Aug. 3, 2020

Review of "How to Create a DED Clinic" - E3

Review of

Optometry in the News: Review of “How to Create a DED Clinic” by Damon Dierker

Optometric Management: How to create a DED Clinic by Damon Dierker

This article was well written, it had a ton of great insight, and I believe it translates to any practitioner trying to create a niche in their practice. The first thing he emphasizes is making education a priority. Now if you are still a student or a recent graduate, a common misbelief is that all education has to occur in the classroom. Absolutely not, false, do not pass go, do not collect $200. We are blessed with access to anything and everything from the comforts of our homes. Via the power of the internet, you can get all the journal articles, webinars, live “zoom” type sessions, podcasts, and just about everything you need to to become an expert in any field you desire. We are smart people by the nature of our profession, book smart, but we need to get our head out of the clouds and realize the real life potential we have as well. 

That being said, target your niches and dive in. There are specialty groups all over. Nearly all equipment, contact lens, and lab reps have tons of resources to help educate you. Realize the source of your information (reps always are selling their products) and take all the information and form your own opinions and expertise.

The next thing is setting a proper protocol for whatever you are going to be doing. This is of the utmost importance, because protocol will save you when you start working with “live” ammunition and have real patients in your chair. Try to foresee any hiccups and have contingency plans in place. It's hard to accept, but the quicker you fail, the better you will get. There is no replacement or better motivation than working with real patients. In addition, protocol applies to your staff and the office as a whole. To be an expert/specialist your office needs to reflect as much. Make sure you guide your staff in how to answer FAQs, schedule patients, and assist you in providing exceptional patient care.

He then suggested trying to create revenue through convenience. I can see how this would work with certain specialties such as dry eye and ocular disease. For example, make sure your dry eye clinic is stocked with bruder masks, supplements you recommend, and artificial tears you prescribe. Your patients want to buy from you and trust you with their care. The same can be said for specialty contacts lens solutions and macular degeneration supplements. He even recommends setting up an online store. I would offer a word of caution that this sounds good in theory, but can kill a practice in two essential (and limited) resources: cash flow (eaten up in inventory costs) and space. Both are rare commodities in any office I have ever been in, so be warned not to get over your skies with these.

Dierker then discusses the pros and cons of advanced technologies in your specialty clinic. He urges you to ease into them and make sure it makes sense for your patient population. This is the very reason I do not have an OCT. They are expensive and I currently do not see enough patients to justify the cost. With time I will get one, but prioritizing the needs of your office are paramount for any practice owner. I definitely refer more than I would like for glaucoma and macular pathologies, but it is the season I am in.

He specifically discusses doing meibography for free on all his patients. This is brilliant in my opinion. I feel some practitioners get caught up in getting “paid'' for every little thing that they do. They lose the forest amongst the trees. If your goal is to find and treat as much disease as possible, preliminary tests will facilitate this goal. Things such as baseline topographies, baseline retinal photos,meibography or schirmer tests, DEM tests or axial length on ALL pediatric patients not only help you find the population you are trying to treat, but it sets your office apart, “You mean you have never had this test before? We just assumed it was the standard of care by now”. Build your brand and open the door to more discussions for advanced treatment.

The next step in his process was to delegate, delegate, delegate. This by far is the hardest thing for me to do. You want everything to be perfect and the patient to have a 5 star experience. Who do you trust more than yourself? This is small minded thinking and stems from a lack of protocol and training for your staff. The plants that you water grow. Invest in your staff and make the best use of your time. He illustrated it as him connecting with the patient and developing a treatment plan and then letting his #1 handle the rest. Essentially he closes the sale and moves on to the next opportunity to help another patient. It's smart and the only way you can scale a niche and not make you hate it.

The last bit of advice he offered was to market yourself. He wants you to wait until the steps listed above are completed, but I kind of disagree. You educate yourself and get a protocol, then it's time to jump in and learn on the fly. It's not the strongest, smartest, or fastest that is the most adaptable. You cannot practice if you do not have patients, and most offices SUCK at marketing to begin with. Take the leap, put it out there, and tell anyone who will listen how you can solve their problems. Just like that, you have a specialty clinic.

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