Issue 5

In this
Issue
Associateship in
Optometry
Motivating
Optometry
Employees
Referring
Comanaging and
Consulting!
Twenty most read Blog posts from July 2021 with Instagram
Story Answers
Bonus
Article:
Legal
Entities in
Optometry
Become a Patron:
https://www.patreon.com/opticalforum
July is UV
Safety
Month
Optical Forum 5
July 2021
Making an Impact
ISSUE
Blog
Flipbook

Optical Forum
Blog flipbook
Making an Impact
Motivating Optometry Employees-
Page 10
Associateship in Optometry -
Page 6
Referring Comanaging and Consulting-
Page 13
2

News and editor’s
perspective
uly is UV safety month. Long-term exposure to sunlight may
increase the risk of skin burning, skin aging, cancer, and
Cataracts. The World Council of Optometry and the American
Academy of Ophthalmology supported UV Safety month and
reminded the public of the importance of protecting eyes from sun
emitted UV rays by wearing sunglasses and hats and protecting the
skin.
At Optical Forum and during July new original content was posted
on daily basis and we invited readers to frequently participate and
engage by commenting on posts and through the “Answer &
Insights” section in Instagram stories. This month’s topics revolved
around Eye Health, Technology, Practice Management, Motivation,
along with other topics of entrepreneurship, leadership, marketing,
etc…
We invite every one of you to share his or her story with Optical
Forum. Discuss your insights become an author and get heard. You
are all invited to accompany us in this journey by sharing your
insights, stories, posts, and articles at
feedback@opticalforum.space or by filling the form at
https://opticalforum.space/contribute/
A big “Thank you” for all our followers and Patrons who believe that
we can make an impact, and are supporting us through
www.patreon.com/opticalforum
Gilbert Nacouzi, BSc, MBA, DBA, EIC
3
B y G i l b e r t N a c o u z i , B S c , M B A , D B A , E I C
J
Gilbert Nacouzi

• Lorem ipsum dolor sit
amet, consectetur
adipiscing elit. Lorem
ipsum dolor sit amet,
consectetur adipiscing
elit.
Sports Eye Safety
4
Enjoy reading our insights
related to the Eye Care
Business
This Blog is like the “Agora” in
Ancient Greek which means
“To Gather Together”. Like
Homer, we characterize a
community without an Agora
as such as that of the
Cyclopes, as lawless
Optical Forum Blog
Contact The Editor:
Dr. Gilbert Nacouzi
admin@opticalforum.space
Issue 5 Reviewer:
Dr. Rasha Faraj
Article Reviewers:
Elise Youssef
Mouhamed Ali
Rana Alawi
Rana Chehab
Rabih Khoury
Sami Alameh
Support us:
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5
July 2021
ISSUE

Contents
Referring
Comanaging and
Consulting
Factors That
Motivate
Individuals
Motivating
Optometry
Employees
6 What Makes
Them Reluctant to
Adding an
Associate
Associateship in
Optometry
1
0
1
3
5
Avoid Fearing the Future 31
Optometry Job Interview Questions
32
Is Your Ability to Making Money
Appreciating or Depreciating?
34
Advantages and Benefits of Purchasing an
Optometry Practice 36
Wholesale and Retail Markup
37
In-house Lens Edging or Outsourcing 39
Disadvantages and Responsibilities of
Purchasing an Optometry Practice
41
Optometry Practice Expenses
Market Segmentation for
Optometry Products
8
Revisiting Quality of Care and
Eye Care 14
Signs That Your Strategy is
Actually Working
16
Employed Optometrists: How to
Work Under Poor Leadership?
17
Using Pareto for Growth 19
Types of Business Models and
Organization Design 21
Why Should we Care About
Theories of Management
23
When Do You Make Your
Legal Entities in
Optometry
2
7
Caring with
responsibility

Associateship in
Optometry
Answer & Insights
OFTEN THE REASON
OPTOMETRISTS DON’T ADD AN
ASSOCIATE
True
False
They Doubt he/she have the
same devotion and passion to serving
patients.
They are afraid he will be supportive
to patients and not the practice.

Associateship in Optometry a real
Catch-22 Situation
We often hear Optometrists say we
couldn’t add an associate to the
practice because we didn’t have
enough patients. At the same time,
senior optometrists emphasize adding
a new associate will increase the
number of patients the practice
serves. From there, it becomes
hard to answer when is the right time
to take on an associate and it evolves
into a Catch-22 situation.
Often the reason optometrists are
reluctant to add an associate is that
they put so much of themselves in
serving their patients that they doubt
an associate will have the same
devotion and passion to serving
patients.
When optometrists consider adding
an associate that would most of the
time be for the sake of increasing
office hours, adding a new specialty,
learning a new perspective in treating
patients, creating time for seminars
vacations and travels, as well as
aiming to decrease the practice
overheads and consolidating
marketing and advertising efforts.
Optometrists also see a potential
future partner in associates even
sometimes a potential practice buyer
at retirement.
Doctor Peter Shaw-Mcminn specified
26 advantages of adding an
associate in a review of optometry
2015 article.
From the associate perspective
entering into an associateship
agreement could be a transition to
either a future partnership or to gain
the proper experience to open his
private practice. Associates are better
paid when they enter an agreement
with an ophthalmologist.
Ophthalmologists are aware of the
skills of optometrists and they hire
associates to help them examining
patients without having to enter into a
partnership with them. Moreover,
ophthalmologists make higher
incomes than optometrists and they
afford to pay associates more than
optometrists.
Associates at ophthalmologists
cannot become partners. However, in
optometry practices associates enter
into the agreement because they will
most of the time become partners.
Optometrists enter into associate
agreements with ophthalmologists
because they want to develop clinical
knowledge in specific clinical areas or
because they want to earn and save
enough to open their private practice
the soonest possible.
Associateship is in high demand in
employment in Optometry and
Ophthalmology. Associate offerings
can be searched
at indeed.com or glassdoor.com
It becomes hard to
answer when is the
right time to take on an
associate and it
evolves into a Catch-
22 situation
7
Associate offerings can be
searched
at indeed.com or glassdoor.c
om

Market
Segmentation for
Optometry Products
Market Segmentation for
Optometry Products
A strong marketing strategy can be
the only difference between a
successful practice and a less
competitive one. Marketers look to
improve their marketing efforts’
effectiveness by using market
segmentation. Market
segmentation types can be
geographic, demographic, cultural,
behavioral, and psychographic.
With market segmentation,
marketers can target and
communicate the right message to
the right and exact group within an
audience. Market segmentation
enables targeted messaging.
Geographic segmentation
addresses where a certain
customer is within an area, a clutch
of zip codes, or a neighborhood.
You may want to refer to local
newspapers, magazines, or even
Facebook location-based targeted
ads.
Demographic segmentation
addresses who your target is. Who
your target audience is? It depends
on age, gender, level of education,
position in a company, and income
level. You may want to target high-
level income customers with your
latest special edition designer

9
Cultural and behavioral segmentation address what and how
customers decide and are based on religion, values, ethnicities,
rituals, and social perception.
Psychographic segmentation addresses why customers with specific
personalities and traits, beliefs, heroes and celebrities attachment,
lifestyles, and societal symbols buy certain products.
Through surveys, marketers can collect relevant information and
data about the target audience and can employ secondary data,
industry reports, and census from official organizations to
understand how your audience compares or differs from the general
population.
For example, if we are trying to introduce an innovative product to
our market we can employ the technology adoption curve from
Everett Rogers ( innovators, early adopters, early majority, late
majority, and laggards) and compare it to its data from our target
market. From industry reports, we can get information about the
demographic, psychographic, and other information. By comparing
our audience with the data about the adoption of an innovative
product at the industry level we can specify which segment to target
and develop the right message and try to convey it to them. This
way we can target, benchmark with industry levels, improve
communicated messages, and increase marketing efforts efficiency.
Answer & Insights
PSYCHOGRAPHIC SEGMENTATION
ADDRESSES WHY CUSTOMERS
True
False
With specific beliefs buy
certain products
With specific incomes buy
certain products

Motivating Optometry Employees
In Optometry Practice management
textbooks, we are often introduced to
a number of factors that motivate
individuals. Those factors are found in
Maslow’s hierarchy of needs, and by
applying them to the profession of
Optometry, they give us the
impressions that they are meant to
make optometrists knowledgeable of
what would be most effective in
motivating employees. However,
those are very basic factors and they
solely relate to extrinsic motivation
that is related to the social context we
live in. In other words, those factors
come from outside, are the result of
imposed conditions, and are based
on offers and rewards. Whereas,
intrinsic motivation comes from inside
of the employee and consists of the
employee’s drive for fulfillment and
growth or getting better.
As Deci and Ryan (2008) put it in
their Self Determination Theory
(SDT) that motivation is divided into
two main types intrinsic and extrinsic
and they both shape the way we
behave linking personality, motivation,
and optimal functioning into one
theory. Motivation is predominantly
and primarily affected by the role of
intrinsic motivation in helping us to
feel motivated in the workplace and
life in general. The role of extrinsic
motivation is thus less dominant and
helps understand the conditions
under which
10
extrinsic motivation can help us.
In his bestselling book “Drive”, author
Daniel Pink set up a notion of
motivation that has become extremely
valuable and known to psychologists.
He divided the understanding of
motivation into three stages. The first
stage which he calls Stage 1.0 that is
all about fundamental biological
needs, the need for safety, security,
and economic wellbeing that is very
much similar to the base level of
Maslow’s hierarchy of needs.
Maslow’s hierarchy includes:
Physiological Needs, that consist of
fulfilling basic needs necessary to
survive like food, water, shelter,
sleep, clothing, and reproduction.
Security and Safety Needs, that
consist of fulfilling needs like personal
security, continuous employment,
health plans, being able to own a
property, etc.
Social Needs of Love and
Belonging, that consist of fulfilling the
needs of the relationship, connecting,
socializing, maintain friendships,
intimacy, and family.
Esteem, that consists of fulfilling the
need to be free, respected, revered,
have status, recognition, self-esteem,
prestige, and strength.
Self-actualization, that consists of
fulfilling the need to achieve one’s full
potential, and the desire to become
the most that one can be.
Motivating Optometry
Employees

Motivating
Optometry
Employee
s
INTRINSIC MOTIVATION COMES
FROM INSIDE OF THE EMPLOYEE
AND CONSISTS OF THE
EMPLOYEE’S DRIVE FOR
Good
Bad
fulfillment and growth or
getting and becoming better.
securing basic needs like
food shelter and clothes.

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Referring
Comonaging and
Consulting
By Dr. Gilbert Nacouzi
By law, we know that a
consultation is a joint
intervention between
two or more
practitioners.
Referring Comanaging and
Consulting!
We gain a lot of confidence when we
receive referrals from other eye care
providers but also other health care
providers like chiropractors, general
practitioners, family practices, and
even dentists. We also refer to other
eye care providers and health care
providers when the service needed is
beyond our scope of practice. When
we refer patients we make sure they
get the best care hence we seek to
orient patients to practices with whom
we’ve had enough experience for not
just referring but also comanaging
and consulting.
Patients highly respect mindful
practitioners who seek to put the
patient service at the center of their
mission and seek to constantly offer
the best care possible to the patient.
Referrals are made by all
practitioners to ensure that the patient
is getting the right service and getting
the best available care for the
problems he has.
Some practitioners decide not to refer
patients either to gain experience in
certain cases or because they have
enough time – especially if a practice
has just started and still does not
have a lot of scheduled
appointments- to perform many
procedures before they start focusing
on a specific scope of practice. By the
time the Optometrist identifies the
scope of practice he becomes better
off if he refers patients who are not
within the scope of the practice to
other practitioners.
By law, we know that a consultation is
a joint intervention between two or
more practitioners. Therefore, even
though a patient may receive the
diagnosis by one practitioner,
however, the care has been
performed by two or more
practitioners making all practitioners
liable if there is negligence or if the
patient was harmed by the care
provided by any of the practitioners.
On the other hand in a referral case,
even though the referring practitioner
is required to employ reasonable and
prudent care while referring he will
not be responsible for the activities
and care of the health care
practitioner to whom the patient was
referred.
Referring, comanaging, or consulting
can all be beneficial for providing
better care to the patient. To fulfill this
goal, the Optometrist should carefully
and prudently build a reliable circle of
practitioners with whom he can
collaborate as his patient base begins
to grow and as he starts to focus on a
specific scope of practice.

14
reimbursed little attention is given to
quality. Most third-party payers
reimburse on the basis of the volume
of services rather than the quality of
care provided. Progress to value care
from volume-based care is still
unhurried and reluctant to change.
Yet mobilizing Optometrists during
the pandemic to provide vaccines has
proved beneficial to society and the
quality of healthcare the population is
being provided.
Donald M. Berwick developed “the
triple aim”, a concept of healthcare
that became a national health policy
in terms of the way how many
healthcare
IN A CONSULTATION MADE BY TWO OR
MORE PRACTITIONERS
all practitioners are liable if there is
negligence or if the patient was harmed
Only one practitioner is held
responsible.
Revisiting Quality of
Care and Eye Care
Revisiting Quality of Care and
Eyecare
Optometry and the definition of
Optometry have constantly changed
over the years reflecting the refined
and integral quality of the eye care
delivered by primary eye care
providers. The role of the optometrist
has proved to be integral during the
pandemic and the lockdown. Being
the first contact patients have with the
healthcare system, once again
Optometrists proved they are at the
forefront of the society health
management. Although no
optometrist intentionally provides poor
quality eye care, however, when

providers think of the healthcare
system. The Triple Aim approach is
focused on three intersecting
elements:
The per capita cost that, according to
the Triple Aim, should be lowered.
The Patient Experience that,
according to the Triple Aim, should be
constantly improved to prompt the
patient to adhere to the treatment
recommended by the provider.
Better Health for the population as
well as the individual that, according
to the
15
Triple Aim, instead of solely focusing
on individual care, the population and
communities should be strategically
and broadly taken care of to improve
the health of those groups.
The idea behind this is providing care
to small segments of a population
consumes enormous amounts of
healthcare resources, while following
the Triple Aim approach generates
greater quality healthcare to the
population.
ACCORDING TO THE TRIPLE AIM
APPROACH THE PER CAPITA COST
Should be reduced
Should be increased
“Truly affordable but high-quality
health care tools and services are
the only means by which quality health
care can be provided to all.”
Muhammad Yunus

Signs that your
Strategy By Dr. Gilbert Nacouzi
16
improving our services and effectively
following up we can motivate our
patients to visit us more frequently
and without hesitation.
Paul Rulkens emphasized achieving
the status of preeminence when we
get to the highest pinnacle of
success. And that is translated by
specific indicators that become
relevant to us in this situation. Among
those indicators:
You start seeing the number of new
patients improving even with the
minimum marketing effort;
Price stops being an issue, but rather
your availability, the availability of
your products and services begin to
be their only concern;
You start being considered as a
When we think about a
strategy working well,
we immediately think
of high return on
investment (ROI) and
growth.
Signs that your Strategy is Actually
Working
Last issue we posted about “signs
that your strategy is not working
well”, and we emphasized that the
strategy is not working when the
practice is not being able to
constantly change and adapt to the
changing nature of the market, the
strategy lacks differentiation, and the
strategy is not producing high-
performance levels of profitability.
When we think about a strategy
working well, we immediately think of
high return on investment (ROI) and
growth. Growth could be on the
number of new patients, the amount
of dollar spent by each patient, and
the frequency that the patient is
visiting and buying our products.
Even though, the number of new
patients is always an attractive
number, however, in terms of
ROI, it is always easier to work on
growth that comes from making
patients spend more and visit more
frequently. By providing value to
existing patients and growing our
product portfolio we satisfy additional
needs of our existing patients, and by
is Actually Working

benchmark by your competition, and
you start seeing your ideas being
copied and imitated.
At this point when you become a
thought leader in your field you
should maintain working on your
practice or product you succeeded in.
That is by increasing marketing
instead of reducing efforts. This is
particularly important to highlight and
create
17
awareness of the specific and unique
value proposition that your practice is
providing to the market. Continue
differentiating by increasing and
strengthening the competitive
advantage over the competition. And
last but not least, systematically work
for positioning your practice for
preeminence and maximum success.
working with an Optometrist who has
poor leadership?
There are a set of objectives and
questions that you must seek to
achieve and answer before deciding
whether you should stay or move on
with another job.
First you should evaluate that you are
not actually the problem and provide
the right evidence to prove it. The
higher the stakes, the bigger is the
issue,
GROWTH BY INCREASING THE
NUMBER OF NEW PATIENTS IS
Easier than increasing sales
through existing patients
Is not easier than increasing sales
through existing patients
Employed
Optometrists: How to Work
Under Poor Leadership?
Employed Optometrists: How to
Work Under Poor Leadership?
Being employed as an Optometrist is
becoming more and more lucrative,
especially for specialized
Optometrists. However, some bosses
have poor leadership, lack of good
vision, and sometimes are less
talented. When this happens the
Optometrist feels like everything bad
almost always falls on him. How can
you succeed with

and the more important are the
consequences, the more specific,
clear, and accurate the evidence
should be.
Next, you should be able to assess
how much influence and credibility
you have with your leader with the
issue being addressed. Unless you
have credibility and influence your
leader you may not be able to prove
you’re right even if you have the
evidence that supports your point of
view.
Never complain about the issue to
your coworkers, but rather deal with it
privately with your leader. Give
yourself plenty of time to think things
through, and understand the possible
18
reactions and outcomes before
addressing him.
After you meet with the leader and
after you have studied and
understood all facets and co-worked
them all through, you will have to
decide whether to accept the
situations and issues or leave. If he
admits responsibility and vows to
correct you must give him three to
four months and see what happens.
After four months if you see that
everything is acceptable and you can
cope with the current state you might
decide to stay otherwise you must not
waste time and start looking to go.
SHOULD YOU CONFRONT POOR
LEADERSHIP ISSUES IN PRIVATE?
Yes
No
“Leadership is about solving problems.
The day leaders stop bringing you their
problems is the day you have stopped
leading them. They have either lost
confidence that you can help or conclude
you do not care. Either case is a failure on
leadership.” -Colin Powell.

Using Pareto for
Growth By Dr. Gilbert Nacouzi
19
To achieve maximum practice growth
through the most appropriate
perspective we have of our practice
we can use the Pareto principle. Plan
for the coming five years, write down
a list of the tasks that you and your
practice staff can perform best, know
that you’ll never have to perform all
tasks if you want to grow, prioritize
your list by order of growing
profitability (not the time spent on
each activity), and subdivide the list
into groups of tasks that you want to
perform first, second, third, etc…
Apply the Pareto rule to your list and
keep in mind that the first 20% of
activities are responsible for 80% of
your growth and profit.
Once you have identified the 20%
The way and the
speed a practice
grows relates directly
to its ability to increase
productivity and use
working time well
beyond what other
practices are doing.
Using Pareto for Growth
In a previous issue, we emphasized
the importance of the Pareto principle
or the 80-20 rule that is widely used in
management and known in
Optometry. We also listed many
places the Pareto principle is
employed including in practice and
business growth. 80% of the growth
comes from 20% of practice activities.
How do we apply this on a day-to-day
basis?
The way and the speed a practice
grows relates directly to its ability to
increase productivity and use working
time well beyond what other practices
are doing. Productive work requires
high amounts of focus, energy,
discipline, consistency, and willpower
to accomplish and achieve goals. The
way we think about our work defines
how well we will do.
Many practitioners work the same
amount of time but think differently
about their practice therefore the
productivity of their practice
completely differs.

activities responsible for the 80% of
your growth and profit, you copy them
on another list that you place on your
desktop that you open and review the
first thing in the morning. Before you
start your meeting with staff at the
beginning of the workday you go
through this list and apply the ABCDE
method. The ABCDE method consists
of putting a letter next to each activity
by level of results or consequences of
completing or not completing this
task.
You put an “A” next to the activity that
is of high importance to the
consequences it makes and so it
must be accomplished. An “A” activity
has serious consequences for being
completed or not completed. “A”
20
activities cannot be delayed and they
should be handled the soonest
possible. A “B” activity has mild and
moderate consequences and should
be performed. A “B” activity can be
performed soon as it can also be
delayed. A “C” task has no
consequences but it would be nice to
perform it. A “C” task like spending
time with colleagues chatting or
talking over coffee. A “D” task is
something that is better done if you
delegate it or outsource it to someone
else. An “E” task is a task that you
can eliminate.
With time, as you identify the most
common ABCDE activities you
become more oriented to performing
activities that have a direct impact on
your growth and profitability.
APPLYING PARETO WHEN 20% TOP
GROWTH IS EYEGLASSES
Growth comes primarily from
focusing on eyeglasses
Growth comes from diversifying
activities.
"Strive not to be a success, but rather to
be of value." - Albert Einstein

Types of Business
Models and Organization Design
21
constantly changing. Those business
models are actually based on the idea
in which the simplified solution can
always be delivered to customers in a
cost-effective way.
Because of that, there are three types
of business models and each type
deals with specific problems,
products, and services. If you try to
force a product into the wrong type of
business model you will certainly fail
as a business. This is another vital
reason why as an Optometrist you
can’t be doing everything for
everybody. This explains why as a
successful Optometrist you have to
limit your work at what you do best.
Professor Øystein D Fjeldstad at BI
A business model is an
outline of how a
company plans to
make money with its
product that it delivers
to customers in a
specific market.
Types of Business Models and
Organization Design
A business model is an outline of how
a company plans to make money with
its product that it delivers to
customers in a specific market. A
company makes money by applying
its resources to specific processes to
get to the desired profit formula. This
is a simple illustration that has been
employed by Professor Clayton
Christensen from Harvard Business
School. First, the company provides a
value proposition then looks at its
resources and tries to figure out what
processes are needed to produce
those products and services, reduce
expenses, increase efficiency, etc…
then it measures the expected
profit. If the profit is not satisfactory,
the company goes through the steps
all over again and tries to change and
play with the different variables until it
reaches the desired profit formula.
Because there are many types of
businesses, business models are

Norwegian Business School defined
many types of business models and
organization design. He emphasized
value-adding, problem-solving, and
subscription-based business models.
A value-adding model for example
deals with providing products and
services that their results are 100%
predictable. For example, you
prescribe an optical frame that
provides with absolute certainty the
corrected vision you received in the
testing room.
A Problem-solving model or a solution
shop business model provides
consultancy independent of whether
the customer will receive an added
value or not. For example, an OCT
will only show if a patient has a retinal
problem or not but it does not correct
the problem. A Topography will only
show if a patient has keratoconus or
not but it never corrects it and never
perfects or adds value to the patient’s
state. If we
22
mix OCTs and topographies with
optical dispensing as processes in the
same business model that would be
completely wrong. We will never be
able to calculate our true profit
formula. Because the price a patient
will pay for any procedure will be full
of overheads that we cannot eliminate
and we cannot explain.
A third business model is a
subscription business model
employed in services that require a
subscription like magazines and CE
sessions.
A fourth business model we can think
of, is the network business model
where members of the network
contribute content that creates value
to other members and to the network
itself. Certainly, the products created
in a network business model can
never be employed in the other two or
three types of previous business
models.
BUSINESS MODELS CONSTANTLY
CHANGE
True
False

Why Should we
Care About Theories of
Management By Dr. Gilbert Nacouzi
23
not use any statistical method. The
study conclusion emphasized the
importance for Optometrists to
increase their statistical knowledge to
successfully appraise the ophthalmic
literature.
Good statistical knowledge is
important for both ophthalmic
literature and practice
management. Professor Clayton
Christensen emphasized that “Theory
often gets a bum rap among
managers because it’s associated
with the word “theoretical,” which
connotes “impractical.” But it
shouldn’t. Because experience is
solely about the past, solid theories
are the only way managers can plan
future actions with any degree of
confidence.”
Good statistical
knowledge is
important for both
ophthalmic
literature and
practice
management
...
Why Should We Care About
Theories of Management
A study that has been presented at
The Association for Research in
Vision and Ophthalmology ARVO
2020 annual meeting aimed to
investigate statistical analyses that
are common in the ophthalmic
literature as well as to measure the
statistical knowledge, attitudes, and
practices (KAP) of Australian
optometrists. The study looked at 376
(55%) articles published in 2018 in
the Clinical and Experimental
Optometry (CEO), Ophthalmic and
Physiological Optics
(OPO), Optometry and Vision
Science (OVS), and Ophthalmology.
The results showed that 90% of
articles used Descriptive
statistics methods, while only 10%
employed Inferential statistics
methods divided into t-tests (33%)
and contingency tables (32%). Non-
parametric tests were employed in
21% of the studies and ANOVA in
17% of the studies. Finally, 15% of
studies did

He always referred to the theory of
gravity that tells us why by simply
dropping an object we are 100% sure
that it will fall on the ground. A theory
is a statement of causality it shows us
what causes what to happen and
why.
If we want to have a clear idea about
the future we need to be able to
employ theories that show us with
absolute certainty that if we do such
or such thing we will get to such
result. We are avid consumers of
theories without even being aware of
them. Every time we follow a plan or
try to implement a business model we
rely on a set of theories that tell us it
is going to be successful.
Descriptive statistics don’t allow us to
generalize or demonstrate a causal
effect relationship. Inferential
statistics aim to figure out or reveal if
a causal effect relationship exists.
Newton’s
24
gravitational principle is based on
inductive reasoning that pertains to
inducting the truth from observations.
We come up with theories following
inductive reasoning based on events
or cases from which we induct a truth.
To empirically test a theory we
conduct deductive reasoning that
leads to test how practical the theory
is through hypothesis testing. If a
theory seems to be robust because it
has been able to prove its practicality
throughout numerous empirical
attempts to test it, it progressively
becomes used by a number of
scholars, and then it opens the door
to a paradigm. But with time
anomalies appear; anomalies are
good indicators that a theory needs to
adjust itself to become more general
and answer those anomalies.
However, when anomalies are
significant and the theory has been
widely known as a paradigm a
scientific revolution occurs.
THEORIES SHOW US WHAT CAUSES
WHAT TO HAPPEN AND WHY
True, theories are
statements of causality
False, descriptive statistics
allow prediction

When Do You Make
Your Time Count By Dr. Gilbert Nacouzi
25
Procrastination as we know it and as
we’ve always been told about is
destructive because it keeps up from
getting our responsibilities done by
not being able to allocate the right
amount of time to completely and
perfectly accomplish them. Some
consider that there are two types of
procrastination; destructive
procrastination and productive
procrastination. Productive
procrastination is when you
procrastinate your most important
tasks and make yourself busy with
other less stressful yet productive
tasks. For example, destructive
procrastination is when you surf
Facebook or do nothing instead of
doing the most important activity first.
…markets and
economies move
toward a sort of
Pareto efficiency
when all goods and
services are
tradeable in
competitive markets
with no transaction
costs.
When do you Make Your Time
Count?
In a previous post, we emphasized
“Time is Money but Time to think is
Gold” and we added that quick
decision-making in order to gain time
and money makes us lose money
compared to taking time to think and
then decide. We are expected to
make decisions on a daily basis and
on the smallest things in our lives at
the office or at home. But once we
decide on doing something and we
start by setting deadlines we put
ourselves in a stressful situation
where we see that by procrastinating
we feel better off and relieved from
this stress. Browsing Facebook,
watching TV, or spending
more time with the staff in the break
room drinking coffee when we feel
that a deadline is approaching is a
sort of stress break from a big
responsibility that we have to do. We
procrastinate and see others
procrastinating on daily basis and
we’ve always done that since
studying at school.

Productive procrastination is when
you do other less important but
required things instead of doing the
most important activities first. And
while many consider that productive
procrastination is good because it
helps you accomplish many tasks, it
is still keeping you from tackling the
most important activities first; and
therefore productive procrastination
should also be avoided when
possible.
To stop procrastination, we usually
start by revealing the motif and the
benefit we have to accomplish the
job. We resume by subdividing the
activity
26
in chunks that we set a timer for
completing each chunk. To avoid
positive procrastination all less
important activities should be
delegated when they are not your
responsibility (For example when an
optometrist performs lens edging, it
should be delegated to the optician).
Last but not least, the five-second
rule by Mel Robbins works well for
many, it tricks the brain into focusing
on the goal that is about to happen.
It’s like you’re waiting for NASA to
launch a rocket or a space shuttle,
you start counting 5-4-3-2-1, and then
you do it.
THE FIVE-SECOND RULE HELPS STOP
PROCRASTINATION
True
False
“God has promised forgiveness to your
repentance, but He has not promised
tomorrow to your procrastination.”
― St. Augustine of Hippo

Legal Entities in
Optometry By Dr. Gilbert
Nacouzi
27
practiced. Moreover, the sole
proprietor decides on who to hire who
to fire, with full ownership of the
practice income as well as assets.
The disadvantages of a sole
proprietorship include no replacement
available in case of illness, vacation,
or absence for conferences and
exhibitions. The sole proprietor will
have to fully support all the practices’
finances. He should accept a low
income at the beginning that may
sometimes continue for a prolonged
time in the case of a cold starting. He
should also develop a good
knowledge and education in law,
finance, marketing, and strategy to be
able to create and sustain a
competitive advantage.
The duration or the lifetime of a sole
proprietorship could be extended to
as long as the optometrist is living or
wants to stay in business. The
practice can later be sold to another
practitioner. In the case of a sole
proprietorship, the owner is
responsible for reporting
Legal Entities in Optometry
This is a bonus article for this July
Issue 5. It describes the different
types of legal entities that self-
employed optometrists can choose
for their practice, the advantages and
disadvantages of each type of legal
entity, as well as some other details
like liabilities, expenses, and taxes.
The types of legal entities in
Optometry include: the sole
proprietorship, the general
partnership, the corporation, the
subchapter S corporation, and the
limited liability company.
The sole proprietorship type of
legal entity
The sole proprietorship is defined as
a natural person. The optometrist is
the only person who owns 100% of
the practice and is responsible for all
the liabilities of the business. In the
United States, a small percentage of
private practice owners are sole
proprietors. The sole proprietor can
employ other optometrists or staff and
he can include independent
practitioners as independent
contractors. There are two ways that
sole proprietorship is possible either
by starting a new practice or
purchasing an existing one.
The advantages of a sole
proprietorship include full control of all
the strategic, planning, and
operational decisions as well as for
deciding on opening hours, products
Legal entities in
Optometry include:
sole proprietorship,
general partnership,
corporation,
subchapter S
corporation, and the
limited liability
company

business taxation and individual
taxation. Even though he can write-off
some business expenses, other
business legal types come with better
tax advantages.
Legal Entities in Optometry: The
General Partnership
So far we emphasized the role of sole
proprietorship in Optometry among
other legal entities. A sole
proprietorship is when one
Optometrist owns and runs the
business. However, a partnership
appears when two or more persons
own and engage in the business; it
can be a general or limited
partnership. In the case of a general
partnership, the business assets are
owned by all partners and together
they are personally liable for the
business obligations and debts. A
limited partnership is a form of hybrid
partnership with both limited and
general partners.
The advantages of a partnership
include:
A partnership does not pay taxes on
its own, but taxes are passed through
to the partners and each partner is
responsible to report income and pay
taxes on his individual tax return.
A partnership produces and
processes a higher work volume and
patient load than a sole
proprietorship. Therefore, it generates
higher earning and potentially higher
individual returns and income.
Capital invested in the practice is
divided among partners. Practice
overheads, as well as fixed and
variable costs and expenses, are
shared among partners.
A partnership enables extended
opening hours and more convenience
28
of partners, Optometrists, and
different shifts possibility.
Each partner’s investment in the
practice is an investment in equity
that does not lose its value in case
the partner stops working as a result
of retirement, or a health issue.
The disadvantages of a partnership
include:
The number one disadvantage of a
partnership compared to a sole
proprietorship is that the co-owner
optometrist will lose independence
and full control over the decisions and
operations in the business. All
decisions are made in a collective
way.
Sometimes if activities are not well
distributed, conflicts may arise among
Optometrists for differences in
workload, income distribution
inequality, and vacation or absence
gaps. Moreover, all partners are
equally responsible and liable for a
mistake that any partner made.
Partnership are more expensive than
sole proprietorship in terms of legal
and establishing expenses as well as
accounting services fees.
The Corporation
The corporation is another type of
legal entity that is common in
Optometry practices. A corporation
differs from sole proprietorship and
partnership entities by its ownership,
management, and the way tax is paid.
A corporation in Optometry could be
either a Professional Association (PA)
or a Professional Corporation (PC).
PAs are usually for a non-profit group
of professionals who work together on
nonprofit-driven projects and PCs are
for for-profit corporations of

professionals requiring a license such
as physicians, doctors, and lawyers.
While some optometrists deliberately
choose to incorporate for specific
reasons, some practitioners don’t
know what corporation they are in. A
corporation could be a C corporation
or an S corporation. While a C
corporation pays tax on its net
income, an S corporation passes
through its net income to its
shareholders and each shareholder
pays tax on his income based on his
individual income tax rate and the
part he owns in the company.
The formation of a corporation is
more complex and expensive than
sole proprietorship and partnership.
An incorporator is required to file
Articles of incorporation with his state,
which costs more fees and taxes than
other legal entities. The corporation is
an independent legal entity that is
endowed with certain characteristics
separate from its owners. Being an
independent legal entity, the
corporation does not end with the
death of the proprietor or of one of
the partners. Corporations continue
as long as they are profitable as
shareholders may change over time.
The management in a corporation is
separated from its owners who are
the shareholders. While in
partnerships, ownership and
management are combined in
partners, in corporations they may be
divided so that the proprietors are not
responsible for or have any direct
authority over the management of the
practice. Ownership is through
purchasing or transferring issued
stocks in the corporation.
As an independent legal entity, the
corporation "has the right to own
29
properties in its own name, sue or be
sued, and claim tax advantages that
are detached from those of the
individuals". Shareholders and
owners are not responsible for the
corporation’s debts and liabilities.
Shareholders are not responsible for
more than the share they own. In
case of bankruptcy, the debts of the
corporation are covered by its assets,
and shareholder’s own assets cannot
be overrun to satisfy the debts of the
corporation.
The corporation advantages
include:
Incorporating limits the liabilities of
shareholders.
Corporations live as long as they are
profitable. Ownership is easily
transferred through stocks purchase
and ownership.
Decisions in a corporation are clearly
defined, centralized, and made by the
board of directors.
Corporations can provide higher
medical plans for a greater number of
employees. Corporations can
establish tax-deductible employee
insurance programs.
As an independent legal entity, the
corporation benefits from tax
deductions that are not present with
sole proprietorship and partnerships.
The corporation disadvantages
include:
Incorporating is a process that
requires paying initial fees and annual
fees with the state. Establishing,
organizing, running, operating, and
administering a corporation is more
expensive than other types of
business entities.
Corporations are required to hold
annual meetings. Moreover,

annual statements as well as other
information to the government and
shareholders compared to other types
of businesses.
Corporations pay tax as separate
entities unlike other types of legal
entities. Corporations are required to
file a tax return even if they don’t
have a taxable income. This
increases accounting and legal
expenses.
Since corporations are required to
provide employees benefits like
health insurance and retirement
plans, increased costs and plans'
prices have turned practitioners
toward S Corporations and Limited
Liability Companies.
S Corporation
An S corporation represents the
optometry practice that has
incorporated a partnership mainly for
tax purposes. The S corporation
combines the advantages of a
partnership and the advantages of a
corporation. It is an independent legal
entity that can own assets, incur
debts, and live as long as it is
profitable. While a C corporation pays
tax on its net income, an S
corporation passes through its net
income to its shareholders and each
shareholder pays tax on his income
based on his individual income tax
rate and the part he owns in the
company. Like a corporation, an S
corporation provides liability
protection that a partnership cannot
offer.
In an S corporation ownership is
obtained through the purchase of
stocks. Shareholders who contribute
their capital become the owners of
the corporation and they can easily
buy and sell shares as the limits
30
and PAs are eliminated in S
corporations. S corporations are an
appropriate environment for
multidisciplinary practices and eye
care centers where optometrists,
opticians, managers, and investors
share ownership.
Requirements of an S corporation:
Even though it is a C corporation,
however, the shareholders have
elected to be treated as S corporation
because they meet certain
requirements: their number does not
exceed 100, they all are individuals,
not corporations, the corporation will
not hold shares in another
corporation, and it will not issue more
than one class of equity. If the
corporation meets those requirements
it will separate the operating income
from taxation at the corporate level.
Each shareholder income will be
proportionate to his part of the
ownership and his profit will be taxed
at his own personal tax rate.
The advantages of an S
corporation include:
It allows shareholders to be taxed as
partners in a partnership while
maintaining their limited liability
characteristic as shareholders.
S Corporations live as long as they
are profitable. Ownership is easily
transferred through stocks purchase
and ownership without any limitations
like PAs and PCs.
Decisions in an S corporation are
clearly defined, centralized, and made
by the board of directors.
S corporations can provide higher
medical plans for a greater number of
employees and can establish tax-
deductible employee insurance
programs.

Avoid Fearing the
Future By Dr. Gilbert Nacouzi
31
To quit taking risks is a serious
mistake, to fear the future is even a
greater mistake. What’s worse is to
become pessimistic about the future.
According to Don Keough, nothing
gives you this feeling more than the
media. News has never been about
good news, it makes you focus on
failures happening around the world
every minute day in day out shaping
your whole attitude toward life and the
future.
Certainly, pessimism didn’t pave the
way to humans to go into space, land
on the moon, or travel to unknown
planets and places. Curiosity and
expedition with the positive attitude of
finding a better future drove people to
take risks and overcome fear. You
should be able to sense the mood,
and when it is negative you need to
know how to change it. You have to
live with the faith in partners around
you and if you start a new business
you will be supported. You need to
believe that tomorrow will be better as
you start a
Avoid Fearing the Future
In a previous issue we emphasized
the Risk of Not Taking risk. The
moment we quit taking risk is the
moment we start driving ourselves to
failure. Entrepreneurship is about
taking risks and starting a business
opportunity or project that no one
started or tried before. We stop taking
risks not because we are scared of
the opportunity but because we fear
failing in the future. We are not afraid
of starting all over again but we fear
failing again for the same reason.
In a football game, the leading team
starts playing safe and slowly stops
taking risks even though the reason
he led the game was that he started
by taking risks to lead by scoring.
Very often we see teams losing at the
last minutes of the game even though
they led for the most of the game.
Their fear of losing the game led them
to adopt a risk aversion strategy that
eventually made them lose.
deductible employee insurance
programs.
Given the great flexibility, should an S
corporation issue multiple classes of
equity securities or include more than
100 shareholders, it can at any time
shift into a regular C corporation.
The disadvantages of an S
corporation include:
Compared with other types of legal
entities the costs and fees of
incorporation are significantly high
due to accounting and law fees.
Like regular corporations, S
corporations are required to hold
annual meetings, prepare and
disclose annual statements as well as
other information to the government
and shareholders.

new opportunity. You need to
understand that unless you prefer
failure over success, you should not
be
32
afraid of the future and let fear control
your thoughts and the ability to
decide.
WE STOP TAKING RISK BECAUSE WE
FEAR FAILURE
True
False
Optometry Job
Interview Questions
going to stay with the practice for a
long time.
The questions that are most
employed include:
Tell me about yourself, where do you
see yourself in 5, 10 years from now?
What do you do for our practice and
how do you think we can help you
grow?
What excites you more about
Optometry?
Those are great questions however if
we want to know about the person
being hired – as well as if we as an
optometrist
Optometry Job Interview
Questions
Whether you are an optometrist being
interviewed for a job or a practice
owner/administrator interviewing an
optometrist candidate, there are
typical questions regularly asked
during job interviews. Moreover,
many considerations make the
interview setting in itself convey
messages to applicants who will get
the job as well as to candidates who
will no get the job. For most practice
owners who conduct interviews
themselves, the hardest part in hiring
is to be able to hire the right person
with the absolute certainty he is

being interviewed want to know if the
practice is hiring based on a selective
care for the practice and the
candidate - we should look for
additional information.
Warren Buffet considers three main
characteristics that a hiring process
includes: integrity, intelligence, and
energy. All three being of the same
important one, but without integrity,
an energetic and intelligent person
will kill the company.
Intelligent people are what Optometry
needs. An intelligent and energetic
Optometrist has what it takes to
accomplish a great job and is fueled
by drive and motivation at the same
time. However, a lack of integrity is
not acceptable. Without integrity, you
will always question your employee’s
decisions. Integrity cements team
members together and develops trust
as each team member will see
himself dependable and accountable
for his
33
actions. Integrity shows who walks
the talk.
Interviewing for integrity includes
asking about situations where the
employee was held accountable, how
did he act, how was he accountable
for his decision.
Integrity relies on getting the
interviewee to talk about a situation
where he had to respond ethically
and fairly to solve a given problem.
When did he or does he feel it is
acceptable to break the rule, how did
he or does he justify his actions?
An employee interviewed for integrity
should demonstrate the points he
values in teamwork and how he
resolves conflict among colleagues.
How does he define white lies?
What are the traits he sees the best
in his superiors or boss? How would
he like to be treated or awarded when
he decides on unusual situations.
WITHOUT INTEGRITY, AN ENERGETIC AND
INTELLIGENT EMPLOYEE
Will kill the practice.
Will make the practice thrive.

Is Your Ability to
Making Money Appreciating or
Depreciating?
34
would be your earning ability as
Bryan Tracy calls it. Your earning
ability is the total sum of the learning,
study, experience, knowledge, and
skills you have accumulated over the
course of your personal life and
career. Because all the components
that constitute your earning ability
appreciate and depreciate over time
as you change and as the people and
environment around you change, your
earning ability appreciates and
depreciates too.
Skills can be acquired and can
become obsolete over time, people
may stop learning at college or can
remain lifelong learners, the speed
and quality of acquiring knowledge
change, and experiences depend on
the situations
“Today people who
hold cash equivalents
feel comfortable. They
shouldn’t. They have
opted for a terrible
long-term asset, one
that pays virtually
nothing and is certain
to depreciate in value.”
Is Your Ability to Making Money
Appreciating or Depreciating?
Two quotes from Warren Buffet come
to my mind when I think of this
topic: “The most important investment
you can make is in yourself”
and “Today people who hold cash
equivalents feel comfortable. They
shouldn’t. They have opted for a
terrible long-term asset, one that pays
virtually nothing and is certain to
depreciate in value.”
In the first quote, he emphasized the
importance of continuous learning
and self-improvement. He is known
for reading for more than six hours or
more than 500 pages a day. The
second quote refers to those who
don’t invest are doing it wrong. Those
quotes answer the
fundamental question of what is your
most valuable asset?
The way to increasing your income is
to spend time and money improving
the most important skill you can
develop which is your mental skill. In
this context, your most important
asset

you are facing. In all cases what you
get paid for your services is the type
of services you provide, the quality,
and the availability of a potential
substitute. If you want to increase
your earnings you have to change
one of those three factors: the
services you
35
provide, the quality of your product, or
you have to become indispensable for
your customer. As you work to
improve yourself keep those factors in
mind to optimized the way you earn
money and increase your productivity.
SKILLS CAN BE ACQUIRED AND CAN
BECOME OBSOLETE OVER TIME
True
False
“We delight in the beauty of the butterfly, but
rarely admit the changes it has gone through to
achieve that beauty.”
― Maya Angelou
Forum and unleash
exclusive content

Advantages and
Benefits of Purchasing an
Optometry Practice
36
Some of the advantages and benefits
of purchasing an existing practice
include:
One of the most important benefits is
being able to employ financial
statements and information to project
cash flow and be able to make
informed decisions to invest in new
projects, equipment, and products.
Accepting patients from day one, and
being able to fill your desired
schedule so that you can plan what to
do in your remaining free time. If your
purchase included transferring
existing staff, you will be operating
the day-to-day workflows smoothly
without interruption.
A known brand and Brand equity;
purchasing a well-known and
operating
If done properly,
purchasing an existing
practice is more
rewarding than starting
cold or getting
employed.
Advantages and Benefits of
Purchasing an Optometry Practice
The majority of Optometry graduates
opt for employment and those who
prefer owning their practice and
working in their own private practice
either cold start the business or buy
an existing one. If done properly,
purchasing an existing practice is
more rewarding than starting cold or
getting employed. The advantages of
purchasing an existing business
exceed the disadvantages in terms of
greater income, the possibility of
equity ownership, more freedom to
program your life, greater
opportunities for choosing what to
practice, and better
retirement options. Purchasing an
existing practice makes you a CEO
from day one, which means that you
will benefit from many things and will
have to be responsible for other
things.

practice includes purchasing brand
equity that has developed over the
years of operation and services in
providing eye care to a local
community. Brand equity includes
yellow pages listing, local business
listing, and social media presence.
An existing patient base; even though
the practice may lose few patients but
the remaining patient base consists of
the majority who is sufficient to
sustain and grow your practice. Your
practice will serve existing patients
and will be convenient to patients who
newly
37
relocated to your area as it is
accustomed to taking part and
involving in social activities in the
community to attract and meet new
patients.
Resilience to disruptive events and
situations: a well-established practice
is less affected and damaged by
potential crises like the event of the
Pandemic or other disasters. Its
organizational strength lies in its
resilience to face and overcome
obstacles and unexpected risks.
Wholesale and Retail
Markup
Wholesale and Retail Markup
Wholesale and retail are two very
important components of the supply
chain that every eye care provider
needs to understand and know how
they function and how they are
interrelated in the optical industry. As
practice owners become busy with
patients, they rarely become
interested in
understanding wholesalers as their
focus remains in retail. For all, we
know that wholesalers make the
liaison between manufacturers and
retailers. Their role as a bridge is very
important to maintaining a healthy
supply chain and a healthy market.
However, failing to complete this role
may lead the whole chain into
oblivion; the unconsciousness
IF DONE PROPERLY PURCHASING AN
EXISTING PRACTICE
is more rewarding than starting cold
or getting employed.
is NOT rewarding AS starting cold
or getting employed.

that this role is a responsibility and an
obligation at the same time to prevent
any negative consequences from
happening especially when it comes
to inappropriately pricing products.
Setting the retail price is one of the
most important decisions that an
Optometrist should make. To be able
to do so, he must understand key
differences between the wholesale
price and the retail price which is
most of the time difficult for new
optometrists and practice owners who
are just getting started in the
business. For most of it, we cannot
argue that wholesalers have low-profit
margins and retailers have high-profit
margins.
The wholesale price formula
encapsulates material costs and
overheads added to profit margin,
whereas the retail price formula is
obtained by dividing the wholesale
price by one minus markup margin in
percentage.
Wholesalers invest large capital, have
no overhead expenses (ex:
advertising), and sell in a variety of
outlets in various less competitive
markets. Whereas retailers invest
smaller capital, have showroom and
advertising expenses, and sell
exclusively in one or two shops where
the environment is highly competitive.
38
Wholesalers don’t sell products
directly to the consumers, they sell
products to retailers, and retailers
resell those products to the end-user
or consumer.
Wholesale profit margin is less than
retail profit margin. This is mainly due
to the fact that wholesalers’ financial
advantages are based on the concept
of stock being purchased and sold in
bulk which cuts down shipping costs
and other overheads. Not having to
invest in advertising, renting
commercial spaces, and paying for
updating displays is another key
financial advantage.
The reason why retailers have a
higher profit margin and markup
prices than wholesalers is that
retailers’ costs are higher
(advertising, individual packaging,
displays costs, lighting, and
electricity,) and a higher profit margin
is often subject to the discount and
special offers to benefit loyal
customers and on special occasions
(sale, events, black Friday,)
According to “ABB Soft Lens Retail
Price Monitor”, soft-lens profit margin
at independent practices ranges from
40% to 60%. The lowest margins are
for heavily advertised spherical
disposable contact lenses (40%) and
the highest margins are for specialty
contact lenses (60%).
RETAILERS SHOULD HAVE HIGHER
MARKUP PRICES THAN WHOLESALERS
True
False

In-house Lens
Edging or
Outsourcing
39
price of the equipment, two to four
pairs of spherical up to three diopters
and cylindrical up to two diopters are
more than enough to begin with.
With the advancement of technology
and new advanced equipment
available to satisfy and support every
practice needs, accommodating an
in-house lens edging lab or
outsourcing lens edging is now a
matter of pure management and
finance decision. When it comes to
management and financial decision-
making this can be a question of
success or failure and a question of
sustaining business activity or exiting.
The key
When we look at the
pros and cons of in-
house edging we
immediately realize
that not every practice
could sustain an in-
house lab.
In-house Lens Edging or
Outsourcing
Despite the piles of facts and figures
in favor of an in-house lens edging
lab, many Optometrists outsource
lens edging. When we look at the
pros and cons of in-house edging we
immediately realize that not every
practice could sustain an in-house
lab. This question, when discussed
with colleagues often turns into a
debate. Those in favor of outsourcing
emphasize, to accommodate an in-
house lab you need a practice with
large space, a sound isolated room, a
dedicated optician or staff member,
more than 30 pairs of glasses per day
or many affiliated
practices, and a large inventory of
lenses. Those in favor of in-house
lens edging emphasize you don’t
need a practice with large space and
soundproof room, optometrists
performed lens-edging for a while
after starting their practice, even
small numbers of pairs of glasses
justify the

factors that an optometrist should
examine when deciding to operate in-
house edging or outsource lens
edging from a managerial and
financial standpoint include:
Cost-Effectiveness: Things that need
to be compared are labor cost
(training a new staff member, hiring
an optician, or the optometrist
dedicating time to operate the lab)
and overhead costs (renting extra
space, leasing equipment, installing
circuit breakers,…)
Improved focus on other activities;
perhaps the practice core
competencies are in mounting
eyeglasses, but what if the practice’s
core competencies are in specialty
contact lenses.
40
Where should you focus? Better
distribution of the most important
resources like staff and Time; the
optometrist should be able to
compare which way increases
flexibility and enables greater frames
mounting capacity as the practice
patient base increases. Flexibility is
being able to adapt as demand
changes.
Efficiency; Optometrists should
assess which way provides fast
delivery, more frames mounted in
less time, and access to larger lenses
inventory.
Depending on your Optometry
practice, when deciding on in-house
lens edging or outsourcing, think
about optimizing those key factors.
SHOULD EVERY PRACTICE PERFORM
IN-HOUSE LENS EDGING?
Yes
No
“Master your strengths, outsource your
weaknesses.”― Ryan Khan

Disadvantages and
Responsibilitiesof
Purchasing an Optometry Practice By Dr. Gilbert Nacouzi
41
relation to the practice is very
indispensable to initiate change
without having to lose them. One
important point is related to
receivables and collection, where the
new Optometrist will have to adapt to
the terms that the previous owner
offered to existing patients. New
terms can be implemented when
introducing new procedures and
products and new patients start
visiting the practice.
The new Optometrist expected to
command the staff must be able to
understand how they manage the
The most relevant
drivers and motives
of purchasing an
Optometry practice
are the financial
benefits of a
predictable cash
flow and the patient
base
Disadvantages and
Responsibilities of Purchasing an
Optometry Practice
In a previous post, we emphasized
the Advantages and Benefits of
Purchasing an Optometry Practice.
The most relevant drivers and
motives of purchasing an Optometry
practice are the financial benefits of a
predictable cash flow and the patient
base. Having paid money purchasing
an existing practice, both drivers or
elements become the primary
responsibility of the purchaser as he
does not want to waste financial
resources and/or lose patients and
customers.
It is very important that the purchaser
understands the demographics and
the population of patients who find
their needs at this practice so that he
can extrapolate and invest in
extending the practice core services
rather than changing them. Moreover,
if a change is required, understanding
the patient’s

day-to-day operations and how they
deal with patients. Every change that
needs to be implemented needs to go
through a process that ensures that
everyone will support and adopt.
Sometimes the new Optometrist
specialization differs from the scope
of practice of the acquired business.
The Optometrist will have either to
employ an associate to handle the
practice main activities so that he can
extend on his specialty practice or he
has to handle the matter himself and
get involved in
42
the scope of the practice.
Purchasing an existing practice
requires a significant amount of
money to be initially paid as well as a
subsequent monthly payment. The
new Optometrist’s responsibilities will
be to carefully manage the practice
financials in order to make-ends-meet
and sustain progress. Old equipment
and furniture as well as introducing
new technologies to the practice
should also be considered in
managing the practice finances.
THE MOST RELEVANT
DRIVERS/MOTIVES FOR PURCHASING
OPTOMETRY PRACTICE
Are the financial benefits of a
predictable cash flow and the patient
base
Expenses and Property Lease
Amount
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Optometry Practice
Expenses By Dr. Gilbert Nacouzi
43
Sometimes we only think of the cost
of goods sold when we are trying to
understand the costs in a practice.
However, there are other important
expenses that an optometry practice
incurs every month that include:
Rent or Mortgages, depending on the
circumstances, an Optometrist may
rent or mortgage a practice, whatever
his decision, the amount paid is
considered a monthly expense.
Employees and staff, incur a monthly
expense of payroll that includes taxes
and employee benefits. It’s crucial to
keep those expenses at their
minimum especially when you seek
funding for new equipment since
lenders require those expenses to be
within a certain percentage.
The financial needs of
both employers and
employees and the
patients demand for
extraordinary care that
requires state-of-the-
art equipment mean
that the cost of making
business and running
an Optometry practice
is likely to continue to
rise
Optometry Practice Expenses
Running a successful Optometry
practice requires the revenue to
exceed expenses by an amount that
is substantial to sustain growth and
profit beyond any other conceivable
investment. As practice owners,
partners, or associates we are
committed to providing great eye
care, managing a sustainable and
profitable business, as well as
conveying this message to
employees, and making sure they
abide by those terms for only those
terms ensure they can grow and
benefit for being employed in an
optometry practice.
The financial needs of both
employers and employees and the
patients demand for extraordinary
care that requires state-of-the-art
equipment mean that the cost of
making business and running an
Optometry practice is likely to
continue to rise.

Marketing, expenses are higher in
newly launching practices and less
significant in established practices.
Laboratory expenses include lens
surfacing and edging independently
whether they are performed in-house
or outsourced. Utility expenses
include office maintenance expenses
(electricity, snow removal, cleaning,
…), expenses related to activities, as
well as expenses related to
purchased items (cases, lens cases,
lens cleaning clothes, …)
Legal and accounting expenses, as
well as contracts and licenses related
to
44
software and IT.
Expenses related to professional and
personal development including CE
courses, participation in seminars,
and organizations membership.
You need to make sure that the
Optometry practice is running
smoothly, in a profitable way, and
with a positive cash flow. You should
not forget that being able to sustain a
successful business and working with
a good company are great
experiences, however, what’s also
important is to be well compensated.
IS THE COST OF GOODS SOLD COGS
THE ONLY COST IN OPTOMMETRY
YES
NO
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Optometry Practice
Revenue By Dr. Gilbert Nacouzi
45
Delayed payments also reduce cash
flow and the value of money collected
due to the time value of money.
Cancellation Policy in case the patient
canceled his appointment or did not
show. Returned checks fees are to be
paid by the patient;
Level 5 leaders
create superb results
that are at the core of
transitioning a
company from good
to great…
Optometry Practice Revenue
Generating a profit is the most
important indicator that an Optometry
practice has a lot of chance to sustain
growth. Revenue must exceed
expenses to make a profit. The first
thing that an Optometry practice
should develop while putting its
financial strategy is a Financial Policy
that explains in detail the different
payment methods that the practice
offers to the patient. It makes a good
idea to share the Policy with patients
online before they schedule an
appointment, however, what’s best is
to make staff, employees, and
associates read, approve, and
memorize it before presenting it to the
patient.
A Practice Financial Policy typically
includes details about:
Insurances that the practice accepts
and plans that cover eye care
services with different benefits. Terms
for payment of deductibles,
coinsurance, copayments. The policy
should include refunds and
adjustments after the service has
been provided. Non-covered services
are paid in advance;
Services Payment modalities, cash,
checks, Visa, MasterCard, or other
cards. Financial programs offered for
patients to finance procedures that
are not covered by their plans;
Collections should detail past due
date before the unpaid amount would
be turned over to a collection agency.
The poor collection will reduce cash
flow.

The practice staff, employees, and
associates should adhere to the
policy and be able to articulate its
content to the patient. Very few
practices operate full cash or all cash
services. However, many provide
discount policies or card member
privileges. Some practices adopt
barter programs.
46
Barter programs are remarkably
beneficial for newly established
Optometry practices where there are
plenty of establishing, furniture,
displays, and other purchased items
that can be battered and would bring
people to know about the practice.
A PRACTICE FINANCIAL POLICY EXPLAINS
IN DETAIL THE
Cash flow amount discounted to the
present value.
Different payment methods offered to
the patient.
For as little as 5$ you can become a
Patron of Optical Forum and unleash
exclusive content
On Patreon.
“Companies that get confused, that think
their goal is revenue or stock price or
something. You have to focus on the things
that lead to those.” -
Tim Cook

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