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The Optometry Success Podcast
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The Optometry Success Podcast

Author: Adam Cmejla, CFP & Chad Fleming, OD, FAAO

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The Optometry Success Podcast helps private-practice optometrists build profitable, sustainable businesses with clarity and confidence. Hosted by Adam Cmejla, CFP—a financial planner and CFO to ODs nationwide—and Chad Fleming, OD, FAAO—a multi-location practice owner with decades of hands-on experience—each 20-minute episode delivers practical strategies and actionable insights you can apply right away. From leadership and financials to team culture, operations, and growth, this is your weekly dose of real-world advice for real-world practice owners. New episodes every Wednesday.
38 Episodes
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Not every patient relationship is worth preserving—and sometimes keeping the wrong patient creates more risk than letting them go.   In this episode of The Optometry Success Podcast, we continue our conversation about managing difficult patient relationships by tackling three situations every practice owner will eventually encounter: the chronically noncompliant patient, the repeat no-show, and the patient who crosses the line with your team.   We discuss when noncompliance moves beyond frustration and becomes a legitimate clinical and risk-management concern, why documentation and clear communication matter, and how Chad approaches patients who repeatedly ignore treatment recommendations. We also explore the important distinction between a routine vision-care patient who repeatedly no-shows and a medical patient whose failure to return could have serious consequences.   Finally, we tackle one of the most important responsibilities of practice ownership: protecting your team. Chad shares why practice owners need to establish clear boundaries around harassment, belittling, and inappropriate behavior—and why being willing to fire a patient can build tremendous relationship capital with your staff.   The goal isn't to look for reasons to get rid of patients. It's to recognize when continuing the relationship is no longer serving the patient, the provider, or the practice.   NBS (Next Best Step): Ask yourself whether your team knows—with absolute confidence—that they can come to you when a patient crosses a line. Make that expectation explicit, establish how those situations should be escalated, and make sure your team knows you'll have their back when it matters.   Have a question for us to address in a future episode? Submit it here!   Resources: Learn more about Partners in Profit Download the Practice Owner's Financial Toolkit 20/20 Money Ultimate Financial Success Masterclass OD Mastermind Interest Form   Subscribe on Apple Podcasts: https://shorturl.at/Fq1Ro  Subscribe on Spotify: https://shorturl.at/jCtsk   
The patient may always deserve empathy—but that doesn't mean the patient is always right.   Every optometry practice has difficult patient interactions: the patient who shows up for an appointment that isn't on the schedule, the person demanding an exception to a policy, or the patient expecting the practice to absorb the consequences of something that simply isn't its responsibility.   In this episode of The Optometry Success Podcast, we role-play two real-world situations and break down how practice owners and their teams can respond without becoming defensive, immediately giving in, or escalating the situation.   We discuss the importance of tactical empathy, giving patients choices, anchoring expectations, and empowering team members to make decisions without unnecessarily involving the doctor. Chad also explains why doctors may actually be the wrong people to handle these situations: our desire to solve the urgent problem in front of us can cause us to forget everyone else affected by that decision.   That leads us to the "tyranny of the urgent"—when the loudest, most immediate problem takes priority over everything else. Saying yes to one demanding patient might simultaneously mean saying no to the eight other patients on your schedule, your team, your profitability, and your own sanity.   And sometimes, even after doing everything right, the patient still won't accept the answer. We leave that question for our next conversation: What happens when empathy, flexibility, and reasonable solutions still aren't enough?   NBS (Next Best Step): Identify one common situation in your practice where your team feels pressured to make exceptions for patients. Define the boundary, decide who has the authority to handle it, and give your team a framework for responding with empathy—without automatically saying yes.   Have a question for us to address in a future episode? Submit it here!   Resources: The Optometry Success Podcast, Episode: Extended Warranty - Your Profits for Patient Peace of Mind Book: Never Split the Difference Learn more about Partners in Profit Download the Practice Owner's Financial Toolkit 20/20 Money Ultimate Financial Success Masterclass OD Mastermind Interest Form Check out Adam's new book: How to Buy an Optometry Practice   Subscribe on Apple Podcasts: https://shorturl.at/Fq1Ro  Subscribe on Spotify: https://shorturl.at/jCtsk   
Being booked out for weeks might feel like proof that you need another doctor—but it could be giving you the wrong answer.   In this episode of The Optometry Success Podcast, we continue our conversation around associate ODs and tackle one of the biggest questions practice owners face: How do you actually know when it's time to hire another doctor?   We discuss why owners often hesitate to add an associate, the financial fear of giving up production and profit, and why adding another OD can actually create significant margin when much of the practice's overhead is already in place. We also get tactical about successfully integrating a new associate, including why established doctors need to intentionally move patients onto the new doctor's schedule rather than simply expecting the associate to build a patient base from scratch.   Most importantly, we challenge the commonly used benchmark of being "booked out" as the signal that it's time to hire. Two practices can both be booked out three weeks and have dramatically different levels of actual capacity.   Instead, we revisit schedule health and the numbers practice owners should be tracking: available appointment capacity, how much of that capacity is already scheduled a week in advance, and how many of those available slots ultimately turn into completed exams.   NBS (Next Best Step): Stop using "how far booked out are we?" as your primary measure of capacity. Calculate your schedule health using actual available appointment slots and completed exams. If you're consistently filling roughly 85% or more of available capacity in advance—and completed exams remain within about 10 percentage points of that number—you now have objective data to help determine whether it's time to seriously consider adding another OD.   Have a question for us to address in a future episode? Submit it here!   Resources: The Optometry Success Podcast, Episode: What is "schedule health" and why should practice owners be measuring it Learn more about Partners in Profit Download the Practice Owner's Financial Toolkit 20/20 Money Ultimate Financial Success Masterclass OD Mastermind Interest Form Check out Adam's new book: How to Buy an Optometry Practice   Subscribe on Apple Podcasts: https://shorturl.at/Fq1Ro  Subscribe on Spotify: https://shorturl.at/jCtsk     
What if making less money actually made your practice—and your life—better?   In this episode of The Optometry Success Podcast, we explore a tension that can quietly create significant friction between practice partners: what happens when one owner wants to maximize profitability while another is willing to trade some of that profit for greater capacity, less stress, and a better quality of life?   We discuss why neither owner is necessarily wrong. Adding staff, scribes, technology, or other resources may reduce profitability if the additional capacity isn't converted into more production—but that doesn't automatically make it a bad business decision. The real question is whether everyone understands what they're receiving in exchange for the dollars they're giving up.   That becomes especially important in partnerships. When owners have different financial goals, work preferences, or definitions of success, seemingly simple decisions about staffing and expenses can quickly become much bigger conversations about fairness and compensation.   We also discuss the danger of trying to solve every difference through formulas, policies, and operating agreements. You can't legislate your way around poor communication. As we discuss in the episode, there's often a seamless transition between communication ending and resentment beginning—especially when money is involved.   Have a question for us to address in a future episode? Submit it here!   Resources: Book: Die With Zero Book: Crucial Confrontation Learn more about Partners in Profit Download the Practice Owner's Financial Toolkit 20/20 Money Ultimate Financial Success Masterclass OD Mastermind Interest Form Check out Adam's new book: How to Buy an Optometry Practice     Subscribe on Apple Podcasts: https://shorturl.at/Fq1Ro  Subscribe on Spotify: https://shorturl.at/jCtsk 
The wrong CPA may file your tax return perfectly—and still be the wrong CPA for your practice.   This week on The Optometry Success Podcast, we're answering a listener question from a new 50% practice owner whose longtime CPA may soon be retiring: What should I be looking for when interviewing a new CPA, and what questions should I ask?   Before you start interviewing firms, though, there's an important distinction to make: What do you actually expect your CPA to do?   Do you need someone to prepare tax returns and make sure everything is filed correctly? Do you expect proactive tax planning throughout the year? Are they handling bookkeeping and financial reporting? Do you want them advising you on business decisions? And how does the CPA fit alongside the other professionals already sitting at your proverbial advisory roundtable?   We discuss why practice owners sometimes overestimate how much their CPA understands about the actual business of optometry. Knowing how to read a P&L and prepare a tax return isn't the same as understanding what healthy margins should look like inside an optometry practice or how an owner should operate the business.   From there, we get tactical with questions you can use when interviewing your next CPA. How many healthcare and optometry practices do they serve? What does their service model actually look like? How proactive is their tax planning? Do they have experience with the tax laws in your state? What technology do they use, and how accessible is your financial data? What mistakes do they commonly find when taking over optometry practices from other accounting firms?   We also discuss why your CPA probably shouldn't be the only person advising you on how to run your business. A strong practice owner builds a roundtable of professionals with different areas of expertise rather than expecting one advisor to know everything.   NBS (Next Best Step): Before interviewing another CPA, define the role you need them to fill. Then build your interview questions around that expectation. You're not simply looking for someone capable of filing a tax return—you're looking for the right person to occupy the CPA seat at your advisory roundtable.   Have a question for us to address in a future episode? Submit it here!   Resources: Learn more about Partners in Profit Download the Practice Owner's Financial Toolkit 20/20 Money Ultimate Financial Success Masterclass OD Mastermind Interest Form Check out Adam's new book: How to Buy an Optometry Practice     Subscribe on Apple Podcasts: https://shorturl.at/Fq1Ro  Subscribe on Spotify: https://shorturl.at/jCtsk 
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