The global coronavirus pandemic shutdown and its impact on the world’s supply chain, rate of inflation and extreme costs for goods and services has caused all of us to be more careful with our money. Most people have experienced losses in their retirement savings and overall decreased performance from a business standpoint — whether that be the loss of a job or the loss of assets for business owners. It’s not outrageous to assume many people are worried about their financial future and questioning every dollar they spend or invest due to the uncertainty that surrounds the global economy.

But we’ve been here before ... sort of. The Dot.com bubble crash in 2002 created a lot of economic downturn. In 2008, the crash of the housing market saw the global economy mired in its deepest downturn since the Great Depression. We’ve lived through those, and we’ll live through the current crisis. There’s reason to believe we can still expect to grow financially while investing in ourselves and/or our businesses.

We can’t predict the market, but we can engage in best practices to provide us with the appropriate fiscal guidance.

This article will offer practical advice on how refractive surgery professionals can navigate their current and future financial ventures with confidence.

CONSERVATIVE VS AGGRESSIVE INVESTING

Pros and cons

Depending on numerous variables, there are times when a conservative approach makes more sense than an aggressive approach, and vice versa — whether we’re talking about investing in new office equipment or an office reconstruction or relocation. Age, number of years in practice, overall income and the state in which one practices are just a few examples of conditions that should steer us a certain way.

Age

For instance, being aggressive as an investor is more advisable for younger professionals. At this point in our careers, we’re probably not yet thinking about the kids’ college or wedding funds. And if we’ve just launched our own practice, we’re going to need to acquire everything that’s needed to run that practice — from the copy machine to the corneal topographer.

Considerations by state

Those who are interested in pursuing growth opportunities for their clinics could be required to follow certificate of need (CON) laws¹ that are established by individual states to control health-care costs by restricting duplicative services and determining whether new capital expenditures meet a community need. Those states that employ CON programs will rely on a state health planning agency or other entity to review and approve projects.

For example, in North Carolina the only option would be to invest in a surgery center that’s already available. Surgeons would be required to disclose how many cases they’d expect to conduct per year and justify that those cases would be brought to that center. Those who practice in some states, such as Oklahoma, can collaborate with other individuals to invest in a situation that fits their means. Consulting a local attorney who is familiar with the state laws is always prudent.

Invest within your means

This latter point is an important concept. It’s not always necessary to “invest big.” We should settle on what can be reasonably afforded at the time and increase our investment later if conditions are favorable. Taking on too big of an investment could lead to difficulties trying to support that investment. For example, in this down market, it might make more sense to consider purchasing a shared clinic space with ancillary providers as opposed to purchasing our own space. Land is always a good thing to own as well, compared to leasing. But rent is not an inherently bad business move.

Current interest rates have ballooned, but there have been times when rates were higher. There are always going to be hurdles to convincing yourself or those within your group to initiate into the marketplace. Ultimately, everything revolves around what we need and what we are comfortable doing.

We should not invest in a piece of equipment if we’re not going to utilize it to the fullest extent. In other words, don’t buy the latest gadget if it’s going to sit on the sidelines, even if the interest rates are remarkably low. Build the patient volume then consider the purchase. All decisions should be rooted in addressing the true necessities of the practice. If a real need arises at a time that interest rates are exceedingly high, that’s unfortunate.

STAFFING NEEDS

The more functional that the staff is, the more patients that can be seen per day. Most physicians are not maxed out on the number of patients they can see. Unfortunately, the pandemic has complicated staff retention at an unprecedented level.

Understaffing can cause more staff members to leave. If individuals seem to be without enough work, that might necessitate curtailing hours. But if people are working overtime because the staff was trimmed, it’s probably more prudent to hire someone.

Staffing is one of the most expensive costs we incur, and some managers believe they can replace experienced staff with those who are lower salaried, but new-employee training is also a hefty and drawn-out expense.

To best position the practice to attract and keep staff, consider investing in training practice managers on how to manage a diverse staff and require that training be ongoing. A subscription to a learning network such as Alchemy Vision that offers subscriptions to an extensive online tech training curriculum can be a helpful tool.

MARKETING

We’re all probably guilty of throwing money at marketing without measuring its return on investment at some point in our careers, but we never should let this happen regardless of whether we are in a recession. We always need to know if our costs are earning their intended results. There’s no reason that you can’t invest more in marketing during an economic downturn if the return is beneficial. That said, the true net value of advertising is not just about bringing in more patients. We must also assess whether more staff was required because of increasing cases and/or if there was a need to purchase more office equipment or space. Only then can we gauge the overall expenditures compared to income.

Any marketing strategy today should include a social media component. Those of us who might not fully understand how to maximize or utilize the mounting social media platforms aren’t likely to have the time to commit to the extent of marketing that these tools allow.

Hiring someone who specializes in this type of communication and paying them well enough to conduct campaigns for our practices is probably a good idea, even for those of us who are well versed in social media. Putting together regularly occurring social media campaigns is a justifiable full-time job in any industry.

Taking digital communications a step further, businesses can’t afford to not have a responsive, engaging website. If need be, hire a professional to design a new site for your practice or redesign an existing site. Another time-consuming aspect of marketing is knowing how to attract people to your site and how you’re going to keep your site refreshed and unique. Investing in a professional who’s trained in search engine optimization can help in this regard.

Traditional marketing methods such as word-of-mouth and community outreach remain valuable tools as well. Speaking at health fairs and other community functions and local gathering spots, such as churches, fitness centers and retirement communities, offers easy access to target populations. Talk about modalities that you are bringing to them and those that you might bring to the community if there’s enough interest. Choose a comfortable forum where you know the format of presenters. If public speaking is not a strong suit, online tutorials are easily accessible.²

Marketing can also be accomplished while traveling. Consider speaking to communities when visiting areas during conferences and other business meetings, which are often held in desirable destinations that can be made more affordable if we are able to earn stipends to help manage costs.

CONCLUSION

While we can’t predict the market, we can engage in best practices to provide us with the appropriate fiscal guidance to invest in ourselves and/or our businesses. For example, an emergency financial fund should always exist and should regularly receive contributions for short-term problems. Also, when it comes to attracting and keeping staff, consider investing in training managers on how to manage a diverse staff and require that training be ongoing.

Additionally, for any marketing strategy that you implement, make sure to also include a social media component; consider hiring someone who specializes in this type of communication.

Finally, 10% to 15% of our net income should go into some type of retirement investment — the earlier we start, the better we’ll do with a retirement-directed investment (see page 23). OM

REFERENCES

1. Certificate of Need (CON) State Laws. NCSL. 2021. www.ncsl.org/research/health/con-certificate-of-need-state-laws.aspx . Accessed November 29, 2022.
2. How to make a great presentation. TED. Available online: www.ted.com/playlists/574/how_to_make_a_great_presentation . Accessed November 29, 2022.

Karl G. Stonecipher, MD, is clinical professor of ophthalmology at the University of North Carolina, clinical adjunct professor of ophthalmology at Tulane University and medical director: laser defined vision, physicians protocol at Physicians Protocol Cosmetic.