There are over 21,000 vision clinics in the U.S., making up over 110,000 jobs and employing, on average,Vision_clinics six employees. As an industry largely made up of small employers, it can be difficult to compete with larger businesses – and larger budgets – for top talent.

As such, vision clinics look to benefits to help attract and retain key vision staff. Benefits commonly include health insurance, recruiting and retention programs. Particularly in the case of health insurance, the landscape is rapidly changing. The passage of the Affordable Care Act opened up new and affordable options for vision clinics wishing to provide health benefits to their employees.

The sections outlined on our left sidebar provide solutions and insight to the common business management challenges faced by vision clinics around the United States.

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The Most Common Challenges Facing Vision Clinics

There are a number of challenges associated with owning a small vision clinic, from constant demands on the owner’s time to never-ending budget constraints. There are, however, commonalities in the obstacles faced by small businesses. Understanding the expected pitfalls can shorten the learning curve in business management and operation.

Three big challenges for small clinics are healthcare costs, employee recruitment and retention, and attracting new customers. All three areas can be a tremendous burden on a optometrist’s time and budget.

Healthcare Costs

Many small and medium vision clinics can’t offer group health insurance coverage due to rising costs and restrictive minimum contribution and participation requirements. Following the passage of the Affordable Care Act, individuals now have an unprecedented number of options for health insurance that all meet a minimum standard of quality and coverage.

Vision clinic employees can now get health insurance through their employer’s group plan, or get reimbursed by their employer for the cost of their individual plans. These new options mean that employers can provide their employees with high quality health insurance while controlling the cost of the benefit.

See our section on health insurance options for more information alternatives in plan design.

Employee Recruitment and Retention

Recruiting and retaining top employees is another major concern facing small vision clinics. With the preferences of the workforce becoming more diverse and dynamic, employers are in need of a more personalized approach to retain their employees.

A common challenge for small vision clinics when hiring is deciding between offering higher wages for more competitive prospects or lower wages for a lower, but more secure, skill set. Vision clinics shouldn’t feel like they are at a disadvantage when recruiting new employees.

Small vision clinics can competitively recruit employees by using employee referrals, adding a career site to their webpage, advertising on online job boards, recruiting interns, and using social media to recruit employees. An outstanding retention program can also give an edge to vision clinics looking to hire. Employee retention strategies include creating a high-feedback environment, customizing benefits strategically, and boosting employee morale.

Attracting New Customers

Finding new customers presents more of a challenge to small vision clinics because they generally do not have the astronomical budgets that larger optometry and ophthalmology facilities do. This can present a challenge when trying to compete with larger facilities' advertising and marketing strategies.

There exist a number of strategies for small businesses to attract new customers include online marketing, search engine optimization, email marketing, and social media outreach. It is vital for small vision clinics to have a deep understanding of what customers really want and educate customers on everything their small business has to offer.

Human Resource Requirements Vision Clinics Need to Know

Vision clinics, large or small, face HR challenges that come along with hiring the right a team, creating and HR_resource_requirements_vision_clinics_needmaintaining a company culture, and complying with ever-changing laws and regulations. HR requirements for small vision clinics include abiding by all applicable regulations and maintaining an appealing and competitive office culture.

Here are five quick tips to keep in mind when getting an HR program up and running.

1. Know, Understand, and Follow HR Regulations and Law

From the very first day an employee is hired, there are HR laws and regulations covering everything from payroll, employee discrimination and harassment to termination.

2. Keep HR Files Organized and Confidential

It’s important to keep employee files organized and confidential. Ideally there should be two files for each employee: a personnel file and a confidential file.

Items to include in the personnel file are things like the employee’s resume and original job application, salary records, transfers, job evaluations, and any disciplinary actions. Items to include in the confidential file are medical records, leave requests, I-9 forms, payroll records, and reference checks.

3. Make Payroll on Time

It may sound like a given to stay up to date and timely with payroll, but many small vision clinics struggle to make payroll on time because of time constraints or disorganization. Stay organized with payroll systems and make sure to hand out paychecks on a consistent basis, at the same time each period. Timesheets can help keep track of vacations and sick time, and there are several online management programs that help small businesses stay organized, and be prepared for tax-time.

4. Create an Employee Manual

An employee manual explains a vision clinic's policies and procedures, and communicates expectations to employees. It also helps protect the clinic in the event of a dispute.

5. Lay the Foundation for Being an "Employer of Choice"

Being an "Employer of Choice" means that candidates are eager to work for the business, that people look up to current employees, that the clinic receives unsolicited resumes, and that the most talented employees stay with the business throughout their careers. It's a coveted status. It signals the vision clinic's brand is top-notch. And, when a brand is reputable, it's much less expensive to recruit and retain key employees.

Any vision clinic can become an Employer of Choice. It's not just reserved for the big dogs. In fact, where small businesses may lack resources, they make up by having a unique, tight-knit, and "I can make a difference here" culture.

Ways small vision clinics can build a unique culture is to focus on company identity, recruiting and hiring, offering the right benefits, offering challenging and interesting work with opportunity for advancement, and recognizing employees.

Health Insurance Options that Best Benefit Vision Clinics

For many optometrists running their own clinic, the Affordable Care Act can feel like a moving target. Health Insurance Options that Best Benefit Vision ClinicsHowever, for businesses with under 50 employees, the options for small group health insurance are clearer.

Small groups have five main options for health insurance:

  1. Individual Health Insurance (with or without premium reimbursement)
  2. SHOP Marketplace
  3. Private Exchange
  4. Co-operative
  5. Private Small Group Plan

1. Individual Health Insurance (with or without premium reimbursement)

The first option is a relatively simple approach, yet it achieves results: direct employees to the individual health insurance Marketplace in the state where they reside to purchase individual health insurance. Eligible employees can access discounts on their premiums via the individual health insurance tax credits.

If the vision clinics would like to contribute to employee's premium expenses, they can use defined contribution allowances to reimburse employees for the unsubsidized portion of their premium. And, premium reimbursement allowances can be set based on job description (e.g. $200/month to managers and $100/month to entry-level). For many vision clinics, this is the most cost-effective solution because the clinic can contribute any amount they desire and individual health insurance costs are, on average, less than small group plans.

The ideal business for this solution is a small clinic who is priced out of group health insurance, wants to offer health benefits for the first time, or who doesn't want the administrative hassle of a group health insurance plan.

Learn more about a health reimbursement arrangement (HRA)

2. SHOP Marketplace

The SHOP Marketplaces are new state- or federally-run exchanges for small businesses. Small group health plans are available on the Marketplaces and could be a good coverage option for employers with 50 or fewer employees, if they can meet certain requirements. For example, in Massachusetts employers participating in the SHOP must contribute at least 50% of the premium amount, employers with 1-5 employees must have 100% of the employees enrolled, and employers with 6-50 employees must have at least 75% enrolled.

For eligible vision clinics, the SHOP Marketplace gives access to the small business tax credits which as of 2014 are only available through the SHOP.

3. Private Health Exchange

With a private exchange the vision clinic gives employees a set contribution to use towards a menu of plan options. The plan options can be individual- or group-based. Private exchanges are a type of “defined contribution” strategy.

4. Co-Op

Joining a co-op for health insurance is a more traditional approach for small businesses. The co-op exists to increase buying power and spread the risk among a larger group. Each co-op is structured differently, so the co-op may offer better insurance rates than a group policy or SHOP depending on regional insurance underwriting laws and the co-op itself.

5. Private Small Group Plan

Purchasing a private small group plan is also an option for vision clinics. Clinics may find more options and carriers to choose from on the private market as compared to the SHOP, where some states only have one or two plans to choose from.

The Future of Small Business Health Insurance?

Group health insurance is largely broken for employers and employees. The lack of portability, rising costs, and existing alternatives are all contributing to the mass abandonment of traditional group health insurance. Individual health insurance with premium reimbursement or private exchanges paired with individual health insurance are the future of small business health insurance -- and are the best options for all small vision clinics.

Ideas to Help Vision Clinics with Their Recruiting


Good hires is key to the success of any company. This is true for mom-and-pop shops, start-ups, and small vision clinics... as well as Fortune 500 companies. But finding and hiring the right employee can be tough. Small vision clinics are often faced with limited time and resources, and need to make each new hire count.

According to a hiring survey by CareerXroads, here are the top ways vision clinics can recruit and hire employees.

Employee Referrals

Employer referrals make up 24.5%, nearly a quarter of recruits. Many small employers offer cash or other incentives to encourage employees to participate.

Career Website Page

Nearly another quarter (23.4%) of recruits hear about the job through the small business's career website page. Make sure your clinic has a career website page where you list (or link to) open positions and describe your company's mission and culture.

Online Job Boards

According to the hiring survey, 18% of candidates are referred by an online job board. Small vision clinics can use free job boards such as and/or job board aggregator sites such as and Businesses can also post paid job descriptions to general boards such as,, and, and to local or regional job boards and newspapers.

Colleges & Interns

College candidates (recruits from college or within 0-2 years of graduation) represent 5% of recruits. Businesses, including vision clinics, have long relied on university recruiting programs to fill entry-level positions and gain access to workers with up-to-date skills. Plus, small businesses offer recent college grads something that many large companies cannot -- opportunity for fast growth and entrepreneurship. Internships are another way to get fresh talent in the door.

Social Media

While social media is still a small percentage of how candidates say they heard about a job (3%), it is a growing strategy for vision clinics. As more job seekers use social media and mobile devices to look for work, vision clinics are using social media as a low-cost way to recruit, source, and interview candidates.

Retention Ideas for Vision Clinic Staff

For a business to thrive in today’s economy, finding and retaining the best employees is important. This is especially true for small vision clinics competing with larger optometry and ophthalmology facilities for top talent.

Happy employees help businesses thriveRetention_ideas_vision_clinic-1

Frequent voluntary turnover has a negative impact on employee morale, productivity, and company revenue. Recruiting and training a new employee requires staff time and money.

Some studies (such as SHMR) predict that every time a business replaces a salaried employee, it costs 6 to 9 months’ salary on average. For a manager making $40,000 a year, that's $20,000 to $30,000 in recruiting and training expenses.

But others predict the cost is even more - that losing a salaried employee can cost as much as 2x their annual salary, especially for a high-earner or executive level employee.

So how can a small vision clinic keep their employees from jumping ship? As our workforce becomes increasingly mobile, a well-thought out employee retention strategy becomes just as important as recruitment (if not more).

Here are seven tips for small business employee retention.

1. Understand Why Employee Retention Matters

Employee turnover costs small businesses time and money. Turnover disrupts the flow of a functioning workforce. When an employee leaves there can be a significant knowledge gap left, creating more work as the remaining team members pick up the pieces.

Recruiting and training a new employee requires staff time and money. Every time a business replaces a salaried employee, it costs on average 6 to 9 months in salary. For a manager making $40,000 a year, that's $20,000 to $30,000 in recruiting and training expenses, along with other intangibles.

While some turnover is inevitable, having an intentional employee retention strategy in place mitigates the turnover, and its costs, for a vision clinic.

2. Benchmark Your Employee Retention Rate

Do you know your vision clinic’s current employee retention rate? Before you start thinking about formal employee retention activities, calculate your employee retention rate and track it periodically, such as quarterly or bi-annually.

The calculation is simple. Divide the number of employees who left during a period by the total number of employees at the end of a period to get the percentage. According to industry standards, 85% or higher is considered a healthy employee retention rate.

3. Use Retention Strategies, Not Guesswork

There are several theories in employee retention strategies. Here's a sample of four common theories:

  1. Positive Organizational Behavior is defined by Fred Luthans as "the study and application of positively-oriented human resource strengths and psychological capacities that can be measured, developed, and effectively managed for performance improvement in today’s workplace"

  2. Valence, in Victor Vroom's Expectancy Theory, is the extent to which an employee's goals match the company's goals. The more aligned these are, the higher the employee retention rate.

  3. Abraham Maslow's Hierarchy of Needs theorizes that companies should first take care of an employee's basic needs, such as job security, payment, and health benefits, and then advance to bigger aspirations, like his or her place in the company.

  4. How important is it that employees feel they are being treated fairly? According to John Stacey Abrams' Equity Theory, if a worker feels he is getting what he considers to be fair for the job he is doing in return, he will be happy and remain in the position.

4. Don't Assume Employees Are Happy

One of the worst mistakes a small business can make is to assume that, because an employee is still there, he or she is happy.

  • Schedule regular, one-on-one reviews with employees. These review meetings serve as a forum where the employee can receive constructive feedback.

  • Feedback is important. Even the most productive employees should be given feedback as a part of the retention strategy. Studies show employees not only want acknowledgment for work done well, but also want constructive criticism and routine review of goals and expectations. This makes an employee feel valued and helps keep morale high.

  • Conduct regular, formal evaluations. Employee evaluations are also a good time to get feedback from employees on what will make them happy. With a retention strategy, always keep a balance between what the employees want and what's best for the business.

5. Health Benefits Are A Key Part of Employee Retention

Health benefits are a vital part of an employee's compensation package, and thus an important strategy for employee retention.

  • Work with an insurance agent or broker to evaluate your small business health insurance options including private exchange and individual health insurance premium reimbursement.

  • If your business can't afford a group health insurance plan, or cannot meet minimum participation requirements, work with your broker to design a premium reimbursement plan. Premium reimbursement allows your business to provide employees healthcare allowances for their individual health insurance policies. This is an alternative to an employer-sponsored group health insurance plan.

6. Provide Different Benefits for Different Employees

Turnover of certain employees may be more costly than others, thus it is common to provide different levels of benefits to different classes of employees. This is routinely done by major corporations. For example, office managers are compensated differently than optometrists.

Because health benefits are such an important part of compensation and retention, why not provide health benefits that vary by class of employee? Vision clinics can do this with premium reimbursement allowances.

As there are no minimum or maximum contribution requirements with premium reimbursement, a vision clinic can design their health benefits plan to fulfill their exact recruiting and retention needs.

7. Conduct Exit Interviews

Exit interviews provide businesses valuable information on the reasons employees seek employment elsewhere.

  • Develop an exit interview survey that asks for feedback on the work environment, employee benefits, areas for improvement, training, supervision, and workload.

  • Evaluate the exit interview surveys and incorporate the feedback into your vision clinic’s employee retention strategies.

Additional Reading For Vision Clinics

Why Vision Clinics are Switching to Individual Health Insurance

As an optometrist and owner of your own vision clinic, you work hard -- you’re dedicated and passionate about what you do and the people you serve. You have little to no time to waste and are always looking for ways to make your employees and patients happy. Having said that, group health insurance is taking up your time and money, and because of this, many vision clinics are switching to individual health insurance to cut down on costs and save time.

The Comprehensive Guide to the Small Business HRA