Independent practices are getting paid roughly 14% more per exam than they were a year ago. They are also seeing 4.5% fewer patients to bill.1
The math behind those two numbers is the conversation playing out across independent optometry, even when it does not get named directly. The system beneath the practice has to capture more from each visit because there are fewer visits to capture. The system underneath the practice is exactly what running an eye care practice is actually about, and most practices we walk into are still missing one of its five foundations.
Dr. Brianna Rhue has been making the same observation for the better part of a year. The problem in most practices is not a missing tool. The problem is that the foundation beneath the tools is still incomplete, and adding another subscription on top of it tends to make the original problem harder to see.
The phones are still ringing
There is one number that sets the table for everything else.
Practices without a formal call-management process miss between 20% and 35% of their inbound calls during business hours, and most callers who reach voicemail never leave a message.2 Almost every "marketing problem" we get asked to look at starts inside that missed quarter-to-third of calls. The leads are arriving. They are just hitting a closed door.
That is also the reason Dr. Rhue puts the phone system first on the list, ahead of every other foundation. A practice that fixes the phone before anything else gets immediate compounding from work it is already doing on the recall list, the website, and the referral network.
The five things
Here is the list in the order Dr. Rhue uses it.
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The phone system. How a patient reaches the practice, and whether the call gets answered before the patient hangs up.
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Reminders. How the practice gets patients back into the chair on the right interval, across annual recall, contact lens renewal, dry eye follow-up, and specialty fitting checks.
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Contact lens ordering. The full motion from prescription release to reorder, including how the practice handles the moment a patient asks for their script and walks out the door.3
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Optical running effectively. Whether the optical side has a process that earns its rent on every patient, or whether the result depends on whoever happens to be working that day.
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Protocols. A documented, repeatable approach to the conditions every practice already sees, starting with myopia management and dry eye.
None of those five categories requires buying anything new. Most practices already pay for at least one tool inside each of the five. The question is whether the tool is connected to a process that actually runs, or sitting in a tab on the front-desk computer, waiting for someone to remember it exists.
Why "pick one" is the real instruction
The first time most practice owners look at the list, the instinct is to fix all five. Dr. Rhue is firm that this is the wrong instruction. The right instruction is to pick one and finish it.
The reason is that the five categories rely on one another. A reminder system that brings patients back to a phone line nobody answers does not help anyone. The contact lens ordering process can run cleanly inside the practice and still lose the order at the prescription handoff. Optical capture that depends on a single staff member ends up looking more like luck than a system. And protocols that exist on paper but never get triggered chairside are decorative.
Picking one of the five and finishing it means the next one has a stable surface to land on. A practice that fixes the phone first will get more out of every reminder it sends, because more patients will actually book the appointment that the reminder was for. A practice that prioritizes contact lens ordering will hold on to more of its existing patients, which lowers the pressure on the recall list to fill the next quarter.4
This is also the part most practices skip. Before any of the five are fixed, the practice has to honestly see which one is currently bleeding the most. That is a research problem before it is a software problem.
The trap of adding a sixth thing
The temptation in every practice we visit is the same. Something inside the five is broken. A new tool gets pitched that promises to fix it. The tool gets added. The original problem remains partially broken because the underlying motion was never finished, and now there is a sixth tool sitting on top of an unfinished foundation, charging a monthly subscription.
We have watched the AI conversation in optometry follow this exact pattern at every kind of practice. A wave of practices added AI subscriptions to the front desk, the exam room, and marketing, all roughly at once. Dr. Rhue's read is that the wave is reversing. Practices are cutting some of those tools and shifting hours back to people because the underlying motion they were trying to automate had not yet been built.
The line Dr. Rhue uses for this is short. Sometimes you have to delete to go back and implement it all the way through.
That is not an argument against new tools. New tools work fine when the motion underneath them is already running. The point is to finish one of the first five, then earn the right to add the next layer on top of it.
How to actually audit the five this month
The practical version of all of this is also short. Step one is a whiteboard.
Start with a real whiteboard on a wall where the whole team can see it — not a project management app, not a shared doc that nobody opens. Across the top: phone, reminders, contact lens ordering, optical, protocols. Underneath each, the team writes the actual tools and owners that run that category today, plus the scripts staff use when the phone rings. Not what was promised in the demo. What is actually running on a Tuesday at 10:15 in the morning?
After about 20 minutes of honest writing, every practice we have done this with finds the same pattern. One column has a working motion that nobody is paying enough attention to. One column is mostly empty. One column has three tools and no owner. The empty column or the three-tools-no-owner column is where the next 60 days of attention should go.
That is the start of a mid-year practice health check that requires no new software, subscription, or hire. It requires looking honestly at what runs the practice today and picking one of the five to bring to completion before adding anything else.
What to do this week
Run the whiteboard exercise once. Twenty minutes. Five columns. Phones out of the room.
If the team cannot fill in a column without arguing, that is the column to start with. If the team agrees on what runs a column, but the data underneath that column does not match the agreement, that is the column to start with. Either way, one of the five gets the next quarter of attention, and the other four wait their turn.
Practices that operate this way tend to feel slower from the outside and faster from the inside. They also tend to be the ones whose per-patient revenue is climbing in line with the industry's 14% rate, not lagging behind.
Talk it through with the team
The RICE Method walks practices through the Research, Innovate, Comfort, and Educate moves that turn an audit into a year-long plan. The free guide covers how each of the five categories maps to the four pillars, with the questions to ask before adding any new tool.
Download the RICE Method guide → Or, if a 15-minute conversation with Dr. Rhue would help you sort your five columns, grab a slot here.
Sources
- BCAT 2026 income trends and Vision Council benchmarks: per-exam value up 14% year over year, exam volume down 4.5%. See mybcat.com/blog/optometry-practice-finances and Review of Optometry, "A Wealth of Experience" income trends.
- BCAT, "Call Management Best Practices for Optometry Offices": "Practices with no formal call management process miss between 20% and 35% of inbound calls during business hours," and "the majority of healthcare callers who reach voicemail do not leave a message." https://mybcat.com/blog/call-management-best-practices-optometry/
- We walked through the prescription-release motion in "The 30-second script that keeps patients ordering with you."
- Months 0-24 are where most patients silently leave the practice. See "The dropout story most practices have wrong" for the data behind the retention window.
