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When Should You Hire an Associate?

Think in terms of freeing your time and your quality of life.

Gary Gerber, O.D.

When is the right time to add an associate, and how do you “make him/her busy?”

We have clients with small practices and those with multi-million dollar practices who both effectively use associates. How is this possible? Let's start by talking about some common misconceptions about associates.

It's often written that the right time to hire an associate O.D. is when your practice gross reaches about $800,000 to $1 million generated by you, the doctor owner. That advice is too broadly based and global to be useful. Here's why.

The impact of fees

First, consider how your gross sales are generated. Meaning, are they generated by many patients or a few? This typically is a reflection of your fee structure, including third party plans. So for example, if you see only 500 patients who generate $1 million (hey, we can dream), as opposed to 5,000 patients, you wouldn't need an associate. The point here is to not just look at top-line revenues but revenue-per-patient and more specifically, the absolute number of patients. That leads directly to the next comment.

The best advice for when to hire an associate is exactly related to the number of patients you see and its effect on your quality of life. Our small practice-owner clients who may practice three days a week have made conscious decisions they'd rather be home with their kids and in exchange, are happy to hire an associate.

On the other side of the equation, our clients with large practices do CEO-type activities that only an owner can do. They pay an associate to see their patients in an effort to free up more of their own time to grow the practice. In neither case is the number of gross collected dollars the driving force for having an associate.

The busy associate

Regarding “How do I make my associate busy?” if you have hired him/her for one of the reasons above, he/she should be busy immediately seeing patients you would have seen. “Cannibalization” of patients isn't a concern if the associate frees you for other non-patient care tasks. However, if you have already hired an associate, and he/she is currently not as busy as either of you would like, try one of these strategies:

► Set aside time in their schedule specifically for practice building. That might mean that one morning per week he/she is out of the office and mingling in the community meeting other doctors or business owners, giving presentations or taking other healthcare providers out for lunch.

► If he/she has a clinical skill you don't, or is willing to add one, market that to your current patient base.

► If you are booked weeks in advance and start to lose patients who only want to see you, transfer those patients to your associate's schedule. Allow staff to say something like, “Unfortunately, Dr. Senior isn't available for the next 14 weeks. However, Dr. Junior, who is my eye doctor and is really great, can see you next Friday at 1 p.m.” For this to work, your staff has to brag about your new doctor.

► Introduce your associate to your patients by having him/her do part of the exam. The associate might “wrap up” the exam by doing the dilated fundus exam and then discussing the case with the patient. This tees things up for the patient's visit the following year. OM