Pillars of Success

A profile of how MDs and ODs work in concert to deliver first-class service.

By Jason Schmit, OD

Vance Thompson Vision is an integrated ophthalmology and optometry practice with locations in Sioux Falls, S.D. and Fargo, N.D. We specialize in laser vision correction, cataract surgery, and corneal procedures, and we have clinics focused on glaucoma, oculoplastics, and research. We also have a large dry eye practice integrated into our business model. Our practice is primarily driven by our optometric comanagement network and word-of-mouth experiences through patient-to-patient interactions. We do some direct-to-consumer marketing through social media sites, television, and direct mail. The key to our success is outlined under three pillars: (1) invest in the world’s best technology, (2) create a fantastic patient experience, and (3) do the right thing (Figure).


Figure. The three pillars of success at Vance Thompson Vision: advanced technology, customer experience, and doing the right thing.

We have four ophthalmologists and five optometrists in the practice. As one of these optometrists, my role is to see every patient as the primary eye care doctor and to determine the surgical plan, whether it be for cataract surgery, laser vision correction, or eyelid procedures. The cataract, laser vision correction, and oculoplastics divisions are organized in similar ways, but with important differences appropriate to the division in question.


For cataract surgery patients, I determine whether standard or laser-assisted surgery is to be performed, the type of IOL to be implanted, whether astigmatic correction is needed, and what postoperative drop management (standard drops or drop-a-day option) is called for. After I complete the surgical plan, the surgeon then comes in to meet the patient, review the surgical plan, and sign off on the chart. I also see most of the postoperative cataract patients at their day 1 visit, and the patients are then released back to their referring optometrist.

Laser Vision Correction

I see all potential laser vision correction patients preoperatively. As the OD, I determine whether the patient is a good candidate for surgery, which procedure best suits his or her condition (LASIK, PRK, phakic IOL, etc.), and which technology is best for this procedure (standard, wavefront-guided, wavefront-optimized). I also determine whether we will target a plano result in both eyes or monovision, and any other surgical variations. Patients are seen postoperatively by the referring optometrist.


I see a potential oculoplastics patient during an initial encounter to determine whether blepharoplasty, ptosis surgery, eyebrow correction, lateral tarsal strip, or some other surgical alignment of the eyelids is needed. The surgeon then meets the patient, agrees with or amends the decision, and signs off on the surgical plan.


Basically, our ophthalmology-optometry model accomplishes three things: (1) our optometrists get to practice at the highest level of their capabilities; (2) our surgeons get to spend most of their time doing what they enjoy most: surgery; (3) and our patients receive the best of everything (ie, two doctors aligned in the surgical decision management of each case).


ODs and MDs at Vance Thompson Vision have clearly delineated roles, resulting in ODs who demonstrate exceptional patient care, surgeons who focus on surgery, and patients who receive quality outcomes.

I am in constant communication with my surgeon, with a focus on our annual business and growth objectives. I get to see new pathology patients; manage dry eye patients; and help teach medical fellows, optometry students, and referring optometrists while they are in our clinic observing or completing their clinical rotations or programs. The surgeons can focus on surgery, strategic planning around the business, and other business ventures and consulting opportunities. Our business model also allows the surgeons more personal time outside of the clinic while maintaining annual growth of the practice.

We are heavily driven by optometric referrals, so we spend an enormous amount of time dedicated to creating and maintaining these relationships. Communication is everything. We send dictated letters to referring doctors for all patient visits. We have a dedicated person committed to optometric practice relations. We schedule weekly practice visits for optometrists, to be accompanied by one of our Vance Thompson Vision doctors, whether an optometrist or ophthalmologist. We also send quarterly newsletters and have developed an optometric portal to our website focused on clinical information that applies to our practice. We sponsor, through our foundation, an annual 2-day optometric practice symposium attended by more than 300 optometrists and staff members, focused on learning and enhancing doctor-to-doctor relationships.

To adhere to the third pillar in our philosophy—doing the right thing—we also focus on our people. We invest in training and education to help improve the knowledge base of our team. We empower team members to make the best decision for any given patient on a daily basis, even if some financial outlay is required to make things right.

We have a monthly staff fun day, where we all might go sledding together, go to a baseball game, or meet at the office after work for a sfamily Easter celebration or an October Halloween party. We work hard and respect each other, but we play hard, too. Attention to culture comes first. Without good people who love their jobs, nothing else can happen.

This is how we have become successful: we are fun, committed, and egalitarian.

Jason Schmit, OD
• optometrist, Vance Thompson Vision, Sioux Falls, S.D.
• financial interest: none acknowledged