Act II

By most accounts, the Canadian primary care optometry practice’s bread and butter is refraction, sprinkled with some management of chronic eye diseases, and the odd acute care case. So, in truth, after such a long period one should expect some degree of monotony. However, how you deal with these feelings may help you progress, expand your footprint, and reinvigorate your passion for the profession.

For me, the COVID pandemic took a lot of the enjoyment out of the practice of optometry. Conversing with patients and exchanging stories during the exam provided me with a constant cultural and culinary education, as well as amazing travel suggestions. Unfortunately, as brevity, sterility and decreased patient interaction became the new norm, I was experiencing increased job dissatisfaction and fatigue.

Burnout

As the pandemic carried on, I struggled with greater responsibilities and increased concern for the well being of my family, staff and patients. I began to realize I was experiencing some of the signs of burnout. I considered trying to keep my head down and just try to plow through until these feeling passed, but knew in truth, this was not a real solution.

By definition, burnout is a condition experienced by workers and professionals in which aspects of their role or workplace induces stress1. This stress results in manifestations of physical, mental and/or emotional exhaustion. Common signs of burnout in the workplace may include anxiety, headaches, insomnia, fatigue and an increasingly cynical outlook on work and life in general 2,3.

burnout, stress

Burnout Can Happen to Anyone at Any Time

There is no defined treatment paradigm for workplace burnout at present. Many people find it helpful to take a leave temporarily, or even permanently. However, identifying the abovementioned signs of burnout and implementing proactive decisions to alter one’s work environment can not only aid in avoiding the symptoms of burnout, but, also open one up to opportunities not previously considered.

Important to realize is that although burnout may be a personal experience it is a community battle. Support from within the workplace, family and friends are integral to overcoming burnout’s depressive cloud. Simply talking to someone about your symptoms or the alternatives you may be considering may help lessen your burden.

Support from Co-workers, Family and Friends is Essential

To avoid burnout myself, the first thing I did was to take a small step away from patient care. I realized that as an optometrist I possessed a narrow academic skill set not easily transferable; however, I also possessed a wealth of life and entrepreneurial experience I could use. I began to think about why I entered the optometric profession, what experiences in my tenure as an optometrist I cherished the most and how I could replicate those experiences. I thought about the personal passions and professional desires I had yet to accomplish or even attempt, and how I may go about doing so.

co-workers

I spoke to several friends and colleagues and found that my experience of burnout, while unique, was not uncommon. This realization gave me some solace. I continued conversing with colleagues and bounced ideas off friends for alternative career paths within the optometric profession. I had often hired students at my office and enjoyed mentoring them as they learned about eye care.

Many of the students I hired went on to pursue careers in the ophthalmic industry. Realizing the desire to impart my knowledge to others led me to speak to a friend who had been teaching in the Opticianry Program at Seneca College. Luckily there was a need for lab instructors, and I was able to provide myself with some variety and a new set of challenges.

I continued to pursue unique experiences and became involved with a community charity project at Seneca. I continued to speak with my peers and colleagues, and sought input on new experiences and opportunities that may be available. It was during one such exchange I was serendipitously surprised to hear of the opportunity to write the article you are currently reading.

As writing has always been a passion of mine, I pounced on the chance to contribute my take on stagnation and burnout in optometry in the hopes it may assist anyone who needs it and provides some ideas of how one may overcome this common condition.

Work Cited:
1 “Staff Burn-Out” Journal of Social Issues. January 1974
2 “Symptoms of professional burnout: a review of empirical evidence”
APA PsycNET. American Psychological Association. 1998.
3 “Health Impact of ThePsychosocial Hazards of Work: An Overview”
World Health Organisation. 2010

Dr. Shaun Rawana

Dr. Shaun Rawana is a practicing optometrist with over 15 years of experience in both the United States and Canada. His area of focus has been primary care optometry with interests in cornea/ocular surface disease and contact lenses. Dr. Rawana recently began teaching clinical skills in the Opticianry program at Seneca College and looks forward to contributing his insights into the current Canadian scene through Optik.


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By Dr. Trevor Miranda. 

Dr. Miranda will be regularly contributing his thoughts and perspectives on the topic of Independent Eye Care Practice in Eye Care Business Canada.

In life and at work, we can often think it is easier not to think of something to avoid having to use the scarce resources of time and energy to properly deal with the task at hand.

For me, it’s organizing my closet or cleaning the garage. I cope by putting it off but every time I open my drawers I am reminded that it needs my attention (I finally did tidy the garage and I feel so much better!).

My stress could be reduced by just stopping the avoidance of these tasks!

Multi-tasking Owners are Challenged

Independent optometric owners have to juggle many responsibilities. Marketing, human resources, inventory management, cash flow, financial statements, scheduling, tax planning, budgeting, equipment purchasing and maintenance, product information, staff training, patient experience, E-Commerce and many other duties can easily overwhelm the minds of optometric owners.

Beyond that, the responsibilities of continuous learning on glaucoma, macular degeneration, vision therapy, low vision, myopia management and primary eye care further compete for optometrists’ time and energy.

Wearing all these hats is very challenging and often leads to avoidance coping.

Avoidance coping is a maladaptive form of coping in which a person changes their behaviour to avoid thinking about, feeling, or doing difficult things.

Stress Management versus Stress Avoidance

Avoiding stress might seem like a great way to become less stressed, but this isn’t necessarily the case.

More often than not, confronting a problem or dealing with a stressor is the only way to effectively reduce the stress it causes.

We strive for “stress management” rather than “stress avoidance”. Usually, procrastination or trying not to think of the stresses leads to further stress and increased frustrations. Actively managing stress is a more healthy and productive strategy.

Ways to Manage Stress

Delegate (don’t abdicate):
Delegation of duties is an effective way to distribute responsibility and accountability.

Effective delegation requires structure and training. It is important that there is oversight of delegated tasks.

This means using “SMART” goals: Specific, Measurable, Attainable, Realistic, Timelines.

As an owner, it is important to be briefed regularly on the status of a particular portfolio. For instance, delegation of marketing in your practice should include a regularly updated budget and a yearly marketing plan with regular reviews at predetermined intervals.

There are task management applications that can assist in overseeing these delegated tasks; examples include Monday.com and Trello.

Delegation of tasks can be divided among the entire team rather than residing as the responsibility of the office manager. For instance, one staffer can be in charge of outstanding accounts; another in charge of ordering supplies.

We utilize Slack to assign tasks that combine communication to both assignee and assignor until task competition. The management of outstanding tasks allows compartmentalization of these potential stresses and combats avoidance.

Empowerment:
Cultivation of empowerment in each team member to be part of the solution is important to stress reductions and better office functioning.

The culture of not passing the buck or saying “that’s not my job” is crucial to a shared responsibility and accountability. This helps reduce the burden and decrease potential stress.

Macromanagement:
Leaders guide their businesses in a directional way. Avoiding micromanaging will reduce stress.

It is important to quickly address large issues but avoid managing each and every mistake. Resist the urge to point out every mistake as this can be demotivating and depressing while adding stress on both sides.

If something is particularly bothersome, ensure you are not actively frustrated and address the issue in private with the appropriate compassion and honesty. Collaborate on ways to improve with training and feedback. Getting buy-in is crucial.

Avoiding difficult conversations will only add to stress levels. It is better to act like the CEO of your optometric business. Guide the ship through small directional maneuvers rather than being stuck in reflexive reactions in day-to-day events.

Outsource:
Another way to help manage the myriad of responsibilities is to outsource to experts.

Companies offer marketing, human resources, accounting, and even optical dispensary management where experts take on the responsibility and reduce the owner’s stress load.

Don’t avoid the necessary time it takes to manage these areas properly. Use outsourced experts that are accountable for results and preset timelines.

I remember when I started my first clinic. I answered the phones, did the accounting, cleaned the office and helped in frame selection.

All of these duties are currently not my direct responsibility. It is important that you change as you grow.

Learning the business by doing it yourself is great if you’re capable, enjoy that aspect of business and have the time to do it.

As your business grows your management techniques need to adapt. With five clinics and a growing team, I know that I must adapt to actively manage stresses rather than avoid them.

 

DR. TREVOR MIRANDA

Dr. Miranda is a partner in a multi-doctor, five-location practice on Vancouver Island.

He is a strong advocate for true Independent Optometry.

As a serial entrepreneur, Trevor is constantly testing different patient care and business models at his various locations. Many of these have turned out to be quite successful, to the point where many of his colleagues have adopted them into their own practices.


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When the decision to sell is made, one is thinking from the logical, left-brain side of the mind. There are numerous practicalities to take care of and the owner knows that selling will help achieve personal goals. However, deciding to sell can be difficult and many cannot imagine things could become any more difficult. But they can. Selling a practice is fraught with a myriad of emotions.

The Emotional Peaks
We know selling a practice is always emotional. We do remind our clients though, that there are two particularly challenging periods once the listing agreement is signed. The first is while we wait for offers to come in and the second is while we wait for conditions to be waived.

During the initial stage of waiting for an offer, one cannot help but feel exposed. After all, potential buyers are reviewing your information and deciding if this is a good opportunity for them.

A vendor cannot help but feel as if he/she is being judged. When an offer does not come quickly, the owner asks, “why is my clinic not good enough”. Of course, it is good enough. In fact, it is a good option, but it must be the right option for a particular buyer.

Any time in life when we are waiting on someone else to make a decision that affects us, it is very difficult, it makes us doubt ourselves and why our practice has not been chosen. As a vendor, it is critical you remember that you cannot appeal to everyone. And that is truly okay.

Offer Anxiety
There is always the right buyer for your office, and it is impossible to appeal to all. It may take time, but the key is not to second guess everything that is or is not happening. Your practice is unique, and the right buyer will have their own unique set of circumstances that make them the right fit.

For many owners, the first emotions experienced around the offer for the practice will be excitement, exhilaration, and pride.

The fact that there is a buyer for your office validates that you have created something of value and your clinic is wanted. As such, once an offer has been placed, many start to celebrate. We encourage owners to simply wait.

It’s Not Over Until It’s Over
Even with an offer being accepted, there are still hurdles that the purchaser must over come.

The toughest two are financing and assigning of the lease. Financing is certainly more difficult during this pandemic. Largely because bankers are scrutinizing the purchasers far more than pre-COVID days. They want to ensure when they grant a loan that they have confidence in the buyer.

The assignment of the lease can be challenging for many reasons – for example if an owner has had a difficult relationship with the landlord over the years, the landlord may not be willing to be so co-operative. Perhaps during the assignment of the lease, the purchaser may use this opportunity to ask for things that may not be granted.

Should any condition not be met, unfortunately, the offer becomes void, and deposit is returned. This is difficult for the vendor as now things start over.

This does happen but it does not mean your practice will not sell. You just need to be patient. The right buyer will be motivated and never stray from the motivation that drew them to your practice initially.

Transition Stress
Another stress a vendor may not be prepared for is the actual transition once all the conditions have been removed and the closing date is in sight.

It is normal to start to question the initial decision to sell. Is it right for your staff and patients? How will things run once it is in new hands? How will the owner really fill their time after the sale?

A sale brings up strong emotions particularly when an owner has been owning and operating for many years. If the vendor stays on, the realization that new management is now in place and that a say in the day-to-day decision making is no longer part of their responsibility.

Many do not realize how a large part of the vendor’s identity is tied to the clinic.

Rest assured that these thoughts and feelings are normal. Preparing ahead of time is the best way to handle the emotions connected to selling your practice.

While some doubts and fears are normal, preparation and planning for what life will look like post sale, will help an owner navigate the transaction as smoothly as possible.

Jackie Joachim, COO ROI Corp

JACKIE JOACHIM

Jackie Joachim is Chief Operating Officer of ROI Corporation. Please contact her at jackie.joachim@roicorp.com or 1-844-764-2020.


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