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Part 3: What Would I Do if I Were a New Grad with a Fresh OD Degree?

By Thomas and Amee Lecoq

A doctor I respect once said, “With all the complexity of running a practice, the most challenging is dealing with staff.”

But to have a successful VT practice, staffing is absolutely critical.

Vision Therapists: VT is not a do it yourself doctor activity. I now know that to produce a million-dollar practice, I will need to consistently see at least 60 patients per week, for a typical session time of 45-50 minutes each.

I also know that a well-trained therapist can handle up to 30 patient sessions per week, with another 10 hours assigned for training, helping with patients and parents, and some indirect community outreach (soft marketing) to select referral sources.

Therefore, I’d need to hire and train two full time therapists, or better yet, one full time therapist and two part timers. The two part time therapists would be able to cover if someone was ill, or on vacation.

Hiring Hints: Some ODs want to hire only people with degrees of some sort, often physical or occupational therapists. In my imaginary practice, I would seek what I call “Empty Nest Moms.” The problem with degreed people is the are expensive to hire, want salaries similar to their professional peers, and are often looking for a better offer in their field. Oops, trained them and poof, they’re gone.

I prefer and recommend empty nest parents, a person with child rearing experience, who no longer has to spend full time parenting, and if I’m really lucky in my search, they may have home schooled. My wife and I used to go for a quick breakfast at a local fast food place. There, we got to know a woman who was the day shift manager and trouble shooter for four stores. She was pregnant with her third child, a late surprise pregnancy.

In our conversations, I realized this person is an absolute gem. I asked her if she would be interested in a job working with kids? The answer was a very happy yes. No, she didn’t have special training, but she’d trained in the restaurant system, and was a master at it. So I knew she would be a great employee.

Or, what about that caring person who teaches Sunday school at your place of worship? Or the lady you meet in a quilting shop, or…you get the idea. I would ask all my friends if they knew someone who was smart, sharp and would love to be trained to work with children.

Training Therapists: Simply, I’d use the slower start-up time to put all the therapists through VT. They’d do every activity themselves and feel and note what happened to them. Monkey see, monkey do is how people learn. Hands on. I’d have all the activities on worksheets, and a simple note taking sheet they will use first for themselves, later with their patients.

We’d rehearse each activity until every therapist did every activity correctly. Lots of public praise for success, soft corrections and encouragement when needed.

The biggest mistake we see is just tossing a new therapist into the training room. For anyone working with children, integrity is really important. If the person doesn’t feel properly trained, they will have poor results with patients, and often will just quit. Training is a capital expense.

Remember, I would focus on learning related, relatively uncomplicated cases at first. So I’m probably going to have about 48 specific activities. I would use the curriculum developed by the Ideal Vision Institute, and would sign us up for that “quick start” course, or bring in Lyna Dyson, COVT to deliver her therapist training program.

Pay: Gone are the days of $14 an hour. Fast food new hires get $17. A full-time, trained therapist is a $50,000 a year position at this time, and with inflation, this will only increase. I would offer a workable starting salary, which will go up as they master the activities.

Vision Therapy Administrator (VTA): This is the person who will make sure marketing outreach occurs, and will escort the patient through our step-by-step-by-step enrollment process. She would set up and back me up for talks in the community, setting up appointments, follow up contacts, and do much of the case presentation during the enrollment consultation.

The VTA is the person who would make my life wonderful. It is a full-time job. At first, she will answer the phone and do what we call triage, which to prepare the parent or adult patient for what’s ahead. (No surprises please.)

I’d hire us to do a training for the VTA because you will never find someone who possesses the specific skills required. But this is NOT a sales position, and sales training actually works against success in this position. The point is that this person must come to love the practice as much as the doctor, and that comes from always expressing the methods in terms of serving the patient, not the doctor, not the practice. So, this person should have a touch of idealism.

Our best ever VTA was an empty nest mom who had been selling makeup, which requires lots of friendly contact to keep customers engaged. She quickly understood the outreach role and learned to do some digital marketing as well.

Salary for the VTA should eventually reach $65,000. So, payroll (without adding taxes and other benefits) is at least $165,000 a year for a million-dollar practice.

During the first year in practice, you might not hit $1 million gross, but by starting marketing from the day you sign your lease, you can easily break even in 6-8 months. Break-even in a primary care practice often takes years.

Next in the series I’ll write about location and the physical aspects of the practice.

Meanwhile, you can use Amee’s help improving some aspect of your practice. From the menu here or on our home page (, take one of our two new VT Practice Assessments. (One for existing VT practices, the other for VT start-ups.) If you’re in practice and not loving every moment, the former will help you pinpoint specific issues. If you want to start offering VT, the latter will help you identify questions and inform your planning. Then contact Amee for a half hour complimentary discussion of solutions. You can also book hourly phone or remote video consultations. Then, hire Lecoq Practice Development to work on having what you consider your ideal practice.

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