicates an effort to support the other person, but doesn’t mean you’re going to go along with the decision.

In cases where you find yourself poles apart, use the “100+1 approach.” Find the one percent of the other person’s position you can agree on and endorse it 100 percent. That suggests that you are committed to finding middle ground.

Research shows that we spend a lot less time talking to people close to us than we imagine. These same studies also show that many of our more challenging dialogues could be avoided by staying in more regular contact.

Blaming the other person for not understanding you — or for you not understanding them — is pointless. Be willing to recognize when you don’t understand or need to know more. If you don’t have a clear understanding of what the other person is saying, keep trying until you do. It could be that their thoughts are unclear. Encourage them to be specific.

What if it’s someone you’re going to have to work with again — for instance, a high-performing sales associate who is suddenly suffering a five-alarm case of body odor? Same deal. Take him aside and let him know his new antiperspirant isn’t quite up to the task. Of course, he’ll be embarrassed but eventually he will thank you. Knowing that you can’t control the reaction of the other person in a conversation can be liberating, say Stone, Patton and Heen.

The best decisions are the ones that people reach themselves. So be lean on the advice, but generous with help and support.

Don’t just listen to the words, listen to the “music” as well, including body language and voice quality. Also, look for clues in what is not being said. Ask yourself and the other person, “What is it they really want, really mean?”

Being genuine is at the heart of all worthwhile communication. Don’t be afraid to share your feelings. Author Scott recalls a conversation with a friend who said: “I notice I’m becoming defensive, and I think it’s because your voice got louder and sounded angry. I just want to talk about this. I’m not trying to persuade you in either direction.” The acknowledgment helped the two to re-center, she says.

Not sure how to open the conversation? Consider some of these lines:

  • “I need your help with something. Can we talk about it?”
  • “I think we have different views about [insert topic]. I’d like to hear your thinking on this.” “I have something I’d like to discuss with you that I think will help us work together more effectively.”
  • “I’d like to talk about the recent changes to our compensation structure with you, but first I’d like to get your point of view.”
  • “I’d like to see if we might reach a better understanding about our store’s dress code. I really want to hear your feelings about this and share my perspective as well.”

Final tip. Realize difficult conversations are part of life. They aren’t going away, but they can become easier, less anxiety-causing and more constructive if you work on it.

STORIES FROM THE OPTICAL FRONT LINES

DAVID W., DALLAS, TX:
One of the tough discussions we had with an employee was about getting involved with our patients in personal matters — selling/buying cars, planning play dates, making social plans, etc. She did not understand why it was inappropriate and was indignant at first, but we explained that if anything “went wrong” in her personal relationship/dealings with the patient, then it might negatively affect the doctor/patient relationship and possibly our bottom line. She eventually understood, and we now have a “WWDD” (What Would Doctor Do) policy.

STEVE N., WESTLAKE, OH:
Our tough talks are most often with a ven- dor. We took on a lot when we opened, including frame lines, labs, etc. Sometimes you nd a line or company simply doesn’t t your vision and you have
to say goodbye. The toughest part of all is that you truly build great personal relationships with people. So business decisions are made but in the end you can feel like you hurt someone’s feel- ings. Nonetheless… we must do what is right for our shop.

KEVIN B., KALAMAZOO, MI:
I called a doctor out on his chronic tardiness starting the day. He asked if I always saw my doctor on time. I told him this wasn’t my doctor’s of ce, it is our patient’s doctor’s of ce, and we see our patients on time. He was never late again. People are unreasonable only because no one has ever told them they are being unreasonable.

RICK R., GIRARD, PA:
When I was the manager of a large retail chain store, a married-with-children associate and a lab tech had an affair. None of our business until it started to affect work. It was interrupting our customer flow as well as causing other associates to complain. The lab tech was an exemplary, invaluable associate. We carefully explained the facts that were affecting his performance, careful not to mention the relationship, although he had to know that was part of his problem. I didn’t think it went very well. I honestly thought
we would lose him. We were lucky. The retail associate had been making the rounds and the problem corrected itself.

SELINA M., EDMOND, OK:
I fired an employee. I sugarcoated why and said that she would be a better off elsewhere. I needed to be more honest that she couldn’t do the job and show her all the times that we tried to train her to, because she sued me for age discrimination. Being honest and direct could have avoided this. I now follow this guideline, “To be kind is to be clear, and to be clear is to be kind.

SIOBHAN B., NEW LONDON, CT:
Telling a potential vendor you aren’t interested in their product is always tough. I recently had someone come in and while showing me trays asked me if I wanted to start writing up my order. I was so shocked that I said what I always want and never do: that I was allowing them to show me their product but I never said I would be taking it on.

KRISTY S., REYNOLDSBURG, OH:
Had several talks with a new optician. She was sloppy and kept dropping the ball. She was a hard worker, but made mistakes that added up. We decided that she would work closer with me. We worked like that for five weeks. Now, she is a great optician with a huge following!

ANGIE P., JOHNSON CITY, TN:
I had a frame rep that was very disrespectful to my optician. I called and spoke to her personally. She was not remorseful, so I dropped the line. I was professional and gave her the opportunity to make things right. Since I felt that I handled myself well, I did not regret phasing out the line.

BRENDA S., BUCHANAN, MI:
We had a patient that was very rude to the staff every time he came in and no one wanted to assist him. I addressed his attitude, asking if we had done anything to anger him or if there was a way we could serve him better because we wanted his experience to be great with us. He apologized to all of the staff, has remained a patient, and has developed a great relationship with all of them.

TED M., TIFTON, GA:
I’ve had so many difficult conversations with our team over the years. I’ve not always been good at it. I came to the realization after listening to an episode of the Dave Ramsey Entreleadership podcast, that by not confronting the issue there would still be tension. By acknowledging the issue (and the tension) at least everyone knows where everyone stands. So, I have been embracing the 800-pound gorilla. The main issue is communication. I know that gets a lot of lip service, but if you are committed to truly communicating it means having those difficult conversations.

RICHARD E., ENGLEWOOD, FL:
I once kept a lab tech around for a long time thinking I had to have him due to our high volume. My instincts kept telling me he was a problem. He was very confrontational. One day in my absence, an associate asked him how long a single vision job would be, and it set him off. He threw trays and yelled while customers and staff watched. I had to terminate him. My lesson was to follow my instincts and document any issues with staff no matter how uncomfortable you feel.

 

 

 

 

 

Chris Burslem is the Group Managing Editor of SmartWork Media.

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Cover Stories

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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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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