Fall 2014
Fall 2014

Doin’ It For Themselves
Young Grads Offer Advice on Starting a Practice Recently Out of School
Written by Bob Cook

Ryan Lang, OD ’12, says that upon graduation from ICO, “all of us, when we leave, want to do our thing.” Yet the “vast majority” of his classmates, he says, are working for someone else, mostly in retail settings. And that’s what Dr. Lang did–for a little while.

However, even before they graduated, Dr. Lang and his wife, Laura (Galvin) Lang, OD ’12, planned for the day they would open their own practice. They found a lender, a city, a building, consultants, equipment and staff, and opened Lang Family Eye Care on May 4, 2013, in New Berlin, Wis., about halfway between his hometown, Appleton, Wis., and hers, Evergreen Park, Ill. They took on $200,000 of new debt on top of their student loans, and they had to face the challenges of starting in a new community from scratch–but he says it’s all been worth it. “I was scared in the beginning,” says Dr. Ryan Lang. “But from there it’s been amazing.”

It’s difficult for anyone to get a practice started: Various surveys, including those from the Bureau of Labor Statistics, find that fewer than 25 percent of optometrists own an independent practice. However, what’s increasingly being noted is that for the 50 to 60 percent of optometrists who work in those practices, the opportunity to buy a share of the practice, take it over, or branch off into their own practice is being viewed more and more as a near-impossible task, especially for those only a few years out of school. Industry reports from investment firm Bain and Company and Jobson Medical Information (the latter commissioned by the American Optometric Association) indicate that optometry is facing increasing pressures to consolidate–mainly, the need to gain greater efficiencies and offer more services to patients, and to respond to competition from retailers. That pressure is making owning a practice less of a reality, the reports said.

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However, surveys have found that the majority of optometry students want to someday own a practice. They might believe it will take a long time to fulfill that dream, if it ever happens at all. But there are young optometrists like the Langs who are proving you can do it, and you don’t have to wait as long as you’d think. It’s not easy, they say, but it’s fulfilling. “All you have to do is put in the time and take your licks,” Dr. Ryan Lang says.

1. START PLANNING AS SOON AS YOU CAN
The Langs began thinking about owning their own practice when they reached their fourth year at ICO. But that’s not the case for everyone. Michael Yu, OD ’10, began his planning when he took a retail job that he realized he didn’t want to keep, in part because he was constantly bouncing from location to location on Vancouver Island in British Columbia, Canada. Nadia Rutayisire, OD ’09, began thinking about independent practice when, after a year of working in retail optometry, she went to Johns Hopkins University to earn her masters of public health with the idea of learning more about health management, perhaps with an eye of someday working in programs in her native Ivory Coast.

The point of planning early, they said, is that it will take at least a year or two to get everything in place needed to open a practice: business loans, a practice site, a build-out of that site, insurance credentials, marketing plan, equipment and staff. You need time to find the right attorney, real estate agent, architect and consultants to help guide you through the process. You need time to figure out where you want to practice–whether taking into account the taxes and overall economic climate, the need for optometry in the region, or if you simply want to be back where you grew up (as Dr. Yu did when he located his practice in his hometown of Calgary, Alberta) or somewhere you just like being. And you need time to network with your professors, professional mentors and classmates to help answer questions and keep you sane.

2. DON’T SWEAT MORE DEBT (IF IT’S THE RIGHT KIND)
It might seem foolish to take on another $200,000-$500,000 in debt to start up a practice when you still have a long way to go on your student loan payments. But young optometrists who have opened their practices say while no doubt that’s a big chunk of change, it’s more manageable than you would think. Plus, says Dr. Laura Lang, “it’s easier to max out [debt] at the beginning than to pay it off and then go back for more. We already had the debt of student loans, so what’s more on top of it?”

Not every bank is going to consider loaning money to you, but if you come to a lender with a plan for how your practice will develop and grow, it will work to get you terms you can handle. Dr. Rutayisire, for example, was able to get a deferment on her student loans as she began opening her practice right outside of Baltimore. The Langs didn’t get a loan from the original bank they worked with, but it did put them in contact with another one happy to help them.

However, they said in exchange you need to keep a handle on what you spend in your personal life. While you might still be able to buy a car and house and new clothes, don’t overextend yourself. “Let the business get started first,” Dr. Ryan Lang says. Keeping spending to a minimum also ensures that your credit score is as high as possible–which then reduces the interest rate on your loan, which itself becomes easier to get, with more money available.

3. EXPECT THE UNEXPECTED
At every point in the process of opening a practice, and even once it’s up and running, you’ll be confronted with surprises. A lot have to do with how much everything costs, and you’ll have to make decisions once you’re confronted with the bill. “You think a bill [related to office renovations] will be $10,000, and then you see it’s $50,000,” Dr. Rutayisire says. Buying equipment that connected directly to an electronic health record “was a lot more money” than she expected–the price tag was $40,000. “Before I opened the door, I maxed out my initial loan” of $200,000, she says. She relied on her own cash and credit cards to pay an additional $40,000-$50,000 in startup costs: “I didn’t want lots of new requests on my credit.”

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“There are things that aren’t accounted for,” says Dr. Yu, “even something as simple as garbage bags.” The unexpected comes, too, after you’ve opened your practice. Dr. Yu found staff turnover to be high early on as he tried to get the right number and fit of people for his practice. Also, you might think you’ve designed a practice that targets a certain population, but that might not be who shows up. Dr. Yu thought his practice would serve all ages, and he sent out mailers, set up his website and used social media to market to a general population. But it turns out that his patient base is skewing toward children. As a result, Dr. Yu, who just opened Montreux Family Eyecare and Gallery in May 2014, says he’s adjusted his marketing, his office decor and his optometric services to be more kid-centric.

Dr. Rutayisire figured when she opened her practice, Vision Iconique, in 2012 that the higher-income clientele in her practice’s Baltimore neighborhood wouldn’t necessarily choose a practice based on what insurance it accepted, so she thought she would do herself a favor and take none. After three months, she realized insurance is an important factor even for those with higher incomes, so she started accepting it.

The moral of the story, they said, is not that you have to abandon your dream. It just might end up looking slightly different than you thought, so you need to be ready to adjust.

4. KEEP A SIDE JOB FOR A WHILE
Nobody opens a practice cold and has it full of patients five or six days a week. That’s why young optometrists recommend keeping another job until the practice grows enough to support your being there full-time.

Dr. Yu continues to work in another optometry office a few days a month–down from a few days a week when he started. Dr. Rutayisire works two or three days a week in her office, and two or three days a week for other people. Dr. Ryan Lang worked full-time for other practices and retail sites while his wife got theirs going, and he’s recently been able to convert to working just at their practice.

Side work, Dr. Rutayisire says, “keeps the cash flow going.” Her goal is to go full-time in her own practice in 2017. “You have to be patient,” she says. “You have to be here for the long haul.”

5. ALWAYS BE MARKETING
There’s no better way to build a reputation than to offer great care to patients. Of course, first you have to get them in the door. Getting on insurance panels is one way young optometrists with their own practices say you can start building a patient base; if nothing else, someone will pick you because you’re on their plan and have appointments available quickly. They also recommend sending postcards announcing your practice, and using email, website and social media marketing to connect with potential patients.

Dr. Laura Lang says her practice has had great success with a ‘live where you work’ marketing strategy. “We see patients at our church, at the grocery store,” she says. “People like to see you as a normal part of the town.”

6. ENJOY YOUR FREEDOM
The young optometrists all said they went to school with the dream of practicing optometry the way they envisioned. By owning their own practices, they can. “It’s great to practice optometry on your own terms,” Dr. Laura Lang says.

Her husband says despite what it looks like coming out of school, it’s also easier to take the risk when you’re young, rather than wait. Dr. Ryan Lang says the birth of their first child, a girl, in October 2014 has put that into perspective; he’s not sure they would have had the time and energy needed to open and grow their practice if they started now. “You should open your own practice while you’re young,” he says. “It’s going to get harder as your life gets busier.”

1 Comment

  • Reply December 12, 2014

    Kashifa

    Very nice and informative article! Something that everyone can learn from.

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