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Practice Development








Start Up: Build VT Success From The Start

Welcome to a new series of four articles, Start Up, Ramp Up, Rev Up and Wrap Up.   Each article covers one of the four phases of VT practice doctors experience, from opening their first practice, to getting ready to hand the practice off and retire.  Each piece offers key ideas and steps that our clients have experienced over the 36 years the Lecoqs have been consulting and training.  Read every article for the full story

By Amee and Thomas Lecoq

Start-up is a nervous time.  Fresh out of school or a few years into primary care but ready to switch to VT, these clients nearly always have ideas about how they’re going to start.  The doors open and the bills start rolling in.  But not necessarily the patients.  

Where to locate, how much money will you need?  How can you work part time to pay bills?  Should you buy an existing practice or start cold?  Where will you find your therapists or will you try to do the therapy yourself?  What about marketing and generating therapy patients in your community?

Should you take a course to “bone up” on therapy?  What kind of structure will the practice have to keep it organized and on target?  Are you up to speed on how to manage and lead a practice?  How much money will you need to start (or even expand) a VT practice and where will you get it?

A lot of questions, now, how about some answers.

First, are you confident you are trained to evaluate and treat binocular vision problems?  There are numerous clinical courses that provide competence and confidence your patients will get the help they need.  OEPF, Sanet and the Cedarwood courses all occur on weekends over a year’s time. 

The Ideal Vision Institute (IVI) offers an intensive quick start program that focuses on "bread and butter,” relatively uncomplicated learning-related cases.  The kinds of patients we urge start up practices to focus their market on.  This amounts to tens of millions of people.   Many primary care trained ODs are attracted to rehab, sports, strab and amblyopia therapies, but they are harder to diagnose and treat and demand inordinate amounts of doctor time often at hourly rates less than operating costs.  IVI Brochure    

Financial concerns.  We suggest new VT ODs borrow about $150,000 to cover startup, if they are going to use our marketing and operating method.  This amount is not far from what it takes to put VT into place in a primary care setting.   It often takes 3 months after finding a location to build out and equip the office, and without income while paying out for training therapists.  Add the cost of paying and training a Vision Therapy Administrator who will do marketing and help you generate patients to start the day you open. 

Active marketing, especially community outreach, talks, and connecting with those in a position to refer, can lead to break even in six to 9 months.  Compare that to the $250,000 to $400,000 you’ll need to open a primary care practice.  Plan on it taking years to have income higher than expenses in that setting. 

Our most successful clients have located in areas with high average incomes, and often in places where education is valued highly (eg: college towns).  More suburban and rural areas are wonderful places to live and work, but you want at least 150,000 population within 20 miles of the practice.

If you are going to actively work the system, then you should consider 1,500 sqft as a minimum startup space.  A professional setting is better than a retail location.  Walk in traffic is of no great benefit and will discourage area ODs from making referrals. 

You won’t need a formal dispensary for a VT only practice, but you can set up a fold-away frame bar, or place it where it isn’t visible.  It will hold mostly children's frames at first.  Patients referred by other ODs will generally be instructed to have the Rx filled by the referring doctor.

Because our startup plan requires only a modest loan, some clients have had parents guarantee (sign for) their loan.  Some banks will make loans but will withhold funds if you miss benchmarks.  That’s where many ODs start having to use credit cards to pay salaries, taxes, lease and other ongoing expenses.  There are a few private equity firms that have learned that the loan default rates for optometrists is about half of one percent.

The market ultimately determines how well you’ll do.  The market is enormous, 80 million people have a binocular vision problem in the USA.  And there is no area that is not underserved for VT.  If you are active about marketing, training, learning to do powerful case presentation, pursuing, finding and following through with patients, you can be very successful with just 125 patients per year.  That will give you a gross of $1 million to 1.25 million per year with margins ranging from 45 to 55 percent.  The percentage goes up over time.

And you can do it without accepting insurance, so you can go home at night.  No staying late to finish paperwork.

However, it will require that you work the system and make sure that all steps are executed every day, with every patient.  What is the system?  There’s a lot of information at idealvt.com.  However, the first step on the business side is to attend our Essentials For VT Success Course.  August 10-11 in Atlanta, GA at the office of David Cook, O.D., FCOVD.

What our clients discover is that the system relies on powerful and effective communication.  The objective is to have potential parents, patients and referral sources come to see for themselves that vision is the problem they’re dealing with and that you have the solution.  And that is what you’ll learn from us. 

We don’t teach you how to “sell” VT.  In our More Patients Breakthrough Course (October 12-14, Dallas, TX), you’ll learn exactly how to communicate so that your audience comes to know that vision is the problem they’re struggling with, and that you clearly have the solution.   Optometry professor, VT practitioner, and leading strabismus expert W. C. Maples called it “Empathetic Communication,” after attending the More Patients course.

You may have noticed that this article didn’t cover all of the concerns we mentioned.  That would take a book.  Instead, we offer you the opportunity to contact us with your specific questions.  No charge for the initial call.  We’ll answer as many as we can because Amee and I are dedicated to expanding the number of VT ODs who have thriving practices.  Your success will inspire other ODs to provide Vision Therapy.  So call, email or text Amee to schedule a conversation about your plans.  (Amee Lecoq, 760-686-4648, idealvt@verizon.net) We'll provide abundant information, without sales pressure.

 *Ideal Vision Institute is a not-for-profit clinical education program.  Dates for this course held over two, 3-day weekends July 13-15/September 14-16 in Charlotte, NC at the VT-only office of Phillip Bugaiski, O.D., FCOVD.  Here’s the brochure.



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Lecoq Practice Development
14420 Iroquois Rd. Apple Valley, CA 92307

CONTACT US BY PHONE:     760-686-4648
To Reach Thomas Lecoq:  visionisfuture@yahoo.com
To Reach Amee Lecoq: idealvt1@verizon.net 
For Therapist Training, Lyna Dyson:  visionhlp@juno.com
FAX  760-240-4794

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Last modified: 10/28/19
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