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Startup Spotlight | May/June '15

Expanding Your Practice: Hiring an Associate

At some point in the development of your practice, you may decide to hire another physician.

At some point in the development of your practice, you may decide to hire another physician. Reasons for this can vary; some physicians want to take more time to pursue other interests, some see it as a way to lower overhead, and others want to increase passive income. Regardless of the motivation, there are several questions to consider before hiring an associate.

1. Am I ready to hire an associate?

There are different ways to look at this question, and there are books, formulas, and professional consultants who can help answer it for you. The reality is that there is a specific time to hire an associate, as there is a specific time to hire any employee. The time to hire is when you are stretched past maximum capacity. You are exhausted. You need help. At this point, a new associate can walk into a relatively busy clinic, and you will worry less about their productivity covering their expenses.

2. What kind of physician should I hire?

Comprehensive, retina, OD? The choices are numerous. You should evaluate your patient population to determine the biggest need. You may want someone who does exactly what you do—or you may want the opposite. If you find you’re referring a lot of patients to retina specialists, you may be inclined to hire a retina doctor. However, if you are an anterior segment specialist, you may need to purchase a lot of equipment for the retina specialist. You may also lose favor with the original retina group, who may no longer refer patients to you. Further, remember the various demographics of patients per specialty. Retina patients tend to be different from LASIK patients, who are different from pediatric patients. I’ve found patients are more comfortable in the waiting rooms when they are among similar patients.

3. Should I offer partnership?

Not at first. You need to ensure that the new hire is actually a good doctor. But if the doctor is a hard worker, takes good care of patients, and works as much as you do, then you should absolutely offer a partnership buy-in. “But I built this practice from nothing,” you may argue. That’s fine, but keep in mind that a solo practice can go from a seven-figure valuation to near zero, should tragedy befall the owner. I’ve seen this pattern happen all too often: Ophthalmologists who believe they will never get sick or need to retire suddenly have a medical issue, and their practice is devoured by the competition in weeks. As practices grow and take on more partners, this risk is greatly reduced.

4. How much more vacation will I be able to give myself?

Realistically, none. Of course, it’s your practice, and you can take as much time as you like. That said, the more you’re out of the office, the less income there is. The only exception to that is if your office is so lean that you’ve maximized things so that a physician is using every room every day of the year. In real-world practice, this is hard to achieve.

5. I have to decide between Dr. A and Dr. B;

Dr. A was overall a stronger candidate, but Dr. A also wants a higher starting salary than Dr. B. Who should I hire? Hire Dr. A. This is someone you want to spend a lot of hours with and who will grow your practice.


In the end, hiring an associate can be a daunting process. Before starting, make sure that you’re ready. If you are, then decide what type of eye care provider will work best in your practice. List your opportunity online, contact residency program directors with offers, and interview away. Finally, never be afraid to pay well for talent—it will pay back multiple dividends in the end.