The Lessons I’ve Learned
“The Lessons I’ve Learned in My Journey to Become a Professional Practice Owner”
Part One: “What I Did Wrong”
by Lee Shuwarger, O.D.
Right off the bat, I can guess what you are thinking – why would anybody write about everything they did wrong? Well, one only learns from mistakes and in the interest and hope that possibly some recent graduates and colleagues may read this and get some help and/or insight in some of the lessons I learned, I wrote this.
Being originally from Los Angeles, I wanted to see why people live on the East Coast. So I decided to go to an Optometry school back east and ended up at NEWENCO in Boston.
Just before I graduated, I wondered why job offers didn’t just arrive on my doorstep. I quickly learned that everything takes effort and I had better get pro-active real fast if I wanted to start working in the profession I had just spent years being trained in.
My first issue was where to practice. L.A. would be fine, but with all my student loans I felt I’d better find a cheaper place to settle down. Unfortunately, that only eliminated Honolulu, New York City, and San Francisco. So, I went to the library to look for places that need optometrists. At the time, Texas kept on appearing in the results. My brother was an OB-GYN in Houston so I thought, “Houston is like L.A., with the climate of Bangladesh- so why not go there?”
After moving to Houston, I was hired by a large chain in Texas. I remember having lunch with one of the co-owners of the practice while negotiating my contract. I wasn’t very happy with the salary but, being naïve, I knew that with the combination of my friendly personality and my abilities as an optometrist, I would be able to impress him in just a few months. I therefore worked out to get the following clause into my employment contract: “Employer will evaluate employee’s performance in 4 months and, based on that performance, will increase the employee’s compensation.” Fair enough I thought.
Satisfied, I went to work for him in a brand new building- even the carpet smelled new! After 4 months of working there, I went out to lunch with him. He told me that the practice had grown in 4 months what he expected to see only after 12 months, that they had received compliments about me from patients and ophthalmologists. “Well, now I get the raise”, I thought. “Sorry”, he said, “we’re not going to give you a raise.” Needless to say, I was a bit stunned. When I questioned him further on this he said, “Look, The University of Houston is graduating 100 optometrists every year that I could hire to replace you at a lower salary.” I couldn’t believe he’d turn his back on his agreement with me.
This brings me to the first three things I learned in this life of becoming a practicing professional:
- Be very wary of practicing in an area that has a school of your profession.
- Get EVERYTHING in writing.
- Never underestimate the potential unethical qualities of your colleagues/employers when it comes to the “mighty buck”.
Within 10 minutes of this lovely lunch I went searching to find a place where I would be “appreciated”. During my time in Houston, I learned that Texas was saturated with optometrists that are practicing at or east of I-35 – one of the main transportation routes in the area. I discovered that if I went to the west I should be able to make a much better living. So I went as far west as I could go in Texas and ended up working for an optometrist in El Paso. He had promised me that he would give me a large bonus if I stayed for three years. I asked him what would happen if I was let go, for instance if business decreased. He said that he would give me that bonus as a severance pay. As he had this practice for about 40 years and he still had people working for him that were with him from the beginning, I thought that this was potentially great. To me it meant that, if he had staff for that long he must truly appreciate them and take good care of them and honor his agreements with them. Otherwise people would not stay with him for so long. That seemed obvious, I thought, and did not need any further investigation.
Wow, was I wrong! I soon learned that the area was very economically depressed and having a job – even a low paying job with no room for advancement, and not necessarily being appreciated – was far preferable to being unemployed. That’s why his staff had been there so long.
One day, while still working for him, I received a job offer in the mail. I’m sure many of you may have seen one like this before: “A wonderful opportunity is waiting for an energetic optometrist in beautiful (insert name of small, barely recognizable town)!”
I called out of curiosity just to find out how much I might be worth on the job market. On the phone, I explained that, even though I was not interested in moving and leaving my present job, I just wanted to call and see how much they were paying. He asked me who I was working for and I told him. BIG mistake. As you might deduce, I ignored rule #3 of never underestimating the potential unethical qualities of your colleagues/employer when the almighty dollar is at hand.
That day, my employer got a call from the potential employer that had sent me the job offer letter. I don’t know exactly what was said in that telephone conversation, but my employer told me, “If you are looking, you are obviously not happy. And if you are not happy, I need to find someone who will be happy here and I can’t afford two of you.”
I asked him about the bonus and reminded him how he had promised it to me if I were let go. He refused. Guess what – I had forgotten rule #2: “Get EVERYTHING in writing.”
Soon thereafter, I was in Lubbock, TX, working for the optometrist that sent me that form letter. That job lasted for just over a year- just long enough to complete my contract.
Through my experiences, I was able to observe the benefits of an individual working for oneself. That led me to wanting to have my own practice. Unfortunately, there was no way I could afford all the equipment and expenses. I was soon contacted by a “recruiter” for a very, very large national chain of stores (I’ll just call that store “Not-Smart,”) which had an in-store optometry office who told me about an opportunity at a their Vision Center in Amarillo, TX. It seemed like a really good deal for a recent graduate. You get to call the practice your own, all the equipment, materials, utilities, and even the phone were all paid for by the rent and the rent was just 10% of the gross receipts. But I soon discovered the negative points:
- Since they collected 10% of your gross receipts you were strongly encouraged to take all the insurance plans you could, and pushed to work for over 60 hours per week. I was told to even charge my family for their eye care.
- Management did not care about personal health issues, family issues, or religious holidays. You were required to either be there, or have another optometrist there during hours that you were suppose to be open. You were not allowed to close for any reason. You were required to have a replacement optometrist there even on religious holidays. If you miss any days for any reason, you are required to make it up by working on a Sunday or another holiday (like Christmas, Thanksgiving, etc.)
- The renewal of your lease was constantly threatened if any of the above type violations took place.
As an example of my dealings with them, one day I asked them for another exam lane so I could see more patients. I ran all the numbers and presented it to them. It was projected that the cost for the construction and equipment would be made up in only 5 months since it was also projected to increase my business about 20%. The regional manager had a meeting with me. He told me, “You’re working about 50 hours a week now, right? Well, you could make that extra 25% if you were open 60 hours/week.” “Yeh”, I thought, “and I could increase by 75% if I was open 24 hours a day and slept there too.” With working relationships like this, it was obvious to me that my growth there was limited.
I will say though, that I made A LOT of money there although it really wasn’t easy or enjoyable. It has now been over 6 years since I worked there and I still have a bad feeling about it. I guess this is what it feels like to sell your soul.
Which brings me to an additional rule I learned, rule #4:
When you work for chains, the money you earn is inversely proportional to the degree to which you sell your ethics.
At this point, although I knew I couldn’t afford to build a practice from scratch, I still wanted to find a place to see patients, a place my patients could go where they would be treated the way I wanted them treated. I always had a good professional relationship with one particular optometrist in town and, after talking to him, we decided to “blend” our practices. We arranged that I would move in to his office and be able to use his staff to schedule appointments for my patients. I would then see my patients and the other optometrist would collect a portion of what I collect as “rent” on equipment and space. I even got this in writing (rule #2).
This seemed to work well for both of us in the beginning. But soon I noticed that my patient exam numbers were decreasing to the point that I was seeing only a patient or two a day. Way too slowly and too late I started wondering what was happening. One day, one of my partner’s employees confessed to me that her boss told her, “Make every appointment for me and NOT Dr Shuwarger- even if they are a previous patient of Dr. Shuwarger’s.” I couldn’t believe he told her that! But that was confirmed by the fact that the number of patients I was seeing was severely down and his was up by the same amount. Foolish me, I forgot rule #3.
During this same time period, I bought a new house and my wife got pregnant. So here I was, 6 months into this venture with my patients being stolen and major life changes occurring.
I decided that I needed to get out of there and save what patients I had. I started negotiations on leasing space in a shopping center to have my own office. When my “partner” heard about this (and I knew he eventually would), he threw me out of his practice.
So, there I was. No job, large house, no patients, and a baby on the way.
I made it work and, in my next article, will explain how I took these hard won lessons and ended up finally creating a very successful practice. I know that everyone will not go through all the trials and tribulations that I went through, but I though it could be helpful to new graduates who are figuring out how to proceed with their professional life to see what I went through and, hopefully, be able to avoid some of these mistakes.
Note from the publisher: The experiences and opinions of the author are completely his own and do not reflect the opinions of The Practice Solution Magazine or its publisher. We are however looking forward with enthusiasm to his next installment to see how the story ends.